Photo credit: Hilliary Anderson
If your heart stops beating, CPR and a shock might not necessarily save your life. Ph.D. student Jason Coult seeks to increase cardiac arrest survival by improving treatment technology. Outside the lab, playing music helps him stay engaged in research.
If your heart stops beating, CPR and a shock might not necessarily save your life. Emergency response workers rely on standard protocols which dictate the timing and use of CPR and electric shock, or defibrillation. These protocols are programmed into automated external defibrillators (AEDs) and provide first responders pre-set resuscitation instructions. However, this generalized approach does not respond adequately to a patient’s specific and changing needs over the course of a resuscitation. So even in a city like Seattle, where the odds of surviving cardiac arrest are among the best in the nation — according to King County Emergency Medical Services — the treatment you receive might not be the best for your specific situation.
Third-year Ph.D. student Jason Coult sees the potential for improvement. This vision guided him through his undergraduate studies, onto a BS/MS degree and finally to his current Ph.D. work. “Technology that is being used currently to treat someone in cardiac arrest could be made a lot smarter,” he explains. Applying his expertise in programming and signal processing to the King County database of cardiac arrests, Jason focuses on improving patient analysis software on AEDs and the protocols for their use.
Jason is exploring the possibilities of intelligent, real-time cardiac analysis during CPR. Current-day defibrillators cannot accurately distinguish a heartbeat through electrical interference caused by CPR chest compressions. Emergency responders that use AEDs, such as emergency medical technicians (EMTs), police or laypersons, must follow the AED’s instructions to stop chest compressions every two minutes. Doing this allows the AED to analyze the patient and determine whether to apply an electric shock to a patient’s heart. Under current protocol, a lot can happen to a patient in these two minutes that responders would not immediately detect, and the pauses in CPR cause loss of life-sustaining blood pressure. Without consistent chest compressions, blood cannot flow to essential organs. Inadequate blood flow deprives the heart and brain of oxygen and eventually causes death. If AEDs could analyze cardiac activity while first responders perform chest compressions, responders would be better able to evaluate and treat a patient’s real-time needs, reduce the patient’s chance of brain damage and energize the patient’s heart muscle to start beating after being shocked. This continuous analysis would allow shockable heart conditions to be detected and treated immediately, without stopping CPR, and hopefully increase survival.
Jason is also investigating whether treatments given before defibrillation and adjustments to shock timing can improve resuscitation success rates. If a patient’s heart has stopped for awhile, immediate defibrillation might not be ideal even if the heart is technically in a shockable state. “The heart will lose energy over time,” he explains, and might be less likely to restart normally if the patient has been down for more than a few minutes. In certain cases, it might be better to apply additional chest compressions and give the patient drugs to stimulate the heart before giving a shock. “Patients should only be shocked if it is likely they will respond; otherwise, ineffective shocks can hurt the chance of a successful resuscitation,” he says.
Shifting from music to math and science: Jason discovers bioengineering
A strong drive “to do something that might actually help someone” motivates Jason’s work. Growing up, however, he never imagined that he would study bioengineering. “I actually didn’t think I would do anything related to science or math,” he admits. His first passion was music. A life-long piano player, he initially pursued music as a major. He also began to study business to gain experience in a “more practical” field than music.
Jason was homeschooled and didn’t gain a lot of exposure to science. However, a distance-learning biology course eventually captured his interest. He enjoyed learning how living things worked and exploring what science didn’t explain. “We know a lot about human health,” he says, “but there’s still a lot to discover.”
He participated in Running Start, a Washington state program that allows students to take college courses while still in high school, and attended a few different colleges to start earning prerequisite credits. A few years after beginning a piano and business double major, he started taking calculus and other math and science courses, and eventually realized that he wanted to pursue an engineering major. Engineering appealed to Jason because it presented the opportunity to solve scientific problems in creative ways.
When choosing a university, comparing UW with other schools “was not even a contest in my mind,” Jason explains. In addition to its location in Seattle, he saw UW as a high caliber institution that offered “such a good value,” he says.
Jason also had no doubt that bioengineering was the right major for him. He loved bioengineering’s combination of biology principles, which he had been interested in since his first science class many years prior, and engineering methods to solve “cutting-edge” human health problems. Also important to him was the department’s interdisciplinary culture and broad research scope.
Jason joins research team; becomes excited by positive, interdisciplinary “energy”
A collaborative research opportunity caught Jason’s attention in his junior year. King County Emergency Medical Services sought student help to explore the technical aspects of improving resuscitation and outcomes of cardiac arrest. After Bioengineering Senior Lecturer Chris Neils referred Jason to the project, it became the focus of his senior capstone project.
As he approached the end of his undergraduate studies, Jason realized that he was “not done with his project” and wanted to pursue it further. He entered BIOE’s BS/MS program, and the project became the focus of his master’s thesis. His project team eventually acquired funding for Jason to continue with a Ph.D., and bioengineering adjunct faculty member Larry Sherman, MD, UW Emergency Medicine, agreed to serve as his principal investigator. Other faculty and scientists became involved as the project continued.
The current multidisciplinary team includes experts from a variety of disciplines, including emergency medicine, statistics, cardiology, public health, electrical engineering and signal analysis. The team members bring a lot of “positive energy,” Jason says, and because they are investigating research problems from different angles, he feels solutions are within sight. “It is continuously getting better and the methods are improving,” he says. “Biotechnology companies are excited too,” he explains. Companies such as Physio-Control and Philips are also working to improve resuscitation methods and often collaborate with Jason’s team. Jason hopes that his project team can contribute to the solutions currently in development at these companies and save even more lives.
Music keeps Jason engaged in research
Jason disengages from science by playing the piano, giving the “scientific half of his brain a rest.” He performs at Seattle restaurants three nights a week; his present gigs include Canlis and the Space Needle’s SkyCity. Maintaining a connection to music gives him fulfillment, he says, and renews his ability to approach research problems in creative ways.