2019 Lead Intern
Hometown: Wayzata, MN
Education: University of Michigan (Ann Arbor, MI)
MD Mentor: Kasia Hryniewicz
Staff Mentor: Ross Garberich
Project: Prognostic Value of Troponin in Ability to Wean Off VA ECMO
Returning this summer as lead intern, Monique North brings her past experience and leadership skills to this year’s cohort. Originally from Wayzata, Minnesota, Monique obtained her bachelor’s degree in movement science from the University of Michigan Ann Arbor, and is interested in pursuing a career as a surgeon or cardiologist. Monique’s passion for medicine stems from the opportunity to forge meaningful relationships with patients and appreciates the problem-solving aspect of medicine.
Monique was drawn to MHIF’s research internship because, “MHIF offers an interesting hybrid where we are conducting clinical research as well as getting to follow full-time practitioners by observing what they do and truly seeing the impact on patients in close to real time. We have so many opportunities to round out our research experience with clinical exposure, which provides important context to our own academic interests”. As a second-year intern, Monique looks forward to gaining additional exposure to the clinical environment, facilitating research, and obtaining insight into the everyday lifestyle of a physician.
This summer Monique is contributing to the study: Prognostic Value of Troponin in the Ability to Wean off VA ECMO, while being mentored by Dr. Kasia Hryniewicz and MHIF staff member Ross Garberich. Cardiogenic shock (CS) is a complication that occurs with approximately 5-10% of acute myocardial infarction (MI) admissions and, despite treatment advances, is associated with high mortality. Extra corporeal membrane oxygenation (ECMO) may be utilized in refractory CS when there is a potential for functional recovery. Cardiac troponin and other biomarkers can be used not only to confirm the diagnosis of an MI, but also to calculate the infarct size and the extent of myocyte injury, and potentially the likelihood of successfully separating from veno-arterial (VA) ECMO. This study will identify the peak troponin value in patients supported with ECMO for refractory cardiogenic shock secondary to AMI and assess the association between the troponin levels and the relative risk of adverse outcomes in ECMO patients.
After this summer Monique will be taking a gap year while applying to medical school. During this process, Monique will be joining the MHIF industry-sponsored research team!
Peak troponin may predict ability to wean off VA ECMO
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is becoming an accepted modality in the treatment of refractory cardiogenic shock (RCS) complicating acute myocardial infarction (AMI). RCS complicates AMI in 5-10% of cases and continues to be associated with high mortality. The optimal timing of separation from support can be difficult to determine, and therefore, it may be beneficial to use peak troponin as a predictor of weaning.
- Elevated cardiac troponins are associated with left ventricle dysfunction, which is a major determinant of long-term morbidity and mortality.
- Our observation suggests that patients with a peak troponin above 400ng/mL are less likely to recover and separate from VA ECMO support.
- In the future, once significantly elevated troponin values have been identified, evaluations for advanced therapies such as LVAD or cardiac transplantation can be instituted sooner with the potential to decrease ECMO support time, which may lead to lower morbidity and mortality.
- A future prospective trial that includes assessment on a larger number of patients could be considered in order to add power to the study.