Careers in Resuscitation Medicine

Benjamin S. Abella

Lance B. Becker

A wide variety of individuals are interested in saving lives following sudden cardiac death and cardiac arrest. There are exciting options for career paths, funding, and collaborative models that make resuscitation science a rich and intriguing arena in which to contribute. Translational medical research provides a bridge to more directly connect basic research and patient care. Resuscitation science centers have been established, empowering translational science to provide models for collaborative interdisciplinary teams. Rich and rewarding careers are possible.

Translational and resuscitation science provide an interdisciplinary foundation for basic and clinical investigation.
Bench-to-bedside training is available for those interested in careers in resuscitation science. A wide range of interdisciplinary portals and funding is available and emerging.
Collaboration between academic investigators and industry partners has proven to be fruitful in advancing resuscitation science.

Introduction

The daunting challenge of improving survival from cardiac arrest will require the collective energies of a wide variety of clinical investigators, basic scientists, public health experts, educators, paramedics, nurses, and physicians. In addition, given the importance of mechanical and electronic devices in emergency cardiovascular care (defibrillators, mechanical chest compression devices, biosensors, etc.), there is an enormous opportunity for contribution from the bioengineering industry as well. Collaboration between academic investigators and industry partners has proven to be particularly fruitful in advancing resuscitation science, and such interaction will provide wide opportunities in coming years.

Translational Science and Resuscitation Care

Resuscitation science, with its wide-ranging areas of inquiry and involvement from the laboratory to the community, is in many ways the ideal model for translational investigation. As the National Institutes of Health (NIH) and other funding organizations focus their interest on projects with a translational scope, resuscitation scientists, emergency cardiovascular care (ECC) community educators, bioengineers, and others have an opportunity to collaborate in teams that can truly move science into the clinical arena and bring clinical phenomena back to the laboratory. A recent body of work exemplifies this notion: the investigation of chest compression only cardiopulmonary resuscitation (CPR). Work by a variety of research teams has studied CPR physiology in the animal laboratory and others have furthered this work in clinical observational trials.¹^,²^,³^,⁴ This will require further translation into educational, training, and community assessment work in coming years. Further iterations will require a return to the laboratory to better understand the role of respiration and oxygenation in more specific cardiac arrest models.

A number of resuscitation science centers have been established with translational science breadth and may serve as models for others as they form collaborative teams. The Safar Center for Resuscitation Research in Pittsburgh, the Center for Resuscitation Science in Philadelphia, and the Emergency Resuscitation Center in Chicago serve as examples of such organizations. Each of these centers comprises resuscitation-focused scientists and clinicians that carry out investigations and programs in cellular laboratories, animal facilities, and clinical trials. Having such collaborations within the same organization will allow for more rapid progress and innovation and neatly fits the NIH vision of translational science.

Opportunities for New Directions: Translational Science

There has been a recent appreciation for the importance of translational research in the biosciences, and this will likely have an important influence on careers and funding as it relates to ECC. As described on the NIH “roadmap” Web site:

As a field of study, resuscitation science could serve as a prime example for translational research, with its broad focus from basic science to the bedside, and for resuscitation beyond the bedside into the community. The NIH has specifically created special funding for translational research via Clinical and Translational Science Awards (CTSAs) and additional funding mechanisms. But there are those who criticize translational research, citing a lack of mechanistic focus, questioning the quality of the science, and noting that most researchers are not even sure what defines the boundaries of translational research. A consideration of what translational research is, why it may represent a particularly important opportunity for resuscitation science, and describing some models for how translational research can be organized is presented in the following section.

To improve human health, scientific discoveries must be translated into practical applications. Such discoveries typically begin at “the bench” with basic research—in which scientists study disease at the molecular or cellular level—then they progress to the clinical level, or the patient’s “bedside.” Scientists are increasingly aware that the bench-to-bedside approach to translational research is really a two-way street. Basic scientists provide clinicians with new tools for use in patients and for assessment of their impact, and clinical researchers make novel observations about the nature and progression of disease that often stimulate basic investigation. (http://nihroadmap.nih.gov.easyaccess1.lib.cuhk.edu.hk/clinicalresearch/overview-translational.asp Dec2007)

What really is translational research? There is general agreement that translational research is still somewhat poorly defined. Wikipedia defines translational research as “a branch of medical research that attempts to more directly connect basic research to patient care” but goes on to say “and is a term whose precise definition is in flux.”⁵

The importance of translational research is growing in the health care industry and the most common notion is that it deals with the advancement of basic science into actual therapies for patients. This is the “bench-to-bedside” definition and is most often used in referring to drug or device development. However, others use “translational research” to mean something quite different. They refer to the broader dissemination of a therapy into the population or community. This definition often encompasses notions about education and training of providers, knowledge translation to various audiences, dissemination of knowledge, patient-oriented research, and putting known therapies into more common practice in a broad community. The American Heart Association’s program “Get With the Guidelines” is termed a translational project under this definition.⁶

Career Opportunities

There are a wide variety of careers that directly impact emergency cardiac care and contribute toward saving lives from cardiac arrest. These career options span a large range of both educational backgrounds as well as areas of focus, including both research and nonresearch endeavors.

Clinical Investigator

A daunting number of clinical questions exist in our scientific knowledge of resuscitation and emergency cardiac care. Such questions will require a cadre of clinical scholars who
practice medicine as well as conduct clinical trials and other human subject investigations. Questions that require further elaboration include the development and testing of novel drugs for ACLS and postarrest care, many of which have already been evaluated with promising results in the animal laboratory⁷^,⁸; the further investigation of postarrest care and development of postarrest care pathways⁹^,¹⁰; the implementation of different methods of CPR and defibrillation⁴^,¹¹^,¹²; the evaluation of new CPR teaching and measurement techniques³^,⁴^,⁵^,⁶^,⁷^,⁸^,⁹^,

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