bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18185: A Proposed Model of the Relationships Between Health Literacy, Self-Care, Self-Efficacy, and Knowledge in Heart Failure
Authors: Chen Aleda M , Yehle Karen S , Albert Nancy , Ferraro Kenneth F , Mason Holly L , Murawski Matthew M , Plake Kimberly S
Published: April 2024

Introduction:
Inadequate health literacy may be a barrier in heart failure (HF) education. Prior research suggests that health literacy may influence HF knowledge, self-efficacy and self-care, but this has not been fully examined. The purpose of this study is to model the relationship between health literacy, formal education, knowledge, self-efficacy, and self-care in HF.

Hypotheses:
H1: Health literacy will be positively associated with HF knowledge and self-efficacy. H2: Health literacy will have indirect effects on self-care through knowledge and self-efficacy. It also will indirectly affect self-efficacy through knowledge. H3: Education will be associated with health literacy and have a direct effect on knowledge.

Methods:
New patient referrals (N=81, age 62.68 ± 13.55 years) to three HF clinics completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (HF Knowledge Questionnaire), self-care and self-efficacy (Self-Care of HF Index v.6), and formal education prior to clinic HF education. Structural equation modeling was used to assess the variable relationships.

Results:
A total of 63 participants with complete data were analyzed. The model demonstrated good fit (Figure 1), with a comparative fit index of 1.000. Although health literacy was associated with more years of formal education, there was an independent effect of health literacy on HF knowledge. Health literacy was not directly- or indirectly-related to self-care. Self-efficacy independently affected self-care. Nearly 34% of the variance in knowledge and 28% of the variance in self-care were explained by the model.

Conclusions:
Health literacy may influence knowledge attainment in HF. However, health literacy, knowledge, and self-efficacy may not fully explain why patients perform self-care. Future research should examine additional factors that may influence HF self-care, such as motivation to perform self-care and social support.
Abstract 18208: Vasomera™, a Novel VPAC2-selective Vasoactive Intestinal Peptide Agonist, Triggers Sustained Blood Pressure Control in Telemetered Spontaneously Hypertensive Rats: Additive Effects to Atenolol, Amlodipine, and Ramipril
Authors: del Rio Carlos L , Georgopoulos Lynne , Arnold Sue , Yeh Steve T , Brown Travis , Pavlina Andrew , Wallery Jeff , Hamlin Robert L
Published: April 2024

The natural vasoactive intestinal peptide (VIP) triggers potent vasodilatation by activating the G-protein-coupled VPAC1 and VPAC2 receptors; however, VIP's clinical utility is limited due to its short half-life and VPAC1-mediated side-effects. Vasomera™ is a novel long-acting biopolymer-based selective VPAC2-receptor agonist. Here, the hemodynamic effects of Vasomera when given as a single-dose SQ bolus to conscious spontaneously hypertensive rats (SHR) pretreated with three common anti-hypertensives were tested. SHR rats (351 ± 4 g, n = 8) were instrumented for telemetric blood pressure and ECG monitoring. First, Vasomera (9 mg [177nmol]/kg, SQ) and placebo (VEH) were assayed in untreated animals. Then, the effects of Vasomera were tested during concomitant oral β-AR blockade (+BB, atenolol 20 mg/kg/day), calcium-channel blockade (+CCB, amlodipine 5 mg/kg/day) and ACE-inhibition (+ACE, ramipril 1 mg/kg/day). Mean pressure (MAP) and heart rate (HR) were measured/averaged over 24hrs both pre and post-dosing. Vasomera induced blood pressure decreases that were sustained for up to 12hrs post-dosing (see Fig. A). On average, Vasomera lowered MAP by 9 ± 1 % (188 ± 6 to 171 ± 5 mmHg, P < 0.05). Vasomera's vaso-relaxation was preserved/enhanced in rats pre-treated with either atenolol (-14 ± 1%, P < 0.05), amlodipine (-13 ± 2%, P < 0.05), and/or ramipril (-9 ± 2%, P < 0.05) (see Fig. B). Vasomera triggered moderate cardio-acceleration in untreated rats (+8 ± 1%, 355 ± 6 to 384 ± 8 bpm, P < 0.05); such chronotropy was blunted under β-AR blockade (+6 ± 1%, 278 ± 2 to 294 ± 2 bpm), but was unaffected by amlodipine or ramipril (see Fig. C). In all cases, heart rates were lower than in controls, and no adverse clinical effects were noted. Vasomera, a novel VPAC2 agonist, can provide long-acting blood pressure control synergistically with concomitant anti-hypertensive therapies (e.g., β-AR blockade) and may represent a novel adjunct therapy for resistant/uncontrolled hypertension.
Abstract 18218: Vascular Dysfunction as a Primary Cause of Hypertension in Mice with Smooth Muscle Specific Deletion of RGS2
Authors: Thoonen Robrecht , Zhang Haihua , Abe Yuichi , Nickerson Heather , Aronovitz Mark , Blanton Robert M , Chambon Pierre , Mendelsohn Michael E , Karas Richard H
Published: April 2024

The etiology of hypertension in most cases is idiopathic. Current dogma states that all forms of hypertension arise from renal abnormalities of sodium handling. We have hypothesized that a primary abnormality of vascular smooth muscle cell (SMC) contraction can cause hypertension. To directly test this hypothesis we created and characterized inducible, SMC-specific RGS2 knockout mice (RGS2-SMC-KO) harboring a SMC-specific deletion of the PKGIα target the GTPase activating protein Regulator of G-protein Signaling 2. In these studies, SMC-specific deletion of RGS2 was induced at 7 weeks of age and Cre-negative mice treated identically as the RGS2-SMC-KO were used as controls. Telemetric blood pressure (BP) studies in ambulatory mice demonstrated that BP was significantly higher in RGS2-SMC-KO vs. control mice (135 ± 5 vs. 122 ± 7 mmHg, respectively.
P
<0.01), with no change in heart rate.
Ex vivo
aortic rings of RGS2-SMC-KO mice were hypercontractile in response to phenylephrine (PE) (138 ± 6 vs. 124±4% of pre-existing tone at 6 mM PE, respectively.
P
<0.05) Hemodynamic studies in anesthetized RGS2-SMC-KO mice revealed increased total systemic vascular resistance (SVR; 3.22x10
4
± 0.01x10
4
vs. 1.61x10
4
± 0.55x10
4
, respectively.
P
<0.001), and significantly higher SBP (106 ± 5 vs. 93 ± 1 mmHg, respectively.
P
<0.01). Following treatment with the NOS inhibitor L-NAME, BP decreased less in the RGS2-SMC-KO than in the control mice (⋔SBP: 38 ± 7 vs. 47 ± 3 mmHg,
P
<0.001). We found identical BP responses to changes in dietary sodium intake in the RGS2-SMC-KO mice vs. control, supporting normal renal function in the RGS2-SMC-KO mice. These data support that SMC-specific deletion of RGS2 leads to hypertension, with accompanying loss of RGS2-dependent attenuation of contractile signaling in blood vessels, with increased SVR and hypercontractile arterial function. The hypertension in RGS2-SMC-KO mice together with normal sodium handling supports the hypothesis that high BP can arise from a primary abnormality of vascular smooth muscle cell contractile regulation. Taken together, these data have potentially important implications for the diagnosis and treatment of human vascular diseases and suggest RGS2 as a new therapeutic target for some forms of hypertension.
Abstract 18229: Evaluation of Atherosclerosis in Ancient Egyptian Mummies Using Multidetector Computed Tomography
Authors: Makaryus John N , Lisk Karen , Makaryus Amgad N
Published: April 2024

Introduction:
Ancient Egyptian mummies have been the subject of scientific inquiry for hundreds of years. In the modern era, paleoradiology has been successful in elucidating the medical problems and potential causes of death of our ancient relatives who are well preserved due to the intricate Egyptian process of mummification. We used 64-multidetector CT technology to study the occurrence of arterial atherosclerosis in five ancient mummies.

Methods:
We performed whole-body, 64-slice CT scanning using the 64-CT GE Lightspeed VCT (GE Healthcare) on five mummies on loan from the Brooklyn Museum in Brooklyn, New York in order to assess the presence of arterial vascular calcification. Vessel wall calcification is considered pathognomonic for the presence of atherosclerosis. The degree of vessel wall calcification was assessed based upon calcium deposit concentration along the expected course of each vessel using calcification standards applied to living subjects.

Results:
The five scanned mummies lived at various times between 1075 B.C.E. and 325 C.E. The identities of four of the five mummies, in addition to their names and demographic data, were known due to information gathered during the excavation process. Four out of the five mummies had some degree of atherosclerosis. No atherosclerosis was detectable on the mummy whose identity was unknown. The mummy Pasebakhaienipet demonstrated mild right femoral, severe right carotid artery, and moderate left carotid artery calcification. Demetrios had severe right femoral calcification. The mummy Hor showed moderate calcification of the right femoral artery. The final mummy Thothirdes had mild bilateral femoral atherosclerosis.

Conclusion:
Our scans indicate that despite a diet which was based primarily upon agriculture and less so on meat/saturated fat, in addition to a lifestyle which was by no means sedentary based upon available evidence, Egyptian remains still showed evidence of often significant atherosclerosis, indicating that vascular disease is not a modern phenomenon but a product of the interplay between human genetic predisposition and environmental factors.
Abstract 18238: Is the Impairment of Diastolic Function in Metabolic Syndrome Simply a Consequence of Hypertension?
Authors: Cavalcante Joao L , Tamarappoo Balaji K , Kwon Deborah H , Alraies M. Chadi , Halliburton Sandra , Dey Damini , Berman Daniel S , Marwick Thomas H
Published: April 2024

Purpose:
Metabolic syndrome (MS) is associated with diastolic dysfunction (DD). However, hypertension (HTN) is a constituent of MS, which may itself be sufficient to explain this association. Hypothesis: We sought to establish the balance between HTN and visceral adipose (measured as epicardial fat volume, EFV) in DD.

Methods:
Pts were eligible if cardiac CT and echo were obtained within 6 months, as long as there was no history of myocardial infarction, revascularization), >2+ valvular regurgitation, valvular stenosis or systolic dysfunction. MS was defined by ≥3 of: fasting blood sugar ≥ 100 mg/dl or diagnosis of DM, body mass index >30 kg/m
2
, HTN, triglycerides ≥150 mg/dl or HDL <40 mg/dl. HTN was defined by either use of antihypertensive medication(s) and/or blood pressure ≥ 130/85 mmHg. DD was defined as per ASE guidelines. EFV was measured using previously validated CT software by 2 independent cardiologists blinded to the echo data.

Results:
Of 110 pts (age 55±13 years, 65% men, body mass index 28±5 kg/m²) HTN, MS and DM were present in 42%, 40% and 12%, respectively. Systolic function (LVEF=58±4%) and mean E/e’ (8±3) were generally normal, but left atrial volume index (25±9 cm³/m²) and diastolic parameters (E/A=1.2±0.5, mean e’ 10±4 cm/s) were variable. Pts were divided into 3 groups: A) MS with HTN; B) MS without HTN; C) No MS but with HTN. Markers of DD are shown in the Table 1. In a univariate analysis, there were no significant differences among the 3 groups in any of the parameters. In contrast, higher EFV was strongly correlated with presence of MS (102±7 vs 80±6 cm
3
, p=0.02) and diastolic dysfunction (107±8 vs 80±6 cm
3
, p=0.005). In a multivariate logistic regression analysis (R
2
=0.39), only age (p<0.001) and EFV (p=0.0008) were independent predictors of DD (decreased mean e'velocities) whereas MS and HTN were not (p=0.7).

Conclusions:
In conclusion, despite the usual association of DD with HTN, its link with MS seems to involve EFV.
Abstract 18267: Novel Cardioprotective Function of CFTR Chloride Channels Agaisnt Myocardial Hypertrophy and Heart Failure
Authors: Duan Dayue D , Ye Linda
Published: April 2024

Background:
CFTR
is a member of the ATP-binding cassette (ABC) transporters and encodes a PKC- and PKA-activated Cl
-
channel in the heart. Recent studies found that the expression of the matured
CFTR
protein in human failing hearts decreased significantly to 52% of
CFTR
levels in nonfailing controls. A pediatric patient with ΔF508
CFTR
mutation died of heart failure (HF) with lethal myocardial lesion but no significant pulmonary fibrosis. The exact functional and clinical significance of
CFTR
in myocardial hypertrophy (CH) and HF is currently not clear. In this study we will test our

hypothesis
that CFTR may play a crucial protective role against HF

.

Methods:
Minimally-invasive transverse aorta binding (MTAB) pressure-overload model of CH and HF was applied to
CFTR
-knockout (

CFTR
-/-

) mice and their age- and gender-matched wild-type (

CFTR
+/+

) and heterozygous (

CFTR
+/-

) littermates. The functional and histological changes of the hearts subjected to MTAB were examined.

Results:
MTAB induced a time-dependent development of CH in

CFTR
+/+

and

CFTR
-/-

mice, as indicated by a significant increase in both end-diastolic and end-systolic left ventricular (LV) mass and wall thickness. During the 9-week period of MTAB, however, the increase in LV mass and LV cavity diameters in the

CFTR
-/-

mice was significantly larger with a much more rapid pace than that in the

CFTR
+/+

mice, indicating a faster development of dilated cardiomyopathy in the

CFTR
-/-

mice. In sharp contrast to the strong compensation capacity to maintain cardiac function of the

CFTR
+/+

mice during the 9-week period of MTAB (%FS changed from 62±1.1 to 43±2, a 22.3±2% reduction, n=3) no significant compensation period but a progressively reduced %FS was observed in the

CFTR
-/-

mice. In 9 weeks of MTAB, %FS of the

CFTR
-/-

mice was reduced from 60±1 to 19±3 (n=3, a 69.3±4% reduction, P<0.001 vs

CFTR
+/+

mice).

Conclusion:
Targeted disruption of
CFTR
gene significantly changed the pressure overload-induced remodeling process. The loss of
CFTR
function may be responsible for the loss of compensation and the faster progression of dilated HF, implicating an important protective role of
CFTR
in the structural and functional remodeling of the heart in response to pressure overload.
Abstract 18271: The Association Between Obesity and Coronary Artery Disease Detected During Non-Emergent Angiography: a Comparison Between Black and White Patients
Authors: Stalls Caleb M , Triplette Matthew A , Viera Anthony J , Pathman Donald E , Cohen Mauricio G , Rossi Joseph S
Published: April 2024

Introduction:
Despite known associations between obesity and the development of cardiovascular disease, the relationship between obesity as reflected by BMI and angiographically demonstrated CAD is not fully understood. Moreover, this relationship has not been adequately defined in black patients, a group demonstrated to have lower rates of angiographic CAD despite higher rates of traditional CAD risk factors, cardiovascular events, and CAD-related mortality.

Methods:
Using an angiography database from a single academic hospital, we studied patients undergoing first-time, non-emergent angiography from 2001 to 2010. From this cohort, we selected those lacking a previous CAD diagnosis, without previous cardiac intervention, and with complete anthropomorphic measures and outcome data. Using models that controlled for patient demographics and CAD risk factors, we compared rates of angiographic disease for blacks and whites by obesity status (BMI ≥ 30 kg/m2). Significant CAD was defined by the presence of a significant lesion (≥50% stenosis in the left main artery or ≥70% stenosis elsewhere), and also quantified by a modified Gensini score of global disease.

Results:
We identified 4,022 white and 1,963 black eligible patients. Black patients had higher rates of diabetes and hypertension, and were more likely to be obese than whites (OR 1.85; 95% CI 1.65-2.06). Nevertheless, black patients were less likely to have a significant stenosis (adjusted OR 0.57; 95% CI 0.48-0.66), and were found to have a lower mean Gensini score (7.33 vs. 8.83, P=0.001). Obesity was not associated with the presence of CAD. In fact, black obese patients were significantly less likely to have a severe stenosis than their non-obese counterparts, and there was a non-significant trend for obese patients of both races to have less disease than non-obese patients using the Gensini score.

Conclusions:
Black patients in this cohort were more likely to be obese than white patients yet were far less likely to have significant CAD. Moreover, obesity itself was not positively associated with the presence or severity of CAD, suggesting that obesity may lead to cardiovascular morbidity and mortality by mechanisms other than the development of atherosclerosis, particularly in black patients.
Abstract 18290: Warfarin Use is Associated With Reduced Mortality in Patients with Left Ventricular Systolic Dysfunction and Pulmonary Hypertension
Authors: Goudie Andrew , Elder Douglas , Robertson Alan , Struthers Allan D , Lang Chim , Szwejkowski Ben
Published: April 2024

Background:
The presence of pulmonary hypertension in patients with left ventricular systolic dysfunction (LVSD) results in an additional increase in mortality. In pulmonary hypertension pathological changes within the lung microcirculation include thrombosis, even in the absence of clinically manifest thromboembolic disease. However, anticoagulation for pulmonary hypertension in those with LVSD is controversial, unless coexistent thromboembolic disease or atrial fibrillation is evident.

Methods:
The Tayside echocardiography database was linked to dispensed prescribing, laboratory and hospital admission coding data as well as the national death registry. All patients undergoing echocardiography between 1994 and 2007 with LVSD and an RVSP of greater than 35 mmHg were included. Patients with pulmonary embolism prior to study entry were excluded. Cox regression was used to assess the influence of warfarin prescription on mortality, adjusting for known confounders.

Results:
Study criteria were met by 2419 patients (mean age, 73.91 ± 11.5 years; 57% male). Mean RVSP for the cohort was 42.8 ± 12.5 mmHg with 1078 deaths during a mean follow-up of 2.06 years. Warfarin was prescribed to 1,086 (45%) of this cohort. In the multivariate proportional hazards model, the adjusted HR for warfarin use was 0.78, 95% CI [0.67 - 0.90], p = 0.001. A similar result was obtained in the propensity score analysis.

Conclusion:
Warfarin use was associated with reduced mortality in those with LVSD and pulmonary hypertension. Adequately designed prospective randomised controlled trials are required to validate this finding given the limitations of this observational study.
Abstract 18385: Serum Amyloid A is an Evolutionary Conserved Apolipoprotein That Functions to “Fine Tune” Reverse Cholesterol Transport During the Acute-Phase Response
Authors: Ancsin John B
Published: April 2024

In response to severe injury, the acute-phase protein, serum amyloid A (SAA) can replace apoA-I as the major apo-protein of HDL. The inclusion of SAA in HDL changes a number of HDL's properties. Our data indicates that SAA's presence reduces HDL's capacity to accept free cholesterol. SAA also increases HDL's binding affinity for macrophages and is dependent on the cell surface glycosaminoglycan, heparin sulfate (HS). SAA contains two HS binding sites and HS binding to SAA can cause it to dissociate from HDL, leaving behind lipid poor apoA-I rich oligomers, with enhanced cholesterol accepting potential. Under "amyloidogenic" condition this dissociated SAA can be readily converted into amyloid fibrils by macrophages and our data suggests this occurs largely on the cell surface. SAA can also be taken up by macrophages and once in the cytoplasm we have shown that it can stimulate neutral cholesteryl ester hydrolase (nCEH) and inhibit acetyl-coenzyme A acetyltransferase (ACAT) activities, respectively, with the net effect of mobilizing stored cholesteryl ester and making it available for export via the ABCA1/ABCG1 transporters. Under experimental conditions SAA can promote the export of over 70% of the cholesterol loaded into macrophages within 24 h. SAA's activities complement those of apoA-I/HDL by increasing the pool of exportable (de-esterified) cholesterol for efflux to an extracellular cholesterol acceptor like apoA-I/HDL and entry into the reverse cholesterol transport (RCT) pathway. The nCEH and ACAT modulating domains of SAA have been identified and as synthetic peptides have been also demonstrated to be potent promoters and inhibitors of nCEH and ACAT activities, respectively, with purified enzyme preparations, intact cells in culture and in vivo in mice, consistent with an allosteric mechanisms of action. When delivered in liposomes to a mouse apoE knockout model of atherosclerosis, these SAA peptides were shown to be highly effective in the prevention and regression of atherosclerotic lesions. We believe SAA has been evolutionary conserved to aid in the recycling of cellular cholesterol.
Abstract 184: The Etiology of Postarrest Mortality Stratified by Location of Arrest
Authors: Giberson Tyler A , Bivens Svetlana , Cocchi Michael , Giberson Brandon , Salciccioli Justin , Donnino Michael
Published: April 2024

Introduction:
Proposed study and treatment of post-cardiac arrest (CA) patients is often organ-specific. It remains unclear whether post-CA patients routinely expire from neurologic injury, refractory hemodynamic instability, or other reasons. Furthermore, there may be differences related to location of the arrest. Therefore, identifying principal reasons for death (a concept yet to be incorporated into Utstein guidelines) in post-arrest populations is essential.

Objective:
To develop a classification scheme for post-CA mortality and compare etiologies for death based on location of arrest.

Methods:
Secondary analysis of a prospective, observational study of CA patients. Inclusion criteria: 1) Age >18 2) CA with ROSC 3) In-hospital death. Traumatic arrests were excluded. Medical records were reviewed independently by 2 MDs and causes of death were classified: 1. Primary neurologic withdrawal of care 2. Presumed neurologic withdrawal of care with other co-morbidities/organ-injury 3. Refractory hypotension 4. Sudden CA. Simple descriptive statistics were used.

Results:
We evaluated 204 post-CA patients. Mean age was 67 (+/- 17) and 32% were female. Median downtime was 20 (IQR: 10-33) min. Overall in-hospital mortality was 50.5%. Of 103 deaths, 91% fell into 4 broad categories. Main cause of death for out of hospital cardiac arrest (OHCA) patients who had ROSC but did not survive hospitalization was primary neurologic withdrawal of care. Main cause of death for in-hospital cardiac arrests (IHCA) with ROSC which occurred in the ED or ICU was refractory hypotension. Among those with IHCA on the wards, the reasons for death were similar to the OHCA group.

Conclusion:
These data provide a simple classification scheme of reasons for death in post-arrest patients. There may be differences based on location of arrest but further study is needed. Investigators may need to consider principal reasons for death when matching therapeutic interventions to a given population.
Abstract 19: Targeted Education Can Change Paramedics' Attitudes to CPR
Authors: Neset Andres , Beairsto Eric , Goulette Edgar , Dugas Susan , Hachée Mathieu , Kramer-Johansen Jo
Published: April 2024

Objectives:
One reason for sub-standard CPR quality may be linked to long-held beliefs and lack of knowledge. We wanted to study if targeted education could change these attitudes among paramedics.

Methods:
Ambulance New Brunswick introduced a continuous quality improvement system (CQI) for out-of-hospital cardiac arrest in 2008 based on CPR-performance recordings. Shortly after this, all paramedics were invited to answer a survey, to study the attitudes and knowledge towards CPR. Learning objectives were constructed from the survey to address attitudes and lack of knowledge, and were used in the following training sessions. The survey was repeated in 2011 to evaluate the effect training had on attitudes. Respondents graded statements on a five-point Likert scale from strongly agree to strongly disagree. Chi-square tests with continuity correction (SPSS v16) were used to test for changes in proportions between the combined agree and disagree answers.

Results:
Of 761 invited paramedics, 288 answered in 2008; in 2011 233 of 967 answered. Learning objectives on three subjects were identified: importance of compression depth, confidence in the importance of pre-hospital cardiac arrest care and acceptance of CQI system. A positive change was seen for all three learning objectives, see table 1.

Conclusion:
It is possible to change long-held beliefs and attitudes towards CPR trough targeted education.
Abstract 192: Double Doses of Tea Polyphenols Are as Effective as a Single Dose in an Asphyxial Rat Model
Authors: Song Feng-Qing , Chen Meng-Hua , Fang Dong-Ming , Xie Lu , Qu Xue-Li
Published: April 2024

Background:
Cerebral ischemia/reperfusion injury following cardiac arrest and cardiopulmonary resuscitation (CPR) has been demonstrated. Oxidant injury plays a critical role in the process. Since tea polyphenols from green tea are efficient free radical and singlet oxygen scavengers, and we have demonstrated single dose of tea polyphenols improved the outcome of CPR in an asphyxia rat model. Theoretically, more tea polyhenols will be more efficient. Therefore, we hypothesized that double doses of tea polyphenols will better improve the outcome of CPR via counteracted the oxidant injury than single dose of that.

Methods:
Male Sprague-Dawley rats, weighing 200-400 g, were induced cardiac arrest by clamping the trachyeal tubes. At the end of 8 min of clamping, mechanical chest compression at a rate of 180/min was performed. Ventilation was started with room air at 70 breaths per min and tidal volume adjusted to 6 ml. Epinephrine was administered at 1 min of CPR. Animals were randomly divided into three groups: Sal-gro, TP-gro1 and TP-gro2 (treated with either saline, 10mg/kg tea polyphenols or 10mg/kg tea polyphenols following ROSC and with saline, saline, or 10mg/kg tea polyphenols after one hour of ROSC).

Results:
There were no significant differences in regard to hemodynamics among three groups before asphyxia. Time from the initiation of asphyxia to cardiac arrest and the duration of CPR were not significant difference among three groups. However, neurological deficit score were better in TP-gro1 and TP-gro2 than that in Sal-gro (P<0.05). And survival time were longer in TP-gro1 and TP-gro2 than that in Sal-gro (P<0.05). There were no significant about neurological deficit score and survival time between TP-gro1 and TP-gro2.

Conclusion:
Double doses of tea polyphenols were as effective as single dose of that in a rat of asphyxia cardiac arrest model.
Abstract 21: Elevated Resting Heart Rate Is Associated with Pulseless Electrical Activity Independent of β-Blocker Use
Authors: Teodorescu Carmen , Reinier Kyndaron , Uy-Evanado Audrey , Ayala Jo , Mariani Ronald , Chugh Harpriya , Daya Mohamud , Gunson Karen , Jui Jonathan , Chugh Sumeet S
Published: April 2024

Introduction:
Higher heart rate (HR) has been associated with increased cardiovascular mortality but mechanisms are poorly understood. Sudden cardiac arrest (SCA) presenting with pulseless electrical activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT).

Hypothesis:
We investigated the hypothesis that resting HR has a predictive role in subjects with future PEA versus VF/VT.

Methods:
Cases of out of hospital SCA, age ≥18 years, with resuscitation attempted were identified from an ongoing prospective community-based study in the Northwest US (pop. approx. 1 million). HR was measured from resting 12-lead ECG prior and unrelated to the cardiac arrest. Pearson's chi-square tests and independent samples
t
-tests were used for comparisons of presenting arrhythmia, arrest circumstances and heart rate. A general linear model was used to identify gender and age differences in heart rate between PEA and VF/VT. Significant predictors of PEA were determined using logistic regression.

Results:
A total of 913 cases (mean age 65±16 years, 68% male) with resuscitation attempted (2002-2009) presented with VF/VT (45%) or PEA (26%). PEA cases were older, more likely to be female and to arrest at home, whereas VF/VT cases were more likely to be witnessed, to have bystander CPR, return of spontaneous circulation and to survive to hospital discharge. There was no difference in the use of beta-blockers between PEA and VF/VT (p=0.19). PEA cases had higher resting HR compared with VF/VT (81 bpm vs. 74 bpm, p=0.0007, n=322). Males with PEA had higher HR than males with VF/VT (83 bpm vs. 75 bpm, p=0.001), but the difference in HR between PEA vs. VF/VT among females was smaller and borderline significant (78 bpm vs. 72 bpm, p=0.06). Heart rate was a significant predictor of PEA after adjustment for age, gender and circumstances of arrest [OR for a 10-beat per minute increase 1.35; 95% CI (1.17-1.56)]. Heart rate remained a significant predictor of PEA after additional adjustment for beta-blockers [OR 1.36; 95% CI (1.18-1.57)].

Conclusions:
Resting HR is a significant predictor of future cardiac arrest manifesting with PEA, independent of beta-blocker use and could, in part, explain the association between higher HR and increased mortality.
Abstract 218: CPR Quality in an Urban Teaching Hospital Emergency Department: Are 2010 AHA Guidelines Being Implemented?
Authors: Roosa Jason R , McCarty Kyle , Kitamura Brian , Page Rianne , Dommer Paul B , Silver Annemarie , Panchal Ashish R , LoVecchio Frank , Spaite Daniel W , Bobrow Bentley J ,   SHARE Study Group
Published: April 2024

Background:
CPR quality is closely linked to outcome in cardiac arrest. AHA 2010 Guidelines recommend monitoring CPR quality performed by healthcare providers both inside and outside the hospital. We recently reported that CPR quality varies significantly during the transition from the prehospital to emergency department (ED) setting in cases of out-of-hospital cardiac arrest (OHCA). While many EMS systems are now monitoring CPR quality, most EDs do not. We began an ongoing ED CPR quality improvement program based upon the 2010 AHA Guidelines. This two-phase study will measure the baseline quality of ED CPR, followed by measurement of CPR quality with the initiation of real-time CPR feedback technology. Here we report preliminary data showing the baseline CPR quality from Phase I.

Methods:
Prospective, IRB-approved study at an urban, teaching hospital ED. Chest compression (CC) quality was measured using accelerometer-equipped monitor/defibrillators (ZOLL R-Series, Chelmsford, MA). These baseline data were collected with the real-time audiovisual CPR feedback feature disabled.

Results:
CC data were captured over 7 months from 31 adult patients in cardiac arrest resulting in 6.5 hours of CPR and 37,348 individual CCs. CC fraction was 76.2%. Mean CC depth was 1.89 ± 0.61 inches and average rate was 122.4 ± 16.5 compressions/min. Using the 2010 AHA Guideline-recommended CC depth >2 inches, 61.0% of compressions were too shallow. The rate of compressions was below 100/min in 6.3%. The mean pre-shock and post-shock pauses in CC were 7.8 and 7.4 sec, respectively (n=24 defibrillations/cardioversions).

Conclusions:
We describe the quality of CPR in a large urban teaching hospital ED. At the beginning of our ED CPR QI program, a large proportion of chest compression depth was less than the 2010 AHA Guideline of 2 inches. These data will be used for resuscitation training during the next phase of the program which will include real-time audiovisual CPR feedback and debriefing sessions for the ED providers.
Abstract 222: Public Access Defibrillation Programs with Automated External Defibrillators Need Targeted Cardiopulmonary Resuscitation Training: Lessons from a Local Japanese City Database
Authors: Hayashi Kenji , Nachi Sho , Ushikoshi Hiroaki , Yamada Noriaki , Nagaya Soichiro , Kanada Hidemi , Yoshida Takahiro , Toyoda Izumi , Ogura Shinji
Published: April 2024

Background:
Public access defibrillation (PAD) with automated external defibrillator (AED) is well known as a common and good implication in the public location for out of hospital cardiac arrests (OHCAs). In Japan, AED is being implemented in public and residential space, and could be used by bystander since July 2004. PAD may improve survival from sudden OHCA, however, the effect for OHCA in a local Japanese city outcome and characteristics remains unclear. Here we examined to identify the clinical outcome, prevalence and problem of PAD five years later since 2004.

Methods and Results:
We studied 836 OHCAs in Gifu city between 2009 and 2010 using Gifu city emergency medical service database. Of these, only 42 (5.02%) were attached with AED (male 25 (mean 67.5 year-old), female 17 (mean 88.7 year-old)). After written informed consent was obtained, we interviewed and characterized bystanders. Location of OHCA were nursing home (n=27 (64.3%)), prison (n=6 (14.3%)), sports institution (n=3 (7.2%)), public space (n=3 (7.2%)), and others (shopping mall, hotel, and office). The incidence in nursing home was significantly older than other group (86.7 vs. 56.9 year-old) (p < 0.01). Bystander cardiopulmonary resuscitation (CPR) was performed 36 (86%) with 50% witnessed. AED records showed the incidence of ventricular fibrillation was 26% (n=11), and asystole was 52%. Eight patients were shock delivered and eleven patients got return of spontaneous circulation by CPR and AED. The one month survival rate after OHCA was 14% (n=6). Lay rescuers were almost staff of the institution (n=38 (90%)) and the rate of health care provider (HCP) was 33% (n=14). We obtained and analyzed the data of 22 bystanders (including HCP (n=3)). Twenty one bystanders participated in any CPR training (non AHA program) within five years and the half of them within one year. However 18 (81.8%) bystanders had some difficulty and environmental stress in practical AED use as a PAD program.

Conclusions:
PAD with AED need to be more appropriately education and implementation with constant PAD program including targeted CPR training, such as AHA program.
Abstract 23: Geriatric Experience Following Cardiac Arrest at 6 Interventional Cardiology Centers in the United States, 2007-2011
Authors: Seder David B , Mooney Michael , Patel Nainesh , McPherson John , McMullen Paul , Kern Karl B , Unger Barb , Browning J , Nanda S , Hacobian Melkon , Kelley M B , Nielsen Niklas
Published: April 2024

Background:
It is unknown if aggressive techniques such as therapeutic hypothermia (TH) and percutaneous coronary intervention (PCI) benefit cardiac arrest (CA) survivors over 75 years old. We evaluated the experiences of these patients at six regional PCI centers in the United States.

Methods:
Demographics, hospital course, adverse events, treatments, and outcomes of 542 cardiac arrest survivors aged 18-75 were compared to 122 similar patients aged >76. These data were retrospectively and prospectively entered into a secure, web-based registry (INTCAR).

Findings:
Cardiac arrest survivors aged >75 frequently underwent TH (98%), urgent coronary angiography (36.9%), and urgent PCI (24%) - rates similar to younger patients. Elderly patients had more comorbidities (3.0 +1.6 vs. 2.1+1.6, P<0.001), worse presenting left ventricular ejection fraction, and shorter time to return of spontaneous circulation (20.4+13.1 vs. 24.2+16.9 minutes, P=0.029). Pneumonia occurred more often among the elderly (32.8% v 23.8%, P=0.04), who also trended toward more sustained hyperglycemia (73% vs 64.4%, P=0.07) and less post-cooling fever (24% vs 32.7%, P=0.06). There were no differences in bleeding, seizures, electrolyte disturbances, arrhythmias, or most other adverse events. Brain MRI was not performed in any patient >75. Elderly patients were more likely to have DNR orders (66.4% vs 50.3%, P=0.001) and to undergo termination of life support (63.1% vs 49.4%, P=0.006). Good neurological outcome at 6-months (CPC 1-2) was seen in 27.9% elderly patients and 40.4% younger patients (P=0.01), and in 44% vs 55%, (P=0.13) of the subgroup presenting with VT/VF. Of 6-month survivors, 4% elderly patients remained severely disabled or vegetative, and 69% were classified as CPC 1.

Conclusions:
Patients over 75 years old were less likely to have a good neurological outcome at 6 months after cardiac arrest, but exclusion of elderly patients from standard post-resuscitation care is not warranted on the basis of age alone.
Abstract 236: Systematic CPR Training in Elementary Schools and Students' Attitudes Toward CPR and AED Use
Authors: Iwami Taku , Kitamura Tetsuhisa , Nishiyama Chika , Ohta Kunio , Kaneko Hiroshi , Kanna Tomoo , Takahashi Hiroyuki , Nachi Sho , Matsumi Hideyuki , Yonezawa Takahiro , Tanaka Hideharu ,   Sch BLS Committee for Japanese Society for Emergency Medicine
Published: April 2024

Introduction:
Despite the proven effectiveness of bystander cardiopulmonary resuscitation (CPR), actual bystander CPR remains infrequent. The Japanese Society for Emergency Medicine started an activity to encourage schools (elementary schools/junior high schools/high schools) and school teachers to conduct a CPR training course as a systematic approach to increase bystander CPR in Japan.

Objective:
The objective of this study is to compare students' attitude towards CPR before and after CPR training, and to evaluate their sense of achievement after the training among young children.

Method:

Designs:
A questionnaire survey.

Main outcome measure:
The positive attitude towards CPR and automated external defibrillator (AED) use.

Participants:
5th- to 6th-grade elementary school students. A questionnaire survey was carried out before and after the CPR training program in schools among 1017 children.

Result:
A questionnaire was completed and collected from 925 (90.9%) students both before and after the CPR training. Before the training, 46.6% and 30.1% answered yes and maybe yes, respectively, to the question: “Do you feel you could check the responses of someone collapsed in front of you? Or call for emergency assistance? ”. The proportion increased to 73.1% and 19.4%, respectively, after the CPR training (Figure). Among 340 (36.8%) children, the attitude towards CPR improved after the training. For the question: “Do you understand how to perform chest compressions?”, 63.6% and 34.6% of children answered yes and almost, respectively, after the training. 72.2% and 26.2% answered yes and almost, respectively, for the question on acquisition of AED use.

Conclusion:
Elementary school children can understand basic CPR skills and AED use, and CPR training can improve their attitude towards CPR and AED use. Systematic CPR training in schools including elementary schools should be more enhanced to spread CPR.
Abstract 238: Effect of a Rapid Response Team on Cardiopulmonary Arrest Rate at a Veterans Hospital
Authors: Abd Thura T , House Dorothy , Miller Heather L , Yee Michelle , Steinbach Scott , Zafari A Maziar
Published: April 2024

Introduction:
Based on recommendations from multiple health care organizations, rapid response teams (RRT) were widely implemented by hospitals in the United States over the past decade. However, studies have shown variable effects of RRTs on reducing in-hospital mortality. We sought to investigate the effect of the implementation of our RRT on the rate of cardiopulmonary arrests (code 99) at the Atlanta Veterans Affairs Medical Center (VAMC).

Materials and Methods:
The RRT started in October 2008 at the Atlanta VAMC. It consists of a respiratory therapist and a registered nurse with at least three years of critical care experience. The medical resident on call is required to participate but is not a primary member of the RRT. Hospital staff and healthcare providers of all medical and surgical non-intensive care units (ICU) were extensively educated about the purpose and role of the RRT. Standard criteria for activating the RRT were placed throughout the hospital. Data of all RRT activations were collected, including reasons for RRT activation, RRT intervention and outcomes. Rate of cardiopulmonary arrests (CPA) during the RRT implementation period (10/2008-9/2010) was compared to a historical control period of 48 months prior to the initiation of the RRT.

Results:
During the study period there were 93 activations for the RRT. The most common causes for RRT activation were acute respiratory distress (38.1%) and altered mental status (30.9%). Fifty percent of RRT activation led to a transfer to the ICU and 7.1% converted to cardiopulmonary arrests. Patients for whom the RRT was activated had a 23.8% in-hospital mortality and 58.3% died within two years. There were similar rates of CPA in the pre- and post-RRT era with 46 CPAs in non-ICU wards during the 2-year period of RRT implementation compared to 49 CPAs during the control period (the two years preceding RRT implementation).

Conclusions:
Implementation of RRT at the Atlanta VAMC did not reduce hospital wide CPA rate in non-ICU wards. However, RRT activation may be a predictor of illness severity resulting in a higher 2-year mortality rate in predominantly male veterans.
Abstract 240: AMSA Predicts Shock Success in Cardiac Arrest Patients with Different Transthoracic Impedance
Authors: Li Yongqin , Quan Weilun , Tan Qing , Freeman Gary , Tang Wanchun
Published: April 2024

Introduction:
Amplitude spectrum area (AMSA), which is calculated from the Fourier transformation of ventricular fibrillation (VF) waveforms, has shown its ability in predicting the likelihood of successful defibrillation and monitoring the effectiveness of chest compression [1-3]. In the present study, we retrospectively evaluated the reliability of AMSA in predicting shock success over entire transthoracic impedance (TTI) range in pre-hospital cardiac arrest victims.

Methods
ECG recordings, along with TTI measurements between two shocking pads, were collected from multiple emergency medical services (EMS) in the USA through a regular field case submission program sponsored by ZOLL Medical Corporation. All the EMSs in this study use ZOLL AED which employs current-based impedance compensation technique. AMSA was calculated based on a 1024 point ECG window ending at 0.5 sec before each shock attempt. Shock success was defined as an organized rhythm that was present for a minimum of 30 seconds, started within 60 seconds after the shock, and had a rate of 40 beats per minute or greater.

Results:
A total of 599 patients with witnessed rhythm of VF were included in the analyses. Only the first shock (120J) was analyzed. As shown in Figure 1, AMSA was significantly higher for successful shocks as compared with failed shocks in different TTI ranges. With an AMSA threshold of 8 mVHz, a large amount of unnecessary shocks (79.3%, 92.4% and 98.1%) were avoided with accuracy of 61.5%, 65.4% and 62.2% when TTI was low, normal and high, respectively. Logistic regression indicated that both AMSA (O.R. 1.19) and TTI (O.R. 0.99) were independent predictors for shock success, though, AMSA was a positive predictor and TTI was a negative predictor for shock success.

Conclusion:
In this patient population, AMSA was confirmed to be significantly higher in the presence of successful defibrillation over the entire TTI range. AMSA therefore can reliably predict shock outcome at different TTI ranges. References 1. Marn-Pernat A, Weil MH, Tang W, et al. Crit Care Med 2001,29(12): 2360-2365. 2. Povoas HP, Weil MH, Tang W, et al. Resuscitation 2002;53(1):77-82. 3. Li Y, Ristagno G, Bisera J, et al. Crit Care Med. 2008 Jan;36(1):211-5.
Abstract 242: Incidence and Relevance of Pulmonary Edema as a Result of Large-Volume, Ice-Cold Saline Infusion for the Induction of Hypothermia During Out-of-Hospital Cardiopulmonary Resuscitation
Authors:   NYC Project Hypothermia Working Group, Freese John
Published: April 2024

Background:
New York City Project Hypothermia is a collaborative effort involving the Fire Department of New York (FDNY), Greater New York Hospital Association, Health and Hospitals Corporation, the Regional Emergency Medical Advisory Committee, and the New York State Department of Health. As part of this effort, the FDNY implemented a pilot protocol that introduced the induction of therapeutic hypothermia during initial resuscitation efforts for nontraumatic adult cardiac arrests.

Purpose:
We sought to measure the incidence of pulmonary edema among patients receiving large-volume, ice-cold saline during initial resuscitation efforts and to assess the impact of this condition on immediate outcomes.

Methods:
Out-of-hospital cardiac arrest data was analyzed for the following periods: August 1, 2009 - May 31, 2010 (historical control group) and August 1, 2010 - May 31, 2011 (study group). Pulmonary edema was defined as having occurred if clinical signs and symptoms were reported by the on-scene paramedics during a standardized post-resuscitation interview. Data were analyzed using Fisher's exact test, and a p <0.05 was considered significant.

Results:
There were 5,582 resuscitations during the control period and 4,727 resuscitations in the study period. Return of spontaneous circulation (ROSC) and sustained ROSC occurred among 29.0% and 21.9% of the control group and 31.7% and 24.1% of the study group, respectively. A total of 361/4,727 patients (7.6%) in the study period were experienced pulmonary edema. The ROSC and sustained ROSC rates for this population were 37.1% and 25.2%, respectively. These outcomes were significantly improved as compared to both the control group and the remainder of the study group (all p <0.01).

Conclusion:
Clinical signs of pulmonary edema develop in some out-of-hospital cardiac arrest patients receiving large volume, ice-cold saline infusion for the purpose of initiating therapeutic hypothermia. Given the improved immediate outcomes among these patients, the clinical relevance of this clinical condition is of uncertain significance.
Abstract 247: Hands-on Defibrillation Has the Potential to Improve CPR Quality and Is Safe for Rescuers: A Preclinical Study
Authors: Neumann Tobias , Gruenewald Matthias , Lauenstein Christoph , Voelk Peter , Rosenthal Anne , Hartramph Isabell , Drews Tobias , Iden Timo , Meybohm Patrick
Published: April 2024

Background:
It has been demonstrated that hands-on chest compressions (CC) during cardioversion in humans can be safely performed.
[1]
We assessed the hypothesis that it will be safe during CPR and improves its quality.

Methods:
Twenty anesthetized swine were subjected to V-fib and subsequent CPR. Self-adhesive defibrillation electrodes were used with a biphasic defibrillator (corpuls3, G. Stemple GmbH, Germany). Swine were randomized either to i)
hands-on
defibrillation, where rescuers wore polyethylene gloves and defibrillation was delivered during ongoing CC, or ii) conventional
hands-off
defibrillation. In the hands-on group CC were interrupted only for rhythm analysis, when a marked increase of arterial blood pressure or endtidal CO
2
was observed suggesting spontaneus circulation. Holter ECG was registered to analyze potential cardiac arrhythmias in rescuers.

Results:
ROSC was achieved in 9 out of 10 swine in the hands-on group compared to 8 out of 10 (ns). Interruptions in CC were reduced by hands-on technique (p < 0.001) and coronary perfusion pressure (CorPP) was earlier restored to the pre-shock level (p = 0.014). In only 13 of 34 cases (38 %) interruption of hands-on CPR revealed a stable spontaneous circulation. Transthoracic impedance was not significantly different (hands-on 66 ± 40 Ohm vs. hands-off 63 ± 24 Ohm, p = 0.720). During all 37 hands-on shocks rescuers never felt any kind of electric stimulus. Holter ECG analysis did not reveal any serious arrhythmia during hands-on CPR (SVES/h: 5.0 ± 5.4, PVC/h: 0.2 ± 0.5).

Conclusions:
Hands-on defibrillation shortens CPR pauses and fastens restoration of CorPP that is predictive for CPR outcome. More sophisticated ECG filters may enable rhythm analysis during ongoing CC to avoid unnecessary pauses. Hands-on CPR can be safely performed but clinical studies are needed before implementation into daily practice.

References:
1. Lloyd MS et al. Circulation 2008; 117: 2510-4