bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 360: Effects of Different Doses of Pralidoxime Administered During Cardiopulmonary Resuscitation and the Role of Alpha-Adrenergic Receptors in its Pressor Action
Authors: Mamadjonov Najmiddin , Jung Yong Hun , Lee Hyoung Youn , Jeung Kyung Woon , Lee Byung Kook , YOUN Chun Song , Heo Tag , Min Yong Il
Published: June 2021

Introduction:
We previously reported that pralidoxime potentiated the pressor effect of epinephrine and improved restoration of spontaneous circulation (ROSC) rate and short-term survival in pigs undergoing cardiopulmonary resuscitation (CPR). We sought to explore the optimal dose of pralidoxime to be used during CPR and to evaluate the involvement of α-adrenoceptors in its pressor action.

Methods:
In the first substudy, 44 pigs randomly received one of three doses of pralidoxime (40, 80, or 120 mg/kg) or saline placebo during CPR. All animals were given epinephrine every 3 minutes. In the second substudy, 49 rats were divided into 7 groups. In the first 4 groups, the effects of 40 mg/kg pralidoxime on arterial pressure were determined after pretreatment with saline, guanethidine, phenoxybenzamine, or phentolamine. In the other 3 groups, the effects of 200 mg/kg pralidoxime were determined after pretreatment with saline, propranolol, or phentolamine.

Results:
In the first substudy, 40 mg/kg pralidoxime resulted in the highest coronary perfusion pressure (CPP) among the groups, while 120 mg/kg pralidoxime resulted in the lowest CPP (group effect
P
<0.001). Sustained ROSC was attained in 4 (36.4%), 11 (100%), 9 (81.8%), and 3 (27.3%) animals in the saline, 40 mg/kg, 80 mg/kg, and 120 mg/kg groups, respectively (
P
<0.001). In the second substudy, 40 mg/kg pralidoxime elicited a pressor response. Phenoxybenzamine completely inhibited the pressor response, but guanethidine and phentolamine did not. The pressor response of pralidoxime was even greater after pretreatment with guanethidine or phentolamine. Two-hundred mg/kg pralidoxime produced an initial vasodepressor response followed by a delayed pressor response. Phentolamine eliminated the initial vasodepressor response and reversed it into a pressor response.

Conclusions:
Forty mg/kg of pralidoxime administered with epinephrine led to a significantly higher ROSC rate by improving CPP in a pig model of cardiac arrest, whereas 120 mg/kg did not improve CPP or the ROSC rate. Our findings suggest that the pressor effect of pralidoxime is unrelated to α-adrenoceptors and that its pressor effect is buffered by its vasodepressor action mediated by the inhibition of the sympathetic nervous system.
Abstract 370: Delivery of CPR in Patients With Single and Biventricular Cardiac Disease
Authors: Sweberg Todd , Griffis Heather , Yu Priscilla , Esangbedo Ivie , Bora Kelly , Niles Dana E , Zhang Xuemei , Hanna Richard , Nadkarni Vinay M , Raymond Tia T
Published: June 2021

Introduction:
Diminished survival after cardiopulmonary resuscitation (CPR) has been shown in patients with congenital heart disease (CHD) and single ventricle (SV) anatomy compared to biventricular anatomy (BV). The role guideline-compliant CPR plays in SV outcomes is unknown.

Hypothesis:
During pediatric in-hospital cardiac arrest (IHCA), there will be a difference in CPR delivery and outcomes of patients with SV compared to BV anatomy.

Methods:
Prospective observational cohort from 12 pediRES-Q sites of IHCA in children ≤ 18 years with CPR quality metric data (chest compression (CC) rate, depth, and fraction (CCF)) (Zoll R-Series, Chelmsford, MA). We compared 60-sec CC epoch compliance with 2015 American Heart Association guideline targets defined as: CC rate 100-120/min; depth ≥4.0 cm in <1 yo, ≥5 to ≤6 cm in 1-<18 yo; and CCF ≥0.80. Total guideline compliance was defined as a CC event with ≥ 60% epochs meeting all targets. Metric summaries were reported as median [IQR] and compliance as frequency (%). Differences were assessed using Wilcoxon rank-sum and Fishers exact tests, respectively. Logistic regression assessed for associations with outcomes, including anatomy and proportion of guideline-compliant CPR.

Results:
From 10/2015 to 3/2019, we analyzed 82 events (> 5 epochs) in patients with CHD. Thirty-seven percent had SV anatomy and more SV patients were post-operative (70% vs 2%). There were no differences in time to first epinephrine dose (1 vs 2 min), shockable rhythm (7% vs 6%), or need for ECMO (27% vs 23%). Total guideline compliance across all ages was not different (SV 10.0% vs BV 5.8%, P=0.67) and not associated with ROSC or survival to hospital discharge (SHD). There was a 75% lower adjusted odds of SHD in 1-<8 yo vs <1 yo.

Conclusion:
There were no meaningful differences in resuscitative practice or delivery of guideline-compliant CPR in those with SV versus BV anatomy. Guideline-compliant CPR was not associated with outcomes regardless of cardiac anatomy.
Abstract 386: Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness
Authors: Barnhart Bruce J , Spaite Daniel W , Helfenbein Eric , Jorgenson Dawn , Babaeizadeh Saeed , Gaither Joshua B , Rice Amber D , Keim Samuel M , Hu Chengcheng
Published: June 2021

Background:
The EMS traumatic brain injury (TBI) guidelines encourage limiting prehospital intubation (ETI) to patients with profoundly depressed level of consciousness (LOC) and who cannot protect their airway or adequately ventilate without ETI. Thus, EMS providers may manage many TBI patients without intubating even when they have significant alterations in LOC. Monitoring End-Tidal CO2 by placing sensors in the nares (NC-CO2) of non-intubated patients may give providers valuable information about ventilatory status and trends.

Study Objective:
To evaluate the association between LOC and NC-CO2 in non-intubated TBI patients.

Methods:
Non-intubated cases from 6 EMS agencies reporting continuous monitor data (Philips MRx™) in the EPIC Study (NIH 1R01NS071049) were evaluated (4/13-3/17). Glasgow Coma Scale (GCS) was available from the EMS record in call cases. Comparisons in patient-level mean, median, lowest and highest NC-CO2 levels were made across GCS categories using clinically meaningful thresholds: <15, <12, <9, and 3. Statistics: Wilcoxon rank-sum test.

Results:
Included were 106 cases [median age: 47 (range: 9-91), 66% male]. The Table shows the NC-CO2 patterns and comparisons across the GCS categories. In no case was there a significant difference in NC-CO2 between the better vs. worse mental status cohort.

Conclusion:
We believe this is the first evaluation of the association between NC-CO2 and mental status in TBI. Patients that had significant (and even profound) decreases in LOC, but whom paramedics chose not to intubate, had remarkably similar NC-CO2 patterns compared to those with normal or near-normal mental status. This may support the overall approach of limiting ETI to those with airway/ventilatory compromise or impending hypoxia as there was no evidence of increasing NC-CO2, indicative of hypercapnia, in the non-intubated patients even when they had very depressed LOC.
Abstract 392: Use of a Low Resource Model for Group Cardiopulmonary Resuscitation Training: Knowledge Gains and Attitude Changes
Authors: Goldstein Matthias , Goldstein Benjamin , Novograd Joel , Wallace Inayzha , Goldstein Leah , Carden Kailah
Published: June 2021

Introduction:
CPR training and regular skills practice is often limited by the availability of a high resource device such as a manikin torso. We investigated the knowledge gains and attitude changes in student participants of group hands-only CPR training (20-50 participants) using a low resource device, a bed pillow, to practice skills.

Methods:
Hands-only CPR trainings, utilizing a bed pillow for skills practice, were conducted for groups of college students. Using a one-group pre-test post-test design, participants (n=360) completed a questionnaire which included demographic information, prior history of CPR training, and multiple-choice questions to evaluate knowledge. Five-point Likert scale questions were used to assess attitudes specific to willingness to perform CPR, confidence in ability to perform CPR and likeliness to practice skills in the next year. The survey was completed prior to training. The participants then watched a demonstration followed by interactive skills practice on a pillow. A specially designed printed pillow case was used to show hand position landmarks and review information. The post training survey was then completed and each participant was provided a printed pillow case for future skills practice and review.

Results:
129 participants (36%) had no prior CPR training, there were more females 273 (76%) than males, and the average age of participants was 20 years old. Correct knowledge regarding depth of compressions increased by 47% (47 to 94) while speed of compression knowledge increased by 52% (40 to 92). In a paired analysis, there were significant differences (p<.0001) in all attitude measures from pre-to-post training. Willingness to perform CPR increased 31% (gain=0.94, pre test=3.01), confidence to perform CPR, 45% (gain=1.18, pre test=2.64) and likeliness to practice skills in the next year, 20% (gain=0.59, pre test=2.97).

Conclusions:
Participation in group hands-only CPR training using a low resource device for skills practice resulted in significant knowledge gains and improved attitudes in the areas of willingness to perform CPR, confidence to perform CPR and skills practice likeliness. This training method can provide an accessible and cost-effective means for providing group CPR training.
Abstract 398: A New Paradigm in Resuscitation Education: “Does Frequency Matter?”
Authors: Ward Kathleen , Rivera David
Published: June 2021

Introduction:
Survival of in-house cardiac arrests (IHCA) is dependent upon high quality cardiopulmonary resuscitation (CPR). While current BLS and ACLS training occur biannually, studies demonstrate that skills and knowledge diminish over time. Although Self Efficacy (SE) correlates with CPR skills and knowledge, one’s SE can be strengthened through mastery experiences. The RQI training program increases the frequency of training. This study questioned Resuscitation Quality Improvement (RQI), a new quarterly training program, and its influence on self-efficacy and skill decay

Methods:
The study used a quantitative, quasi-experimental design with a convenience sample derived from 3 medical-surgical (MS) units. Registered nurses (RNs) completed the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) survey. Two units were enrolled in traditional life support training, an intervention unit completed the RQI program. Performance data was obtained from program mannequins. Data analysis used Chi-square statistic and ANOVA; p-value 0.05 determined statistical significance. Data sets were inclusive of BRS-SES and performance reports from RQI.

Results:
SE increased on the intervention unit baseline to 1 year (1512.4±226 to 1600±164, p=0.068); SE improved for safe use of automated external defibrillator (AED)/Defibrillator (627.2±91 to 661.8±71, p=0.034); CPR Skill (350±52 to 374.6±65, p=0.117); recognition (535.2±91 to 563.6±55, p=0.173). RNs < 40 years of age demonstrated an increased SE compared to their peers. Performance was measured by average attempts to pass (ATTP) and mean score with the RQI: compression (2.3 to 1, 79 to 95.4); ventilation (1.6 to 1, 81.1 to 94.9).

Conclusions:
The RQI training program was associated with increased SE and decreased skill decay. Age appears to influence the degree of success in nurse training using this new methodology. Data suggests an association between RQI and clinical outcomes. Multi-site studies are recommended for future study.
Abstract 418: Categorization of Post-Cardiac Arrest Patients According to the Pattern of Amplitude-Integrated Electroencephalography After Return of Spontaneous Circulation: Analysis of Long-Term Prognosis
Authors: Sugiyama Kazuhiro , Miyazaki Kazuki , Hamabe Yuichi
Published: June 2021

Introduction:
Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG easily interpreted by emergency physicians and intensivists at the bedside. We previously reported that categorizing post-cardiac arrest patients according to the pattern of aEEG, after return of spontaneous circulation (ROSC), could help predict the neurological function at hospital discharge (Critical Care. 2018;20:226). In post-cardiac arrest patients, increasing importance is being placed on long-term prognosis. In this study we evaluated the neurological outcome of patients in each category from our previous study, one year after cardiac arrest.

Methods:
We assessed the outcomes of patients who received post-cardiac arrest care, including targeted temperature management (TTM) and aEEG monitoring, in our tertiary emergency center, between March 2013 and April 2017. The patients were divided into four categories: C1 included those who displayed continuous normal voltage (CNV), within 12 hours of ROSC, and the best aEEG pattern in post-cardiac arrest patients; C2 included those who recovered CNV between 12 and 36 hours after ROSC; C3 included those with no CNV up to 36 hours after ROSC; and C4 included those who revealed burst suppression any time after ROSC. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2, one year after cardiac arrest.

Results:
A total of 60 patients, with a median age of 60 years, were assessed; of them, 41 (68%) had an initial shockable rhythm. A good outcome was recorded in 18/19 (95%) C1 patients, 8/14 (57%) C2 patients, 1/10 (10%) C3 patients, and 0/14 C4 patients. Three patients could not be categorized because the recording period was too short.

Conclusion:
The categorization of post-cardiac arrest patients according to the pattern of aEEG after ROSC may be useful to predict long-term neurological function. C1 patients had excellent prognosis, while C3 and C4 patients had poor prognosis. However, one patient in the C3 group had CPC 3 at hospital discharge and then recovered to CPC 2 within one year. Withdrawal of care should be considered cautiously, using a multimodal approach, for patients in this category. C2 patients have borderline prognosis and are targets for intensive post-cardiac neurological care.
Abstract 446: Availability and Quality of Cardiopulmonary Resuscitation Films Featuring a Female Victim on the Internet: A Cross-Sectional Study
Authors: Lynes Carlos , Brown Lorrel
Published: June 2021

Introduction:
Bystander cardiopulmonary (CPR) improves survival following out-of-hospital cardiac arrest (OHCA). However, women are less likely than men to receive CPR in public locations. Female-specific issues such as fear of touching breasts have been identified as barriers to performing CPR on women. The purpose of this study was to quantify and evaluate online CPR instructional films featuring a female victim.

Methods:
Using the search query “how to do CPR” via Google and YouTube, 374 and 500 films (38 and 25 result pages), respectively, were reviewed in May 2019. Exclusion criteria included: non-English, non-instructional, pediatric or animal victim, duplicates, parity, or in-hospital cardiac arrest. We identified 11 films featuring a female victim. These films were scored on 6 key aspects of CPR education: scene safety, check responsiveness, activate Emergency Medical Services, proper hand position, accurate rate, and appropriate depth of compressions.

Results:
Of the 874 reviewed films, 11 featured a female victim. Just 5 films were high-quality (correctly addressing 5 or 6 key aspects of CPR training, Figure 1). Furthermore, 2 of the 5 high-quality instructional films taught rescue breathing, which is no longer a recommended component of bystander CPR in the U.S. The remaining 3 films were all created outside the U.S. (Australia, New Zealand, England). None of the films explicitly addressed barriers to performing CPR on a female, including fear of touching breasts or concerns about causing harm.

Conclusion:
Out of the billions of films available online, we identified only 3 high-quality instructional films teaching modern, hands-only CPR featuring a female victim, none of which addressed specific female-related CPR issues. This gender disparity can be addressed with high-quality CPR training films that feature a female victim and explicitly address previously-identified barriers to performing CPR on a female.
Abstract 448: Impact of Novel Healthcare Facility First Responder Training on Resuscitation Task Self-Efficacy Measures
Authors: Becker Les R , Camacho Cheryl , Titus Sheryl J , Thorne Janet L , Goyal Munish
Published: June 2021

Introduction:
When sudden cardiac arrest occurs in non-resuscitation focused care settings, bedside clinicians may not intervene prior to dedicated resuscitation team arrival. As perceived self-efficacy (SE) contributes to cognitive functioning, facilitating effective intervention, we developed and evaluated a mock code training approach,
First Five (FF)
, to enhance bedside responders’ resuscitation task SE using an entity’s defibrillator and manikin. Self-efficacy is knowing that one can perform actions in principle and envision performing the steps to reach a goal.

Hypotheses:
Participants’ resuscitation SE will improve after FF training; 2) Inpatient (IP) and Ambulatory Care Center (ACC) providers will differ in their pre-SE and post-SE in response to FF training.

Methods:
Participants enrolled from ACCs and medical-surgical IP units at a large, urban tertiary care hospital from May 2018 to April 2019 completed a de-identified 10-point Likert-scale SE survey before and after they were trained to perform initial bedside resuscitation tasks (Figure 1 x-axis labels). Matched, complete, pre/post data for 85 in-hospital and 107 ACC participants were analyzed via repeated measures multivariate analysis of variance.

Results:
Patterns of reported change in the seven resuscitation task SE measures of IP personnel differed significantly from those of ACC personnel [Pillai’s Trace = .222, F(7,184)=7.483, p=.0005, partial η
2
= .222]. In both settings, post-session SE measures increased significantly from pre-session SE measures [Pillai’s Trace = .588, F(7,184)=37.438, p=.0005, partial η
2
= .588]. Moreover, though ACC providers consistently reported lower pre-training SE resuscitation task scores, post-training scores from both settings were comparable (Figure 1).

Conclusions:
First Five training is effective in enhancing resuscitation task SE among inpatient and ambulatory care setting providers that are not resuscitation-focused.
Abstract 456: Increasing the Compression Velocity and Acceleration Improved the Quality of Simulated Chest Compression Under the Direction of Real Time Visual Feedback Device
Authors: Cao Yu , He Yarong , Yao Peng
Published: June 2021

Background:
To investigate whether a real-time visual feedback device could improve the quality of chest compression (CC), and, if so, whether the mechanism is associated with dynamic indexes such as velocity and acceleration.

Methods:
A self-control trial of 2-minutes CC on a manikin by trained rescuers compared the quality of CC without or with a visual feedback device. Demographic characteristics were recorded and CC metrics for the two tests were computed. Multivariable linear regression analyses were performed to examine the impact of variables on rate of qualified chest compression (RQCC). Multivariable logistic regression was performed to determine independent risk factors for achieving qualified chest compression (QCC) in the second test.

Results:
A total of 159 participants (average age: 29.36±9.0 years, 80 (50.3%) men) were recruited. RQCC of the second test was significantly greater than that of the baseline test. Multivariable linear regression analysis showed that maximum compression velocity (V
compression
) and maximum compression velocity (a
compression
) were independent risk factors for RQCC for both tests. The mean V
compression
and a
compression
of the second test were significantly greater than those of the baseline test. However, V
compression
was the only independent risk factor predicting QCC achievement during the second test. ROC curve analysis showed the area under curve (AUC) was0.84,and the optimal cut-offvalue ofV
compression
was 39.48 cm/s.

Conclusions:
Increasing the V
compression
and a
compression
might improve the quality of simulated CC and should be recommended to improve QCC. Only V
compression
was an independent risk factor for achieving QCC during CC with a visual feedback device.
Abstract 458: Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA
Authors: Clark Lyra R , McDannold Robyn , Mullins Margaret , Bobrow Bentley
Published: June 2021

Introduction:
AHA guidelines emphasize the importance of limiting pauses during CPR to less than 10 seconds due to the association of interruptions in chest compressions (CC) with adverse outcomes. Previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause in CC with lower odds of survival, though these analyses were restricted to patients with initial shockable rhythm. The aim of this analysis is to investigate the association between CC pause duration and patient outcomes in all-rhythm OHCA.

Methods:
OHCA cases from three EMS Agencies in Arizona between Jan 2016-Dec 2016 (n=229) were analyzed. De-identified prehospital patient data were linked to outcome data as part of the state quality program. Pauses calculated from CPR pad accelerometer data were defined by a minimum duration of 1000 ms. Mean pause duration was calculated by case as the average of all pauses, while longest pause duration was defined as the single longest pause in CC. Descriptive statistics and multivariate logistic regression was performed in STATA 15.1. Primary outcome measures defined were ROSC, survival-to-discharge, and favorable neurological outcome (Cerebral Performance Category 1 or 2). Covariates included in the statistical model include time in CPR, age, witnessed arrest, initial shockable rhythm, bystander CPR, and CPR quality.

Results:
A total of 37.1% of patients (n=85) achieved prehospital ROSC, 12.7% (n=29) survived, and 10.5% (n=24) had favorable neurological outcome. Average mean and longest pause duration was 8.13
+
0.76 s and 24.93
+
2.84 in survivors with favorable neurological outcome compared to 9.21
+
0.47 s and 35.56
+
3.55 s in non-survivors. Mean pause duration was associated with survival (adjusted OR 0.89, 95% CI 0.80-0.99) and favorable neurological outcome (adjusted OR 0.83, 95% CI 0.72-0.97). Longest pause duration was associated with favorable neurological outcome (adjusted OR 0.97, 95% CI 0.94-1.00).

Conclusions:
Prolonged pauses in CC during prehospital resuscitation was associated with worse survival and neurological function in OHCA patients with all cardiac rhythms. Pause duration should be kept as brief as possible due to the impact upon outcomes regardless of presenting cardiac rhythm.
Abstract 459: The TripleCPR 16 Study: Does Rhythm Truly Needed to Be Checked Every 2 Minutes in Cardiopulmonary Arrest Patients?
Authors: Takegawa Ryosuke , Shiozaki Tadahiko , Ohnishi Mitsuo , Muratsu Arisa , Tachino Jotaro , Sakai Tomohiko , Muroya Takashi , Hayakawa Koichi , Shimazu Takeshi
Published: June 2021

Purpose:
Current guidelines recommend rhythm checks every 2 minutes during CPR, but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO
2
) monitoring as useful in detecting ROSC and that coronary and cerebral perfusion decrease with the 2-minute rhythm check. On the basis of our previous study, we began the TripleCPR 16 study, which omits 2-minute rhythm checks because stopping chest compression to check rhythm may increase cerebral damage and decrease the ROSC.

Methods:
The multicenter, prospective TripleCPR 16 study began in January 2017. The inclusion criterion is a cardiopulmonary arrest patient aged ≥16 years with a non-shockable rhythm on hospital arrival. Subjects are divided into 3 groups based on their mean cerebral rSO
2
value in the first minute of arrival: ≥50%, <50% to 40%, and <40%. Continuous mechanical chest compression is performed on all subjects for 16 minutes or until their rSO
2
value exceeds the initial value by 10%, 20%, or 35%, respectively. We are comparing the TripleCPR 16 study results with our previous hospital data obtained from 86 patients with non-shockable rhythm who underwent every 2-minute rhythm checks and mechanical chest compression.

Result:
Currently, 218 patients are registered. Rates of ROSC were 34.9% for these patients and 39.5% for the previous 86 patients (p=0.51). There were no severe adverse events. Subanalysis of the data of Osaka University Hospital alone showed no significant increase of rSO
2
value in the 48 patients with non-sonographic cardiac activity and 26 patients with Stanford type A aortic dissection diagnosed by CT scan, and only two patient in each group achieved ROSC. When excluding the patients with Stanford type A aortic dissection, rates of ROSC was 47.8% for the patients in this study and 39.0% for the previous 86 patients (p=0.26).

Conclusion:
The TripleCPR 16 study is ongoing without severe adverse events. In the patients with non-sonographic cardiac activity or Stanford type A aortic dissection, rSO
2
values did not increase and it was difficult to achieve ROSC. A simpler CPR protocol could be devised that omits the 2-minute rhythm check in patients with a non-shockable rhythm.
Abstract 470: Understanding the Distribution of CPR Training in Pennsylvania High Schools
Authors: Meskers Paige , Mejia Vanessa , Salerno Jessica , Weiss Leonard , Salcido David D
Published: June 2021

Introduction:
Bystander CPR may increase out-of-hospital cardiac arrest survival rates. Incorporating CPR education into high school curricula is an efficient way to teach a large number of individuals CPR. Pennsylvania, unlike most states, does not require CPR training prior to graduation, and the prevalence of school training programs is not known.

Objective:
The goal of this study was to describe the distribution and characteristics of CPR training practices in high schools across Pennsylvania.

Methods:
As part of an ongoing public health project, we developed and administered a 7-question survey designed to determine if school districts offer CPR training programs, and if so, query key details about those programs. Using the Pennsylvania Education Names and Addresses database, we compiled contact information for all Pennsylvania school districts. Student researchers then contacted district personnel by telephone or email to administered the survey. Survey results were tabulated and summarized, and basic comparative statistics were calculated using Stata (ver. 15). Geographic patterns were assessed using QGIS (ver. 3.0.1) To understand the role of race and economics in availability of CPR training, our analyses incorporated census data on median income, race and ethnicity.

Results:
Between July 2018 and May 2019, we attempted to contact all 500 school districts in Pennsylvania, 494 of which were determined to have high schools within the district. We received survey responses from 446 (90%) school districts. Of those, 255 (57%) offered some form of CPR education and 141 (32%) of those programs were mandatory. Of the 255 districts that offered programs, 157 (62%) programs certified students as CPR providers. School districts that have CPR training have a median household income on average $4906 higher than school districts without CPR training. Clusters of districts with and without training were observed, however these clusters did not correlate with state geographic divisions, white race or Hispanic ethnicity.

Conclusion:
In Pennsylvania, where CPR training is not mandatory in high schools, at least half of all schools have training programs. Factors determining program adoption are unclear.
Abstract 473: Will Obesity Bankrupt the United States? Obese Patients Who Underwent Cardiopulmonary Resuscitation Have Increased Thirty-Day Readmission and Total Hospital Cost
Authors: Ho Kam , Narasimhan Bharat , Wu Lingling , Nasserifar Shabnam , Sheehan Jacqueline , Herzog Eyal
Published: June 2021

Purpose:
To determine the relationship between obesity and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who underwent cardiopulmonary resuscitation (CPR) during their hospitalization in the in the United States.

Method:
A retrospective study was conducted using the AHRQ-HCUP NRD for the year 2014. Adults (≥ 18 years) with a primary diagnosis of CPR (1), along with a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature (2). The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use. Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders (3).

Results:
113,394 hospital admissions among adults with a primary and secondary diagnosis of CPR were identified, of which 14.8% were obese. 1:1 PS matching was performed based on demographic and clinical characteristics. The 30-day rate of readmission among obese and non-obese with CPR were 4.94% and 2.82% (p <0.001). The most common readmission for both groups was unspecified sepsis (17.3%). During the index admission for CPR, the length of stay (LOS) among obese and non-obese patients were similar (10.3 vs 9.4 days, p=0.16). However, the total cost for the obese patients was statistically different ($33,232 vs $33,692, p <0.001). Most importantly, obese patients’ in-hospital mortality rate during their index admission was significant higher (58.7% vs 6.72%, p <0.001). Amongst those readmitted, obese patients similarly had a significantly longer LOS than their non-obese counterparts (8.1 vs 4.5 days, p <0.001) and their total cost was more expensive ($19,027 vs $10,572, p <0.001). But, obese patients’ in-hospital mortality rate during their readmission was not significant different (0.34 % vs 0.08%, p =0.09). Obesity (HR 1.77, p <0.02) was an independent predictor associated with higher risks of readmission.

Conclusion:
In this study, obese patients admitted with CPR have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p <0.02) than non-obese patients.
Abstract 475: Association Between Bystander Delay in Activating the Emergency Response System and Outcomes Following Out-Of-Hospital Cardiac Arrest: All-Japan National Utstein Registry
Authors: Tamura Tomoyoshi , SEKI Tomohisa , Suzuki Masaru , Sasaki Junichi
Published: June 2021

Introduction:
An emphasis on the chain of survival has contributed to improved outcomes of out-of-hospital cardiac arrest (OHCA). Although immediate recognition of cardiac arrest (CA) and activation of the emergency response system are the first links in the chain of survival, their impact on outcomes is unclear.

Hypothesis:
Delayed time from collapse to activation of the emergency response system (bystander delay) is associated with an unfavorable neurological outcome after adult OHCA.

Methods:
Data from the prospective, nationwide, population-based All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2012 and December 31, 2016 were analyzed. Of the 625,916 eligible cases, 164,256 adult, non-traumatic, witnessed OHCA including bystander delay times (age, 79 [IQR, 67-86] years; 60% male) were studied. The primary outcome measure was favorable neurological outcome 1 month after an OHCA, defined as a score of 1 or 2 on the Cerebral Performance Category Scale.

Results:
The median bystander delay time of 2.0 [1.0-4.0] min was shorter among patients who achieved a favorable outcome as compared to 3.0 [1.0-6.0] min (P < 0.001) for patients with an unfavorable outcome. In multivariable logistic regression analyses, bystander delay had an OR for favorable neurological outcome of 0.94 [95% CI, 0.93-0.97] after adjusting for age, sex, etiology of arrest, first documented rhythm, provision of bystander CPR, use of public access automated external defibrillator, epinephrine administration, time intervals of activation of the emergency response system and hospital arrival, and collapse to initiation of CPR, and regional location. Similarly, bystander delay was independently associated with reduced neurologically favorable survival among patients who received bystander CPR within one minute of collapse (adjusted OR, 0.97 [0.97-0.98]).

Conclusions:
Bystander delay was independently associated with decreased odds of neurologically favorable survival, even among patients for whom bystander CPR was immediately performed.
Abstract 004: Electronic Health Record-Based Overestimation of Failure to Prescribe Statins in Patients With Coronary Artery Disease in a Large, Academic, Multispecialty Clinic Practice
Authors: Shin Eric Y , Ochuko Patricia , Bhatt Kunal , Howard Brian , McGorisk Gerard , Delaney Linda , Langdon Kristan , Khosravanipour Marjan , Nambi Andiran , Grahovec Allison , Morris Douglas , Castellano Penny , Shaw Leslee , Sperling Laurence , Goyal Abhinav
Published: June 2021

Background:
Programs such as Meaningful Use leverage electronic health record (EHR) systems to hold medical providers accountable for delivering high-quality care. However, the fidelity of querying population-level EHR data for assessing quality of care compared with manual chart review is unclear.

Objective:
To determine the accuracy of EHR data query in measuring the rate of statin prescriptions in eligible patients with coronary artery disease (CAD).

Methods:
The study was performed at The Emory Clinic (TEC), a large, academic, multispecialty clinic practice in Atlanta, GA. Query of TEC’s clinical data warehouse which captures data from TEC’s EHR system identified 29,713 total outpatient encounters for CAD between July 1, 2014 and June 30, 2015, of which 3,839 encounters (13%) had no detectable statin prescription or documented exemption. Of these 3,839 “failure” cases, 120 patient charts were randomly subjected to manual adjudication by two physicians and were categorized as follows: 1) CAD recorded on EHR problem list but without documented evidence of clinical, symptomatic CAD as defined by the 2013 AHA / ACC cholesterol guidelines; 2) Failure of EHR data query to recognize an active statin prescription on the EHR medication list; 3) Failure of EHR data query to recognize a statin allergy or contraindication in a discrete data field (e.g. allergy section or problem list); 4) Statin exemption listed in only free-text clinical notes; 5) Comorbidity that downgrades strength of evidence supporting statin use in CAD (e.g. end-stage renal disease); or 6) True failure of provider to prescribe statin therapy (i.e. true gap in care).

Results:
Of 120 patient charts reviewed, only 35 (29.2%) represented a true failure of to prescribe statins in eligible CAD patients. Forty (33.3%) patients did not meet criteria for clinical CAD; 21 (17.5%) had statin exemption documented in free-text format only; 17 (14.2%) had statin exemption listed in discrete EHR fields; 6 (5%) were on a statin according to the EHR medication list; and 1 (0.8%) had end-stage renal disease.

Conclusions:
Among outpatients with presumed CAD who were identified by EHR data query as “failures” to receive statin prescriptions, an estimated fewer than one-third constituted a true gap in care. These findings raise concern about the accuracy of EHR data query in measuring performance in the Meaningful Use era.
Abstract 008: Statin Use and Its Facility Level Variation in Patients With Peripheral Artery Disease: Insights From the Department of Veterans Affairs
Authors: McBride Cameron L , Akaroyd Julia , Ramsey David J , Nambi Vijay , Nasir Khurram , Michos Erin D , Birtcher Kim K , Morris Pamela B , Bittner Vera A , Ballentyne Christie M , Peterson Laura A , Virani Salim S
Published: June 2021

Background:
The 2013 ACC/AHA cholesterol guideline recommends high-intensity statin therapy in patients 75 years or younger and moderate-intensity statin therapy in patients > 75 years with atherosclerotic cardiovascular disease including those with peripheral artery disease (PAD). Statin prescribing patterns and their facility-level variation in patients with PAD are unknown.

Methods:
We examined the frequency and facility-level variation in the use of any and correct intensity of statins in patients with known PAD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system with or without concomitant ischemic heart disease (IHD) or ischemic cerebrovascular disease (ICVD). We calculated the median rate ratios (MRR) adjusted for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns for comparable patients.

Results:
Among 194,151 patients with PAD, 88,905 (45.8%) had PAD without IHD (with or without ICVD) and 70,404 (36.3%) had PAD without IHD or ICVD. Rates of statin use in the entire PAD cohort, patients with PAD without IHD and PAD alone were 79.0%, 69.1% and 66.3%, respectively. Median facility-level rates of statin use were 78.9% (IQR 75.9-81.5), 69.2% (65.4-72.6) and 66.4% (62.6-70.1), respectively. Correct intensity statins were prescribed among 40.9% for the entire PAD cohort, 28.9% of those with PAD without IHD, and 26.4% of those with PAD alone. Median facility-level rate of correct statin intensity use in all PAD patients was 40.1% (36.4-44.2), 27.8% (24.1-32.4) for patients with PAD without IHD and 25.3% (10.8-29.7) in patients with PAD alone. Calculated MRRs reflected a 20-22% variation among two facilities in treating identical PAD patients with statin therapy and a 24-28% variation in treating identical patients with correct statin intensity (Table).

Conclusions:
The use of statin and especially correct statin intensity is suboptimal in PAD patients, especially in PAD patients without concomitant IHD or ICVD. There is a significant facility-level variation in the receipt of guideline directed statin therapy in PAD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and to reduce variation in care in this high-risk group.
Abstract 016: Endovascular Management of Major Vascular Access Site Complications During Transcatheter Aortic Valve Implantation (TAVI).
Authors: Majeed Muhammad U , Green Kelly D , Fudim Marat , Robbins Mark A , Zhao David X
Published: June 2021

Background:
Major vascular access site complications remain a challenge in the field of TAVI and are associated with higher 30 day mortality. However, outcomes following endovascular management with covered stents for such complications are not well established.

Methods:
We reviewed the one year data of patients who underwent TAVI at our institution with a Sapien valve by percutaneous femoral approach. Identified were patients who suffered major vascular complications according to the definitions set forth by the Valve Academic Research Consortium. We then compared the outcome of patients managed by an endovascular approach with a population whose femoral access site complications were managed surgically/endovascularly (85.7% surgically), as reported from the Partner trial.

Results:
A total of 16 patients experienced Major Vascular complications. TAVI was aborted on 2 patients due to access site complication. Excluded were 3 patients who had benign small ascending aortic dissections after successful valve deployment and 3 patients who were managed surgically. Ten remaining patients were managed by a pure endovascular approach with covered stents. Four of these patients suffered ilio-femoral dissection, 4 had perforation and 2 had both perforation and dissection. No significant difference was observed in pre and post procedure creatinine (1.01 vs 1.14, p=0.16) and none required dialysis within 30 days, as compared with 8.1% in Partner trial. We observed no statistically significant difference between the Partner trial cohort and our patients in 30 day all cause mortality (14.1% vs 10%, p=1), stroke rate (4.8% vs 0%, p=1), access site hematoma (22.9% vs 0%, p=0.1), retroperitoneal bleed (9.5% vs 0%, p=0.6), pseudoaneurysm (3.4% vs 0%, p=1), and gastrointestinal ischemia (1.6% vs 0%). No access site infection, stent thrombosis, or stenosis leading to limb ischemia were noted clinically at 30 day follow-up.

Conclusion:
Many patients with major vascular complications during TAVI can be treated with a pure endovascular approach. In our small series we observed no difference in concurrent complications when an endovascular repair can be rapidly initiated as compared to a primary surgical approach.
Abstract 017: Feasibility of Audit and Feedback for Reducing Rarely Appropriate Nuclear Myocardial Perfusion Imaging Among Veterans
Authors: Winchester David E , Schmalfuss Carsten , Wymer David C , Helfrich Christian D , Beyth Rebecca J
Published: June 2021

Background:
Appropriate Use Criteria (AUC) are complex documents which provide great detail on which patients are likely to benefit from a test. For providers who order a low volume of cardiac tests, regular application and navigation through the AUC may be difficult. Audit and feedback (A&F) has been proposed as an effective method for encouraging de-implementation of unnecessary testing. We hypothesized that the volume of myocardial perfusion imaging (MPI) ordered by most providers would make A&F ineffective.

Methods:
We performed a secondary analysis of data gathered for the evaluation of a program to reduce rarely appropriate MPI. Patients who underwent nuclear myocardial perfusion imaging (MPI) were rated using the AUC. Appropriateness rating was performed retrospectively by a nurse trained in application of the AUC. We extracted data on both the patient and the ordering provider from the medical record which accompanied the visit where the MPI was ordered. Patients were compared in two cohorts: those with rarely appropriate indications for MPI, and all others. We performed logistic regression to determine which patient and provider characteristics were associated with rarely appropriate MPI. We ranked the most common indications for rarely appropriate testing and calculated the mean number of MPI ordered by our providers.

Results:
A total of 889 cases over six months were included; 22 MPI (2.5%) were rated as rarely appropriate. A minority of patients had a prior myocardial infarction (n=127, 143%) or coronary revascularization (n=291, 32.7%). Chest pain was more common among appropriate or maybe appropriate MPI (n=528, 61.1% vs. n=1, 4.5%, P<0.0001) while lack of symptoms was more common among rarely appropriate MPI (n=18, 81.8% vs. 107, 12.4%, P<0.0001). In logistic regression, lack of symptoms was retained in association with rarely appropriate testing (odds ratio 31.6, 95% confidence interval 10.5-95.2, P<0.0001). The majority (59.1%) of rarely appropriate tests were accounted for with only 3 indications (#8, #71, and #67). A total of 219 providers ordered MPI during the study period, with an average of 4.1 MPI per provider, less than one MPI per provider per month. The greatest number of rarely appropriate tests from any single provider was 3.

Conclusions:
Within the setting of an educational program to reduce rarely appropriate MPI, the number of rarely appropriate MPI per provider was low. Lack of symptoms and indications including preoperative testing and screening in low risk patients were common drivers of rarely appropriate MPI. These data raise doubt about efficacy of a broadly applied program which provides individualized A&F. Efforts to increase awareness of common reasons for rarely appropriate testing may have greater impact.
Abstract 021: Most People Who Need to Perform CPR in Their Home Cannot
Authors: Trenkamp Robert H , Perez Fernando J
Published: June 2021

Objective:
To determine by examining the physical characteristics of pairs of people who cohabitate whether each is physically capable of performing two-inch chest compression on the other.

Methods:
Name, gender, age, total body weight, and hands on scale weight (“HOSW”) data was collected from couples. HOSW is the reading on a scale when one is kneeling in front of the scale and pressing down with the hands as if performing CPR, until the knees barely leave the ground. One member of the cohort mechanically measured his chest stiffness. Chest stiffness for the cohort was calculated from a simplistic model where the measured subject’s relationship between chest stiffness and total body weight was assumed to prevail in all other test subjects. Doing so yielded an average chest stiffness of 128 pounds, as compared to the actual average adult chest stiffness of 130 pounds. A similar method was used with the heel of the foot. The result was FOSW, the force one could apply to a chest while performing Pedal Compression. A subject with an HOSW or FOSW equal to or greater than their partner’s chest stiffness was judged to be capable of performing guideline-compliant chest compression on the other using manual or pedal compression, respectively. The two outcome measures for each couple were: each’s physical ability to perform two-inch compression on the other, using manual and pedal compression.

Results:
At the time this abstract was submitted, data from twelve couples showed that slightly more than half the male subjects had sufficient HOSW to perform two-inch manual compression on their wife, and no wives had sufficient HOSW TO PERFORM a two-inch compression on their husband. In the 700 cardiac arrests in a private residence each day, two-thirds of the victims are male and will not receive two-inch compression. The results show the number of females and males that can apply enough force to their spouse’s chest to perform a two-inch compression with manual chest compression and pedal (heel) compression with FOSW at 95 and 90 percent of body weight. Zero of twelve females weighed enough to perform and seven of twelve males weighed enough to perform a two inch compression on their spouse using manual compression. One of twelve females and ten of twelve males weighed enough to perform a two inch compression on their spouse using pedal compression under the 95% of body weight equals FOSW model. Zero of twelve females and ten of twelve males weighed enough to perform a two inch compression on their spouse using pedal compression under the 90% of body weight equals FOSW model. Heel compression increases the likelihood of a male’s being able to perform a two inch compression significantly. Heel compression only improves a female’s likelihood of performing a two-inch compression using the 95% of body weight assumption.