OUWB alum researches telephone-assisted CPR survival rates

Manali Shah presentationManali Shah presentation on 911When Manali Shah, M.D., came to OUWB from the University of California, Berkeley, she knew she wanted to continue researching cardiac issues.

“Arrhythmia, heart failure, cardiac arrest – I found all of it fascinating because you can’t function without a heart,” she says.

When Robert Swor, D.O., FACEP, OUWB professor in the department of Emergency Medicine, mentioned his interest in evaluating the impact of 911 dispatch-assisted cardiopulmonary resuscitation (CPR) on people with apparent cardiac failure, Shah was intrigued. She had never forgotten the cardiac arrest she had witnessed years before. The pair began discussing what they might study – and how to do it.

After several months of discussion and examination, they settled on a methodology. Using a combination of first-person observation and existing data, Shah would evaluate several factors that come into play when an individual calls 911 for help in a potential cardiac arrest situation.

Two-phase process

Shah began by listening to 911 calls at a dispatch center to get firsthand knowledge of how possible cardiac arrest cases are assessed and handled. She was particularly interested in how situations are evaluated, how long it takes, and how CPR instructions are presented. After that, she rode with paramedics dispatched to the patients for more observation.

This gave her the context needed to evaluate two years of dispatch data in a voluntary national database to help determine the effectiveness of federal guidelines on:

  • How dispatchers should instruct on CPR
  • Whether there were barriers to delivering those instructions that resulted in bystanders not performing CPR
  • If dispatch-assisted CPR delivered by bystanders improved patient survival rate.

Research outcomes

The team’s research revealed that dispatchers were skilled at recognizing cardiac arrest and bystanders usually performed CPR by following instructions provided over the phone. Even so, there wasn’t a statistically significant improvement in survival.

Still, Shah points out that there’s a difference between statistical and clinical significance. She believes that if CPR delivered over the telephone saves even one life, it matters clinically, and should continue to be worked on to make it statistically significant.

In addition to presenting the research at a number of medical conferences and publishing in Prehospital Emergency Care Journal, Shah was one of two students presenting their research at the school’s Embark Capstone Colloquium.

“This adds to the body of knowledge on this topic and will be used to support development of programs,” says Swor.

A future in neurology 

Interestingly, by the end of her OUWB training, Shah decided to move away from cardiology and accept a neurology residency at Johns Hopkins University with a long-term goal of an academic career. While meeting with patients as part of her neurology electives, she realized that she was particularly drawn to using exam skills and tools – not imaging or lab work – to provide a diagnosis, especially with progressive diseases.

Shah also felt deeply connected to patients and families she met as part of this work.

“The biggest thing about medicine for me is connecting with my patients. I used to think being emotional in medicine was a negative. However, I’m an emotional person and I have found that channeling these feelings has allowed me to have deeper connections with my patients, and I hope to continue to develop these skills,” she says.

Swor is optimistic about his researcher’s future.

“She will be a great clinician and researcher if she so chooses to follow that path.  Students like her are the reason that physicians go into academic medicine,” he says.