Pediatric cardiac arrest remains a significant cause of mortality and morbidity and thus it is an important public health problem. In the United States, it is estimated that 16,000 children die annually of cardiac arrest. Asphyxia is the cause of cardiac arrest in the majority of pediatric victims. Most survivors have severe neurological impairment. Cerebral blood flow (CBF) disturbances after resuscitation may further contribute to neuropathological damage after cardiac arrest. Reactive oxygen and nitrogen species play an important role in regulating CBF, and are generated during and after resuscitation from cardiac arrest. CBF, cerebral metabolism, oxidative stress, nitrative stress and the interaction of these factors remain to be defined in pediatric cardiac arrest, and may represent an important therapeutic target toward improving outcome of this debilitating condition. The candidate recently has developed a protocol for serial and regional assessment of CBF in developing postnatal day 17 rats via arterial spin label MRI and found insult duration dependency of CBF after asphyxial cardiac arrest. The candidate will (i) determine the relationship between CBF, cerebral metabolism and neuropathological damage and (ii) quantify production of nitric oxide, reactive oxygen species and other reactive nitrogen species after two durations of asphyxial cardiac arrest (8.5 min and 12 min). The candidate will also (iii) determine if scavenging ROS and RNS in either vascular or parenchyma! compartments will prevent pathological CBF alterations and reduce neuropathological damage after asphyxial cardiac arrest. Regional CBF will be measured serially via arterial spin label MRI. Cerebral metabolic rate for glucose will be measured with autoradiography. Nitric oxide will be measured in vivo serially with tissue minisensors and ex vivo with electron paramagnetic resonance spectroscopy. Oxidative and nitrosative stress will also be quantified: we will measure 3-nitrotyrosine by ELISA and immunofluorescence, ascorbic acid by high liquid field chromatography, and reduced glutathione by fluorescence. The candidate is a pediatric emergency physician at Children's Hospital of Pittsburgh. There is a need for training pediatric emergency clinician-scientists, as interventions likely to impact outcome after pediatric cardiac arrest should ideally be started at the arrest scene or in the Emergency Department. This Mentored Career Development Award will allow the candidate to pursue a unique and highly integrated mentored program in resuscitation medicine. To assure success in becoming an independent clinician-scientist, the candidate assembled a multidisciplinary and multi-institutional advisory committee that includes senior mentors with special expertise in 1) resuscitation research, 2) vascular biology, 3) oxidative stress, 4) MRI and 5) pediatric clinical resuscitation guidelines development and implementation.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Clinical Investigator Award (CIA) (K08)
Project #
Application #
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Maholmes, Valerie
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Schools of Medicine
United States
Zip Code
Manole, Mioara D; Kochanek, Patrick M; Bayýýr, Hulya et al. (2014) Brain tissue oxygen monitoring identifies cortical hypoxia and thalamic hyperoxia after experimental cardiac arrest in rats. Pediatr Res 75:295-301
Manole, Mioara D; Kochanek, Patrick M; Foley, Lesley M et al. (2012) Polynitroxyl albumin and albumin therapy after pediatric asphyxial cardiac arrest: effects on cerebral blood flow and neurologic outcome. J Cereb Blood Flow Metab 32:560-9
Walson, Karen H; Tang, Minke; Glumac, Ashley et al. (2011) Normoxic versus hyperoxic resuscitation in pediatric asphyxial cardiac arrest: effects on oxidative stress. Crit Care Med 39:335-43
Manole, Mioara D; Tehranian-DePasquale, Roya; Du, Lina et al. (2011) Unmasking sex-based disparity in neuronal metabolism. Curr Pharm Des 17:3854-60
Manole, Mioara D; Kochanek, Patrick M; Fink, Ericka L et al. (2009) Postcardiac arrest syndrome: focus on the brain. Curr Opin Pediatr 21:745-50