Circulatory Shock

Dr. Weil, during his residency at the University of Minnesota Hospitals and subsequently during his fellowship in physiology, became interested in circulatory shock states and especially septic shock. Dr. Herbert Shubin, a cardiologist during his training in Cardiorespiratory Medicine had major interest in myocardial infarction. The mortality rate of circulatory shock at that time ranged from 50 to 95%. This prompted the initial effort to establish methods of measurement from which we might better understand the mechanisms and therefore gain insight into better treatment of circulatory shock states.

CPR/AED: The Life you save, may be someone you love

Every year more than 300,000 people in the United States fall victim to sudden cardiac arrest outside of the hospital.  More than 95% of these cardiac arrest victims die before ever reaching the hospital. That equates to as many as 917 victims each day.  Working together there is something communities can do to increase a person’s chances of surviving such a deadly attack. Early CPR coupled with early defibrillation may increase survival by as much as ten-fold.   Cities such as Seattle where citizen CPR training is promoted have increased their survivability from less than five percent up to 30%.  Preparing thousands of citizens with the basic knowledge of CPR will increase the odds that a by-stander will act promptly and appropriately with more lives saved.   

Weil Institute of Critical Care Medicine has partnered with the Desert Healthcare District, local fire departments, the City of Rancho Mirage and the City of Indian Wells to make the Coachella Valley a safer place to live.  The Coachella Valley PAD/CPR Program is a project with an objective to enhance the save rate for cardiac arrest victims by 25% within the Coachella Valley.   We intend to accomplish this making AEDs more available in public places.   We have placed more than 100 AEDs in public buildings, senior centers, schools, churches and sports venues throughout the Coachella Valley.  We at the same time recruit and train ten percent of the Coachella Valley’s adult population in CPR utilizing the new American Heart Association’s self instruction CPR training kit.  The kit reduces training time from the traditional four hours to about 40 minutes. Many more are trained by this advanced capability for teaching.

More than 80% of out of hospital cardiac arrests occur in the home.  Odds are that if you are called upon to help someone, that person will be a loved one. This Program is offered free to residents of the Coachella Valley over the age of 16.  The CPR/AED training sessions and self instruction CPR kits are made available to individual  residents, schools, and diverse public, private and faith based organizations. Interested individuals or agencies may contact Mike Potter at the Weil Institute of Critical Care Medicine for training at (760) 778-4911.

Clinical Measurements

Hemodynamic measurements initially included central venous pressure, arterial pressure, and cardiac output measured by the dye dilution technique. These were complimented by early measurements of blood gases on arterial and central vein blood and so-called “STAT” laboratory measurements including blood chemistry, urine, and radioisotope blood volume measurements.  In parallel with already established measurements which guided respiratory interventions including  mechanical ventilation, control of the airway with endotracheal intubation, and breathing of patients were initially supported with primitive positive pressure machines.

Ethics

As an Institute, we are also committed to the humane, ethical practice of life saving care  To sustain life by interventions that are in accord with the priorities and expressed wishes of the patient, to assure comfort and provide education for physicians to assure professionally expert, compassionate end-of-life care and to respect and join in the integration of the diversity of providers in addition to the critical care physician who constitute the life-saving team.  

We have extended our commitment to teach CPR and First Aid in conjunction with modeling readiness to intervene without fear of doing harm or being injured or infected when we have an opportunity to help save the life of another. To indeed persuade that we are our brothers keepers.

Pharmacological and surgical management

The Institute developed protocols for more general management of shock states including volume repletion by fluid challenge techniques, methods for minimizing the risk of shock during myocardial infarction, and implemented mechanical assist methods including balloon counter-pulsation. Pharmacological management and especially vasopressor drugs, antimicrobial drugs, and cortico-steroids were routinely used for managment of septic shock but with poor outcomes.At the Los Angeles General Hospital, there was a very high maternal mortality due to septic abortion which prompted our group to search for options to secure early rescue. We learned that for managment of septic shock associated with pregnancy, very early surgical interventions which would control of the infection by removal of the uterus with its contents improved outcomes. Accordingly, almost immediate referral to surgical management became the routine.

Molecular Biology

We seek better understanding of the molecular basis for cell dysfunction when blood supply is critically reduced such that cell death is minimized, and especially so in settings of cardiac arrest. Accordingly, one laboratory is devoted to research on heart cell replacement when there are muscle cells that are lost during the global ischemic injury of cardiac arrest leading to life threatening post resuscitation myocardial dysfunction.  The same principals prompt us to research opportunities for preserving the brain.