bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract Or114: Development of an Innovative Cardiac Arrest Recovery Pilot (CARP) Program
Authors: Beekman Rachel , Gray Joanna , Neuschatz Kaile , Nguyen Christine , Lucey Kenia , Fung Celia , Moeller Jeremy , Perman Sarah , Lovelett Laurel , Coutinho Jennifer , Driskell Lucas , Gilmore Emily
Published: November 2024

Background:
Cardiac arrest survivorship is wrought with psychological, physical, and cognitive disability, much of which goes underrecognized by healthcare professionals. Discharge planning is not standardized, thus limiting access to critical evaluations and services that have the potential to impact intermediate and long-term outcomes.

Aims:
We describe the development of a novel cardiac arrest recovery clinic.

Methods:
At our institution, all unresponsive cardiac arrest survivors are followed prospectively by our neurocritical care consult service who provide recommendations on brain centered resuscitation and neuroprognostication. Eligibility for CARP included patients admitted to an intensive care unit following out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA) who subsequently regained consciousness and were following commands prior to discharge. Nurse navigators (JG, KN) and neurointensivists (RB, EG) tracked inpatient recovery and coordinated with the primary medical team and rehab colleagues to ensure optimal discharge planning. The primary outcome was incidence of cognitive deficits at hospital discharge. Secondary outcomes included discharge disposition.

Results:
Between February 1 and June 4, 2024, 54 patients, including 24 IHCA and 30 OHCA, were screened for eligibility, of which 22 (41%) were enrolled in the CARP program. Patients with IHCA were more likely to be enrolled than patients with OHCA [13 (54%) vs. 9 (30%)]. Prior to discharge, all eligible patients underwent cognitive screening performed by speech and language pathology, which identified 18 (82%) with cognitive deficits. All CARP enrollees were referred to neurology resident clinic; of those with cognitive impairment, 16 (89%) were also referred to neuropsychology. Discharge disposition included 8 (40%) to home ± services, 7 (35%) to acute rehab, 4 (20%) to short term rehab, and 1 (5%) to inpatient substance abuse recovery program. Follow up data is pending.

Conclusions:
Amongst cardiac arrest survivors, in-hospital cognitive screening by speech and language pathology was feasible and frequently identified cognitive impairment not detected on crude bedside assessments. Using a prospective screening approach, we were able to track inpatient recovery, anticipate discharge needs, and facilitate expedited outpatient neuropsychological evaluations. CARP will continue to perform a needs assessment regarding resources with the potential to improve survivorship.
Abstract Sa1003: Variability In Arrest Characteristics in A Multicenter Swine Cardiac Arrest Registry
Authors: Tiba Mohamad , Tissier Renaud , Ristagno Giuseppe , Magliocca Aurora , Fumagalli Francesca , Hsu Cindy , Mlcek Mikulas , Belohlavek Jan , Friberg Hans , Persson Olof , Holzer Michael , Alexander Szinovatz , Weihs Wolfgang , Granfeldt Asger , Vammen Lauge , Cha Kyoung-Chul , Jung Woo Jin , Neumar Robert
Published: November 2024

Introduction:
Many post-cardiac arrest (CA) therapies shown to be effective in animal models have failed to translate in human clinical trials. The predominance of single site pre-clinical studies, which lacks the heterogeneity and variability inherent in multicenter human clinical trials, could contribute to this failure. Multicenter pre-clinical studies might yield variability that more closely approximates human clinical trials, and thus result in reduction of bias and better initial screening of interventions. Here we describe the variability of CA characteristics among participating centers of an international multicenter preclinical CA research network.

Methods:
This is a retrospective analysis of control group subject data from swine CA studies submitted to the TRANSatlantic Cardiac arrEst Neuroprotection aDvancement (TRANSCEND) Network pre-clinical registry. Data for 101 animals from ten different models at seven institutions across the U.S.A, Europe, and Asia were included in this analysis. Data related to CA characteristics (intervals), post-CA characteristics (hemodynamics and blood gas at 1 hour post-ROSC), and neurological outcome were compiled and compared between the ten models. One-way ANOVA and Bartlett Test were used to estimate differences in means and standard deviations (SD). Chi Square test was used to compare proportions.

Results:
There were significant differences in CA characteristics between all ten models. The mean (SD) interval from CA to start of cardiopulmonary resuscitation was 8 (4)min (range of 2 to 14min) and from onset of CA to ROSC was 19 (7)min (range 13 to 38min) (
p
<0.0001). There were also significant differences between models when comparing sex, weight, post-ROSC hemodynamics, arterial blood gas results, and neurological outcome (
p
<0.0001). Data is detailed in the table.

Conclusion:
This analysis illustrates significant variability in CA and post-ROSC characteristics and neurologic outcomes when comparing different swine CA models in an international pre-clinical registry. Such variability could make interventional CA studies performed in a multicenter network more predictive of human clinical trials.
Abstract Sa1004: Chest compression synchronized ventilation is associated with improved oxygenation but also with increased incidence of pneumothoraces in an experimental CPR model.
Authors: Kopra Jukka , Mehtonen Lassi , Laitinen Merja , Litonius Erik , Oestman Robert , Heinonen Juho , Skrifvars Markus , Pekkarinen Pirkka
Published: November 2024

Background:
Recent experimental results have shown promising potential for chest compression synchronized ventilation (CCSV). This technique triggers ventilation during cardiopulmonary resuscitation (CPR) by the counterpressure from each chest compression (f = 100 min
-1
), with a positive inspiratory pressure of 60 mbar. The objective is to enhance the compressive force directed at the heart and increase venous return while preventing lung atelectasis.

We examined the effects of CCSV on arterial blood gas levels, pH and lactate compared to manual ventilation in an animal model of CPR. The hypothesis was, that it would provide superior oxygenation sustained over 30 minutes of advanced life support (ALS).

Methods:
Anesthetized healthy Landrace pigs (n = 30; weight circa 50 kg) were electrically induced to ventricular fibrillation and randomized to either CCSV (delivered with the Medumat standard
2
ventilator) or conventional ventilation (manual bag-valve) with mechanical chest compressions by Lucas
TM
2.

After a 5 min no-flow time ALS was commenced and delivered for 35 minutes. The pigs were not defibrillated but received three 1 mg intravenous doses of epinephrine. Arterial blood gas samples were taken in 5 min intervals. Femoral artery pressure levels and end-tidal carbon dioxide (EtCO
2
) were measured continuously. PaO
2
, PaCO
2
, pH, lactate, arterial pressures and EtCO
2
over time were compared using a mixed linear model. Chest injuries were diagnosed with post-mortem CT scans.

Results:
PaO
2
levels were significantly higher in the CCSV group (p = 0.0455,
Figure 1
). EtCO
2
levels were significantly lower in the CCSV group (p = 0.0047) whereas there was no difference in SBP or MAP (
Figure 2
). The number of pneumothoraxes were significantly higher in the CCSV group (12 vs. 3, p = 0.0078) with 8 being severe.

Conclusions:
CCSV provides increased oxygenation but is associated with more pneumothoraces in this animal model. The effect on hemodynamics was neutral. The promising CCSV protocol warrants further research and refinement.
Abstract Sa102: Does Benefit of An Advanced Airway Depend on Initial Rhythm? A Secondary Analysis of the Pragmatic Airway Resuscitation Trial
Authors: Eurick-Bering Kianna , Wang Henry , Berger David , Swor Robert , Nichol Graham , Idris Ahmed , Daya Mohamud , Carlson Jestin
Published: November 2024

Background:
About 80 percent of patients with out-of-hospital cardiac arrest (OHCA) present with a non-shockable initial rhythm (asystole or pulseless electrical activity (PEA)), which is associated with lower survival. Advanced airway management and oxygen delivery are important OHCA interventions, but their impact based on different presenting rhythm groups are unknown. Our objective was to determine if advanced airway strategy is associated with outcomes in shockable, PEA and asystolic OHCA.

Methods:
We performed a secondary analysis of data collected from the Pragmatic Airway Resuscitation Trial (PART), which assigned adult OHCA to a strategy of either endotracheal intubation (ETI) or laryngeal tube (LT) for initial airway management. We stratified patients by initial cardiac rhythm: shockable (ventricular fibrillation/tachycardia, AED shock), PEA or asystole. We excluded AED non-shockable and unknown rhythms. The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation (ROSC) at emergency department arrival, survival to hospital discharge, and survival with good neurological function (modified Rankin score ≤3). We used general estimating equations to determine the associations between airway strategy and outcomes, stratified by initial rhythm and adjusted for age, sex, witnessed status, and bystander CPR.

Results:
There were 3,004 patients in the parent trial of which 2,847 were included in this analysis. Of these 575 were shockable, 671 were PEA, and 1,601 were asystole. Compared with ETI, LT airway was not associated with improved 72-hour survival in shockable rhythms (OR
adj
1.30 (0.91-1.67)), PEA (OR
adj
0.97 (0.65-1.45)), or asystole (OR
adj
1.13 (0.79-1.64)). Similarly, we noted no significant difference by airway strategy for secondary outcomes of ROSC, survival to discharge, and survival to discharge with good neurological function.

Conclusion:
Prehospital advanced airway management strategy (ETI vs. LT) was not significantly associated with outcomes regardless of initial rhythm.
Abstract Sa104: Ventilation Efficacy of Automatic Oxygenators for Patients with Out-of-Hospital Cardiac Arrests at Different Pressure Limits in Prehospital Settings
Authors: Chen Chi-Hsin , Fan Cheng-Yi , Huang Edward Pei-Chuan
Published: November 2024

Background:
Automatic oxygenators can be used for ventilation in out-of-hospital cardiac arrest (OHCA) patients. However, their efficacy under different pressure limits is unknown.

Research Question:
Does the ventilation efficacy of Ambu bag and automatic oxygenators under different pressure limits differ in OHCA patients during prehospital resuscitation?

Aims:
To compare the ventilation efficacy of Ambu bag and automatic oxygenators under different pressure limits and investigate the association of different ventilation settings with patient outcomes.

Methods:
This retrospective study included adult patients with non-traumatic OHCA who received prehospital advanced airway in Hsinchu county, Taiwan, in 2023. Patients were categorized into three groups: Group A (ventilated by Ambu bag), Group B (automatic oxygenators, pressure limit at 45 cmH2O), and Group C (automatic oxygenators, pressure limit at 60 cmH2O). Ventilation efficacy was monitored by recording tidal volume using Zoll® X-series monitors. The median and maximum tidal volume and percentage of adequate ventilation (tidal volume between 500-600 ml) of each patient among 3 groups were compared. Associations between ventilation settings, efficacy, and patient outcomes were analyzed using multivariable logistic regression.

Results:
Group A, Group B, and Group C consisted of 57 (32.0%), 41 (23.0%), and 80 (45.5%) OHCA patients, respectively. The demographics and prehospital managements, including advanced airway type (laryngeal mask [LMA] or endotracheal tube [ETT]), did not differ between groups. The median tidal volume was highest in Group B, followed by Group A and C (Group A: 363.0 ml, Group B: 403.0 ml, Group C: 275.0 ml,
p
= 0.016). The median maximum tidal volume was highest in Group A, followed by Group C and B (Group A: 644.0 ml, Group B: 534.0 ml, Group C: 567.5 ml,
p
= 0.024). The median percentages of adequate ventilation were equally low in 3 groups, (Group A: 5.7%, Group B: 3.1%, Group C: 2.0%, p = 0.372). Different ventilation settings or efficacy were not associated with prehospital or in-hospital return of spontaneous circulation. However, patients receiving prehospital ETT insertion had better outcomes than those with LMA.

Conclusion:
This study presents the ventilation efficacy of OHCA patients ventilated by Ambu bag or automatic oxygenators under different pressure limits. Despite slight differences in tidal volumes measured across groups, patient outcomes did not differ significantly.
Abstract Sa1109: Aerobic Capacity of Adults with Fontan Palliation: Disease-specific Reference Values and Relationship to Outcomes
Authors: Ali Ahmed , Goda Ahmed , Abozied Omar , Egbe Alexander
Published: November 2024

Background:
Patients with Fontan palliation have reduced aerobic capacity because of impaired cardiac, pulmonary, and skeletal muscle function. However, the assessment of aerobic capacity in this population still relies on comparisons with people without cardiovascular disease, rather than comparison with the expected aerobic capacity of other Fontan patients. The purpose of this study was to determine the expected aerobic capacity of adults with Fontan palliation.

Method:
Adults with Fontan palliation who underwent cardiopulmonary exercise test at Mayo Clinic (2003-2023) were stratified into quartiles based on the predicted peak VO
2
. We assessed the correlates of predicted peak VO
2
, and the relationship between predicted peak VO
2
quartiles and cardiovascular outcomes (death/transplant).

Results:
Of 323 patients (age 29±9 years; 177 [55%] men), the median peak VO2 was 19.1 (15.2 - 23.9) ml/kg/min, and this corresponds to a predicted peak VO
2
of 51% (range 19 -88; interquartile range 41 - 62). The correlates of higher predicted peak VO
2
were smaller body mass index, higher systemic saturation, and lower Fontan pressures. The top, 2
nd
,3
rd
, and bottom quartile of predicted peak VO
2
corresponds to predicted peak VO
2
of 63-88%, 51-62%, 41-50%, and 19-40%, respectively. Using the top quartile as the reference, the 3
rd
quartile (HR 1.13, 95% CI 1.03-1.28, p=0.02), and 4
th
quartile were associated with a higher risk of death/transplant (HR 1.32, 95% CI 1.16-1.69, p<0.001).

Conclusions:
The results of the current study would help calibrate the interpretation of exercise test data in adults with Fontan palliation and improve risk stratification in this population.
Abstract Sa1201: Emergence of an Online Support Community for Cardiac Arrest Survivors, Co-Survivors, Lay Rescuers, and Advocates
Authors: Newman Mary , Presciutti Alexander , Farrell Joe , Lupton Joshua , Sanko Stephen , Perman Sarah
Published: November 2024

Background:
Cardiac arrest survivors often experience physical, cognitive, emotional, and social challenges that can linger for years. Co-survivors and lay rescuers can also experience distress. In January 2023, the Sudden Cardiac Arrest Foundation (SCAF) launched the Cardiac Arrest Survivor Alliance™ (CASA), an online community to support these individuals. CASA offers evidence-based information about common challenges post survival, easy connection with peers, access to experts, and pathways to further clinical support.

Methods:
We built CASA using Mighty Networks (MN) and assembled a leadership team that includes clinicians, researchers, and survivors with expertise in survivorship. We recruited members through SCAF’s existing Survivor Network and outreach via SCAF’s website, newsletters, and social media. Additional recruitment resulted from articles about CASA in multiple national news outlets, Internet searches, conference presentations, partner collaboration, and member invitations. We obtained analytic reports through MN to evaluate CASA’s growth and engagement during the past 12 months.

Results:
By early June 2024, there were 1,435 members primarily from the U.S. (92%), plus members from 26 other countries. This compares with 868 members from the U.S. and 21 other countries in June 2023. Approximately 65% of members are survivors. Other members include co-survivors (22%), advocates, lay rescuers, and bereaved. During the 12-month period, there were: 10,058 contributions (sum of actions taken by hosts, moderators, and members including posts, “cheers,” comments, chat messages, direct [private] messages [DMs], and RSVPs); 923 active members (total members who visited); 468 unique members providing contributions.

Members have not only engaged publicly, but also privately; 189 members (21%) have sent 1,448 DMs, exceeding MN’s benchmark of 15%. Attendance at monthly webinars has ranged from 22 to 47 participants. Further, we have established a formal research protocol and are working with several researchers seeking to improve understanding of survivorship and develop resources to support survivorship.

Conclusion:
CASA has grown substantially during the past 12 months and there is a high level of engagement. Goals include providing additional evidence-based content, outreach to hospitals and targeted healthcare providers nationwide including in rural areas, and further collaboration with program partners.
Abstract Sa1203: Application of a Centralized Media-Based Strategy for Exception from Informed Consent Community Consultation and Public Disclosure in the Pediatric Prehospital Airway Resuscitation Trial
Authors: Wang Henry , Stephens Shannon , Jacobsen Kammy , Brown Brittany , ELSHOLZ CARA , Frey Jennifer , VanBuren John , Gausche-Hill Marianne , Shah Manish , Bosson Nichole , Leonard Julie , Ward Caleb , Nishijima Daniel , Adelgais Kathleen , Remick Katherine , Gaither Joshua , Colella Riccardo , Swanson Doug , Goldkind Sara , Hansen Matthew
Published: November 2024

Background:
In the United States, enrollment in clinical trials that involve emergency care may require compliance with federal regulations for Exception from Informed Consent (EFIC), including Community Consultation and Public Disclosure (CCPD). The most effective methods for CCPD in studies of emergency care in children are not known.

Aim:
To describe the results of a centralized media-based CCPD outreach effort for the Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART), a multicenter trial testing paramedic airway management strategies in critically ill and injured children.

Methods:
During a three-month window, across 10 participating US communities, we deployed social media (SM - Facebook and Instagram) advertisements of the study, targeting users within Emergency Medical Services service regions and zip codes with high anticipated need for pediatric airway management. The SM advertisements hyperlinked to study websites and surveys. We also solicited survey completion using a marketing research platform (Qualtrics Marketing Research Services), targeting the same communities. We determined the extent of SM exposure (impressions), interactions (shares, reactions, saves, comments, likes and clicks), and referrals to study website. For each site, we determined the number of completed surveys and the time required to achieve 200 surveys as required by the Institutional Review Board. We determined the demographics of survey respondents and the percentage with supportive responses.

Results:
The SM campaign resulted in 23.3M advertisement impressions (range 1.8-2.7M per site) reaching 3.4M unique users (range 239,494-439,360 per site), 13,873 engagements (range 828-1,656 per site) and 10,154 click-throughs to the study website (range 760-1,589 per site). There were 6,771 completed community surveys (range 531-914 per site). Across the sites, time to 200 completed surveys ranged from 5-28 days. Survey respondents were: 54.1% <45 years old, 61.9% female, 27.0% minority race, 14.2% Hispanic ethnicity, and 40.8% household income <$50,000. A total of 6,144 (90.7%; range 88.6-92.6% per site) survey respondents supported trial deployment in their communities.

Conclusions:
In Pedi-PART a centralized media-based outreach campaign efficiently reached and engaged a vast and diverse population, and yielded key community feedback. This strategy illustrates one robust approach to facilitate CCPD in pediatric emergency care trials.
Abstract Sa306: View Adequacy and Compression Delays During CPR: Carotid vs Cardiac Ultrasound In Out-of-Hospital Cardiac Arrest
Authors: Patrick Casey , Wells L. Michael , Crocker Kevin , Ward Brad , Smith Nicolas , Seek James , Dickson Robert , Powell Jonathan , Gage Christopher , Panchal Ashish
Published: November 2024

Introduction:
Manual pulse palpation during cardiopulmonary resuscitation has poor reliability in both hospital and prehospital settings. Recently, point-of-care ultrasonography (POCUS) of the carotid artery has been used for pulse determination in the in-hospital setting. However, this approach has not been evaluated for out-of-hospital cardiac arrest (OHCA) events where adequate views and prolonged pauses during pulse checks could be challenges. Our objective was to evaluate the potential use of POCUS for pulse determination by paramedics using carotid artery and subxiphoid cardiac views. We hypothesized that carotid POCUS views may be obtained more quickly and successfully in the prehospital setting than the traditional subxiphoid cardiac view.

Methods:
This was a retrospective analysis of carotid and subxiphoid POCUS use for pulse determination at a high-volume, ground-based EMS agency. Adult patients suffering from medical OHCA with POCUS attempted were included. Those under 18 years of age, protocol deviations, missing data, or uninterpretable data were excluded. Video was recorded throughout each CPR pause in which ultrasounds were conducted. EMS clinicians alternated carotid and subxiphoid views. Pause length and view adequacy were evaluated by two expert paramedic reviewers. Disagreements were adjudicated by an EMS physician. Statistical analysis: McNemar’s test was used to evaluate for differences between adequate view and compression pauses < 10 seconds between carotid and subxiphoid approaches. Generalized estimating equations were used to evaluate the association of adequate view and compression pauses < 10 seconds to POCUS approaches.

Results:
A total of 196 POCUS recordings from 94 patients were analyzed. Videos were evaluated by rates for adequate views with k=0.83 with 92% agreement. Overall, 73% (n=143) had a pause length < 10 seconds, and 62% (n=121) had an adequate view. Adequate views and compression pauses < 10 seconds were achieved more frequently using carotid POCUS (Figure). Adjusting for body mass index, carotid views had increased odds (AOR 9.3, 95% CI: 4.3-20.4) of combined adequate view and compression pause < 10 seconds as compared to subxiphoid imaging.

Conclusion:
Paramedic-obtained carotid POCUS demonstrated improved view adequacy and fewer extended CPR pauses. Limitations include the high level of POCUS training for paramedics and the single agency data source, making generalizability difficult to determine.
Abstract Sa307: Head and Thorax Elevation Cardiopulmonary Resuscitation versus Flat Cardiopulmonary Resuscitation with Extracorporeal Membrane Oxygenation as Salvage Therapy in a Severe Porcine Model of Cardiac Arrest
Authors: Moore Johanna , Pourzand Pouria , Salverda Bayert , Suresh Mithun , Lick Michael , Hai Hamza , Kent Bailey , Metzger Anja , Lurie Keith
Published: November 2024

Background:
Elevation of the head and thorax (HUP) in combination with active compression decompression (ACD) cardiopulmonary resuscitation (CPR) and an impedance threshold device (ITD) is starting to be used clinically by first responders. Extracorporeal membrane oxygenation in cardiac arrest (ECPR) for refractory cardiac arrest is also increasingly used and evolving. The potential benefit of ACD+ITD HUP CPR with ECPR is unclear.

Aim:
Demonstrate superior incidence of survival with ACD+ITD HUP CPR versus ACD+ITD CPR flat in an animal model that includes salvage with ECPR.

Methods:
Female and male Yorkshire-hybrid swine (~40 kg) were sedated and anesthetized. After intubation, bilateral percutaneous venous and arterial access were obtained. High fidelity micromanometer pressure transducers were used to measure arterial and venous pressures. Regional cerebral tissue oxygenation (rSO2) was also continuously monitored. Ventricular fibrillation was induced and left untreated for 15 minutes. During this time, animals were randomized to 1) HUP CPR or 2) flat CPR, and ACD+ITD CPR in both groups was then performed for 45 minutes. At 44 minutes, epinephrine and amiodarone were given and defibrillation attempted up to 3 times. If return of spontaneous circulation (ROSC) was not obtained, ECPR was then performed and continued for up to 6 hours. Neurological assessment was performed at 24 hours post arrest by a veterinarian blinded to the intervention. A Fisher’s exact test was used to compare outcomes between groups and an unpaired t-test for continuous data.

Results:
In this ongoing study (n=17), 8 animals were randomized to HUP and 9 to flat. After 44 minutes of CPR, mean ± SD rSO2 (%) was 63 ± 7.7 for the HUP group and 54.7 ± 6.6 for the flat group (p = 0.04). ROSC was achieved in 4/8 (50%) in the HUP group and 4/9 (44%) in the flat group (p = 1.0). ECPR was performed in 3/8 (37.5%) in the HUP group and 5/9 (56%) in the flat group (p = 0.64). Most animals (7/8, 88%) had ECPR performed successfully. ROSC was not obtained and ECPR deemed futile in one HUP animal. At 24 hours, 3/8 (37.5%) of the HUP animals and 0/9 (0%) of the flat animals survived (p= 0.08). One HUP animal (12.5%) survived without any neurologic deficit. None of the animals that required ECPR survived to 24 hours.

Conclusions:
In this severe model of cardiac arrest, a small number of animals survived, all of them receiving ACD+ITD HUP CPR and did not require ECPR.
Abstract Sa404: Implementation of a Nurse-Centric Resuscitation Institute and the Impact on Quality Metrics
Authors: Pyles Amanda , Busch Rebecca , Campbell Taylor
Published: November 2024

Introduction:
Healthcare organizations evaluate resuscitation using a wide array of methods. OThe American Heart Association’s (AHA) Get With the Guidelines-Resuscitation® (GWTG-R) database facilitates the collection of data to develop evidence-based guidelines. The four main metrics include time to shock (TTS), time to epinephrine administration, confirmation of airway (COA), and arrest monitored/witnessed. An academic health system (AHS) identified a need for improving how resuscitation data was translated at the bedside. Prior to the COVID-19 pandemic, resuscitation data within the AHS was focused on GWTG-R metrics for reporting only. The AHS’s Nursing Professional Development (NPD) department identified inaccuracies in data collection and minimal educational resources for improvement.

Hypothesis:
Would a nurse-centric Resuscitation Institute impact quality survivability metrics at an AHS?

Goals:
The NPD department reviewed GWTG-R data and survival to discharge at two hospitals. In 2021, the NPD department developed a team comprised of a data abstractor and resuscitation coordinator (NPD practitioner). The goal of this team was to improve data collection and translate identified needs from the data into resuscitation education and process improvement.

Approach:
The team found gaps in documentation, education, and emergency response process. GWTG-R metrics COA, TTS, and survival to discharge were lower than national benchmark and an abundance of resuscitation events were occurring than estimated. Descriptive data for GWTG-R 2021-2022 metrics identified gaps in guideline adherence and documentation standards: COA 83%, TTS 56%, and survival to discharge 36%. Based on these findings, approval from administration allowed the team to expand into a nurse-centric Resuscitation Institute comprised of three data abstractors, a resuscitation coordinator, and program manager. The Institute now collects data across the AHS on resuscitation events, and collaborates with NPD practitioners, leaders, providers, and emergency responders.

Results:
Since implementation of the Institute in 2023-2024 percentage increases revealed an improvement in survivability metrics: COA 87%, TTS 79%, and survival to discharge 37%.

Conclusion:
The Resuscitation Institute used nurses and survivability quality metrics to create a multifaceted approach to education and process improvement that improved early recognition, optimal resuscitation practices and post-cardiac arrest care.
Abstract Sa502: Early uric acid clearance and survival after out-of-hospital cardiac arrest: A prospective observational study
Authors: Tamura Tomoyoshi , Yamamoto Ryo , Homma Koichiro , Kitamura Nobuya , Nomura Tomohisa , Tagami Takashi , Yasunaga Hideo , Aso Shotaro , Takeda Munekazu , Sasaki Junichi
Published: November 2024

Background:
Hyperuricemia is frequently seen in patients after cardiac arrest. Persistent hyperuricemia during a cellular energy crisis is believed to result from the breakdown of nucleotides into uric acid (UA) and indicates an insufficient restoration of adenosine triphosphate (ATP) synthesis.

Hypothesis:
Early reduction in serum UA level, UA clearance (UA-CL), is associated with survival after cardiac arrest.

Aims:
The study examined the association between UA-CL and 30-day survival following out-of-hospital cardiac arrest (OHCA).

Methods:
This was a prospective, multicenter, observational study of OHCA cases conducted from 2019 to 2021. The study included adult non-traumatic OHCA patients whose UA levels were measured upon hospital arrival (UA-0h) and 24 hours after cardiac arrest (UA-24h). The proportional change from UA-0h to UA-24h was represented as UA-CL (%). The primary outcome was 30-day survival. An association between UA-CL and 30-day survival was investigated using restricted cubic spline regression and multivariable logistic regression analysis fitted with generalized estimating equations adjusted for patient characteristics, pre-hospital information, resuscitation variables, and within-institution clustering.

Results:
Among a total of 9,909 OHCA patients, 375 patients were included in the analysis. Compared to the non-survivors (N=166), the survivors (N=209) had more cases of witnessed arrests, bystander CPR, initial shockable rhythms, cardiogenic arrests, and a shorter duration of cardiac arrest. However, there was no difference in UA-0h between survivors and non-survivors (median 7.5 [IQR: 6-9] mg/dL, 7.4 [6-9] mg/dL, respectively; P=0.72). In contrast, UA-CL was significantly higher among the survivors compared to non-survivors (21 [3-42]%, 2.5 [-16-26]%, respectively; P<0.001). Cubic spline curb showed a linear increase in odds for survival with positive UA-CL. Finally, UA-CL was independently associated with 30-day survival after accounting for covariates (adjusted OR 1.01 [1.00-1.02], P=0.04).

Conclusion:
Regardless of UA-0h level, UA-CL was independently associated with 30-day survival after OHCA. Early UA-CL after cardiac arrest warrants research as an exploitable target to improve outcomes.
Abstract Sa503: Serum lactate/albumin ratio at hospital arrival and neurological outcome of patients 30 days after the occurrence of out-of-hospital cardiac arrest: a nationwide multicenter observational study
Authors: kawama toshinari , Hatakeyama Toshihiro , Sano Takashi , Nakada Koki , Matsuyama Tasuku , Kiguchi Takeyuki , Berg Benjamin , Kitamura Tetsuhisa , Matsushima Hisao
Published: November 2024

Background:
Previous studies have shown that a lower serum lactate/albumin ratio was positively correlated with the survival of severely ill patients, such as those with septic shock, in critical care. However, there is limited knowledge regarding the association between the serum lactate/albumin ratio and neurological outcome in patients with out-of-hospital cardiac arrest. Thus, we investigated whether a lower serum lactate/albumin ratio at hospital arrival was associated with good neurological outcomes in such patients.

Methods:
This was a multicenter observational study using data from The Japanese Association for Acute Medicine out-of-hospital cardiac arrest Registry. We reviewed records of patients aged ≥18 years with out-of-hospital cardiac arrest of medical etiology and hospitalized after return of spontaneous circulation, with serum lactate and albumin levels recorded at hospital arrival, between June 1, 2014 and December 31, 2021. The medical etiology excluded trauma, drowning, poisoning, burns, asphyxia, or hanging. We excluded cases with missing data, patients who were treated with extracorporeal membrane oxygenation, and those for whom the time period from the emergency call to the measurement of laboratory data was >120 mins. The primary outcome was 30-day survival with good neurological outcome, defined as cerebral performance category scale 1 or 2. Analyzed patients were divided into quartiles based on the serum lactate/albumin ratio. Multivariable logistic regression analysis was performed to adjust for several factors.

Results:
We analyzed 5,016 patients. The proportions of good neurological outcome were 56.0% (709/1,267), 27.9% (348/1,246), 11.3% (142/1,253), and 2.8% (35/1,250) in the first (serum lactate/albumin ratio ≤ 2.06), second (2.06 < serum lactate/albumin ratio ≤ 3.24), third (3.24 < serum lactate/albumin ratio ≤ 4.59), and fourth (4.59 < serum lactate/albumin ratio) quartiles, respectively. The multivariable logistic regression analysis showed that the adjusted odds ratio (95% confidence interval) values for good neurological outcome in the second, third, and fourth quartiles, compared with the first quartile, were 0.34 (0.28–0.42), 0.19 (0.15–0.25), and 0.06 (0.04–0.08), respectively.

Conclusions:
In the Japanese national registry, a lower serum lactate/albumin ratio at hospital arrival was significantly associated with good neurological outcome in patients with out-of-hospital cardiac arrest.
Abstract Sa604: Trapezoidal wave chest compression plays neuroprotective role by alleviating neuronal ferroptosis in mice after CA-CPR-ROSC via cerebral microvascular endothelial cell derived extracellular microvesicles
Authors: jian mengyao , Gan Lu , Cao Yu
Published: November 2024

Background:
Nowadays, cardiopulmonary resuscitation (CPR) instruments used worldwide utilize sinusoidal wave for chest compression. The instrument independently invented by our research group performs chest compression through trapezoidal wave, which can achieve higher carotid blood flow and cerebral microcirculation blood perfusion, and ultimately reduce neuron death and blood brain barrier (BBB) injury after CPR, ultimately, improve the prognosis. However, the underlying mechanisms are complicated and remain largely unknown. Therefore, this study investigated the specific mechanisms so as to make contribution to the popularization of TWCC.

Methods:
Cardiac arrest-CPR-return of spontaneous circulation (CA-CPR-ROSC) mouse models attained by TWCC/sinusoidal wave chest compression (SWCC) and the oxygen-glucose deprivation reoxygenation (OGD/R) model of primary neurons treated by brain tissue derived sEV
TWCC
/sEV
SWCC
were established, and the level of neuronal ferroptosis was detected. AAV-BR1-CD63-GFP was injected via lateral cerebral ventricle to lable brain microvascular endothelial cells-derived small extracellular vesicles (BMEC-sEV), and AAV9-BR1- Rab27a-shRNA was used to suppress the generation of BMEC-sEV. The effects of ferroptosis on ROSC rate and neurological prognosis in mice were confirmed by ferroptosis activators/inhibitors.

Results:
It was confirmed that, compared with SWCC/ OGDR+sEV
TWCC
group, the ferroptosis level of neurons in TWCC/OGDR+sEV
TWCC
group was significantly higher, which was mainly manifested by the changes of mitochondrial morphology, ferroptosis related proteins and lipid peroxidation levels. Immunofluorescence showed that BMEC-sEV labeled by green fluorescent protein (GFP) could be taken in by neurons. Compared with SWCC+AAV-BR1-CD63-Rab27a-NC group, the ferroptosis level of neurons in SWCC+ AAV-BR1-CD63-RAB27A-shRNA group was significantly reduced, indicating that the neuroprotective effect of TWCC was closely related to BMEC-sEV. In addition, the ROSC rate, neurological function score and 7-day survival rate were higher in SWCC group treated with Fer-1 and Lip-1 than SWCC group, while, mice given RSL3 and Erastin were completely opposite to that.

Conclusion:
In general, our results demonstrate that TWCC exacerbates brain damage after CPR by facilitating neuronal ferroptosis via BMEC-sEV.

Key words:
cardiac arrest; neurons; ferroptosis; small extracellular vesicles
Abstract Sa605: The Trend of Standardized ETCO
2
After ROSC May Reveal Cellular Damage During Cardiac Arrest
Authors: Uriguen Jose Antonio , GUTIERREZ JOSE JULIO , Leturiondo Mikel , Redondo Koldo , Russell James , Daya Mohamud
Published: November 2024

Introduction:
Cardiac output and oxygen supply to vital organs cease after cardiac arrest, resulting in cellular damage with the brain being one of the most affected organs. From collapse to ROSC, no-flow and low-flow phases lead to primary injury due to ischemia. Then, at normal-flow phase after ROSC, reperfusion of the ischemic cerebrovascular bed triggers secondary injury. Both effects combined may cause post-cardiac arrest brain injury (approximately 2/3 of all deaths 48-72h after ROSC). Recently, standardization of ETCO
2
to constant ventilation rate and chest compression depth has been proposed as a potential indicator of the patient’s physiological status during resuscitation.

Aim:
Retrospectively assess how the trend of standardized ETCO
2
during CPR in patients achieving ROSC may reflect an increment in cellular damage that could promote brain injury.

Methods:
Out-of-hospital cardiac arrest cases of patients achieving sustained ROSC, with defibrillator and clinical data. ETCO
2
was standardized to 10 ventilations per minute and 50mm (ET
s
). Trends were calculated as the percent variation between the initial and the final values of ET
s
in the low-flow phase before the onset of ROSC and in the normal-flow phase after ROSC. We used the modified Rankin Score (mRS, from 0 to 6) to classify the patients into good (mRS ≤ 3) or poor functional outcome (mRS > 3)

Results:
Forty-two sustained ROSC cases were included, 8 with good and 34 with poor functional outcome. The median (IQR) trend of ET
s
was +0.9 (–3.9, +3.6) %/min in the low-flow phase, and –1.8 (–4.1, +0.3) %/min in the normal-flow phase (
p
= 0.03). The low-flow phase lasted 12.0 (11.2, 14.7) min in patients with good outcome, and 16.2 (14.1, 19.2) min in those with poor outcome (
p
= 0.02). The trend of ET
s
in the normal-flow phase was +0.1 (–0.2, +1.2) %/min in patients with good outcome and –2.4 (–4.2, –1.0) %/min in those with poor outcome (
p
= 0.01).

Conclusion:
The trend of standardized ETCO
2
was significantly different in the normal-flow phase after ROSC than in the low-flow phase before ROSC. The negative trend in the normal-flow phase combined with a longer low-flow phase may reflect an increment of cellular damage, with a major impact on the brain. This is possibly because reperfusion aggravates primary injury the longer the low-flow phase has lasted.
Abstract Sa606: Analysis of Ventricular Fibrillation Waveform Response to Asphyxial Hemodynamics in an Infant Swine Model of Out-of-Hospital Cardiac Arrest
Authors: Jackson Aaron , Gumucio Jorge , Menegazzi James , Salcido David
Published: November 2024

Background:
Asphyxia can be a common cause of cardiac arrest in infants, in which survival rates remain low even for in-hospital arrests. Amplitude spectrum area (AMSA) is a numerical value based on the sum of weighted frequencies in ECGs. The greater the AMSA value, the greater probability of ventricular fibrillation (VF) reversal. During the decompensation phase of asphyxia, it is not known how compensatory hemodynamic mechanisms impact subsequent episodes of VF.

Hypothesis:
We hypothesized that the level of hemodynamic compensation during asphyxia will correlate directly with AMSA level during subsequent VF.

Methods:
In 4-week-old infant piglets, we induced cardiac arrest via asphyxia for 9 minutes. If the animals were not in VF by that point, a 3-second transthoracic shock was administered to induce VF. During the asphyxial phase, each animal was classified with one of 3 types of compensatory hemodynamic response based on peak mean arterial pressure (MAP) relative to baseline: hypo, normal, and hyper. AMSA measures were computed for artifact-free ECG at the 9-minute mark. ANOVA was used to compare mean AMSA value by response category.

Results:
We used 34 animals (16 females, 18 males) that were approximately 4 weeks old. They had a combined average AMSA of 3.875 mV-Hz, weight of 10.62 kg, and MAP of 77.29 mmHg. The hyper responders (7) had an average AMSA of 4.5 mV-Hz and were 28.6% female. Normal responders (10) had had an average AMSA of 4.22 mV-Hz and were 60% female. Lastly, hypo responders (17) had an average AMSA of 3.47 mV-Hz and were 47.06% female. AMSA values differed between groups (p = 0.045).

Conclusions:
Hyper responders had higher AMSA values compared to both normal and hypo responders. Future study could examine the mechanisms behind this action.
Abstract Sa705: Knowledge and Perceptions of Hands-Only Cardiopulmonary Resuscitations in Chinese Americans Who Speak Mandarin as a First Language
Authors: Wang Ethan , Jiang Jasmine , Li Lyric , Chase Alexis , Perman Sarah , Yang David
Published: November 2024

Introduction:
Bystander Cardiopulmonary Resuscitation (CPR) is crucial to the survival of out of hospital cardiac arrest (OHCA) patients, but only 40.2% received bystander CPR in 2023. Asian Americans are less likely to receive bystander CPR in witnessed OHCA versus Non-Hispanic Whites. Existing literature identifies language comprehension as one barrier. For Mandarin speaking populations, there has been a demonstrated need for CPR education but a paucity of research regarding the effect of Mandarin language CPR classes. Our project hopes to fill this need and research gap.

Hypothesis:
Teaching CPR in Mandarin will improve CPR knowledge and perception in Mandarin speakers, including willingness to perform CPR.

Methods:
This pre- and post-test cohort study included 40 parents of students at a Chinese language school. First, pre-surveys were administered, collecting demographics, perceptions, and knowledge. There was a presentation of Hands-Only CPR and Automated External Defibrillator (AED) by native Mandarin speakers, a video and live demonstration on a CPR manikin, and then small group practice. Participants filled out a post-survey and were tested on CPR/AED usage by trained CPR instructors. This pilot analysis provides describe data of our results.

Results:
Of the 40 participants who completed the course, 37 completed both pre- and post-surveys. Of these, 26 (70%) were female, none were native English speakers, 32 (86%) have never learned CPR. Additional demographics are provided in Table 1. There was an improvement in knowledge related to CPR after the hands-only CPR course. Most were willing to perform CPR on those they knew (94%) and strangers (86%) post- course. There was an increase in agreement (from disagree to neutral) for all positive perception questions except for comfort speaking in Chinese with 911 operators. There was also a decrease in agreement for all negative perception questions. Further data is provided in Table 2 and 3. In the final proctored assessment, 36/37 participants passed (one did not participate).

Conclusion:
This novel, proof-of-concept study shows that our Mandarin-language CPR class positively improved knowledge and perceptions related to CPR in both written and performance assessments. Our findings align with existing literature and addresses a critical gap in improving bystander CPR rates. We plan to conduct additional classes with Mandarin-speaking community members and expand this class to other Asian subgroups.
Abstract Sa806: Prognostic Predictions after Pediatric Cardiac Arrest: A Single Center Prospective Study
Authors: McSherry Megan , Zhang Bingqing , Louderback Lauren , Little Aubree , Walsh Kathleen , Graham Kathryn , Press Craig , McGuire Jennifer , Ichord Rebecca , Douglas Rebecca , Morgan Ryan , Kirschen Matthew , Woods-Hill Charlotte , Topjian Alexis
Published: November 2024

Background:
Almost half of children who have a cardiac arrest die after withdrawal of life sustaining therapy (WLST), which is influenced by provider outcome predictions. Clinical factors used by providers to predict outcomes after pediatric cardiac arrest and the prognostic accuracy of providers are not known.

Aims:
We describe clinical factors providers report using to predict outcomes in the first week post-arrest and determine the concordance of prognostic predictions with patient outcome at hospital discharge.

Hypothesis:
We hypothesized that the use of post-arrest factors would increase within the first week and that the concordance of prognostic predictions with patient outcome would increase over time from return of circulation (ROC).

Methods:
This is a single-center prospective cohort study from 7/2023 to 4/2024. We included children with an index pediatric in-hospital (IHCA) or out-of-hospital (OHCA) cardiac arrest with ROC who received post-arrest care in the PICU. Multidisciplinary team members completed real-time surveys on post-arrest days 1, 2, 3, and 7. Surveys assessed provider demographics, top 3 factors used to form their prediction, and prediction of patient discharge outcome (Pediatric Cerebral Performance Category [PCPC] score). Actual outcome was PCPC at hospital discharge or 30 days, whichever was later, and was compared to provider prediction. Prognostic concordance is defined in Table 3. Mixed-effect models explored changes in factors used for prediction and concordance between prognostic predictions and patient outcomes over survey time points.

Results:
Fifty cardiac patients (median age: 4 years [IQR: 1, 10], 60% OHCA, and 52% pre-arrest PCPC = 1) were analyzed; survival at discharge/30 days was 76%. There were 461 surveys completed by 217 providers (Table 1). Over all survey time points, the top 3 factors reported to predict outcomes were pre-arrest neurologic function, post-arrest neurologic exam and EEG (Table 2). Use of neurologic exam, other organ dysfunction, and MRI findings increased over the first 3 days, OR 1.6 (95% CI 1.2-2.2). More than 75% of provider predictions were concordant with the actual outcome, by all definitions, with no significant change over the first week (Table 3).

Conclusions:
During the first week post-arrest, providers report increasing incorporation of the post arrest factors to prognosticate outcomes. Concordance of outcome prediction was more than 75% and did not change over the first week.