bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19056: Tailoring Strategies to Improve Implementation of a Heart Failure Admission Decision Aid: A Qualitative Study
Authors: Alvarenga Maria A , Farr Stacy L , Vilain Katherine A , Olds Danielle , Garcia Raul Angel , Hejjaji Vittal , Spertus John A
Published: December 2023

Introduction:
High variability in heart failure (HF) readmissions persists despite national efforts and incentives. A standardized care path, CodeHF, was developed for use in the emergency department (ED) to better identify HF patients warranting admission. CodeHF was implemented in Kansas City in 2018. Despite positive patient and hospital-level outcomes, use of CodeHF has lagged.

Hypothesis:
A qualitative study was conducted to understand barriers and facilitators behind the implementation of CodeHF with the goal of tailoring strategies to increase usage and scalability to other hospitals.

Methods:
Semi-structured interview guides were developed based on the Tailored Implementation in Chronic Diseases (TICD) list. 21 stakeholder interviews were conducted and thematic coding of interview transcripts was performed. Codes were matched to a relevant TICD determinant and implementation strategy from the Expert Recommendation for Implementing Change project. A tailored recommendation was created for each strategy.

Results:
Analyses revealed 10 key themes: 1) Quality of Evidence: Skepticism of evidence; 2) Liability: Concern of CodeHF use in litigation; 3) Technical Difficulties: Challenges and errors during roll-out; 4) Ownership: Lack of ED ownership and champions; 5) Buy-In: Lack of ED buy-in due to the external project origin; 6) Understanding of Tool: Confusion of purpose and intended users; 7) Utility of Tool: Doubts of value in practice; 8) Exceptions to pathway: Concerns about inappropriate use; 9) Admitting Physician Awareness: Lack of recognition of CodeHF by admitting physicians; 10) Follow-up: Appreciation for rapid follow-up for discharged patients.

Conclusions:
Despite evidence supporting the positive impact of CodeHF, several implementation barriers and few facilitators were identified. Presenting updated evidence, partnering with new champions, educating providers on clinical and legally protective benefits, spreading awareness about technical solutions, inviting ED providers to lead redesign/relaunch, encouraging initial and ongoing educational meetings at all levels, emphasizing the follow-up benefit, and educating cardiologists and hospitalists are potential strategies for overcoming these barriers.
Abstract 19057: Temporal Changes in Patient Predicted Survival With Heart Failure and Predictive Characteristics
Authors: Shore Supriya , Richards Blair , Nallamothu Brahmajee K , Aaronson Keith D , Cascino Thomas
Published: December 2023

Background:
Accurate understanding of life-expectancy is critical to shared decision making for heart failure (HF) patients. HF patients largely over-estimate their life expectancy compared to model predicted estimates in cross-sectional studies. This study evaluates if patient understanding of prognosis associated with HF changes over time.

Methods:
We analyzed 298 ambulatory patients with high-risk HF from the prospective, multicenter, REVIVAL registry. Patients were asked to predict their survival in the absence of advanced HF therapies at baseline enrollment and follow-up visits at 6-month intervals. Changes in patient predicted survival from baseline to follow-up were assessed using a repeated measures regression analysis, adjusted for baseline predicted survival, time and patient characteristics.

Results:
Included patients had a median (IQI) age of 62 (65-78) years, 224 (75%) were male and had a median (IQI) number of 4 (2-5) assessments of patient predicted survival. At baseline enrollment, 38% patients overestimated their survival by 30% or more than the Seattle Heart Failure model. With time, on an average, patient predicted survival did not change (Figure 1a). Black race and higher baseline INTERMACS score (suggesting less severe disease) correlated with an increase in patient predicted survival over time. Whereas a higher baseline patient predicted survival correlated with a decrease in predicted survival over time (Figure 1b).

Conclusions:
In a cohort of high-risk HF patients, patient predicted survival was greater than model predicated and did not change with time. These findings suggest continued poor understanding of disease prognosis that could impact decision-making for therapies and highlight the need to develop strategies to improve prognosis communication with HF patients.
Abstract 19076: The Association of Soluble Fms-Like Tyrosine Kinase-1 (sflt-1) With Risk of Heart Failure and Atrial Fibrillation: Insights From the Dallas Heart Study
Authors: Patel Lajjaben , Subramanian Vinayak , Nagori Aditya , Pandey Ambarish , Mauricio Rina
Published: December 2023

Introduction:
sFlt-1 has emerged as a biomarker of cardiovascular disease (CVD). However, its role in the development of incident non-atherosclerotic CVD (atrial fibrillation and heart failure) among a multi-ethnic community-dwelling cohort is not known.

Methods:
Participants from the Dallas Heart Study with available sFlt-1 measures at baseline were included. The primary outcome of interest was a composite of incident Heart Failure (HF), Atrial Fibrillation (AF), and death, and secondary outcome was a composite of recurrent HF, AF or death. The clinical events were adjudicated by a blinded end-point committee. Adjusted Cox proportional hazard models and Anderson Gill models were used to determine the association of sFlt with composite outcomes adjusting for traditional CV risk factors (diabetes, hypertension, hyperlipidemia, smoking, and BMI).

Results:
The study included 2907 participants (mean age 43.8 yrs, female 57%, median sFLt level 0.46 ng/mL). Participants with higher s-flt levels were older and had a higher proportion of traditional CV risk factors (Q1 vs Q4: 43 yrs vs 46 yrs, HTN 29.9% vs. 38.3%; DM 8.7% vs. 14.3%). Over a median follow-up of 14 years, the primary composite outcome occurred in 323 participants. In unadjusted analysis, sFlt was associated with a higher incidence of the primary composite outcome (HR [Q1 vs. Q4] 95%CI = 2 [1.4-2.7]; p<0.001). This association was completely attenuated after adjustment for traditional CV risk factors (HR 1.3[0.9-1.9, p=0.1]). s-Flt was associated with a higher risk of secondary composite outcome in unadjusted analysis (HR [Q1 vs. Q4] 95%CI = 3.1 [1.3-7.3]; p<0.01) but not after adjusting for traditional CV risk factors (HR [Q1 vs. Q4] 95%CI = 2 [0.8-4.7]; p=0.1)

Conclusion:
Higher levels of sFlt-1 were associated with the development of adverse non-atherosclerotic CVD events among participants of the Dallas Heart Study. However, this did not persist after adjustment for traditional CV risk factors.
Abstract 19084: The Deadly Squeeze - Coronary Vasospasm Complicated by Myocardial Infarction and Cardiac Arrest
Authors: Butt Maliha , Nelson Maxine , Ishwarawaka Vyshnavi , Annappah Dilanthy , Victor Varun , Godil Sara , Masri Abdallah , Gopalakrishnan Prabhakaran
Published: December 2023

Introduction:
Acute coronary syndrome (ACS) typically results from atherosclerotic plaque rupture. However, about 6% of ST elevation Myocardial Infarction (STEMI) patients have no obstructive disease. We present a case of STEMI, diagnosed with coronary vasospasm.

Hypothesis:

Methods:
A 54-year-old female with alcohol abuse, smoking and uncontrolled hypertension presented after an out of hospital ventricular fibrillation cardiac arrest. EKG showed anterolateral ST elevation (STE). Left heart catheterization (LHC) showed moderate to severe multi-vessel disease without a definitive culprit lesion. STE resolved. Heart team approach for revascularization was contemplated. Echocardiogram showed systolic dysfunction with ejection fraction (EF) of 25%. Patient had another cardiac arrest and EKG showed recurrent anterolateral STE. Repeat LHC showed severe vasospasm of Left anterior descending (LAD) artery and diagonal branch, which improved with intracoronary (IC) nitroglycerin. Vasospasm was attributed to smoking and catecholamine excess from alcohol withdrawal. She was started on intravenous nitroglycerin and amlodipine. Her hospital course was complicated by high degree AV block requiring temporary pacer. She was eventually extubated with good neurological recovery and recovered systolic function (EF 60%). She was counselled on smoking and alcohol cessation and discharged home on isosorbide dinitrate and Amlodipine with planned surgical revascularization.

Results:
Coronary vasospasm (CVS) can occur both in normal and diseased coronaries. Risk factors include smoking, alcohol use and withdrawal, cocaine, mental stress, etc. Vasospasm may present as Prinzmetal’s angina, myocardial infarction, AV block, or fatal arrhythmias. IC nitroglycerine during LHC aids in diagnosis of CVS in setting of ACS. IVUS (Intravascular ultrasound) may help diagnose presence or absence of concomitant atherosclerotic disease. Provocative testing with IC ergonovine and acetylcholine may be considered in non-ACS setting.

Conclusions:
This case emphasizes the need to have a high index of suspicion for vasospasm to prevent associated complications and establish an accurate diagnosis and guide proper management of this potentially fatal disease.
Abstract 19087: Cardiac Magnetic Resonance Imaging Increased Utilization of Cardiac Treatment in Young Duchenne Muscular Dystrophy Patients
Authors: Hor Kan N
Published: December 2023

Introduction:
Duchenne muscular dystrophy (DMD), an X-linked recessive disorder affecting up to 1 in 6000. DMD-associated cardiomyopathy (DMD-C) is universal and starts as young as 6 years of age by cardiac magnetic resonance imaging (CMR) with presence of late gadolinium enhancement (LGE). Heart failure signs and symptoms are vague due to skeletal muscle myopathy. Echocardiogram only detects global dysfunction by left ventricular ejection fraction (LVEF) which rarely occur before 10 years of age. The current DMD cardiac care consideration guidelines (CCCG) recommends initiation of cardiac medication around 10 years of age or if there is LGE and/or LVEF abnormalities .

Hypothesis:
We hypothesized young DMD were more likely to have cardiac therapy initiated after CMR compared to only TTE evaluation.

Methods:
Electronic medical records for DMD patients (6 to < 10 years) who underwent routine TTE or CMR evaluation between 2014-2023 were included. Demographic data at the time of the study and initiation of cardiac medication including angiotensin-converting-enzyme inhibitor (ACE-I), Angiotensin II receptor blockers (ARB) and/or Mineralocorticoid Receptor Antagonists (MRA) were recorded.

Results:
150 patients met inclusion criteria, of these 81 patients underwent TTE only and 69 underwent CMR evaluation in lieu of TTE with no difference in age (8.4±1.1 versus 8.6±0.8 years, P = 0.07). Of those with TTE evaluation 10/81 (12.3%) was initiated with ACE-I or ARB ( 3/10 (33%) had LVEF < 55% (average 53.5%), 4/10 (40%) turned 10 on the follow-up visit and 3/10 (30%)) because family requested. Of the 69 patients with CMR, 51/69 (73.9%) had cardiac therapy initiated (28/51 (54.9%) because of new LGE, 6/51 (11.8%) due to isolated LVEF < 55% (average 53%), 12/51 (23.5%) would turn 10 on follow-up and 5/51 (9.8%)) the family requested. All patients with LGE on CMR also had MRA therapy started.

Conclusions:
DMC-C is universal and the use of CMR improved disease specific treatment of both ACE-I/ARB and MRA. Duboc et al, in a placebo control study showed that in 9.5 - 13.5 year old DMD patients treated with ACE-I had fewer patients develop dysfunction with reduced mortality at 10 years. Early and aggressive treatment may attenuate DMD-C. Future longitudinal study is needed.
Abstract 19098: Physical Activity is Associated With Better Quality of Life and Perceived Health
Authors: szuba rochelle G , Hoffmann Thomas , Whooley Mary , Elnaggar Abdelaziz , Park Mijung , Johnson Julene , Park Linda G
Published: December 2023

Background:
People living with coronary heart disease (CHD) experience decline in physical and social functioning, contributing to poor quality of life (QOL) and perceived health. Evidence shows that physical activity in the adult population is associated with improved QOL and better perceived health, but little is known about its benefits for community-dwelling older adults with chronic CHD.

Hypothesis:
Engagement in the self-care activity of physical activity is strongly related to better perceived health and QOL.
Objective:
Describe the association between physical activity and perceived health and QOL among older adults with long-standing CHD (>20 years).

Methods:
In this cross-sectional study, 20-year follow-up survey data were collected from 126 survivors from the Heart and Soul prospective cohort study of people living with CHD. To identify variables associated with perceived health and QOL, we utilized nested ordinal logistic regression models (four-level model).

Results:
The mean age for 126 surveyed survivors was 80.9 ± 9.1 years; 71.8% (n=94) were males, less than half being physically active (47.3%, n=62) and 23.7% had heart failure. Analysis adjusted for socioeconomic status (SES), physical activity, and activities of daily living (ADL) revealed a positive association between physical activity and perceived health (
aOR
=2.316,
p
=.023) and a strong association with QOL (
aOR
=2.070,
p
=.046). The QOL adjusted model found heart failure diagnosis was associated with lower QOL (
aOR=
.431,
p
<.033).

Conclusions:
Physical activity was positively associated with perceived health and QOL among older adults with CHD, even after adjusting for SES, physical activity levels, and ADL suggesting that engagement in self-care activities such as physical activity is associated improve the overall perceived health and QOL of individuals with CHD. Furthermore, the study highlighted the impact of heart failure on QOL, even after adjusting for physical activity. These findings underscore the need for interventions and programs to promote physical activity among older adults with CHD and targeted interventions in managing heart failure.
Abstract 19102: E-Cigarettes Induce Persistent Cardiac Autonomic Dysfunction and Molecular Signatures of Dilated and Arrhythmogenic Cardiomyopathy
Authors: Ramalingam Anand , Kucera Cory , Merchant Michael , Bhatnagar Aruni , Carll Alex P
Published: December 2023

Introduction:
Evidence is mounting that use of e-cigarettes (e-cigs) promotes cardiopulmonary injury and dysfunction, but the long-term consequences remain unclear. Consumption of menthol e-cigs has surged amid imminent bans on combustible menthol cigarettes and cigars. Recently, we found e-cig aerosols with menthol (but not tobacco) flavor acutely induced spontaneous ventricular arrhythmias in mice.

Hypothesis:
Menthol e-cigs induces persistent cardiac autonomic imbalance.

Methods:
Adult C57BL/6J male mice with electrocardiogram (ECG) and blood pressure (BP) telemeters were exposed for 4 weeks to menthol e-cig aerosols (JUUL, 180 puffs/day, 5 days/week; n=8) or filtered air (Air; n=7) and challenged with restraint stress to determine cardiovascular reactivity to stress. Hearts (n=5/group) were collected immediately after final exposure for phosphoproteomics.

Results:
Menthol e-cig exposures increased HR, decreased HR variability, and evoked ventricular premature beats only on exposure day 1, but consistently increased BP throughout the 20-day exposure (+16 mmHg systolic BP vs. Air). Additional exposures in females (n=4) recapitulated these acute effects. Pre-treatment with atenolol (n=4 males) abolished e-cig-induced arrhythmias, suggesting β
1
-adrenergic mediation of e-cig-induced arrhythmias. After 4-week JUUL Menthol exposure, mice had basal sinus bradycardia and impaired stress reactivity, characterized by reduced maximal HR and rapid recovery to baseline. All three effects persisted up to 3 weeks following cessation and were accompanied by prolonged ventricular repolarization (QT
c
). Phosphoproteomic analysis revealed upregulation of protein kinase A signaling, and mitochondrial dysfunction in e-cig-exposed mice. Phosphoproteins associated with dilated & arrhythmogenic cardiomyopathy (ATP2A2, FN1, CACNB2, PFKM, ADCY6, and PRKAR1A) were differentially regulated in e-cig-exposed mice.

Conclusions:
We demonstrate that menthol e-cigs induce persistent cardiac autonomic imbalance associated with molecular signatures of dilated & arrhythmogenic cardiomyopathy. Autonomic imbalance and cardiac electrical dysfunction may contribute to the long-term health effects of repeated use of e-cigarettes.
Abstract 19203: Predictors of Mortality Among Patients Admitted With Both Acute Myocardial Infarction and Non-Alcoholic Fatty Liver Disease
Authors: MUNGUTI CYRUS , Hayat Umar , Challa Abhiram , Wanjala Stephen , Mahdi Ahmad , Ahmad Tariq Ali
Published: December 2023

Introduction:
Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular disease (CVD). Indeed, cardiovascular disease is the most common cause of death among NAFLD patients We aimed to assess the association between NAFLD and mortality due to acute myocardial infarction and the predictors of in-hospital mortality among patients with both diagnosis in the USA.

Methods:
Hospitalizations with AMI with a concurrent diagnosis of NAFLD were identified in the National Inpatient Sample (2016-2019) using ICD-10 codes. The prevalence and trends over four years were calculated among different sociodemographic groups. Regression model was used to determine mortality outcomes due to AMI among NAFLD patients by age, race, and gender. A multivariable regression analysis was done to determine NAFLD as an independent predictor of mortality.

Results:
A total of 5450 patients were hospitalized with concurrent diagnosis of AMI and NAFLD during the study period. Among them, 5.11% (279) died in the hospital. Males were more likely to die compared to the females [OR 1.58, 95% CI 1.25-1.91]. Also, patients > 50 had higher odds of dying due to AMI if they had NAFLD compared to those <50 [OR 4.29, 95% CI 2.94-6.27]. Compared with the white population, Blacks [OR 0.79, 95% CI 0.54-1.15,
p
<0.001] Hispanics [OR 1.21, 95% CI 0.85-1.74,
p
<0.001], Asian and Pacific Islanders [OR 0.95, 95% CI 0.45-2.03,
p
<0.001], and Native Americans [OR 0.58, 95% CI 0.08-4.17,
p
<0.001] are less likely to die due to AMI if they have NAFLD. The NAFLD patients had higher odds of dying if they were admitted to the hospital with AMI [OR 1.96, 95% CI 1.74-2.21,
p
<0.001].

Conclusion:
Elderly white males with NAFLD are more likely to die if they are admitted to the hospital due to AMI. NAFLD was found to be an independent predictor of death among patients who had AMI.
Abstract 195: Dose-Dependent Induction of Nitric Oxide Production in Human Induced Pluripotent Stem Cell-Derived Endothelial Cells by Poloxamer 188
Authors: Chen Gaoxian , Chen Ian Y , Li Zhu , Riess Matthias L , Obal Detlef
Published: December 2023

Background:
Poloxamer 188 (P188), a triblock copolymer, protects against ischemia/reperfusion injury. The precise mechanisms remain incompletely understood. Human induced pluripotent stem cells (hiPSCs) constitute a unique model system, allowing the parallel generation of different cell types from individual patients to study drug-specific effects in human tissue. Here, we aimed to investigate the potential of P188 to induce nitric oxide (NO) production in hiPSC-derived endothelial cells (ECs) and its effect on cell viability during hypoxia-reoxygenation.

Methods:
hiPSC-ECs were cultured in phenol red-free endothelial Cell Growth Medium-2 and subjected to hypoxia (1% oxygen) at 37°C for 36 hours. At the end of hypoxia, the cell culture medium was supplemented with NO-sensitive fluorescent dye DAF-FM diacetate (1:5000 dilution, final concentration 1 uM, 30 min). Hypoxic medium was removed, and P188 at different concentrations (0.1 nM to 100 nM) was added for 8 hours. DAF fluorescence and cell viability were assessed at the end of reoxygenation. One-Way ANOVA & Dunn's post hoc test was utilized for statistical analysis (* P < 0.05 vs. untreated control group).

Results:
P188 dose-dependently increased hiPSC-ECs viability (control group: 53±2%, 0.01 nM P188: 59±2%, 100 nM P188: 64±5%). Interestingly, DAF fluorescence increased dose-dependently as well (control group: 182±9%, 0.1 nM P188: 199±11%, 100 nM P188: 264±4%, data expressed as percent of normoxic cells, n=3 / treatment).

Conclusion:
This suggests that P188 protects hiPSC-ECs with increased NO production, shedding new light on the underlying mechanisms of its cardioprotective effects.
Abstract 198: Protective Effects of Exosomes Derived From Remote Ischemic Adaptation on Neurological Function After Cardiac Arrest in Rats
Authors: Zhai Heng , Su Chenglei , Xu Tie , Yan Xianliang
Published: December 2023

Objective:
To assess the therapeutic effects and underlying mechanisms of exogenous exosomes derived from RIC in improving post-resuscitation neurologic dysfunction in a rat model of CA.

Methods:
Exogenous exosomes were isolated from the plasma of healthy adult male Sprague-Dawley rats that underwent RIC.36 adult male SD rats were randomly assigned to three groups: 1) Sham, 2) Control, or 3) Exosome. The control and exosome groups underwent 7 minutes of asphyxia-induced cardiac arrest. Five minutes after the ROSC, either exosome (1х10
10
Particles) or placebo (normal saline) were administered via intravenous infusion. Neurological outcomes were assessed using the neuropsychological deficit score (NDS), open field test, Y maze, and Morris Water Maze. Levels of plasma hyaluronic acid (HA) and syndecan-1 (Sdc-1) were measured to evaluate the degree of endothelium glycocalyx degradation.

Results:
Compared with Sham group, the Control group showed significant neurological dysfunction after ROSC. Compared to the control group, the exosome group exhibited significantly better performance in the open field, Y maze experiments and Morris water maze (
p
< 0.05). Compared with the Sham group, the plasma levels of HA and Sdc-1 in the Control group were significantly increased 24 hours after ROSC (P<0.05), while the plasma levels of HA and Sdc-1 in the Exosome group were significantly lower than those in the Control group(P<0.05).

Conclusions:
Exosomes derived from RIC have been shown to be effective in improving neurological dysfunction following cardiac arrest. The reduction of endothelium glycocalyx degradation may be involved in the underlying mechanism.
Abstract 202: Liposome-Encapsulated Hemoglobin (HbV) Rescues Hemorrhagic Shock Heart Through Anti-Ischemic and Anti-Arrhythmogenic Effects on Myocardium in Repetitive 65% Bleeding Rat Model
Authors: Takase Bonpei , Higashimura Yuko , Masaki Nobuyuki , Kinoshita Manabu , Sakai Hiromi
Published: December 2023

Phase I clinical trial of Liposome-encapsulated hemoglobin vesicles (HbVs) was successfully accomplished. Since several ameliorating mechanisms are not fully understood on HbVs, to investigate its mechanisms of salutary effect on myocardium, optical mapping analysis (OMP) and electrophysiological study (EPS), immunostaining pathological examination for HIF1-alpha in heart and measurement of blood troponin I (TnI) were performed in 30% spontaneous arterial bleedings five times up to approximately total 65% hemorrhage in rats. Eighteen rats in each group were resuscitated by immediately after bleeding by same volume as bleedings each five times by transvenous infusion of 5%albumin solution (ALB-group), washed erythrocytes (wRBC-group) and HbVs (HbV-group). Survival effects over 24 hours were examined. After excising heart, OMP and EPS were performed. All rats died in ALB-group, whereas all survived in wRBC-group and HbV-group. OMP showed impaired (prolonged) action potential duration dispersion (APDd: which is arrhythmogenic index) in LV in ALB-group, whereas APDds were attenuated in HbV-group and wRBC-group (26±4 vs. 11±6, 14±5ms, P<0.05). Lethal arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]; VT/VF) were provoked by EPS and/or spontaneously occurred in ALB-group whereas not in both wRBC-group and HbV-group. HIF1-alpha was positively stained and TnI levels were significantly elevated only in ALB-group (Peak TnI; 186±47 vs. 64±25, 91±24, 44±10pg/mL, P<0.05: Figure). Conclusions: HbVs rescue lethal hemorrhage through improving lethal arrhythmias and myocardial damages by reflected by inducing HIF1-alpha and elevated TnI. HbVs could be useful for resuscitation and saving life from gun-shot arterial bleeding on-site occurred in terrorisms.
Abstract 209: The Relationship Between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcome of Out-of-Hospital Cardiac Arrest Patients
Authors: Ryu Seok Jin , Lee Dong H
Published: December 2023

Background:
Progressive hypoxic brain injury after cardiac arrest can affect serum osmolality (SOsm) and urine osmolality (UOsm) in out-of-hospital cardiac arrest (OHCA) patients. This study aimed to examine the association between the ratios of UOsm to SOsm (USRs) within 3 days after return of spontaneous circulation (ROSC) and neurological outcomes in OHCA patients.

Methods:
The present study was prospective observational study and included OHCA patients with targeted temperature management (TTM) at Chonnam National University Hospital in Gwangju, Korea, between January 2016 and December 2022. We collected SOsm and UOsm at admission and at 24 h, 48 h, and 72 h after ROSC. We assessed the predictive performance of USRs to determine neurological outcome at discharge.

Results:
A total of 319 patients were included. UOsm levels and USRs at admission and 24 h, 48 h, and 72 h after ROSC in patients with poor outcome were lower than those in patients with good outcome. In multivariable analysis, the USRs at 24 h (odd ratio [OR], 0.363; 95% confidence interval [CI], 0.221-0.594), 48 h (OR, 0.451; 95% CI, 0.268-0.761), and 72 h (OR, 0.559; 95% CI, 0.357-0.875) after ROSC were independently associated with poor neurological outcome at discharge. The area under the receiver operating characteristic curves of USRs at admission and 24 h, 48 h, and 72 h after ROSC for predicting neurological outcome at discharge were 0.615 (95% CI, 0.559-0.669), 0.711 (95% CI, 0.658-0.760), 0.724 (95% CI, 0.671-0.772), and 0.751 (95% CI, 0.699-0.797).

Conclusions:
The USRs within 3 days of ROSC were associated with poor neurologic outcome at discharge in OHCA patients.
Abstract 211: Targeting the Mitochondrial Fission Protein Dynamin Related Protein 1 to Mitigate Oxygen Toxicity Following Cardiac Arrest
Authors: Piao Lin , Fang Yong-hu , Wu Rongxue Rosie , Hamanaka Robert , Mutlu Gokhan , Garcia Alfredo J , Archer Stephen L , Sharp Willard
Published: December 2023

Introduction:
Oxygen administration following cardiac arrest (CA) is associated with cardiac dysfunction, brain injury, and poor survival. These injuries are driven in part by mitochondrial injury, but the specific mechanisms underlying oxygen-induced mitochondrial injury are unclear. Here we hypothesized that oxygen-mediated injury following CA is influenced by the mitochondrial fission protein Dynamin Related Protein 1 (Drp1) and that targeting Drp1 could mitigate the effects of post-CA oxygen toxicity.

Methods and Results:
Mice underwent brief asystole CA (12 min) followed by cardiopulmonary resuscitation (CPR). One hour following successful CPR, mice were randomized to receive hyperoxia (33% O
2
), normoxia (21% O
2
), or hypoxia (10% O
2
) in an environmental chamber for 6 hours. After exposure, the mice were returned to room air. Hyperoxia and normoxia groups exhibited lower 10-day survival rate compared to mice exposed to hypoxia (15% and 67% vs. 92%, n=13/group, P<0.05, respectively). The hyperoxia group also showed decreased myocardial fractional shortening (30.1±3.0% vs 45.0±1.4%) and neurological scores (5.8±0.8 vs 9.8±0.3) 48 hours post CA compared to the hypoxia group (n=13, P<0.05, respectively). Hyperoxia increased the expression of the activated form of Drp1 (Drp1-S616) to 134% in the heart (n=4, P<0.05) and decreased cardiomyocyte mitochondrial size to 75% (n=30, P<0.05) compared to hypoxia-treated CA mice. The hypoxia-dependent decrease in Drp1 activity was associated with a 46% increase in myocardial mitochondrial respiration (n=5, P<0.01) and a 32% reduction in ROS production vs hyperoxia-treated CA mice (n=6, P<0.05). Administration of the Drp1 GTPase inhibitor Drpitor1a to hyperoxia-exposed post-CA mice increased survival (40% vs 20%), myocardial function (31.5±4.4% vs 42.0±1.3%) and neurological scores (4.1±0.7 vs 9.0±0.0) compared to untreated hyperoxia-exposed post-CA mice (n=10, P<0.05, respectively).

Conclusions:
Oxygen dependent post-CA injury is partly dependent on the mitochondrial fission factor Drp1. Targeting Drp1 is a promising strategy to limit post-CA oxygen toxicity.
Abstract 222: Real Time Feedback of Chest Compressions by Hands-Free Carotid Doppler in a Porcine Model
Authors: Faldaas Bjoern , Nielsen Erik , Storm Benjamin S , Lappegård Knut Tore , How Ole-jakob , Nilsen Bent Aksel , Kiss Gabriel , Skogvoll Eirik , Torp Hans , Ingul Charlotte B
Published: December 2023

Background:
Real-time hemodynamic feedback devices provide information on cardiopulmonary resuscitation (CPR) quality. This can improve hand positioning and technique, thereby maximizing blood flow and potentially improve survival.

Hypothesis:
We hypothesize that a newly developed hands-free Doppler for carotid blood flow velocity (RescueDoppler, RD), can identify optimal vs. suboptimal chest compression sites during CPR.

Aim:
To assess the potential of the RD device to continuously monitor the effect of each compression by ultrasound metrics and waveforms in a porcine model.

Methods:
Ventricular fibrillation was induced in 5 pigs using an ICD. Manual CPR (blinded for hemodynamic data) was performed for 10 seconds at 3 different compression sites in random order (Fig.), and repeated 6 times. We analyzed ultrasound waveforms with Time Average Velocity (TAV) in a linear mixed model with site as fixed effect, and animal and site within animal as random effects. We further compared TAV to invasive systolic blood pressure (SBP) from the contralateral carotid artery.

Results:
Data from 5 pigs (mean weight 31.2 kg) and 29 of 30 sequences were included. Overall, blood flow velocity was highest at compression site 2 (TAV 33 cm/s, P<0.01), but there was significant variability (P<0.01) in animals (SD= 3.7) and at sites within animal (SD= 7). A compression site yielding the highest TAV (range 19 to 48 cm/s) or lowest TAV (6-25 cm/s) was successfully identified in all animals with corresponding SBPs 50-81 mmHg, and 46-64 mmHg, respectively. The correlation between TAV and SBP was 0.62-0.90 within animals. Conclusions In this animal study, a newly developed hands-free Doppler enabled assessment of blood flow velocity during CPR and detected significant variation according to chest compression site. RD identified the sites with both high and low blood flow velocities and is thus a promising device for effectively identifying the optimal and suboptimal chest compression sites during CPR.
Abstract 231: Assessing the Effectiveness of Food Delivery Service Integration for Automated External Defibrillator Delivery in Out-of-Hospital Cardiac Arrest Response Through Computer Simulation
Authors: Chin Kuan-Chen , Lee Yen-Ju , Sun Jen-Tang , Chu Sheng-En , Lin HaoYang , Ma Matthew Huei-Ming , Chen Albert Y , Chiang Wen-chu
Published: December 2023

Background:
The number of food delivery (FD) motorcycle riders in Taipei has rapidly increased. These riders often wait near popular restaurants during rush hours and could potentially act as first responders to retrieve automated external defibrillators (AED) for out-of-hospital cardiac arrests (OHCA).

Objectives:
This study aimed to assess the feasibility of integrating FD riders into the emergency medical service (EMS) system as OHCA responders.

Methods:
We enrolled OHCAs from the Taipei registry between 2017 and 2019. Using the Uber Eats website, a prominent FD service platform, we obtained data on FD hotspots to establish a reference point. Assumptions were made in our simulation to develop an integrated system where FD riders could participate in a crowdsourcing program. In the simulation, FD riders were assigned to respond to an OHCA within a 2-km distance by retrieving an AED or directly responding to the OHCA if bystander CPR was unavailable. We tested response rates from 10 to 100% and compared simulated AED arrival time with documented EMS response time in the registry.

Results:
During the study periods, 8,952 of 11,660 OHCA cases were accessible by FD riders. There were 418 restaurants clustered around 24 hotspots, and 2,050 AEDs were found within range of these restaurants (Image1). For FD-accessible OHCA cases, with simulating response rates ranging from 10 to 100%, the AED arrival time was reduced by 2.99 to 3.67 minutes. The effect was more pronounced during peak hour (Image 2).

Conclusion:
The results indicate that incorporating FD riders as OHCA responders into the EMS system is practical and beneficial in reducing the defibrillation waiting time for OHCA patients.
Abstract 234: Longitudinal Trends in Prehospital Advanced Airway Management in the United States
Authors: Wang Henry E , Yu Mengda , Crowe Remle , Nassal Michelle , Gage Christopher , Hyer Madison , Powell Jonathan , Ulintz Alexander , Wei Lai , Sharkey-Toppen Travis , Panchal Ashish R
Published: December 2023

Background:
While endotracheal intubation (ETI) is the most common prehospital advanced airway management technique in the United States (US), observations from clinical trials and the COVID-19 pandemic have motivated the broader use of supraglottic airways (SGA). The current national patterns of prehospital airway practices are unknown. We sought to describe longitudinal trends in Emergency Medical Services (EMS) advanced airway management in the US.

Methods:
We analyzed 2011-2021 data from ESO, a data set of US prehospital electronic health records. We identified all 911 events with attempted advanced airway management, determining the annual percentage receiving ETI and/or SGA attempts. We determined temporal trends using mixed effects regression. We stratified the analyses by condition (cardiac arrest, trauma, medical non-arrest) and age (adult vs. children [<18y]).

Results:
During the study period 355,532 patients underwent prehospital advanced airway management (annual incidence 9.0-10.0 per 1,000 911 events). Annual patients with SGA attempts increased almost three-fold (20.8% to 53.2%; p-trend<0.001), while annual patients with ETI attempts decreased (90.0% to 60.7%, p-trend<0.001). (Figure) Trends for cardiac arrest (SGA increased from 25.1% to 60.6%; ETI decreased from 87.3% to 54.7%) and trauma (SGA increased from 17.2% to 40.7%; ETI decreased from 90.5% to 71.8%) were similar. Advanced airway management in medical non-arrest patients remained stable (SGA 15.7% to 20.0%, p-trend=0.26; ETI 93.3% to 87.5%, p-trend=0.85). In children SGA attempts increased five-fold (11.2% to 50.9%, p-trend<0.001) while ETI attempts decreased (89.7% to 60.6%, p-trend<0.001).

Conclusion:
US prehospital advanced airway management practices have shifted, with marked increases in SGA and decreases in ETI attempts. These observations have critical implications for EMS care, training and system planning.
Abstract 235: Smartphone Dispatch of Trained and Untrained Volunteer Responders for Out-of-Hospital Cardiac Arrest: A Big Data Study Based on Five Years of Experience With the SAUV Life App
Authors: Soumagnac Tal , Soumagnac Maayane Tamar , Cazes Caroline , Lamhaut Lionel , Hutin Alice ,   SAUV Life Investigators
Published: December 2023

Introduction:
The use of smartphones to dispatch volunteer responders for out-of-hospital cardiac arrest (OHCA) has emerged as a promising strategy for improving response times. The SAUV Life app was progressively implemented in France since 2018. In the event of a suspected OHCA, volunteer responders were dispatched by emergency medical services and received remote guidance through the app to the location of the alert, enabling them to initiate or assist in CPR.

Hypothesis:
Trained volunteers were more likely to arrive at the scene before medical teams and to initiate CPR compared to untrained volunteers.

Methods:
We conducted a retrospective observational study to analyse user profiles and interventions from January 1, 2018, to November 30, 2022. Data were automatically collected during interventions and stored in a confidential and anonymized file. Statistical analyses were performed using Python libraries. Volunteers were classified as trained if they possessed a first aid training certificate or an equivalent qualification.

Results:
During the study period, a total of 631,221 volunteers subscribed to the app. The mean age of volunteers was 40.5 ± 14.5 years. Among them, 461,892/631,221 (73.2%) were categorized as trained volunteers, while 169,329/631,221 (26.8%) as untrained volunteers. There were 1,102,317 alerts recorded, resulting in a total of 21,986 interventions. Among these interventions, 3,687/21,986 (16.8%) involved a volunteer arriving before medical teams, with 4602/4850 (94.9%) being trained volunteers and 248/4850 (5.1%) being untrained volunteers. Trained volunteers were more likely to arrive at the scene before medical teams compared to untrained volunteers, 4602/798102 (0.6%) vs 248/304215 (0.1%) respectively (p < 0.001). Trained volunteers were more likely to initiate CPR compared to untrained volunteers: 3137/4602 (68.2%) vs 121/248 (48.2%) respectively (p < 0.001). During the study period, 522 patients for whom an alert was triggered achieved return of spontaneous circulation.

Conclusion:
The development of smartphone applications for emergency dispatch following OHCA must continue to be promoted for both trained and untrained populations, but it is essential to prioritize first aid training.
Abstract 241: Neurologic Complications Associated With Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest
Authors: Deverett Ben , O'Riordan Andrea , Hirsch Karen G , Vogelsong Melissa
Published: December 2023

Background:
Neurologic complications are frequently encountered after ECPR and there is a limited understanding of the associated clinical trajectories following ECPR for in-hospital cardiac arrest (IHCA).

Aim:
To determine the prevalence, properties, and outcomes of radiographic neurologic complications following ECPR for IHCA.

Methods:
In this single-center retrospective chart review, we collected data on all adult IHCA patients who underwent ECPR from 1/1/2018 to 12/31/2019. Measured variables included demographics, clinical data, timing of diagnostic studies, and outcomes.

Results:
Data were analyzed from 36 adult ECPR patients, 16 (44%) of whom survived to hospital discharge. Twenty (56%) underwent head computed tomography (CT) and 9 (25%) had pathology identified, diagnosed a median of 1.8 days afterECPR. The most common complications were intracranial hemorrhage and focal ischemia (4/9 patients each). Neurologic complications were not associated with total ECMO duration (median 4 vs 5 days, p=0.57) and patients with complications trended toward poorer survival outcomes (22% vs 52% survival to discharge; p=0.25).

Conclusions:
Radiographic neurologic complications occurred in one quarter of IHCA ECPR patients and were associated with trends towards poorer clinical outcomes. Consistent with data in the non-ECPR literature, rates of global anoxic injury and hospital mortality were lower in this IHCA cohort than in previously published OHCA and mixed ECPR cohorts. This study is limited by its small sample size, single center design, and lack of a standardized neuroimaging protocol. Future prospective studies are needed to assess the efficacy of ECPR for IHCA.
Abstract 243: Comparing the Effectiveness of Extracorporeal and Conventional Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis
Authors: Elfaituri Muhammed K , Khaled Ala , BenGhatnsh Ahmed , Faraj Hazem Abdelkarem A , Msherghi Ahmed
Published: December 2023

Background:
Cardiac arrest is a leading cause of death worldwide, with out-of-hospital cardiac arrest (OHCA) presenting unique challenges in terms of timely and effective treatment. Conventional Cardiopulmonary Resuscitation (CPR) remains the standard intervention; however, the emerging use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) and its potential for superior hemodynamic support necessitates a comprehensive comparison of these interventions in the context of OHCA to guide resuscitation practices.

Aim:
This study aims to compare ECPR and conventional CPR in patients experiencing OHCA.

Methods:
We searched several databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) until May 2023. Studies that compared ECPR and conventional CPR in OHCA were included in the analysis. The outcomes assessed included in-hospital mortality following admission, return of spontaneous circulation (ROSC), 30-day mortality, and positive neurological recovery at discharge. Data analysis was performed using a random-effects model, with Relative Risk (RR) computed for each outcome. All statistical analyses were performed using R software (version 4.0.3) with metafor and meta packages.

Results:
We included a total of 5 studies totaling 8,632 patients (4,315 in the ECPR group and 4,317 in the conventional CPR group). The analysis revealed no significant difference between ECPR and conventional CPR in terms of in-hospital mortality (RR 0.95, 95% Confidence Interval (CI) 0.88 to 1.03, P=0.19, I2=60%) and ROSC (RR 1.01, 95% CI 0.97 to 1.05, P=0.58, I2=0%). However, ECPR was associated with a significant reduction in 30-day mortality (RR 0.93, 95% CI 0.91 to 0.95, P<0.01, I2=0%). No significant improvement was found in positive neurological recovery at discharge with ECPR compared to conventional CPR (RR 1.25, 95% CI 0.80 to 1.93, P=0.33, I2=16%).

Conclusion:
This study highlights the potential of ECPR in reducing 30-day mortality compared to conventional CPR in OHCA cases, although its effectiveness in other outcomes, such as in-hospital mortality and neurological recovery, remains inconclusive. Given the observed heterogeneity among the studies, further high-quality studies are needed.
Abstract 244: Geospatial Access to Extracorporeal Membrane Oxygenation in the United States
Authors: Van Wyk Hannah , Qi Man , Gottula Adam L , Lane Bennett , shaw Christopher , Gorder Kari , Koshoffer Amy , Benoit Justin , Hsu Cindy H
Published: December 2023

Introduction:
Extracorporeal Membrane Oxygenation (ECMO) is a form of complete cardiopulmonary support which has been associated with improved survival in both severe acute respiratory distress syndrome and refractory cardiac arrest. ECMO is a resource-intensive therapy limited to specialized centers in urban environments, restricting its availability in suburban and rural areas. We examined the proportion of the U.S. population within a 15-minute, 30-minute, and 45-minute drivetime area to an ECMO-capable center.

Methods:
Using geographic information systems (GIS), we created shapefiles with polygons representing 15, 30, and 45-minute drivetime areas to ECMO-capable centers. Census block group centroids were then overlaid to determine the proportion of the population with access to ECMO-capable centers.

Results:
We found that 22%, 52%, and 67% of the U.S. population live within 15, 30, and 45 minutes of ECMO-capable centers, respectively. One hundred and ten million people, more than one third of the U.S. population, live further than 45 minutes away from an ECMO-capable center. Puerto Rico, Wyoming, North Dakota, and Alaska have 0% population access. Texas, California, and Florida have the highest number of people with low access (9, 8, and 5 million, respectively).

Conclusion:
Population access to ECMO-capable centers in the U.S. is highly variable and limits time-dependent interventions, which are essential for successful deployment of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest. Our GIS model can be used for future planning of ECMO systems to optimize access for the U.S. population or to comparatively evaluate proposals to improve access.
Abstract 245: A Validated Score to Predict Poor Neurological Outcome After 72 Hours of Refractory VF/VT in Out of Hospital Cardiac Arrest Patients Requiring Extracorporeal Cardiopulmonary Resuscitation
Authors: Rojas-Salvador Nelly Carolina C
Published: December 2023

Introduction:
The challenge with neuroprognostication is finding a multimodal prediction model that yields the lowest false positive rate for a poor outcome.

Objectives:
To develop and validate a score that accurately predicts poor neurological outcome after 72 hours of ECPR initiation.

Methods:
Single-center, retrospective cohort study included 361 OHCA patients who underwent ECPR at the University of Minnesota between December 2015-January 2023. In a 50% random modeling sample, we obtained a derivation (n=180) and validation sample (n=181). The primary outcome was poor neurological outcome (defined as CPC 3-5) at hospital discharge. Neurological predictors were neuro specific enolase (NSE)>3ULN on day 1, myoclonus status epilepticus on day 1-3, neurological pupillary index (NPI)<2 on day 3-6, Glasgow motor=3 on day 3-6, highly malignant pattern on EEG (hmEEG) on day 3-6, CT with anoxic brain injury on day 3, and absent of brainstem reflexes on day 3-6. Univariate and multivariate analysis were performed on each predictor. A simple prediction score tool was constructed and evaluated through ROC analysis. A youden index was used for optimal cut-off.

Results:
Of 361 patients, 170 (47%) survived to hospital discharge. Of these, 85% (145/170) survived with favorable neurological outcome. The final multivariate logistic regression model in the derivation sample retained eight predictors: Absence of witnessed status and bystander CPR; downtime≥ 7min, lactate≥ 9mmol, low flow≥ 55min, NSE>3ULN, hmEEG, CT with anoxic brain injury and absence of brainstem reflexes, which were combined to develop an 8-point risk scoring model Minnesota OHCA using ECPR (MECPR). Model discrimination had an AUC of 0.87 [95%CI 0.82-0.92] in the derivation sample and 0.86 [95% CI 0.85-0.92] in the validation sample, and calibration (goodness of fit p=0.04). MECPR≥6 predicted poor neurological outcome with a sensitivity ~21%, specificity 100% and a FPR 0%. A MECPR ≥4 and ≥6 had an 89% and 97% probability of poor neurological outcome, respectively.

Conclusions:
A simple, accurate prediction scoring tool (MECPR) based on a multimodal approach after 72hrs of refractory cardiac arrest provides estimates of probability of poor neurological outcome among patients treated with ECPR.