bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 225: Sudden Cardiac Arrest Messaging Study. The Public’s Motivation to Learn CPR/AED Skills and to Act in an Emergency Increases With a Clear Understanding of SCA and the Impact These Skills Have on Increasing Survival
Authors: Newman Mary M , Chap Jennifer , Ba Karen , Ba Youssou , Chap Rick , Sawyer Kelly N
Published: July 2021

Introduction:
Survival from sudden cardiac arrest (SCA) outside hospitals depends largely on immediate bystander intervention. We measured the impact a layperson-friendly definition of SCA has on increasing perceived importance of CPR/AED (automated external defibrillator) skills and the likelihood to act, plus messages that drive action.

Hypothesis:
Low public awareness of SCA contributes to low survival rates; a layperson-friendly definition of SCA could improve perceived importance of CPR/AED training and likelihood to act in emergencies; identifying messages that motivate action could help reveal an effective communications strategy.

Methods:
We conducted a quantitative/qualitative study with an online survey of a representative national sample of adults (n=2,232) and in-depth interviews (n=20). Online respondents were exposed to framing questions, then split into two matched panels. One panel was exposed to a layperson-friendly definition of SCA (n=1,128); the other was exposed to 11 discrete messages (n=1,104). Questions pre- and post-exposure to the definition measured lift in importance to learn skills and likelihood to give CPR/use an AED. Messages were tested on relative strength in motivating action and grabbing attention.

Results:
The public is confused/unfamiliar with SCA and the need for immediate intervention. Barriers to bystander intervention include lack of confidence (39%), concerns about hurting the victim (38%), belief another is more competent (37%), and liability (28%); notably, 18% of respondents indicate no barriers (n=2,232). A friendly definition of SCA increases the belief that learning CPR/AED skills is “extremely important.” Those “very likely” to give CPR/use AED jump 26% and 38% respectively (n=1,128). Including “sudden” in the definition proves important, conveying urgency. The messages that drive motivation to act and grab attention address doubling or tripling the chance of survival and saving the life of a loved one.

Conclusions:
Lack of awareness/understanding of SCA contributes to public apathy. A layperson-friendly definition of SCA significantly increases likelihood to give CPR and use an AED. Including “sudden” in the definition signals urgency. Two key messages show strength in driving action.
Abstract 226: Comparison of a Low and High Resource Model to Effectively Train College Students in Compression Only Cardiopulmonary Resuscitation
Authors: Goldstein Matthias , Goldstein Benjamin , Novograd Joel , Carden Kailah , Kirwan Michelle
Published: July 2021

Introduction:
High quality chest compressions, as measured by depth and rate per minute, are an integral component of cardiopulmonary resuscitation (CPR). CPR compression skills are often taught on a high resource training device such as manikin torso. Use of these manikin torso devices may be limited by availability and cost, reducing the number of individuals trained in CPR. We hypothesize that a bed pillow, a low resource device, is as effective as a manikin torso, a high resource device, in training college students to perform compression only CPR.

Methods:
College students with no prior CPR training were randomized to one of two training rooms, one with a bed pillow (n=119) and one with a manikin torso (n=123). Each participant watched a two- minute training video, which included a demonstration using the respective device and a practice-while-watching technique chest compression skills practice. Each room had a certified CPR instructor to assist and answer any technical questions. Another CPR instructor, blinded to the training randomizations, observed each participant for one minute on a recording manikin that evaluated the depth and rate of compressions.

Results:
Manikin-trained students had a significantly higher mean rate of compressions per minute compared to the pillow-trained students (122.9 vs. 118.0; p= 0.028). The manikin group exceeded the recommended rate range (100-120 compressions per minute). There was no significant difference between compression depth in the two groups; manikin-trained students had an average compression depth of 38.27 mm while pillow-trained students had an average compression depth of 38.50 mm (p=0.89). Mean compression depth for both groups were below the guidelines (50-61 mm).There was no significant difference (p=0.81) between the overall CPR competency of the pillow-trained compared to the manikin-trained students as measured by rate and depth of compressions.

Conclusions:
These findings demonstrate that a low resource pillow is comparable to a high resource manikin as a CPR training device. The use of a low resource training device can remove the barriers of cost and availability in training college students in CPR. This training method will allow for an increase in the number of people trained to save lives.
Abstract 227: The Acceptability and Impact of a Pilot Community Hands-Only Cardiopulmonary Resuscitation Training Program in India
Authors: Martinez Brent V , Chimata Radhika , Dedania Nishi , Khosla Shaveta , Mayer Stockton , Murthy Vemuri , Yeldandi Vijay
Published: July 2021

Background:
Sudden Cardiac Arrest (SCA) is a leading cause of global mortality. In India, 700,000 people die from SCA annually, many of which are under the age of 50. Immediate bystander CPR improves chances of survival, however, CPR education and training are difficult in a developing country such as India. In collaboration with University of Illinois Global Health Program, the Indian American Medical Association (Illinois), SHARE INDIA, and the American Heart Association we studied native rural Indian populations, hoping to enhance CPR education and skills training. This is the first rural community CPR project in India involving a university residency-training program from the USA.

Methods:
We conducted hands-only CPR training (based on the latest AHA guidelines) in the Telangana State in India, recruiting 582 participants with the help of local health outreach workers. A pre-training survey was used to assess baseline knowledge and impressions of CPR. This was followed by training in hands-only CPR consisting of an oral presentation followed by interactive CPR manikin training. A post-course survey was conducted after training. Chi square test and McNemar’s test were used for the analysis of data using SAS.

Results:
Of 582 participants, 65% were males and the mean age was 19.4
+
5.9. Gender was not associated with pre/post-test CPR knowledge, comfort with CPR, or belief in CPR efficacy. However, in paired analysis, there were significant differences (p<0.0001) in all knowledge and perception measures from pre-to-post training. While only 6% knew the correct compression rate pre-training, 96% knew the correct answer post-training (4% vs. 94% in females, 6% vs. 96% in males). Similar results were seen for the compression depth variable. Training also improved comfort level in performing CPR (64% vs. 87% in females and 70% vs. 89% in males) and belief that CPR can save lives (49% vs. 96% in females and 51% vs. 97% in males).

Conclusions:
The program was successful in enhancing knowledge, comfort, and perceptions of CPR. Given the high prevalence of SCA in India, training the public in hands-only CPR can be a cost-effective care strategy in resource-limited areas. Due to the success of this pilot, we are planning to continue the program.
Abstract 228: Comparing a Virtual Reality Mobile App vs. a Standard Mobile App for CPR Training
Authors: Leary Marion , Almodovar Alfredo , Patel Jaldhi , Chaudhary Zainab A , Blewer Audrey L , Abella Benjamin S
Published: July 2021

Introduction:
Virtual Reality (VR) via a mobile platform has the ability to heighten realism for CPR training. Whether training with VR compared with a standard mobile application (mApp) would improve CPR quality and response is unknown.

Objectives:
We sought to test whether a VR mApp would confer improved CPR skills compared with an existing CPR training on a standard mApp.

Methods:
Using a VR viewer combined with a smartphone for multisensory immersion, we created a VR CPR training mApp based on our established CPR mApp (Figure 1); both included Hands-only CPR instruction. Subjects were randomized to our intervention arm (VR mApp) or our control arm (mApp). Subjects in the VR mApp arm underwent CPR training and were able to interact with avatar bystanders, “perform” CPR via VR viewer click button, and acquire an AED. The standard mApp arm underwent our established CPR training, but did not have the VR immersion. We collected bystander response data (Call 911, Perform CPR, Ask for an AED), along with CPR quality during a 3-min post-intervention scenario.

Results:
Between 3/2018 and 5/2018, 38 subjects were enrolled: 19 VR mApp and 19 mApp. Mean age was 45±15 yrs, 34% were female, and 32% were currently CPR trained. In total, 70% called 911, 97% performed CPR, and 41% asked for an AED. Mean chest compression (CC) rate was 102±40 compressions per minute (cpm), depth was 40±13 mm. When comparing the VR mApp arm to the mApp arm, mean CC rate was 102±48 cpm vs 102±33 cpm, and mean CC depth was 40±13 mm vs 40±13 mm, respectively. The percentage of bystander response was higher in the VR mApp arm compared with the standard mApp arm: calling 911 (88% vs 52%), asking for an AED (55% vs 26%) (Figure 2).

Conclusion:
In our study comparing a VR mApp versus a standard mApp for CPR training, CPR quality did not differ but a trend toward increased bystander response was found in the VR mApp arm. Further studies will need to be powered to detect difference using immersive VR trainings and their effect on bystander response.
Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States
Authors: Holmberg Mathias J , Ross Catherine , Chan Paul S , Duval-Arnould Jordan , Grossestreuer Anne V , Yankama Tuyen , Donnino Michael W , Andersen Lars W
Published: July 2021

Introduction:
Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States.

Methods:
Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (>18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events.

Results:
There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases.

Conclusions:
Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.
Abstract 241: Incidence of Definite Stent Thrombosis in Comatose Survivors of Out-of-Hospital Cardiac Arrest Undergoing Percutaneous Coronary Intervention and Therapeutic Hypothermia - Preliminary Results
Authors: Rauber Martin , Nicol Philipp , Joner Michael , Bunc Matjaz , Noc Marko
Published: July 2021

Background:
Immediate percutaneous coronary intervention (PCI) is increasingly performed in comatose survivors of out-of-hospital cardiac arrest (OHCA) undergoing therapeutic hypothermia (TH). Since reported incidence of stent thrombosis (ST) varies significantly from 2.5% to 31%, we investigated definite ST using systematic coronary angiography (CAG) and autopsy.

Methods:
Consecutive comatose survivors of OHCA undergoing immediate PCI and TH admitted between August 2016 and May 2018 were investigated. CAG was performed if ST was suspected and systematically between day 10-14. Patients who died underwent autopsy with analysis of stented segments.

Results:
Among 147 consecutive patients, immediate CAG was performed 103 (70%) and 52 (50%) underwent PCI. Since 5 patients refused to participate or had no follow-up, 47 patients were included. Definite ST, which was confirmed 8 patients (17%), was diagnosed either by clinically-driven CAG (n = 6), routine CAG (n = 1) or autopsy (n = 1). Patients with ST had more often diabetes (38% vs. 5%; p = 0.008), longer interval of prehospital resuscitation (12.6 ± 10.7 minutes vs. 25.0 ± 10.6 minutes; p = 0.005), higher admission lactate (6.8 ± 6.3 mmol/L vs. 3.2 ± 2.9 mmol/L; p = 0.013), lower arterial pH (7.13 + 0.19 vs. 7.27 ± 0.11; p = 0.005) and less favorable survival with good neurological outcome - Cerebral Performance Category score 1 - 2 (13% vs. 62%; p = 0.03). There was no difference in left ventricular ejection fraction (40 ± 12% vs. 39 ± 13%; p = 0.85), periprocedural dose of unfractioned heparin (8944 ± 2504 IU/kg vs. 8188 ± 2764 IU/kg; p = 0.45), use of GP llb/llla (16 % vs. 25 %; p = 0.59) and of novel P2Y12 inhibitor ticagrelor (79% vs. 63%; p = 0.33). There was no significant difference in total length of stented segment (32.7 ± 24.4 mm vs. 36.6 ± 20.7 mm; p = 0.68) nor in average stent diameter (3.1 ± 0.5 mm vs. 3.2 ± 0.4 mm; p = 0.62).

Conclusions:
Incidence of definite ST in comatose survivors of OHCA undergoing immediate PCI and TH is significant (17%) and is associated with worse outcome. Prolonged prehospital resuscitation and diabetes rather than PCI characteristics represent the risk factors for development of ST.
Abstract 25: Cost-Effectiveness of Public Automated External Defibrillators
Authors: Andersen Lars W , Holmberg Mathias J , Granfeldt Asger , James Lyndon P , Caulley Lisa
Published: July 2021

Introduction:
Despite a consistent association with improved outcomes, automated external defibrillators (AEDs) are used in only approximately 10% of public out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost. The objective of this study was to provide a contemporary cost-effectiveness analysis on the use of public AEDs in the United States (US) to inform guidelines and public health initiatives.

Methods:
We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the US over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs (in 2017 US dollars) per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. It was assumed that AED use was associated with a 52% relative increase in survival to hospital discharge with a favorable neurological outcome in those with a shockable rhythm. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Consistent with recent guidelines from the American Heart Association, we used a willingness-to-pay threshold of $150,000 per QALY gained.

Results:
The no AED strategy resulted in 1.63 QALYs at a cost of $42,757. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. At an incidence of 1%, the incremental cost-effectiveness ratio was $101,040 per QALY gained. In sensitivity analyses across a plausible range of health-care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively.

Conclusion:
Public AEDs are a cost-effective public health intervention in the US. These findings support widespread dissemination of public AEDs.
Abstract 26: Evaluating Variation in Return of Spontaneous Circulation Rates Across EMS Agencies in Michigan
Authors: Abir Mahshid , Salhi Rama , Goldstick Jason , Lehrich Jessica , Fouche Sydney , Setodji Claude , Forbush Bill , Kronick Steve , Shields Teri , Brennan Erin , Swor Robert , O’Neil Brian , Neumar Robert , Nallamothu Brahmajee , Surveillance Group CARES
Published: July 2021

Background:
Out-of-hospital cardiac arrest (OHCA) outcomes vary significantly across U.S. communities; however, systems of care factors that increase the likelihood of survival have not been well elucidated. The Enhancing Pre-Hospital Outcomes for Cardiac Arrest (EPOC) study is quantifying variation in the rate of sustained return of spontaneous circulation (ROSC) upon ED arrival across Michigan EMS agencies as a first step to identifying ‘best practices’ in prehospital OHCA care.

Methods:
Michigan Cardiac Arrest Registry to Enhance Survival (CARES) data for the years 2014-2016 was used. EMS agencies with 5+ arrests over the study years were included in the analysis. Using mixed-effects logistic regression, we calculated each agency’s reliability-adjusted sustained ROSC upon ED arrival; these rates were standardized across patient-, community-, and arrest-level characteristics.

Results:
A total of 91 agencies covering >6.8 million lives met inclusion criteria. We included 14,219 OHCA patients with a mean age of 62.6, 40.0% female, and 18.2% with a shockable rhythm in the analyses. Across all agencies, the mean patient-standardized rate of sustained ROSC with pulse upon ED arrival was 25.3% (range, 6.1%-51.9%; IQR range, 18.9%-31.2%) (
Figure 1
). There were 14 agencies with patient-standardized rates and 95% CIs that exceeded the overall mean survival rate suggesting better-than-average outcomes while 16 agencies had rates and 95% CIs that were lower than the overall mean survival rate.

Conclusion:
We found more than 8-fold variation in OHCA survival rates across EMS agencies in Michigan, suggesting large differences in the effectiveness of prehospital systems of care. Future qualitative work will seek to identify ‘best practices’ by further determining the role of key factors such as tele-dispatch CPR, EMS agencies, fire, and police within high performing systems.
Abstract 260: Associations of Chest Compression Release Velocity and Age, Weight, and Gender During Cardiac Resuscitation
Authors: Sutter John H , Beger Samuel , Hu Chengcheng , Spaite Daniel W , Silver Annemarie , McDannold Robyn , Mullins Margaret , Vadeboncoeur Tyler , Bobrow Bentley J
Published: July 2021

Background:
Higher chest compression release velocity (CCRV) is associated with better outcomes after OHCA. Patient age and gender have been associated with variations in chest wall compliance and compressibility which may impact outcomes.

Hypothesis:
To evaluate the association between CCRV and OHCA patient age, weight, and gender.

Methods:
Observational study of prospectively collected OHCA quality improvement data in two suburban EMS agencies in Arizona between 10/1/2008 and 12/31/2016. Patient age and weight were categorized into quartiles for the analysis. CCRV was summarized at each level of the categorical variable by median and inter-quartile range (IQR), and was then compared between different levels by the Kruskal-Wallis test.

Results:
During the study period, 2,661 OHCA cases were treated. After exclusion criteria, 1,140 cases remained for analysis. Median duration of compressions was 8.70 minutes. Mean CCRV was negatively correlated with age and positively correlated with weight (Table). Male patients exhibited a greater mean CCRV compared to female patients [344.4 mm/s (IQR 307.3-384.6) vs. 331.5 (285.3-385.5), p=0.0133].

Conclusion:
Patient characteristics including younger age, male gender, and increased weight were associated with a higher CCRV during OHCA resuscitation.
Abstract 262: Hemodynamically-Guided Optimum Chest Compression Point in a Rat Model of Cardiopulmonary Resuscitation
Authors: Olivari Davide , De Giorgio Daria , Novelli Deborah , Magliocca Aurora , Ruggeri Laura , Ristagno Giuseppe
Published: July 2021

Introduction:
CPR aims to re-establish blood flow by chest compression (CC), achieving threshold levels of coronary perfusion pressure (CPP). For this, current guidelines recommend the lower sternal half as optimum CC point. However, this point might be not optimal for every individual. We investigated the hemodynamics generated by CC performed on different chest points in a rat model of CPR. We hypothesized that a CC point hemodynamically-identified would be a better approach compared to the lower sternal half.

Methods:
Ten male rats were anesthetized and arterial and right atrial pressures monitored. Ventricular fibrillation was induced and untreated for 8 min. CPR, including mechanical CC, ventilation, and epinephrine, was then performed for 8 min. Animals were divided to receive CC performed either on the lower sternal half (standard (STD), n=5) or on an optimum point identified as the one able to generate the maximum CPP (MaxCPP group, n=5). Cardiac districts involved in CC were subsequently identified by computed tomography (CT).

Results:
STD CC produced a CPP that was constantly below the threshold for successful resuscitation and trended to decrease over time. When the optimum CC point was identified hemodynamically, the CPP generated was constantly > 20 mmHg. Indeed, CPP was significantly higher in the MaxCPP group compared to the STD one for the whole 8 min of CPR (p<0.01, Fig). Moreover, administration of epi rapidly further improved CPP (p<0.01 vs. pre-epi) in the group with an optimized CC point, while no drug effect was observed in the STD one. CT scan showed that the lower sternal half did not correspond to the LV maximum diameter, known to account for a maximum stroke volume generation during CC (Fig).

Conclusion:
Standard lower sternal half CC point is not able to maximize hemodynamics during CPR, making ineffective CC efforts and vasopressor administration. The quality of CPR may improve if the optimum CC point is identified as a reflection of CPP generated.
Abstract 279: Cardiac Arrest is Associated With a Global Level Alteration in Oxygen Metabolism: A Clinical Pilot Study
Authors: Shinozaki Koichiro , Saeki Kota , Zhou Qiuping , Cassiere Hugh , Jacobson Lee , Rolston Daniel , Falotico Julianne , Li Timmy , Olshan Marc , Levitus Matthew , Lampe Joshua W , Becker Lance B
Published: July 2021

Objective:
We recently reported that a global-level metabolic alteration occurs after cardiac arrest (CA) in our high fidelity rodent model. The finding was that dissociation of O
2
consumption (VO
2
) and carbon dioxide generation (VCO
2
) resulted in a respiratory quotient (RQ: calculated by dividing VCO
2 by
VO
2
) that fell well outside the normally cited range of 0.7-1.0. We hypothesized that a lowered RQ is similarly found in human CA patients.

Methods:
The study consisted of three subject groups: 1) healthy volunteer, 2) post-surgical patient (control) and 3) post-CA patient. We measured the VO
2
and VCO
2
of mechanically ventilated subjects using the Douglas bag method. Inspiration and expiration gas samples were collected in two separate bags
.
and RQ was calculated from CO
2
and O
2
gas concentrations in the samples. The patients and healthy volunteers were ventilated using the same model mechanical ventilator. Alert healthy volunteers bit onto a mouthpiece and the samples were collected, while post-surgical and post-CA patients were unconscious during the measurements. We measured the RQ of healthy volunteers at normal and high fractions of inspired oxygen (FIO
2
) in order to test the validity of our methods at various inspired O
2
levels.

Results:
The RQs of the three healthy volunteers were 0.83, 0.92 and 0.85 at an FIO
2
of 0.21 and 0.86, 0.88, and 0.83 at an FIO
2
of 0.90 respectively. The RQs of the two post-surgical patients were 0.92 and 0.88 at an FIO
2
of 0.5. None of the post-surgical patients had any complications following the surgery and all were discharged. The RQ of a post-CA patient measured 2.5 hours after the CA was found to be 0.72 at an FIO
2
of 0.9. The CA patient expired within 24 hours of hospital admission.

Conclusions:
The same trend between the findings of both our rodent study and the CA patient suggest that resuscitation from CA alters cellular metabolism on a global level. This metabolic alteration in turn causes the dissociation of O
2
consumption and CO
2
generation resulting in a lowered RQ. Our findings warrant a larger clinical study to confirm a lowered RQ in post-CA patients and bench work to elucidate the causative mechanism of this relationship.
Abstract 285: Higher Walk Score Associated With Higher Rates of Bystander AED Use in Street-Level Cardiac Arrest
Authors: Chen John , Effoe Valery , Lisko John , Sabbak Nabil , Reginauld Shawn , Ko Yi-An , Corrigan Frank , Lerakis Stamatios
Published: July 2021

Introduction:
Bystander CPR (BCPR) and AED use are crucial life-saving measures in out-of-hospital cardiac arrest (OHCA). OHCA occurring in low-income black neighborhoods are less likely to receive bystander assistance. In addition to socioeconomic disparities, characteristics of the built environment may also contribute to large variation in BCPR and bystander AED rates.

Hypothesis:
We hypothesized that pedestrian-friendly spaces have higher rates of BCPR and bystander AED use.

Methods:
Using the Cardiac Arrest Registry to Enhance Survival, we studied OHCA occurring in street/highway locations in the US in 2016. We excluded cardiac arrests that were witnessed by a 911 responder. Each incident address was assigned a 0-100 Walk Score® using an open-source algorithm and linked to census tract race and income data. We analyzed the relationship between Walk Score and key elements of bystander behavior: witness of arrest, provision of BCPR, and use of AED.

Results:
Of 3225 OHCA, 1666 (51.7%) were witnessed, 934 (29.0%) received BCPR, and 165 (5.1%) used an AED. After adjusting for age, gender, neighborhood median household income, and neighborhood percent black, every 10-point increase in Walk Score was associated with higher odds of bystander AED use (OR, 1.23; 95% CI, 1.14 to 1.32) but lower odds of witnessed arrest (OR, 0.95; 95% CI, 0.93 to 0.97) and BCPR (OR, 0.92; 95% CI, 0.90 to 0.95) (Table). Lower neighborhood household income predicted less BCPR and AED use; higher neighborhood black composition also predicted less BCPR.

Conclusions:
After adjusting for neighborhood-level race and income, OHCA occurring in walkable areas had higher rates of bystander AED use but lower rates of witnessed arrest and BCPR. The effects of built environments on bystander behavior and AED availability warrant closer investigation.
Abstract 298: Identification of LncRNA-miRNA-mRNA Network in Myocardium After Successful Resuscitation in a Rat Model of Prolonged Cardiac Arrest
Authors: Hou Jingying , Yang Zhengfei , Tang Wanchun
Published: July 2021

Introduction:
Previous studies have indicated that lncRNA participates in regional myocardial ischemia-reperfusion injury (IRI). However, the lncRNA-miRNA-mRNA crosstalk in the global myocardial IRI, which is implicated in the pathophysiology of post-resuscitation myocardial dysfunction (PRMD), has still not been explored.

Hypothesis:
To identify lncRNA-miRNA-mRNA regulatory network in myocardium after successful resuscitation in a rat model of prolonged cardiac arrest.

Methods:
Six male Sprague Dawley rats were randomized into sham control and ventricular fibrillation (VF)-CPR groups, with three rats in each group. VF was induced and untreated for 8 minutes. Defibrillation was attempted after 8 minutes of CPR. Heart tissue was obtained at 6 hours after resuscitation and lncRNA, miRNA and mRNA expression profiles were examined by using high-throughput sequencing. LncRNA-miRNA-mRNA interaction network was predicted and constructed.

Results:
Numbers of differentially expressed (DE) lncRNA, miRNA and mRNA were detected (Fig 1A). LncRNAs co-located or co-expressed target mRNAs and DE mRNAs were revealed (Fig 1B). The intersection of DE mRNAs with targeted mRNA of DE miRNAs was made (Fig 1C). A total of 129 feed forward loops were predicted as lncRNA-associated ceRNA networks,with 126 lncRNA (up)-miRNA (down)-mRNA (up) and 3 lncRNA (down)-miRNA (up)-mRNA (down) (Fig 2).

Conclusions:
LncRNA-miRNA-mRNAs network was predicted and constructed in myocardium after successful resuscitation in a rat model of prolonged cardiac arrest. Further exploration into the specific functional roles of the ceRNA regulatory network will be conducive for the treatment of PRMD.
Abstract 301: Reasons for Death Following In- and Out-of-Hospital Cardiac Arrest
Authors: Witten Lise , Gardner Ryan , Holmberg Mathias J , Wiberg Sebastian , Moskowitz Ari , Donnino Michael W , Berg Katherine M
Published: July 2021

Introduction:
There is no standard method for reporting reasons for death in cardiac arrest patients. Categorizing reasons for death is important for comparing outcomes across cardiac arrest trials, assessing the benefits of targeted interventions in in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest patients, and developing quality-improvement initiatives. We developed and tested a method for categorizing reasons for death in post-cardiac arrest patients, assessed inter-rater reliability, and compared reasons for death between IHCA and OHCA.

Methods:
Single-center, retrospective, cohort study of patients who had return of spontaneous circulation (ROSC) after an OHCA or IHCA between 2008 and 2017, but died before hospital discharge. Traumatic arrests and patients with a “do-not-resuscitate” order prior to their initial arrest were excluded. Two independent investigators reviewed medical records and assigned each patient to one of five predefined categories of reasons for death. Inter-rater reliability was assessed using Fleiss Kappa. For final categorization, discrepancies were resolved by discussion with a third investigator. Categorical data was compared by Fisher’s Exact Test, and continuous data by Wilcoxon Rank-Sum Test.

Results:
There were 182 IHCA and 227 OHCA included, with the initial rhythm being non-shockable in 77% and 69% of cases (p=0.07), respectively. Median time to ROSC was shorter in IHCA compared to OHCA (10 [IQR: 6-20] vs 30 [IQR: 21-42] min, p<0.01). Median time to death was 3.3 (IQR: 1.4-8.7) days in IHCA vs 3.5 (IQR: 1.8-5.9) days in OHCA (p=0.92). The Kappa for reasons for death was 0.62 for IHCA and 0.61 for OHCA. Reasons for death for IHCA and OHCA were: neurological withdrawal of care (28% vs 72%, p<0.01), comorbid withdrawal of care (36% vs 4%, p<0.01), refractory hemodynamic shock 24% vs 18%, p=0.11), respiratory failure (1% vs 2%, p=0.47), and sudden cardiac death (11% vs 4%, p<0.01).

Conclusion:
Five categories for reasons for death in post-cardiac arrest patients were developed. The primary reason for death was neurological withdrawal of care after OHCA and comorbid withdrawal of care after IHCA. Categorizing reasons for death may be important for investigators when targeting an IHCA vs an OHCA population.
Abstract 302: NeuroCardiac Comprehensive Care Clinic Seeks to Define and Detect Neurological, Psychiatric, and Functional Sequelae in Cardiac Arrest Survivors
Authors: Agarwal Sachin , Presciutti Alex , Anbarasan Deepti , Golding Linda , Pavol Marykay
Published: July 2021

Introduction:
Despite improved survivability, cardiac arrest (CA) survivors face significant “extracardiac” (i.e. functional, cognitive and psychosocial) sequelae. More so, survivors and their caregivers are seemingly unaware that they will be confronted with these issues post-discharge. As a response, we have created a multidisciplinary, follow-up clinic to provide comprehensive and well-coordinated care to CA survivors. The team includes a neurointensivist, neuropsychologist, neuropsychiatrist and a chaplain.

Hypothesis:
CA survivors attending a follow-up clinic will have improved outcomes compared to historical controls.

Methods:
Fisher’s exact and Wilcoxon Rank-sum tests were used to assess differences in 1-year outcomes between survivors who had at least one follow-up visit in the NeuroCardiac clinic (2/2017-1/2018), with historical controls (9/2015 - 1/2017) who had no clinic visits.

Results:
Clinic patients (n= 34; median visit per patient=2), were slightly younger (49 vs 57 years, p=0.03) than historic controls (n=47), but otherwise there were no significant differences in demographic, psychosocial or functional status at hospital discharge. At 1-year, clinic patients, compared to historic controls, had significantly greater independence on the Lawton Physical Self-Maintenance Scale (mean score 7.6 vs 8.9, p=0.03) and Instrumental Activities of Daily Living scale (4.9 vs 8.8, p =.01). In clinic patients, there was a trend towards return to work (38.2% vs 23.4%), having a less negative impact on their marital status (5.9% vs 21.3%) and reduced complaints of sleep issues (29% vs 52%). Clinic patients had lower rates of depression symptoms on the Center for Epidemiological Studies-Depression scale (9.8 vs 13.4), were less fearful about the possibility of arrest recurrence (23.5% vs 31.9%), had more positive recovery perceptions (55.9% vs 38.3%), and had higher self-reported overall health ratings on a 100-point scale (84.7 vs 75.4) at one year.

Conclusions:
We have taken an important step in early detection of extracardiac symptoms in a systematic manner after CA. This paradigm shift could potentially be utilized to develop and implement novel interventions responsible for improving clinical outcomes and quality of life.
Abstract 306: Combining Clinical Utstein-Variables With Ventricular Fibrillation (VF) Waveform Characteristics to Discriminate Between Survivors and Non-Survivors of VF Cardiac Arrest
Authors: Nas Joris , Thannhauser Jos , van Grunsven Pierre M , Meinsma Gjerrit , van Royen Niels , de Boer Menko Jan , Bonnes Judith L , Brouwer Marc A
Published: July 2021

Introduction:
During ventricular fibrillation (VF) cardiac arrest, identification of potential survivors and non-survivors could aid treatment related decision making. Several studies have shown the association between clinical Utstein-variables and survival. More recently, VF-waveform characteristics were shown to be associated with survival as well. We aim to assess the discriminative ability for survival of a model combining these approaches.

Methods:
We studied non EMS-witnessed VF cardiac arrest patients (2008-2011), who had an analyzable ECG-tracing and were not treated with an AED. We compared Utstein-variables and the amplitude spectrum area (AMSA, a marker of VF-coarseness) between survivors and non-survivors to hospital discharge. Age was assessed as categorical variable (<65, 65-80, >80). Variables associated with survival (p<0.1) were combined using a binary logistic regression model. The area under the receiver operating characteristics curve (AUC) was used as measure of model discrimination.

Results:
We studied 115 patients: 70% (81/115) male, median age 64 years (interquartile range 54-72). In total, 24% (27/115) survived to discharge. Among survivors, the proportion male patients was lower and the proportion receiving bystander cardiopulmonary resuscitation (CPR) was higher. Survival decreased across increasing age categories. There was no difference regarding arrest location, witnessed status and EMS response times. AMSA was higher in survivors vs. non-survivors (15 [12-24] mV·Hz vs. 8 [6-11] mV·Hz, p<0.001). The model including age category, gender, bystander CPR and AMSA resulted in an AUC of 0.88 (0.80-0.96, p<0.001), figure 1.

Conclusion:
We found a good discriminative ability for survival after VF cardiac arrest of a model combining VF-waveform characteristics with clinical Utstein-variables. If confirmed in larger cohorts, this approach may be used to aid treatment related decision making during cardiac arrest.
Abstract 314: Survival From Sudden Cardiac Arrest in Heart Failure With Preserved vs. Reduced Ejection Fraction
Authors: Rusinaru Carmen , Reinier Kyndaron , Uy-Evanado Audrey , Chugh Harpriya , Stecker Eric C , Nichols Gregory A , Jui Jonathan , Chugh Sumeet S
Published: July 2021

Introduction:
The distinct cardiac pathophysiological differences in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF) could affect resuscitation outcomes from sudden cardiac arrest (SCA). It is possible that relatively normal systolic function conveys a survival advantage in HFpEF, but this has not been previously evaluated.

Hypothesis:
We hypothesized that HFpEF (EF ≥50%) patients have better survival outcomes from SCA compared to HFrEF (EF ≤35%) patients.

Methods:
SCA cases (age ≥18 years) were enrolled from a large ongoing population-based study of out-of-hospital SCA in the Northwestern US. LV EF was obtained from echocardiogram, angiogram, or MUGA performed prior and unrelated to the SCA event. Utstein variables and lifetime clinical history were recorded from first responder reports and medical records. Univariate comparisons between HFpEF and HFrEF cases were evaluated using Pearson’s chi-square tests, Cochran-Mantel-Haenszel test and independent samples t-tests. Multivariable logistic regression was used to evaluate the independent association of HFpEF vs. HFrEF with survival from hospital discharge.

Results:
Compared to HFrEF cases (n = 204), HFpEF cases (n = 214) were older (71.2 ± 13.0 vs. 68.7 ± 13.0, p = 0.05), more likely to be female (42.5% vs. 20.1%, p <0.0001) and to present with a non-shockable rhythm (65.9% vs. 47.1%, p = 0.0001). Coronary artery disease was more common among HFrEF cases (81.4% vs. 71.0%, p = 0.01) whereas hypertension was more common among HFpEF cases (89.2% vs. 79.4%, p = 0.006). There were no significant differences in other resuscitation variables, return of spontaneous circulation or clinical co-morbidities (p ≥ 0.07). Survival to hospital discharge was similar between HFpEF and HFrEF cases overall (13.6% vs. 15.2%, p = 0.63), and when controlling for age, sex, presenting rhythm or clinical factors (p ≥ 0.24).

Conclusions:
Despite better LV systolic function, HFpEF patients have SCA survival rates that are equivalent to HFrEF patients. The relative contributions of presenting rhythm during SCA and coronary perfusion during CPR should be investigated in further detail.
Abstract 324: An Engineered Protein as an Antidote for Carbon Monoxide Poisoning That Can Reverse Cardiovascular Collapse Through Scavenging of Carbon Monoxide and Rescue of Mitochondrial Respiration
Authors: Rose Jason J , Xu Qinzi , Bocian Kaitlin A , Bachman Timothy N , Hu Jian , Wang Ling , Azarov Ivan , Huang Xueyin N , Corey Catherine G , Guimaraes Danielle , McTiernan Charles F , O’Donnell Christopher P , Mora Ana L , Tejero Jesus , Shiva Sruti , Gladwin Mark T
Published: July 2021

Background:
Carbon monoxide (CO) is the most common human poisoning. There is no antidote. One-third of hospitalized patients will have cardiac dysfunction and increased mortality. Little is known about the nature of cardiovascular dysfunction during acute CO poisoning. CO toxicity results from: (1) global hypoxia and decreased oxygen delivery through CO binding to hemoglobin, (2) inhibition of oxidative phosphorylation from CO binding to cytochrome c oxidase, and (3) ensuing superoxide injury. We have developed a recombinant neuroglobin molecule (rNgb) with a high affinity for CO, that can chelate CO from intrinsic heme proteins.

Hypothesis:
The addition of rNgb will scavenge CO from hemoglobin and cytochrome c oxidase, reversing CO-induced cardiovascular dysfunction.

Methods:
We inserted micromanometer-tip catheters into the left ventricle of ventilated, severely CO poisoned mice to study the mechanisms of CO-induced cardiovascular collapse. In a similar model, we measured blood pressure and heart rate of severely CO poisoned, ventilated mice through a carotid arterial catheter and treated with phosphate buffered saline (PBS) or rNgb. Hearts were isolated from these mice and we measured tissue respiration using a Clark-type oxygen electrode. We compared the respiration rates of these animals and compared with non-poisoned, sedated control mice. We also compared the enzymatic activity of electron transport chain complexes.

Results and Conclusions:
When compared to control mice (exposed to 21% oxygen/no CO), CO poisoned mice develop a decreased contractility index (-32.3% baseline vs. -10.8% in control, t-test, p=0.002), hypotension and death, indicating primary cardiac toxicity. CO-poisoned mice treated with PBS had heart tissue respiration that was 62.3% (+/- 7.5%) of sedated control mice (t-test, P=0.015). Treatment of mice with rNgb restored tissue respiration (P=0.037 versus PBS treated mice) similar to control values. CO poisoning reduced the activity level of complex IV in PBS treated mice (P=0.011), but levels were similar to control in rNgb treated mice. These molecular changes were associated with reversal of cardiovascular collapse in rNgb treated mice versus PBS, demonstrating the potential of rNgb as a CO poisoning antidote.
Abstract 326: The Prediction Value of Minute Volum of Carbon Dioxide (mvco2) for Return of Spontaneous Circulation in a Porcine Model of Cardiac Arrest
Authors: Xu Jun , jin kui , Sun Feng , Fu Yangyang
Published: July 2021

The prediction value of Minute Volum of Carbon dioxide (MVCO2) for return of spontaneous circulation in a porcine model of cardiac arrest

Background:
Parameters that can predict ROSC ramins incompletely understood. EtCO2 in prediction ROSC may be influenced by minute ventilation during CPR. Minute volume of CO2 (MVCO2) theoratically can be less affected by ventilation. The value of MVCO2 in prediction ROSC remains unknown.

Objective:
To investigate whether MVCO2 can predict the ROSC in porcine model and define the best cutoff value to predict failure of ROSC.

Method:
15 healthy Norwegian domestic pigs received mechanical CPR 2 mins after electriclly induced VF. ETCO2, MVCO2, ALP, MAP, were recorded continuously. Arterial and central venous blood gas were tested at 5-minute after the start of resuscitation. Defbrillation was given at 6-mins after resuscitaion. Parameters were compared between animals with ROSC after difibrillation and those without.

Results:
9 pigs were successfully resuscitated after defibrillation while 6 failed. There was no difference of MVCO2, ETCO2, ALP, and MAP between the two groups before induced VF. There was a correlation between MVCO2, ETCO2, ALP, and MAP values (Fig 1). Furthermore, MVCO2 was significantly lower among those animals that failed ROSC, the receiver operating characteristic (ROC) curve of MVCO2 predicte difibrillation results showed that the area under the ROC curve was 0.981. The optimal cut-off value was 123.5ml/min, with sensitivity of 97.2% and specificity of 91.7% (Fig 2). Multivariate logistic regression models suggested that MVCO2 index was an important factor affecting the prognosis of resuscitation.

Summary and conclusion:
This study indicates MVCO2 are highly related with ETCO2, ALP, and MAP with a better preidiction value for resuscitation prognosis than ETCO2, ALP, and MAP.
Abstract 352: Predictive Value of Discharge Neurological Outcome Scores Following Out-of-Hospital Cardiac Arrest for Long-term Neurological Status: A Systematic Review
Authors: Wu Wen Yu , Chopra Amit , McLeod Shelley , Ziegler Carolyn , Lin Steve
Published: July 2021

Introduction:
Neurological outcomes following out-of-hospital cardiac arrest are commonly assessed using clinically validated outcome measures such as the Cerebral Performance Category (CPC) score, and are mainstay for evaluating neurological status at discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The primary objective of this systematic review was to better understand the predictive value of discharge neurological outcome scores for long-term neurological status.

Methods:
Comprehensive electronic searches of Medline, Embase and The Cochrane Library from inception to September 2016 were conducted and reference lists were hand-searched.Randomized controlled trials (RCT) and prospective observational studies were included. Our primary outcome was the correlation between discharge or 30 days post-arrest neurologic status and long-term (
>
3 month) neurological outcome score.

Preliminary Results:
After screening 4,265 titles and abstracts independently and in duplicate, 6 studies including 5 prospective observational studies and 1 RCT were included. Four studies reported long-term follow-up at 6 months post-arrest and 2 studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368/450 patients (82.7%) had favourable short-term neurological scores (CPC 1-2) at discharge or 30 days post-arrest, and 352/445 patients (79.1%) had favourable scores at 6 months post-arrest. In the studies with 1-year follow-up, 67/80 patients (83.8%) had favourable neurological scores at discharge or 30 days post-arrest, and 60/80 patients (75%) patients had favourable neurological scores at 1 year.

Conclusion:
Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. Further studies are needed to elucidate more comprehensive prognostic factors for predicting long-term neurological outcome.
Two new species of soldier beetles (Coleoptera, Cantharidae), the first from the tribe Silini in Dominican amber
Authors: FANTI FABRIZIO , PANKOWSKI MAXIMILIAN G.
Published: July 2021

The Silinae is the most frequently observed subfamily of soldier beetles (Insecta, Coleoptera, Cantharidae) living today in Hispaniola (the Dominican Republic and Haiti). This subfamily also was recently found in Dominican amber with the discovery of the genus Tytthonyx (Silinae, Tytthonyxini). Here we describe and illustrate two new species of this subfamily—the first representatives of the tribe Silini and genus Silis in Dominican amber. Silis (s. str.) hegnai sp. nov. and Silis (s. str.) curleri sp. nov. are easily distinguishable from extinct species of Silis as well as those living in Hispaniola today.
New taxonomic and nomenclatural acts in Cephenniini (Coleoptera: Staphylinidae: Scydmaeninae)
Authors: JAŁOSZYŃSKI PAWEŁ
Published: July 2021

Status of some species and names in Cephenniini is clarified. Cephennium ovatum Nietner is transferred to Cephennodes resulting in Cephennodes (incertae sedis) ovatus comb. n.; Cephennodes zwaluwenburgi Zimmerman is placed in the nominotypical subgenus; Cephennium felicitas Scott is transferred to Pomphopsilla Jałoszyński, resulting in Pomphopsilla felicitas comb. n.; Pseudocephennium maximum Jałoszyński is placed as a junior synonym of Pseudocephennium integricolle Reitter; and Cephennomicrus ignarus nom. n. is proposed as a replacement name for the preoccupied Cephennomicrus impressus Jałoszyński.