Gunshot wounds, traumatic brain injuries, cardiac arrest, stroke — these life-threatening injuries and illnesses differ in symptoms and treatments, but they all strike without warning, day or night. That’s not just scary for patients and their families, but it’s also complicated for researchers. These time-sensitive events can occur outside the business hours of most researchers so the opportunities to investigate new prevention or treatment techniques are limited.
The Penn Acute Research Collaboration (PARC), a one-of-a-kind clinical and translational research program at Penn Presbyterian Medical Center, is working hard to change this, driving studies that will help bring care for critical patients to a new level.
Debuting a Game-changing Clinical Strategy
The concept for PARC was first considered in 2015 when it was announced that the Penn Medicine Level 1 trauma center would move from the Hospital of the University of Pennsylvania (HUP) to Penn Presbyterian Medical Center (PPMC). As they sat in on meetings about the logistics of the transition and the clinical resources that would be needed to care for patients at PPMC, three physicians — Benjamin S. Abella, MD, MPhil, director of the Center for Resuscitation Science and an Emergency Medicine physician, Joshua Levine, MD, chief of Neurocritical Care, and Carrie A. Sims, MD, PhD, a trauma surgeon then at Penn — were struck by the lack of discussion about research.
As they made plans to move their research from one hospital to another, the trio recognized that the transition offered a chance to break out of traditional silos and try something new. They proposed the creation of a cost-effective, collaborative structure that would support the research of acute conditions — such as those experienced by the trauma patients and critically ill and injured patients who were moved to PPMC
With the enthusiastic backing of their department chairs and Penn Medicine leaders, including J. Larry Jameson, MD, PhD, EVP of the University of Pennsylvania for the Health System and dean of the Perelman School of Medicine, and now-CEO of UPHS, Kevin B. Mahoney, the team moved ahead with their vision — hiring staff, constructing a workspace, reaching out to their colleagues across departments, and developing study protocols, all without a model to look to. Abella took on the role of clinical director, Levine was named education director, and Sims became the laboratory director. In October 2016, PARC’s home base officially opened at PPMC, and as Abella noted, “it’s been an exciting adventure ever since.”
To perform acute research, investigators require a carefully targeted patient population, and to identify these patients, PARC relies on the highly skilled clinical research coordinators (CRCs) and research assistants (RAs) who manage clinical enrollments. To ensure that a patient transported to the emergency department after a traumatic fall at 3 a.m. has the same opportunity to participate in research studies as a patient brought in at 2 p.m. suffering from a heart attack, the PARC clinical team is available 24/7 every day.
One member of the clinical core is CRC Edith Teng. When a patient arrives at PPMC via the ED or trauma bay and they may fit parameters for an active study, Teng receives an alert and immediately heads over to screen them and determine what studies they may be eligible for. A head wound may indicate that a patient is a good fit for a newly initiated traumatic brain injury study, for example, while a patient with a condition that required a blood transfusion may be able to co-enroll in both of the transfusion studies currently in action.
PARC provides patients with access to studies in a way that might not be possible at other institutions. If a patient is severely injured or critically ill and unable to provide consent to participate in a study, the team can enroll them in observation studies and obtain consent afterward. “The feedback that we’ve received has been very gratifying. Investigators in different departments have approached us wanting to join our efforts,” Abella said, adding that “we’ve had a number of really exciting successes.” For example, a recent randomized trial found that treating trauma patients suffering from severe blood loss with the arginine vasopressin hormone could improve their blood pressure and reduce their need for blood transfusions.” These findings were published in JAMA Surgery last year.
“We’re going to be supporting a number of clinical trials this year that would be hard to envision without PARC’s existence.”
A Space Built with Research in Mind
What truly takes PARC to the next level is its laboratory core. Its two state-of-the-art wet labs make it possible to conduct an entire clinical research study from start to finish on one campus.
Just as the clinical team works in shifts and is available to enroll patients at any time, the lab is also staffed all day, every day. This infrastructure allows the team to follow patients over the course of their hospitalization and regularly collect samples of blood, plasma, urine, and other fluids and tissues in real time, depending on the needs of the study or studies that the patient qualifies for. The lab also keeps comprehensive records of patient data — vital signs, medications they were given at certain times, and other clinical details — recorded by the patient’s care team and by PARC’s RAs and CRCs in order to aid in analysis.
Samples are stored and catalogued in a database, and the process for testing them is as simple as walking from the ED or ICU to the Andrew Mutch Building within PPMC. Protocols can change depending on the study, but because samples don’t need to be sent to an offsite lab, communication is seamless, and the clinical enrollment and lab teams can answer any questions without delay.
Some researchers choose to utilize the open lab and delve into a sample’s molecular biology and biochemistry themselves; laboratory manager and senior research investigator Antonio Davila, PhD, is there to help. Teng said that Davila “built the lab from the ground up,” so it’s no surprise that he’s an expert on every piece of the lab’s equipment and is equally comfortable teaching techniques so researchers can conduct their own experiments, or running the sophisticated analyses himself. Unlike the average lab, PARC can do far more than a simple blood test.
Davila also plays an integral role in shaping PARC-affiliated studies by collaborating with investigators to design their experimental protocols. “We’ve got researchers studying traumatic brain injuries, and others, like myself, trying to prevent sepsis,” he said. “We’re in such a unique position because we have all of the components we need in one place.”
“The data may not immediately help the patients who participate in studies, but every patient has benefitted from the research that came before them,” Davila continued. “Our goal is to translate whatever we learn in the lab back into the clinic to improve patient care, and so far, we’re doing what we set out to do.”
Sparking Innovation Through Collaboration
When Abella, Sims, and Levine first set their goals for PARC, they envisioned a structure with no departmental separations, no siloes, and no barriers except the stipulation that the research be time-sensitive and focused on acutely ill patients. Researchers from all fields and departments would instead share resources and technology, and this community would accelerate breakthroughs. PARC has made key strides towards these goals.
The trio’s shared commitment created the perfect environment for interdisciplinary collaboration. To foster these relationships, PARC hosts monthly seminars that cover a variety of topics and cultivate a culture of scholarship. “I like to think of our set-up as fitting into the approach Silicon Valley startups take. People naturally come into contact and find that that they can help each other in ways they never expected,” Levine said. “That’s how innovation starts.”
“Critical care research is a point of excellence at Presbyterian and for Penn Medicine. It’s very hard, but if we’re going to save lives at very challenging moments of traumatic injury or stroke or cardiac arrest, we need to understand how to do it better,” Abella said. “I hope entities like PARC will lead the way in our understanding of how to provide the best care to patients with acute injury or illness.”
“If this sort of infrastructure existed in a widespread way across the country, imagine how we could accelerate the pace of discovery for those diseases,” Levine said. “Imagine the breakthroughs we could make on a national level if we all could respond to and learn from emergencies around the clock instead of only during normal business hours.”