Medical Student Research Fellowship for Summer 2009

Mentor: Dr. Philip Greilich
Department: Department of Anesthesia, Division of Cardiothoracic Anesthesiology
Room number: HQ3.320B
Mail Code: 8894
Phone number: 58089
E-mail: Philip.Greilich@utsouthwestern.edu
Project title: Management of Excessive Bleeding following Cardiopulmonary Bypass: A Pilot Feasibility Study

Human subjects IRB approved project number (where applicable): 082006-043

Animal subjects IRB approved project number (where applicable): N/A

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Patient-based research

Brief Description of Project:

This project is designed to enroll up to 400 patients at 4 medical centers (up to 150 at UTSW) that are at high risk for excessive blood loss following CPB surgery. Our hypothesis is that our approved transfusion protocol can be adhered to even in an environment with rapid blood loss. We will document our adherence to our treatment protocol at 15 points in the intraoperative transfusion algorithm. In addition, we will collect data regarding the impact of our protocol on blood loss/transfusion and the incidence of excessive bleeding despite conventional treatment (with blood products). The anesthesiologist will be responsible for administering the blood products based on the transfusion protocol. The protocol will be in effect until 8 units of fresh frozen plasma, 2 units of platelet concentrates and 10 units of cryoprecipitate have been administered. Patients that still have excessive bleeding beyond this point will be deemed "resistant to conventional therapy" and data collection for the primary endpoint will end at this juncture. Subsequent transfusions and treatments for persistent and excessive blood loss will be at the discretion of the treating anesthesiologists and surgeons based on each institution's current practice and institutional protocols.

The roles of the student will be statistical analysis, figure/table design, manuscript revision, literature research as well as some data entry.

Previous Research Activities or Publications with Medical Students:

Neeraj Satyanarayana, Medical student at UTSA:
Neeraj worked as a research assistant in my lab for the year prior to starting at UTSA. He worked on a number of projects with the roles described above.

Manuscripts:
Greilich PE, Jessen ME, Satyanarayana N, Whitten CW, Nuttall G, Beckham JM, Wall MH. Effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and blood loss in patients undergoing primary, isolated coronary artery bypass grafting: A Placebo-controlled non-inferioity trial. Anesthesia and Analgesia. Accepted

Abstracts:
May T, Douning LK, Satyanarayana N, Sarode R, Gaza J, Davis M, Jenevein E, Buck B, Jessen M, Greilich PE. Cost:Benefit Analysis of Thromboelastography in Cardiac Surgery. Transfusion 2007;47 (11):A123.

Greilich PE, Taneja R, Satyanarayana N, Whitten CW, Sarode R. Thrombin generation is attenuated with aprotinin, but not with epsilon-aminocaproic acid, in patients undergoing cardiopulmonary bypass surgery. Anesth Analg 2008;106(SCA suppl):A80.

Greilich PE, Satyanarayana N, Brilakis E, Leonard D, Jessen ME. Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. Anesthesiology 2008;109:A1620.

Jonathan Boyd, Medical student at UTSW:
Jonathan currently works as a research assistant in my lab during a leave of absence prior to beginning his final year of medical school. He worked on a number of projects with the roles described above.

Manuscripts:
John A, Yeh C, Boyd J, Greilich PE, Treatment of Refractory Hypotension with Vasopressin in a Patient Receiving High-Dose Clozapine. Journal of Cardiothoracic and Vascular Anesthesia. Submitted

Greilich PE, Leonard D, Boyd J, Brilakis E, Jessen ME. Epsilon-aminocaproic acid, but not aprotinin increases cardiac enzyme levels following CABG surgery. In Preparation

Abstracts:
Wyrick CC, Boyd JD, Adesaya A, Greilich PE, Sarode R. Platelet Responsiveness to Clopidogrel andis Not Influenced by Weight or Body Mass Index in Patients Undergoing Neuro-Endovascular Procedures. In Preparation

As a principal investigator, I believe in rewarding hard work and I assign authorship based on the quality and the amount of work done, not the degrees involved.