bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract Sa903: Adverse effect of Autoimmune Diseases on In-hospital Cardiac Arrest Mortality
Authors: Pius Ruth , Markson Favour , Antia Akanimo , ODUGBEMI OLUFEMI , Nwogwugwu Enyioma , Ong Kenneth
Published: November 2024

Introduction:
Cardiac arrest (CA) has been linked with worse outcomes in patients with chronic medical conditions such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, hypertension, and coronary artery disease. Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have been linked to increased risk of cardiovascular diseases, but their effect on the outcome of CA is not well studied.

Aim:
This study aimed to evaluate the effect of SLE and RA on the outcomes of admitted CA patients.

Methodology:
We identified all adult CA hospitalizations in the US between 2016 and 2020 using the National Inpatient Sample database and categorized them based on RA and SLE diagnoses. We applied logistic regression analysis to study the effects of SLE or RA diagnosis on CA outcomes, with a p-value threshold of 0.01.

Results:
A total of 1,099,235 adults were admitted with CA between 2016 to 2020. There were 5745 and 16920 patients with SLE and RA diagnoses among CA hospitalizations, respectively. Among CA patients, the mean age was 54.4 vs. 70.5 years among SLE and RA groups. CA patients with SLE diagnosis had 18% higher odds of in-hospital mortality (OR: 1.18 [1.04-1.34]; p=0.008), similar to those with RA diagnosis (OR:1.16 [1.08-1.24]; p<0.001) when compared to those without SLE or RA. Unlike RA, the SLE effect persisted (AOR:1.44 [1.26-1.64]; p< 0.001) after adjusting for sociodemographic factors (such as age and sex) and other co-morbidities (for RA, AOR: 1.09 [1.01-1.18]; p=0.023).

Further analysis to determine if this reported mortality effect of SLE on CA patients is explainable by a general SLE mortality revealed that the interaction of SLE and CA is associated with higher mortality in the broader adult patient population, independent of CA or SLE alone (OR:1.52 [1.34-1.71]; P<0.001). This synergistic effect persisted after controlling for comorbidities and sociodemographic factors (AOR: 1.9 [1.66-2.27]; p< 0.001).

RA or SLE diagnosis were not associated with acute heart failure, cardiogenic shock, and acute kidney injury outcomes in CA patients.

Conclusion:
Our findings suggest an adverse clinical interaction between SLE and CA that is independent of CA or SLE alone, and also independent of other comorbidities and sociodemographic factors. More research is needed to further explore the potential mechanisms involved.
Abstract Sa908: Evaluating the Alignment of Recent Cardiac Arrest Randomized Controlled Trials with the Top Resuscitation Science Knowledge Gaps
Authors: Coute Ryan , Toy Jake , Wilhelm Kelsey , Kim Michael , Friend Lauren , Gahm Claire , Gausche-Hill Marianne , Panchal Ashish , Menegazzi James
Published: November 2024

Objective:
To determine if recently published cardiac arrest randomized controlled trials (RCTs) align with and address the top scientific gaps previously identified in the American Heart Association (AHA) cardiac arrest treatment guidelines.

Methods:
All RCTs involving human subjects experiencing non-traumatic cardiac arrest, published between January 1, 2015, and December 31, 2022, were identified through searches in MEDLINE, Embase, and Web of Science. Abstracts, and full manuscripts when needed, were individually reviewed and categorized according to the themes and rationale for the ten most urgent knowledge gaps in the 2015 AHA cardiac arrest guidelines published by Panchal et al. The data were analyzed descriptively.

Results:
A total of 87 cardiac arrest RCTs were identified over the study period. Most trials included the adult population (84, 96.5%) and out-of-hospital cardiac arrest (62, 71.3%). The RCTs addressed the following top scientific gaps: optimization of post-cardiac arrest care (40, 46.0%), optimal airway management strategies (9, 10.3%), hemodynamic monitoring/goal-directed resuscitation (1, 1.1%), dispatch-directed CPR (1, 1.1%), individualizing resuscitation strategies (1, 1.1%), and novel technology for out-of-hospital cardiac arrest identification and response (1, 1.1%). Recognized gaps in early neuroprognostication, optimizing educational strategies for providers, and prediction of patients at risk of cardiac arrest were not specifically addressed. A total of 34 RCTs (39.0%) targeted other knowledge gaps outside of the top 10.

Conclusion:
More than half of cardiac arrest RCTs published since 2015 have focused on optimizing post-resuscitative care or airway management strategies, leaving a disparity among other well-recognized knowledge gaps in the AHA cardiac arrest treatment guidelines. Future RCTs aligned with other high-priority gaps in cardiac arrest recognition and treatment are warranted.
Abstract Su1009: Effect of Increasing Force on Perfusion Pressures During Circumferential Constriction Cardiopulmonary Resuscitation
Authors: Paradis Aidan , Paradis Norman
Published: November 2024

Introduction:
Outcomes after treatment with currently available CPR remain poor. CPR related injuries are associated with worse outcomes. In comparison to standard sternal piston-type CPR, the utilization of pneumatic circumferential constriction CPR (CC-CPR) enables the application of a greater motive force while minimizing localized injury force. This technique has the potential to enhance hemodynamics and reduce skeletal injuries. Nonetheless, the optimal pneumatic belt pressure for CC-CPR, which equates force around the chest, has not been comprehensively studied.

Hypothesis:
CC-CPR with increasing force may be associated with improved perfusion pressures without increased skeletal injuries.

Methods:
Ventricular fibrillation was induced in female Yorkshire swine (n = 7, 30-40 kg). CPR was provided by inflating a circumferential pneumatic ‘belt’ 80 times per minute. Belt pressures were varied in one-minute treatment epochs among 200, 220, 240, 260, and 280mmHg. Aortic
(Ao)
and right atrial
(RA)
pressures were measured using micromanometer catheters. Coronary perfusion pressure
(CPP)
was derived as the difference between the Ao and RA pressures at the end of the decompression phase. Airway end-tidal CO2 (
ETCO2
) was recorded as a secondary indicator of cardiac output. At the end of each experiment, animals were examined for rib fractures on postmortem. Results from all experiments were grouped by treatment type and evaluated by ANOVA.

Results:
Increasing pneumatic belt pressures were associated with a trend toward higher CPPS and a significant increase in ETCO2 (P < 0.01) (See Figure). There were no palpable rib fractures in any of the animals, despite occasional constriction pressures as high as 300mmHg (5.8 PSI). Necropsy revealed visceral organ injury in some of the animals, but this could not be attributed to any specific CPR pressure.

Conclusion:
During CC-CPR, higher pneumatic belt pressures were associated with increased CPPs and ETCO2. Pressures as high as 300mmHg did not cause skeletal fractures. These trends may be affected by also optimizing rate and duty cycle. If confirmed in other models, higher belt pressures during CC-CPR merit evaluation in human clinical studies.
Abstract Su1011: Effect of Constriction Rates on Indicators of Hemodynamics in Circumferential Thoracoabdominal Cardiopulmonary Resuscitation
Authors: Paradis Aidan , Gaddy David , Moodie Karen , Mader Timothy , Dufresne Alexandre , Couturier Christine , Dufresne Simon , Davis Daniel , Sims Christopher , Paradis Norman
Published: November 2024

Introduction:
Data from human case series suggest that the optimal compression rate for sternal piston type CPR may be in the range of 130 compressions/min. Existing mechanical devices have compression rates of between 80 and 100 per minute. Circumferential thoracoabdominal CPR (
CTA-CPR
) may have enhanced hemodynamic effects and a superior safety profile, but the optimal constriction rate is currently unknown.

Hypothesis:
Constriction rates are positively correlated with indicators of hemodynamics in CTA-CPR.

Methods:
Ventricular fibrillation was induced in female Yorkshire swine (n = 9, ~30kg). CPR was provided by a prototype pneumatic CTA-CPR system. Constriction rates were varied in 45s epochs among 80, 100 and 120 per minute. Aortic (
Ao
) and right atrial (
RA
) pressures were measured using micromanometer catheters. Coronary perfusion pressure (
CPP
) was derived as the difference between the Ao and RA pressures. The change in CPP (
Δ-CPP
) from the beginning to the end of each treatment epoch was the principal indicator of hemodynamics. Data from all experiments were grouped by treatment type and subjected to Analysis of Variance.

Results:
Final Ao pressures for 80, 100, and 120 constrictions per minute were 27, 31, and 28 mmHg, respectively. Final RA pressures were 6, 7, and 7 mmHg. This yields CPPs of 20, 24, and 21 mmHg. The Δ-CPPs trended upward 5.3, 5.7, and 6.0, respectively (p < 0.10).

Conclusion:
Increasing constriction rates were associated with improved indicators of hemodynamics. The optimal rate may be similar to that seen in sternal piston CPR, and considerably higher than available with commercial automated devices.
Abstract Su102: Brain and plasma metabolic profiles after molecular hydrogen inhalation in a rat model of cardiac arrest
Authors: Ito-Hagiwara Kanako , Becker Lance , Endo Yusuke , Hagiwara Jun , Hayashida Kei
Published: November 2024

Background:
Inhaled molecular hydrogen gas (H
2
) has been shown to improve outcomes in both animal models and patients of cardiac arrest (CA). Although the molecular mechanisms of H2 have been studied, the impacts of H
2
on metabolic alterations following CA remain to be elucidated.

Methods:
Rats were subjected to 10 minutes of asphyxial CA followed by CPR to achieve a return of spontaneous circulation (ROSC). Ten minutes after achieving ROSC, rats were mechanically ventilated with 21% O
2
(Air group) or with 21% O
2
plus 1.3% H
2
(H
2
group). Whole-brain and plasma samples were obtained 2 h post-ROSC in each group (n = 5 for each). Unbiased GC/MS analysis was performed and the data were analyzed using MetaboAnalyst 6.0.

Results:
In brain, a total of 117 metabolites were analyzed. In H
2
group, 15 were significantly increased and 3 were decreased metabolites in comparison with Air group (raw P < 0.05, Fold Change (FC > 1.2 or < 0.8). By using metabolites with the variable importance in projection score > 1.0 based on partial least squares discriminant analysis, pathway enrichment analysis (PEA) was conducted. PEA identified specific metabolic pathways that are significantly changed in the brain following H
2
inhalation, including “Alanine, aspartate and glutamate metabolism”, “Glycine, serine and threonine metabolism”, “Arginine biosynthesis,” and “Arginine and proline metabolism” (all FDR < 0.01). These pathways are integral to cellular processes such as neurotransmitter synthesis, energy production, and cell signaling, highlighting the potential neuroprotective mechanisms of H
2
. In plasma, a total of 123 metabolites were analyzed. The H
2
group had 2 increased and 3 decreased metabolites compared to the Air group (raw P < 0.05, FC > 1.2 or < 0.8). PEA identified the “Valine, leucine and isoleucine biosynthesis” pathway (FDR < 0.01), suggesting the involvement of branched-chain amino acid metabolism, which plays a critical role in energy homeostasis and protein synthesis. These findings emphasize the systemic impact of H
2
inhalation on post-CA metabolic regulation.

Conclusion:
Our analysis reveals that inhaled H
2
induces significant metabolic alterations in both brain and plasma post-CA. The data highlight the broad metabolic impacts of H
2
in modulating several pathways crucial for cellular recovery and protection. Further research is warranted to elucidate biomolecular mechanisms and clinical applications of H
2
therapy in CA patients.
Abstract Su103: Targeting succinate metabolism for neuroprotection after cardiac arrest and resuscitation
Authors: Hagiwara Jun , Becker Lance , Ito-Hagiwara Kanako , Endo Yusuke , Hayashida Kei
Published: November 2024

Background:
Succinate dehydrogenase (SDH) is a key enzyme involved in succinate accumulation during ischemia and its subsequent oxidation upon reperfusion, leading to excessive reactive oxygen species production. Malonate, a competitive inhibitor of SDH, has emerged as a promising candidate for selective SDH inhibition to reduce reperfusion injury. However, studies targeting succinate metabolism for neuroprotection after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) are still extremely limited.

Methods and Results:
Adult male Sprague-Dawley rats were intubated, mechanically ventilated, and instrumented under anesthesia. Microcatheters were inserted into the left femoral artery for monitoring blood pressure and the left femoral vein for drug administration. The animals were subjected to 10 minutes of asphyxial CA, followed by CPR with epinephrine injection and finger chest compressions. The animals were assigned to three groups based on intravenous drug injections: dimethyl malonate injected during CA (DMM-CA group, n = 11), dimethyl malonate injected at the initiation of CPR (DMM-STAT group, n = 8), and saline injected during CA (saline group, n = 11). The animals were extubated 2 hours post-resuscitation, then were returned to their cages with easily accessible food and water and were monitored in a rodent facility with controlled room temperature. At 72 hours after a return of spontaneous circulation (ROSC), the survival rates were 72.7% in the DMM-CA group, 50.0% in the DMM-STAT group, and 36.4% in the saline group. The DMM-CA group exhibited a significantly higher survival rate (Kaplan–Meier analysis, P < 0.05) and better neurological function scores at 72 hours after ROSC (Mann-Whitney U test, P < 0.05) compared to the saline group. There was no statistically significant difference in survival rates between the DMM-STAT and saline groups. To further test the impact of succinate accumulation during CA on survival, dimethyl succinate was intravenously administered during CA in a separate group of animals subjected to 10 minutes of asphyxial CA (n = 6). None of the animals that received dimethyl succinate survived for 48 hours, confirming that succinate accumulation during CA contributes to mortality after CPR.

Conclusion:
Our results demonstrated that SDH inhibition was beneficial when initiated during CA in rats. Further studies are warranted to elucidate the impact of succinate metabolism on outcomes after CA and CPR.
Abstract Su105: Evaluation of a Novel Oxygen Carrier for Resuscitation in Hemorrhagic Shock Model Using a Target Mutation of Recombinant Heme-Protein
Authors: Lawrence Joshua , Abdelghany Youmna , Gandhi Alay , Tejero Jesus , DeMartino Anthony , Dent Matthew , Xu Qinzi , Hwang Hyon , Bocian Kaitlin , Huang Xue , Chen Xiukai , Poropatich Ronald , Gladwin Mark , Rose Jason
Published: November 2024

Introduction:
Hemorrhage remains a leading cause of preventable death in warfare and acute trauma. Given blood shortages, ongoing research is looking into successful artificial oxygen carriers. We engineered a non-globin heme-based molecule, the Bacterial Regulator of Carbon Monoxide Metabolism (RcoM), has oxygen carrier properties suitable for resuscitation in hemorrhagic shock.

Hypothesis:
We hypothesize that resuscitation with RcoM would improve mean arterial pressure (MAP) in hemorrhagic shock.

Methods:
A murine model of traumatic hemorrhagic shock was used to investigate the hemodynamic effects of RcoM. Mice were anesthetized with 1.5% isoflurane and received a laparotomy to induce soft-tissue trauma. The left femoral artery and vein were cannulated. The arterial cannula was used for blood pressure monitoring, and the venous cannula was used for bleeding and intravenous infusion. Upon stabilization, hemorrhage was induced by a 30-minute controlled pressure bleeding (25 to 40 mmHg) through the venous cannula then shock was maintained for another 30 minutes. This was followed by resuscitation infusion for 30 minutes by either lactated Ringer (LR) solution, human hemoglobin (HHb), or RcoM with a volume equal to the shed blood volume. The concentration was 2 mM for HHb and Rcom. Baseline MAP, post-resuscitation MAP, and MAP change were compared across the three groups using a one-way ANOVA.

Results:
There was no difference in the ratio of shed blood volume to the total blood volume (26.8 ± 3.4% for LR (n=7), 26.0 ±2.6% for HHb (n=3) and 27.6 ± 1.3% for Rcom (n=5), p = 0.7295). There was no difference for the baseline MAP between LR (83.5 ± 5.7 mmHg), HHb (87.4 ± 3.0 mmHg) and Rcom (82.3 ± 1.9 mmHg, p = 0.2931). The post-resuscitation MAP was significantly higher for RcoM (67.0 ± 6.3 mmHg) and HHb (60.4 ± 16.0 mmHg) compared to LR (25.9 ± 21.4 mmHg, p = 0.0029). There was no difference between Rcom and HHb in the post-resuscitation MAP (p = 0.8573). The MAP increase during resuscitation was significantly higher for Rcom (25.6± 5.8 mmHg) compared to LR (-8.5 ± 21.6 mmHg, p = 0.0197), but the difference between the HHb (19.0 ± 23.2 mmHg) and LR (p = 0.1155) was not statistically significant.

Conclusion:
This study demonstrates that resuscitation with RcoM supports the blood pressure in a murine traumatic hemorrhagic shock model, suggesting its potential application as a non-globin artificial oxygen carrier for hemorrhagic shock.
Abstract Su106: Cardiac Protection using Inhaled Argon During Resuscitation from Cardiac Arrest in Rats
Authors: Barajas Matthew , Oyama Takuro , Kashif Hisham , Kumar Aayush , Li Zhu , Riess Matthias
Published: November 2024

Recent investigations have demonstrated early promising results using inhaled noble gas therapy during cardiopulmonary resuscitation. Despite characterization as chemically inert, they have demonstrated biological activity at varied enzyme and receptor sites. Importantly, their mechanism of action on ischemia reperfusion injury remains unelucidated.1 We aimed to determine the efficacy of inhaled argon on ameliorating cardiac dysfunction associated with fibrillatory arrest in a rat model.

Fifteen male Sprague Dawley rats were utilized. Rats were mechanically ventilated via endotracheal tube and anesthetized with isoflurane. Femoral artery and vein were cannulated for pressure monitoring and drug delivery. An esophageal pacing probe provided low voltage current to induce fibrillatory arrest lasting a total of 7.5 minutes. CPR was initiated utilizing an automated chest compressor at a rate of 200/min with a controlled depth. Animals were randomly assigned to inhaled argon (70% with 30% O2) or control (70% N2 with 30% O2.) Defibrillation and epinephrine were given, in a standardized fashion. If return of spontaneous circulation (ROSC) was achieved, epinephrine drip was titrated to maintain a mean arterial pressure (MAP) of 70 mmHg. Data was collected at 15 min, 1 and 2 hr after ROSC. Data were analyzed using unpaired t-test. Significance set at p <.05, two-tailed.

There was no significant difference in rate of ROSC between groups (66% control vs 83% argon), however time to achieve ROSC was significantly reduced in the argon group, 350 v. 948 seconds, p = 0.02. Furthermore, animals treated with argon had increased survival time, 116 min vs 62 min control, p = 0.03. Decreased epinephrine requirement to maintain mean arterial pressure at 70 mmHg was seen in argon group 9.3 mcg min-1 vs 53.7 mcg min-1 in the control group, p = .04. There was no significant difference in peak lactate or other arterial blood gas markers.

Inhaled argon therapy remains a promising novel treatment after prolonged cardiac arrest. While other animal models have suggested similar findings, this is the first description in a fibrillatory rat model. Continued evaluation should aim to elucidate mechanism of action after demonstration of model effectiveness.
Abstract Su1102: The Effect of Structured Team Training on Basic Life Support Rates in General Wards of a German University Hospital
Authors: Jacobsen Nils , Wnent Jan , Hoffmann Hanna , Friebe Saskia , Neuenfeldt Felix , Hannappel Leonie , Scholz Jens , Graesner Jan-Thorsten
Published: November 2024

Background:
Basic CPR (B-CPR) is recognized as a crucial intervention in managing in-hospital cardiac arrest (IHCA). In 2020, only 80% of patients with cardiac arrest attended by an emergency medical team (EMT) at The University Medical Center Schleswig-Holstein (UKSH) received B-CPR by ward staff in advance.

Hypothesis:
It is anticipated that nursing staff in general wards of a hospital will significantly increase the initiation of basic resuscitation following education on the significance of basic resuscitation during a structured resuscitation training.

Aims:
The objective is to achieve a resuscitation rate of over 90% among ward staff within a two-year period through training efforts.

Methods:
The UKSH employs 16,000 individuals at two locations. All employees are required to participate in basic cardiopulmonary resuscitation (CPR) training every two years. A retrospective data analysis was performed using data from the German Resuscitation Registry for Kiel Campus. The primary outcome parameter was the frequency of basic resuscitation performed on general wards. Secondary outcome measures included the rate of return of spontaneous circulation (ROSC), mortality at the scene of the emergency, and the rate of discharge from the hospital.

Results:
Between 2020 and 2022, the number of calls for EMTs and the proportion of resuscitations remained stable at approximately 35%. However, the rate of basic life support initiated by ward staff increased significantly from 80% in 2020 to 98.6% in 2022 (χ2 = 11.52, p < 0.001). Other parameters, such as ROSC or mortality on scene, remained unchanged. The hospital discharge rates rose from 8.1% in 2020 to 12.2% in 2022, but this increase was not statistically significant (p = 0.408). Approximately 60% of employees participated in the training, equating to 5000 staff members attending a 2-hour session per year. This participation rate is likely due to personnel changes and the impact of the COVID-19 pandemic.

Conclusions:
The enhancement of resuscitation training resulted in an increase in basic cardiopulmonary resuscitation (B-CPR) performed on general wards. However, there was no statistically significant increase in hospital discharge rates, suggesting that while training enhances immediate resuscitation efforts, additional factors influence long-term survival outcomes. It is crucial to continuously emphasize the importance of basic resuscitation skills and training to sustain and further improve these outcomes.
Abstract Su1103: Resuscitation Reality: A Review on Current CPR Training for Older Adults
Authors: Xiong Jonathan , Gutta Gnanesh , Chiaberta Alexandria , Lane Nina , Doshi Ankur , Salcido David
Published: November 2024

Background:
Older adults are at high risk for experiencing out-of-hospital cardiac arrest, and therefore they are an important target for CPR training efforts. Physical, mental, and other barriers associated with advanced age present plausible obstacles to training/learning, and may warrant a need for tailored training programs.

Hypothesis:
Barriers to CPR training for older adults may be widely characterized, but efforts to resolve them are limited.

Goal:
This literature review’s purpose is to consolidate existing knowledge on teaching CPR to older adults and identify any gaps for future study.

Methods:
A complete search in both CINAHL and PubMed was conducted for the capture period 2014-2024. The terms “CPR”, “bystander CPR”, “older adult”, “training”, “development”, “out-of-hospital cardiac arrest”, “chest compressions”, and synonyms were used. The full search strategy will be shared at time of presentation. Search results not mentioning CPR, elderly people, and training of older adults were excluded. Any duplicates between the two databases were resolved. Included articles were reviewed by 2 researchers. Age, sex, and study designs were documented and summarized, with ranges, percentages or means reported where appropriate.

Results:
A total of 14 articles from CINAHL (n=8) and PubMed (n=6) were selected and were either qualitative surveys (n=4) or randomized control trials (n=10). In the studies reviewed, disparate knowledge or retention of CPR skills in older adults was linked to increased course duration or intricacy, physical or mental limitations (real or perceived), and lack of confidence. When analyzing the participants, the definition of older adult ranged from 55 to 65 years old and above with variable sample sizes (n=21-119, median=58). All the studies that documented sex had over 53% of older adults being female (n=53%-100%, median=64.85%). Studies identified methods to address limitations in older adults, including employing continuous chest compression delivery (versus 30:2) to improve quality/compliance, and Andrew’s Maneuver, also known as 4-hands CPR, for increasing effective compression depth while mitigating limited mobility and frailty.

Conclusion:
Within current literature, established best practices for teaching older adults CPR are limited, and few studies attempt to characterize the limitations of training older adults. Of those studies available in the literature, valuable foundations are available for future work.
Abstract Su1106: Evaluating Culturally Competent Cardiopulmonary Resuscitation (CPR) Training in Urban Minority Communities
Authors: Sivashankar Smaran , Monk Lisa , Lightfoot Alexandra , Cope Tyler , Osude Nkiru , Woodward Kim , Shirolkar Parth
Published: November 2024

Introduction:
Timely resuscitation can triple the chance of survival for out-of-hospital cardiac arrest (OHCA) patients. Differences in bystander CPR rates between white and minority communities lead to significant racial and ethnic disparities in OHCA survival rates. Immigrant populations, in particular, face several educational barriers and are often excluded in community CPR trainings. Previous efforts have increased the inclusivity of CPR education for female and disabled citizens through targeted interventions. Significant opportunities exist to apply similar strategies and tackle community-level disparities.

Aim:
To examine the impact of culturally competent CPR instruction on confidence levels and acceptability of CPR skills among minority citizen groups.

Methods:
CPR cohorts were taught using a local emergency services syllabus. Through discussion with course site leaders, the syllabus was adapted in three categories: language variations, cultural adaptations, and/or consideration of cultural learning styles. A pre-post design was utilized to assess impact of culturally-tailored CPR training. Confidence and acceptability levels in performing CPR were measured using a digital survey. An unpaired t-test was used to analyze pre/post-course data. Trainings were held from November 2023 to May 2024.

Results:
All participants were 18 years or older (n=217). The response rate was 36.7% (n=80). Confidence levels increased by 121% for checking for breathing and responsiveness (p<0.0001), 63.9% for communicating with 911 (p<0.0001), 137% for administering chest compressions (p<0.0001), and 172% for connecting an AED (p<0.0001). CPR acceptability improved, with participants reporting a 47.8% reduction in perceived difficulty post-course (p<0.0001).

Conclusions:
Implementing culturally tailored CPR training significantly improved confidence in CPR skills and acceptability of CPR. Future experiments may compare outcomes between intervention and control CPR cohorts at more course sites.
Abstract Su1107: Online educational film depiction of opioid overdose causing cardiac arrest
Authors: Bejto Ensi , Mofidi Nasab Pouyan , Toft Lorrel
Published: November 2024

Introduction:
Opioid overdose (OD) is a growing cause of cardiac arrest in the US, spurred by the rise of illegally manufactured fentanyl and analogs. Naloxone is a reversal agent that can be administered by bystanders. Intra-nasal (IN) naloxone is now widely available in pharmacies across the US. Despite increasing access, minority populations remain disproportionately affected by drug overdose deaths. There are many free online opioid OD educational videos. Digital media can be a powerful tool for mass education, but the effectiveness is unknown.

Research Question and Aims:
The goal of this study was to evaluate online opioid overdose videos for content and gender/racial representation.

Methods:
We performed an online search with the query “how to give Narcan” (popular term for IN naloxone). Results were limited to the first 52 Google, 50 YouTube, and 60 TikTok videos. Exclusion criteria included: animal victim, duplicate, or no mention of naloxone. For each video, 2 reviewers evaluated content and identified the race and gender of featured characters. Disagreements were resolved through consensus. The race and gender of featured characters was compared using a two proportion z-test. Inter-rater reliability (IRR) for each data point was calculated using the arithmetic mean of Cohen's kappa.

Results:
Of 121 videos, the majority (87.6%) mentioned naloxone as a treatment for opioid OD; 62.8% provided instruction on how to administer IN naloxone, and 4.1% featured a testimonial. Only 43.0% provided a realistic visual demonstration of IN naloxone administration; 25.6% showed a realistic re-enactment of opioid overdose, and even fewer (19.0%) showed the dramatic response to naloxone. IRR was high for all categories.

Videos predominantly featured white compared to non-white-appearing characters in both the victim (75.5 v. 17.8%, p< 0.00001) and rescuer roles (72.5 v 21.6%, p<0.00001). The rescuer gender was evenly distributed male v. female; however, the victim was more often male (77.8% v. 22.2%, p<0.00001).

Conclusion:
Most online opioid OD videos provide instructions on how to use IN naloxone, but do not feature realistic depictions of cardiac arrest caused by opioid OD, naloxone treatment, or response. There is a significant lack of racial diversity in these videos. Digital materials are needed with improved diversity and which teach learners how to RECOGNIZE and respond to opioid OD.
Abstract Su1201: Alteration in cerebrospinal fluid flow in out-of-hospital cardiac arrest patients who underwent target temperature management.
Authors: Jeon So Young , You Yeonho , Park Jung Soo , Kang Changshin , Min Jin Hong , Jeong Wonjoon , IN YONGNAM , Ahn Hong Joon
Published: November 2024

Background:
Various parameters of cerebrospinal fluid (CSF) flow measured through magnetic resonance imaging (MRI) flowmetry are utilized to assess the progression of certain diseases. Our study evaluated changes in CSF flow using MRI flowmetry in survivors of out-of-hospital cardiac arrest (OHCA) who underwent target temperature management (TTM).

Methods:
This prospective observational cohort study was conducted from May 2023 to April 2024 at a single center. We performed Wilcoxon signed-rank tests to compare maximum velocity (V
max
), stroke volume (SV), maximum flow (flow
max
), and stroke distance measured immediately after return of spontaneous circulation (ROSC) with those measured at 72 h after ROSC.

Results:
Of the 20 patients enrolled, 7(35.0%), 1(5.0%), 2(10.0%), 5(25.0%) and 5(25.0%) patients had CPC scores of 1, 2, 3, 4, and 5, respectively. V
max
, SV, flow
max
, stroke distance measured immediately after ROSC were 3.41 (2.03~4.96), 14.00 (4.00~23.38), 0.09 (0.06~0.22), -0.07 (-0.17~0.05), respectively. V
max
, SV, flow
max
, stroke distance measured at 72h after ROSC were 5.26 (2.76~9.28), 24.00 (10.38~42.25), 0.14 (0.08~0.31), -0.07 (-0.18~0.03), respectively. Although V
max
, SV, and flow
max
measured at 72 h after ROSC were statistically significantly higher compared to those measured immediately after ROSC (p = 0.002, 0.02, 0.002), there was no significant difference between the stroke distances measured immediately after ROSC and at 72 h after ROSC (p = 0.43). Additionally, the caudocranial direction of CSF flow was observed in 13 (65.0%) patients immediately after ROSC, and in 14 (70.0%) patients 72h after ROSC.

Conclusion:
This study demonstrated that alterations in cerebrospinal fluid flow were observed in OHCA patients. However, Further studies are needed to determine whether there are differences in alteration in CSF flow based on neurological prognosis.
Abstract Su1204: Impact of Hypothermia vs. Normothermia Temperature Management Based on Body Temperature at Hospital Arrival on 30-Day Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients: A Nationwide, Retrospective Study in Japan
Authors: Nojima Tsuyoshi , Naito Hiromichi , Obara Takafumi , Kosaki Yoshinori , Hongo Takashi , Yumoto Tetsuya , Tsukahara Kohei , Nakao Atsunori
Published: November 2024

Introduction:
Temperature management (TM) to prevent fever is crucial to mitigate neurological deterioration post-cardiac arrest. Whether hypothermic TM (h-TM) is superior or equal to normothermic TM (n-TM) after out-of-hospital cardiac arrest (OHCA) is debatable, prompting ongoing effects to identify patients who might benefit more from h-TM. We hypothesized that effect of TM would differ based on body temperature at hospital arrival.

Aim:
Explore which post-cardiac arrest patient subsets might benefit from h-TM by stratifying them based on body temperature at hospital arrival.

Methods:
This retrospective, observational study used data from the OHCA registry in Japan. Patients 18 years and older who experienced OHCA due to medical cause and received TM in the intensive care unit were included. Primary outcome measure was 30-day favorable neurological outcomes, defined as a Cerebral Performance Category score of 1 or 2. Patients were stratified into groups based on body temperature at hospital arrival: normothermia (36.0-38.0°C), hypothermia (<36.0°C), and hyperthermia (>38.0°C). Effect of TM post-cardiac arrest (h-TM [32-34°C] or n-TM [35-36°C]) was evaluated in each stratified group. Univariable and multivariable logistic regression analysis was used for comparison. Adjusted odds ratio (OR) for favorable neurological outcome with h-TM was calculated using n-TM as a reference. Hyperthermia was excluded from multivariable analyses due to small sample size.

Results:
We analyzed 3,044 patients, 1,273 in the normothermia group, 1,747 in the hypothermia group, and 24 in the hyperthermia group. Numbers of patients with favorable neurological outcomes were as follows: 530/1,273 (41.6%) in the normothermia group, 584/1,747 (33.4%) in the hypothermia group, and 4/24 (16.7%) in the hyperthermia group. There were no differences in favorable 30-day neurological outcomes between h-TM and n-TM in any stratified group in the univariable analysis: normothermia (h-TM 323/785 [41.2%] vs. n-TM 207/488 [42.4%], p=0.66); hypothermia (411/1,185 [34.7%] vs. 173/562 [30.8%], p=0.11); hyperthermia (3/13 [23.1%] vs. 1/11 [9.1%], p=0.59). Multivariable analysis also showed no differences: normothermia (OR: 0.96, 95% CI: 0.72-1.26), hypothermia (OR: 1.10, 95% CI: 0.85-1.42).

Conclusion:
TM (h-TM vs. n-TM) did not significantly affect 30-day neurological outcomes, regardless of initial temperature at hospital arrival.
Abstract Su1206: Reduced Time to Goal Therapeutic Hypothermia With Implementation of a Post Cardiac Arrest Consult Service
Authors: Palka Sydney , George Ben , Gonillo Jenna , Cardamone Lisa , Helmy Samantha , Cardona Jeronimo , Escobar Samantha , McHugh Daryl , Roberts Debra , Khan Imad
Published: November 2024

Introduction:
Critical care after advanced cardiac life support can be pivotal for survival and outcomes in patients with out-of-hospital cardiac arrest (OHCA). Prior studies have demonstrated improvements in survival after OHCA with shorter door-to-therapeutic hypothermia (TH) initiation times. Post-cardiac arrest consult teams (PCACT) can facilitate TH to goal 33°C and other aspects of post-arrest care. However, the effects of such a service on TH have not been consistently quantified.

Hypothesis:
More OHCA patients would undergo TH and reach goal temperature sooner following implementation of a PCACT.

Aims:
We aim to evaluate the effectiveness of a PCACT in optimizing TH in survivors of OHCA.

Methods:
We conducted a retrospective chart review of 305 patients admitted between January 1, 2021 and December 31, 2022. Implementation of a dedicated PCACT, comprised of a neurointensivist and an advanced practice provider or neurocritical care fellow, occurred on January 1, 2022. The PCACT was active on weekdays only. One year before and after this date were designated as “pre-PCACT” and “post-PCACT”, respectively. De-identified patient demographics, clinical features of cardiac arrest, and TH data were collected and compared using Wilcoxon rank-sum and Chi-squared tests for continuous and categorical variables, respectively.

Results:
Of the 305 patients admitted during the study period, 149 were in the pre-PCACT group and 156 were in the post-PCACT group. Baseline demographics between the two groups were similar except that the post-PCACT group had more patients with non-shockable rhythms (64% vs. 54%,
p
=0.001). Patients were not cooled to 33°C more frequently (50 vs. 52%) pre- or post-PCACT. TH to 33°C was performed in 156 (51%) patients, 78 patients (50%) pre- and post-PCACT implementation. There were no baseline demographic or temperature differences between the two groups amongst patients undergoing TH to 33°C. Post-PCACT patients were quicker to reach 33°C (1.6 vs. 3 hours,
p
=0.001). After PCACT implementation, this difference was noted during weekdays but not during weekends (1.3 vs. 2.7 hours,
p
=0.05).There were no differences in survival or neurologic outcomes pre- and post-PCACT introduction, nor between patients who were or were not cooled to 33C.

Conclusion(s):
Implementation of a PCACT may streamline care to reduce time to goal temperature during TH. However, further study is required to determine whether a PCACT can improve outcomes.
Abstract Su202: Physiological response to vasopressor administration during hemodynamic-directed CPR
Authors: Sueishi Takayuki , Gaudio Hunter , Silva Luiz , Ko Tiffany , Slovis Julia , Mavroudis Constantine , Hwang Misun , Zuckerberg Jeremy , Herrmann Jeremy , Senthil Kumaran , Berg Robert , Sutton Robert , Morgan Ryan , Kilbaugh Todd
Published: November 2024

Background:
The hemodynamic response to successive vasopressor doses during CPR and its association with survival is poorly defined. Understanding these relationships can facilitate identification of alternative vasopressor strategies.

Hypothesis:
Non-survival is associated with lower responsivity to successive vasopressors.

Methods:
We performed retrospective analysis of hemodynamic data acquired in pediatric swine models (sus scrofa, 9-12kg) of asphyxia-associated ventricular fibrillation cardiac arrest with use of hemodynamic-directed CPR (n=175). Starting 2m into CPR, if hemodynamic targets were not met, vasopressors were given in cycles comprising two doses of 0.02mg/kg epinephrine (Epi) followed by vasopressin (Vaso, 0.4U/kg), separated by a minimum of 1m. After a minimum of 2m, the cycle was repeated. Hemodynamic response was evaluated using the peak diastolic blood pressure (DBP) within 1m for Epi, 2m for Vaso administration and the difference between the initial and peak DBP (delta DBP). Subjects were classified as “responder” if either a delta DBP > 5 mmHg or a peak DBP > 25 mmHg was achieved, and a “non-responder” otherwise. Animals were deemed “survivors” if ROSC was achieved following initial defibrillation.

The change in delta DBP for successive vasopressors was compared in survivors versus non-survivors using two-sided Wilcoxon rank-sum tests. Continuous variables are summarized using the median with interquartile ranges. The burden of “non-response” was used to a construct confusion matrix and calculate performance.

Results:
Non-survivors (n=30) had lower delta DBP than survivors (n=145) following successive vasopressor administration at the first cycle (first Epi dose: 7.8 [2.4, 14] vs 16 [7.5, 24], p< 0.01; second Epi: 2.0 [0, 4.7] vs 7.1 [2.0, 12], p< 0.01; Vaso : 1.1 [0, 2.3] vs 7.1 [2.0, 12], p< 0.01). Classification as a “non-responder” at the first cycle (Epi-Epi-Vaso) was significantly predictive of non-survival (Sensitivity 32%, Specificity 92%). Animals that failed to respond to all vasopressors at the first cycle had a significantly increased rate of mortality (86%; 6 non-survivors, 1 survivors) compared to animals that responded to all 3 vasopressors (13%; 16 non-survivors, 111 survivors).

Conclusion:
Mortality was significantly associated with lower DBP response to successive vasopressors during hemodynamic-directed CPR in pediatric swine models of cardiac arrest, which may suggest a critical timepoint to activate ECPR.
Abstract Su203: Development of Bioimpedance for the Measurement of Ventilation During Cardiopulmonary Resuscitation
Authors: Prakash Rithika , Jarrett Philip , Idris Ahamed
Published: November 2024

Introduction:
Previous studies have shown that ventilation during cardiopulmonary resuscitation (CPR) produces better patient outcomes. However, research regarding ventilation during the early stages of basic life support CPR is limited. Prior studies showed that thoracic bioimpedance, recorded by the LifePak 12 defibrillator device, can be used to count ventilations with a tidal volume at least 250 mL during CPR. However, the relationship between thoracic bioimpedance and tidal volume has yet to be studied for the Phillips MRx device, excluding a large data set from ventilation studies.

Hypothesis:
Bioimpedance, measured by the Phillips MRx device has a linear relationship with tidal volume.

Aims:
To determine the relationship between bioimpedance measured by the Phillips MRx device and tidal volume in males and females.

Methods:
We conducted the study in a respiratory laboratory at a University Hospital. We asked 27 volunteers to breathe fixed volumes (250 mL, 300 mL, 400 mL, 600 mL, and 800 mL) delivered by a mechanical ventilator while recording bioimpedance simultaneously with the Philips MRx monitor-defibrillator through electrode pads placed on the chest. Six measurements of bioimpedance waveform amplitudes (Ohms) were taken at each tidal volume.

Results:
Of 27 volunteers, 11 were female and 16 were male. In the female sample set, a linear equation of y=0.003x + 0.837 with an R^2 value of 0.9995 was calculated. In the male sample set, a linear equation of Y=0.0016x +0.1039 with a R^2 value of 0.995 was calculated. Females had a higher median bioimpedance amplitude than men at each tidal volume, and a steeper linear regression slope. At the minimum threshold tidal volume used for counting ventilations (250 mL), the median bioimpedance amplitude was 0.5 (0.4, 0.6) ohm for males and the median bioimpedance amplitude was 0.8 (0.6, 1) ohm for females.

Conclusion:
As measured and recorded with the Philips MRx monitor-defibrillator, there is a linear relationship between tidal volume and thoracic bioimpedance. The linear models created in this study can be used in future studies to count ventilations during CPR using the Philips MRx device.
Abstract Su204: Association between delta E
T
CO
2
and Return of Spontaneous Circulation in a National US Cohort
Authors: Grabman Bartholomew , Fisher Benjamin , Mann N. Clay , Braude Darren , Huebinger Ryan
Published: November 2024

Introduction:
International guidelines support use of end-tidal carbon dioxide (E
T
CO
2
) for monitoring resuscitation in out-of-hospital cardiac arrest (OHCA). Specific E
T
CO
2
cutoffs have been proposed for termination of resuscitation, though data on rates of ROSC based on changes in E
T
CO
2
is limited. We aimed to evaluate the relationship between change in E
T
CO
2
in OHCA and its relationship to return of spontaneous circulation (ROSC) using a US national database.

Methods:
This retrospective analysis of National Emergency Medical Services Information System (NEMSIS) datasets from 2020 to 2022 evaluated all adult patients who underwent resuscitation for OHCA and had multiple E
T
CO
2
measurements. We excluded cases with missing data. The highest difference between two sequential E
T
CO
2
measurements (MΔE
T
CO
2
) and total difference between minimum and maximum E
T
CO
2
measurements [TΔE
T
CO
2
] were calculated for each case. ΔE
T
CO
2
groups were stratified into 10-unit increments and we compared rates of ROSC between groups. We then used multivariable logistic regression to evaluate the association between each 5 unit increase in ΔE
T
CO
2
and ROSC. We adjusted for age, sex, location, witness status, initial shockable rhythm, and CPR or AED prior to EMS arrival.

Results:
We included 274,516 total patients with 1,686,390 E
T
CO
2
measurements. The median number of E
T
CO
2
measurements was 5 (IQR 3-8). Median age was 65, 62.8% were male, 60.1% had witnessed arrests, and 78.3% received CPR and 32.3% received AED placement prior to EMS arrival. ROSC rates based on MΔE
T
CO
2
were 0-10 mmHg [33.3%], 10-20 mmHg [42.3%], 20-30 mmHg [49.7%], 30-40 mmHg [53.2%], and >40 mmHg [56.6%]. ROSC rates for TΔE
T
CO
2
were 0-10 mmHg [29.6%], 10-20 mmHg [36.7%], 20-30 mmHg [43.5%], 30-40 mmHg [48.9%], and >40 mmHg [54.6%]. Adjusted odds of ROSC per 10 mmHg increase in MΔE
T
CO
2
was 1.21 [1.21-1.22] and TΔE
T
CO
2
was 1.19 [1.19-1.19].

Conclusions:
Increasing max and overall ΔE
T
CO
2
was associated with increased rates and odds of ROSC for OHCA.
Abstract Su206: Early Metabolic Effects of Prehospitally Administered High-Dose Glucocorticoids in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest
Authors: Beske Rasmus , Obling Laust Emil Roelsgaard , Meyer Martin , Grand Johannes , Josiassen Jakob , Moller Jacob , Kjaergaard Jesper , Johansson Per , Hassager Christian
Published: November 2024

Background:
Administration of glucocorticoid in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) mitigate the inflammatory response within the first 24 hours. The anti-inflammatory action is mediated through genomic effects, taking hours to days to set in, but glucocorticoids may also exert acute, non-genomic effects. The interplay between inflammation and metabolism is becoming more evident and emerging evidence suggests that early metabolic interventions can reduce reactive oxygen species, thus preventing cell apoptosis and necrosis. Hence, it is pivotal to investigate whether glucocorticoids cause significant metabolic effects in this context.

Methods:
Sub-study of a two-center, blinded, randomized controlled trial (NCT04624776) examining the effects of prehospital administration of 250 mg methylprednisolone versus placebo in comatose patients resuscitated from OHCA of presumed cardiac cause. Blood samples were collected upon hospital arrival (T0) and 48 hours later (T48). A total of 60 metabolites were quantified by mass-spectrometry and compared between groups following adjustment for sex, age, time to return of spontaneous circulation (ROSC), ST-elevation myocardial infarction, and time from intervention to sampling (only at T0). All results were corrected using the false-discovery rate method to account for multiple tests.

Results:
In the modified intention to treat population (mITT) 68 (50%) had been randomized to glucocorticoid and 69 (50%) to placebo. Blood samples were available for 121 (88%) and 117 (82%) patients at T0 and T48, respectively. Median age was 66 years (IQR: 56- 74) and 100 (83%) patients were men. Median time to ROSC was 16 min (10-20), and study medicine was administered prehospital 20 min (13-29) following ROSC with blood samples at T0 being drawn after 107 min (64-180).

Though a nominal difference was observed at hospital arrival (Figure 1 left), we found no metabolic effects following correction for multiple testing. At T48, glucocorticoid showed increased plasma levels of many amino acids, especially tryptophan (Figure 1 right), while prostaglandin E2 and free fatty acids associated with inflammation were higher in the placebo group.

Discussion:
We did not find evidence for early metabolic effects of glucocorticoid treatment after OHCA. In contrast, several metabolites were affected at T48, including an increase in plasma tryptophan levels in the glucocorticoid group and lower levels of prostaglandin E2.