CLINICAL INNOVATORS
Interview by
KATLYN NEMANI, MD
Lance B. Becker, MD
Improving Survival from
Cardiac Arrest
L
ance B. Becker, MD, is a professor of emergency medicine at the Perelman School of
Medicine at the University of Pennsylvania,
and an expert in the field of resuscitation science.
He was the founder and director of the Emergency
Resuscitation Center at the University of Chicago in
Chicago, IL, and Argonne National Laboratory, an
interdisciplinary team of investigators focused on understanding and treating sudden death from cardiac
arrest and traumatic injuries. He is board certified in
internal medicine, emergency medicine and critical
care medicine. Dr. Becker has worked closely with
the National Institutes of Health (NIH) as a reviewer,
grantee, and in a leadership role as the Chair of the
Myocardial Protection Working group for the NIH
NHLBI’s sponsored PULSE Conference and PULSE
Leadership Group, which is dedicated to support of
funding in resuscitation research. He also served as a
member of the Food and Drug Administration (FDA)
Device Evaluation panels and has appeared as an
expert presenter before the FDA panels.
How did you become interested in resuscitation
science?
I first became interested in it when I started taking
care of cardiac arrest patients as a house officer. We
had an Advanced Cardiac Life Support course, and
I was so proud that I completed the course and did
well. I became certified and ready to save people’s
lives. In a general way what I found is that it
didn’t work the way the book said it was supposed
to work. Despite heroic efforts, the majority of
patients would die. And when I read the book they
didn’t come out and say that. So I thought that perhaps I had some terrible dark cloud that followed
me and all of my patients were doing poorly when
everyone else’s patients were doing well. I became
more and more interested in it, and that’s when I
realized that there was a lot we didn’t know about
this whole field. I was thunderstruck. What became
pretty clear to me is that we didn’t know very
much about it, and we weren’t nearly as successful
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as we told ourselves. We sort of said, “If you
do good CPR, and defibrillate, and give the
right drugs, you’ve done everything you
can for that patient…if they don’t make it,
it’s a sad thing, but that that’s what was
meant to be.” I just began to question
that whole idea.
I fundamentally do not believe
that “it was meant to be.” I do not
believe that when patients are routinely
declared dead that it has to be that way.
That’s not to say that given our current
therapies that patients aren’t doing to die,
but at that moment in time, after 45 minutes
of a cardiac arrest code, perhaps we have not
actually reached the point of futility. I became
very interested in what the basic science says about
this. The conclusion I came to is that there isn’t any
particular reason why right at that moment the
patient is any more or less dead than they were 5
minutes before, or 5 minutes after. I recognized that
this was a field that was crying out for discovery.
We do not seem to accept the futility of other
conditions such as stroke or cancer; these are
not things we typically consider “meant to be.”
You have spoken about the fact that despite its
large public health footprint, cardiac arrest does
not resonate with the public and policy makers
in the same way. Why do you think this is?
It’s complicated and I think there are a lot of
reasons. One of the big ones is that doctors think
it’s hopeless. When you’re working in the hospital
during your training and you’ve seen five or six or
seven people who you try really hard to resuscitate
and it doesn’t work, you get a little jaded. I think
there’s a lot of doctors who say, “This is hopeless.”
And they haven’t followed the literature in the last
10 years, which has changed so much of what we
think about that. Most haven’t looked at the real
evidence of when you can bring somebody back to
life, and most practicing cardiologists working in
their specific areas of practice do not have the
experience with cardiac arrest that they once did.
Cardiologists want patients who they feel they can
help. Many times the cardiologist doesn’t feel they
can help a person with a cardiac arrest. And then it
doesn’t resonate with them that we could do better,
we can do better as a nation, we can do better with
all of these interventions from the community, with
the public, with EMS, with dispatchers, with better
emergency departments, with better inpatient care.
They don’t get that you have to have all of that
working to make a difference.
Many of these systemic factors were addressed
in a recent report from the Institute of Medicine
(IOM)— “Strategies to Improve Cardiac Arrest
Survival: A Time to Act,” which you wrote about in
the Journal of the American Medical Association.
What did we learn from this report?
What is very bold and different about this IOM
report is that it addresses a system, not an individual. To be blunt, most doctors do not train to look
critically at our system of care. It’s a system that
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