Supported by funding from the National Institutes of Health (NIH), Yale School of Medicine is a leading hub for a network of medical institutions in the northeast, in collaboration with 12 other large hubs across the U.S. The network conducts clinical trials designed to advance the science of emergency care, improving outcomes for patients with neurologic, cardiac, respiratory, hematologic and trauma emergencies. It is an area of medicine unlike any other because of the high stakes and time pressures involved for patients in sudden need of emergent treatment.
“Will the patient survive? And if they do survive, are they going to survive with return to a functional state, or be severely disabled?” asks Gail D’Onofrio, MD, Albert E. Kent Professor of Emergency Medicine, and professor of epidemiology (chronic diseases) and of medicine (addiction medicine). “It is in those first few minutes and hours that interventions can make a major difference in someone's life.”
Called SIREN (“Strategies to Innovate EmeRgENcy Care Clinical Trials Network”), the collaboration tests emergency interventions for life-threatening illnesses and injuries, which are infrequent enough that sufficient data can only come through assessments of encounters at multiple institutions. “Access to large and diverse populations is essential to adequately testing these interventions,” explains D’Onofrio, who will be the lead principal investigator for Yale hub, which is called Yale-METRO (Metropolitan Emergency Trial Network to advance patient Outcomes). The trials will span the entire spectrum of prehospital, emergency department and hospital care through long-term follow-up and rehabilitation. The results of these trials will inform clinical care and practice standards in the future. Several physician-scientists from Emergency Medicine, including Charles Wira, MD; Richard Andrew Taylor, MD, MHS; and Basmah Safdar MD, MSc, have significant roles in the project.
Will the patient survive? And if they do survive, are they going to survive with return to a functional state, or be severely disabled? It is in those first few minutes and hours that interventions can make a major difference in someone's life.”
Gail D'Onofrio, MD
Yale New Haven Hospital, one of the largest in the nation with more than 1,500 beds, adds a substantial number of potential patients who can enroll in the trials. And Yale’s extensive emergency medicine expertise, the advanced technology it possesses, and collaborations and experience of its intensivists, neurosurgeons, neurologists, cardiologists, and trauma surgeons provide unique opportunities to contribute great value and innovation to the project.
Yale School of Medicine’s participation will be a multidisciplinary collaboration between the departments of Emergency Medicine and of Neurosurgery. Kevin Sheth, MD, professor of neurosurgery and of neurology, has a highly successful track record as principal investigator for two multi-center NIH neuroscience networks, NeuroNEXT and StrokeNet, which enrolled new and large patient populations that were rich in ethnic and racial diversity. Sheth, who also is vice chair for clinical & translational research in Neurosurgery and Neurology, says his specialties and Emergency Medicine are firmly intertwined, something that NIH’s National Institute of Neurological Disorders and Stroke increasingly recognizes.
“When you think about neurosurgery you appropriately think of outpatient, chronic diseases: Parkinson’s, Alzheimer’s, migraines. However, there's another set of neurosurgical diseases which are common and deadly, which include things like stroke, head trauma, seizures, spinal cord compression, and infections of the brain like meningitis,” he explains. “They are emergencies, so they intimately involve collaborations with the prehospital system and they often present and take place in emergency departments.” Sheth also notes D’Onofrio’s expertise in the field of addiction and substance use, another area where Neurology and Emergency Medicine intersect, along with Psychiatry. Additional team leaders include Emily Gilmore, MD, and Rachel Beekman, MD, from the Department of Neurology, and Sacit Bulent Omay, MD, from Neurosurgery.
Teams from these and other Yale departments have already been working together for years, Sheth says. That made Yale an especially strong candidate to join this clinical trials group. Membership also promises to strengthen Yale by offering new avenues for young investigators to develop their knowledge and skills.
“I am particularly thrilled,” says Sheth, “because YaleMETRO represents an exciting collaboration with the newly formed and interdisciplinary Yale Center for Brain & Mind Health, which aims to bring clinically relevant, cutting-edge neuroscience research to our communities.” Sheth is one of the new center’s directors.