bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 269: Relationship Between Characteristics of Early Postresuscitation EEG Activity During Hypothermia and Neurological Outcomes in a Rat Model of Cardiac Arrest
Authors: Chen Bihua , Song Fengqing , Sun Leilei , Lei Lingyan , Li Yongqin
Published: April 2024

Background.
Therapeutic hypothermia (HT) improves neurological outcomes and survival after resuscitation from cardiac arrest. However, the effects of HT on early recovery of electroencephalographic (EEG) activity after resuscitation are still unknown. In the current study, we investigated the effect of HT on the characteristics of early post resuscitation EEG activity in a rat model of cardiac arrest.

Methods.
Twenty male Sprague-Dawley rats (289±28 g) were used in this study. Cardiac arrest was induced through high frequency transesophageal cardiac pacing and untreated for 5 mins. Manual chest compression was initiated at a compression rate of 300/min and continued until return of spontaneous circulation. Immediately after resuscitation, animals were randomized to either 2 hrs hypothermia (N=10) or normothermia (N=10). ECG, EEG, aortic pressure, together with core temperature were continuously recorded.

Results.
There were no differences in baseline measurements between groups. All the animals were successfully resuscitated, however, 80% of rats survived till 48 hrs in the hypothermia group, in contrast to only 20% in the normothermia one (
p
=0.023). Characteristics of EEG activity, including the onset time of EEG bursting (15.1±1.9 min vs. 21.5±6.1 min,
p
=0.008), and the time of recovery of continuous EEG activity (171.2±15.2 min vs. 242.5±44.0 min,
p
=0.001) were significantly shorter in the HT group. Both of the onset time of EEG bursting (r=0.66,
p
=0.002) and the time of recovery of continuous EEG activity (r=0.65,
p
<0.002) were correlated with good 48 hrs neurological outcomes.

Conclusion.
The characteristics of early post resuscitation EEG activity during HT were associated with good neurological outcome in this rat model of cardiac arrest. EEG analysis therefore has the potential to monitor neurological recovery and guide HT after resuscitation.
Abstract 27: Novel Use of Wireless 12-Lead Electrocardiogram Transmission in a Prehospital Setting
Authors: Nishikawa Go , Nonogi Hiroshi , Mori Noriko , Matsuo Yoko , Shimizu Shiro , Oda Toshiko , Doi Osamu , Kambara Hirofumi
Published: April 2024

Introduction
The AHA/ACC guidelines recommend pre-hospital 12-lead electrocardiogram (ECG) transmission to a percutaneous coronary intervention (PCI) hospital to facilitate the care of patients with acute coronary syndrome. We created a handheld wireless 12-lead ECG transmission system called Fujiyama involving Cardiospy® Mobile, a handheld 12-lead ECG recording device. Fujiyama functions by transmitting the ECG from Cardiospy® Mobile to a smartphone through Bluetooth wireless technology, converting the ECG to MFER(Medical Waveform Format Encoding Rule)/JPEG, and sending it to a designated email address using ubiquitous and standard network.

Hypothesis
We predicted that our smaller device will be equally efficacious in transmitting accurate data as the current portable ECG recording device used in the healthcare industry.

Methods
We recorded and transmitted 12-lead ECGs using our device from a moving vehicle (simulating an ambulance), and investigated the influences of road turbulence, body movements, fast driving, as well as transmission time and accuracy by comparing ECGs recorded in a hospital setting. Furthermore, after approval from the institutional review board, the device was tested on 24 actual patients (4 emergency room, 5 clinic, 4 home hemodialysis, 11 visiting nurse care) transmitting ECGs to the attending cardiologist of a PCI hospital.

Results
There were no significant ECG differences found between sent and received ECGs, and vehicle speed did not affect the baseline ECG. Body movement, blood pressure measurement and cardiac compression caused the baseline to wander to some extent, but did not affect ECG interpretation. The transmission time of a 250-350 KB file was 7-95 s (median 23 s), short enough for emergency settings. Transmission rate of the 24 ECGs was 100 %, and only one had significant interference from appliances and peripheral equipment.

Conclusions
As far as we know, this system is the first wireless 12-lead ECG recording and transfer device in this weight (150 g, including batteries) and size category (70 × 38 × 125 mm). In conclusion, successful implementation of this system may improve the communication and care of patients with acute coronary syndrome in various settings, including emergency pre-hospital care.
Abstract 291: A Targeted Approach to Community Consultation for an Exception from Informed Consent Study: More Support than Willingness to Participate
Authors: Vu Eugene , Arnold Kathy , Carnevale Tony , Griffiths Denise , Zive Dana , Sidhu Aarzoo , Schmidt Terri , Daya Mohamud
Published: April 2024

Objectives:
Community consultation (CC) is a key part of research conducted under the FDA Exception from Informed Consent (EFIC) framework. The best practices to achieve CC remain uncertain. We report results from a targeted approach that surveyed at-risk members of a health maintenance organization.

Methods:
The Resuscitation Outcomes Consortium (ROC) Amiodarone, Lidocaine, or Placebo Study (ALPS) is being conducted under EFIC. As part of the CC effort, we designed a survey with the Kaiser Permanente Northwest Center for Health Research. Surveys were mailed to 2,000 Kaiser members between the ages of 48-78 residing in a 3 county region served by participating EMS agencies. The age group was considered representative of the population-at-risk for out-of-hospital cardiac arrest (OHCA). The survey described ROC-ALPS and the opt-out option. Respondents were asked if the study was important to do, whether the benefits justified doing it under EFIC and if they would be willing to be enrolled in the study. Responses were recorded using a 5-point Likert scale. Demographic information collected included age, gender and race. Descriptive statistics were used to tabulate responses to survey questions. Pearson chi- square test was used for sub-group analyses.

Results:
Of the 2,000 mailed surveys, 1951 were delivered and 337 returned (17.2% response rate). Respondents were 48.8% male with a mean age of 63.1 years. Most respondents were white (89.3%) and representative of the study community. A majority (88.3%) of respondents agreed that EFIC research is important, and 73.9% felt that the benefits justify this method of research. Fewer respondents (53.1%) expressed a willingness to be enrolled in ROC-ALPS. There were no gender differences in question response. More respondents under the age of 65 expressed a willingness to be enrolled in the study. (p=0.002). However, those ≥ 65 were more likely to agree that the benefits justify the risk in EFIC studies. (p =0.029)

Conclusions:
A majority of at-risk HMO community member respondents expressed support for EFIC research and more than half expressed a willingness to be enrolled in the ROC randomized placebo control ALPS study. The response rate was low and differences were identified between respondents in relation to age.
Abstract 302: Transthoracic Impedance Is Poorly Predicted by Patient Characteristics but Significantly Reduced by Placement of Defibrillator Pads in the Anteroposterior Position
Authors: Howe Andrew J , DiMaio Rebecca , McEneaney David
Published: April 2024

Introduction

The American Heart Association Resuscitation Guidelines advocate four pad positions to achieve defibrillation success following cardiac arrest. Transthoracic impedance (TTI) reflects the electrode-skin interface and patient impedance and affects current amplitude, energy delivered and defibrillation efficacy. Modern defibrillators utilise an impedance compensated waveform to account for changes in TTI to improve defibrillation success. However the effect of electrode pad position and patient characteristics on TTI remains unclear.

Objective

To evaluate the effect of patient characteristics and pad position on Transthoracic impedance (TTI).

Methods

Patients undergoing diagnostic cardiac catheterisation were recruited for the study following regional ethical approval. Standard self-adhesive defibrillator electrodes were applied to patients in both the anterolateral and anteroposterior positions and connected to Heartsine Samaritan defibrillators. TTI was measured by applying a 30kHz sinusoidal signal through the chest. The voltage was then converted to digital samples using an 8-bit microprocessor. The digital samples were then stored on the secure digital card to be retrieved using custom-made download data recovery software. TTI was measured at 10 second intervals in both positions for the duration of the clinical procedure.

Results

32 patients (mean age 63), (66% male), were recruited. TTI measured at 10 seconds was significantly higher in the anterolateral position (88.3ohms vs 68.5ohms, p <0.001). Mean TTI reduction over 5 minutes was 2.4% in the anterolateral position and 1.9% in anteroposterior position. There was no significant correlation between TTI measured from either pad position and age, height, weight, body surface area and Haemoglobin (r<0.4 for all parameters).

Conclusion

TTI is significantly reduced by placement of defibrillator pads in the anteroposterior position. Furthermore patient characteristics are poorly predictive of TTI from either pad position. Patients suffering failed defibrillation attempts from pads positioned in the anterolateral position may benefit from prompt relocation to the anteroposterior position to improve defibrillation efficacy.
Abstract 317: The Los Angeles Cardiac Arrest Network: Hypothermia Experience in Nonshockable Rhythm
Authors: Sung Gene Y , Shavelle Dave , French William , Eckstein Marc , Niemann James , Bosson Nichole , Gorospe Deidre , Rashi Paula , Tadeo Richard , Koenig William , Thoma Jay
Published: April 2024

Therapeutic hypothermia after resuscitation from a non-shockable cardiac arrest rhythm: Outcomes in a regionalized cardiac arrest system

Introduction:
Therapeutic hypothermia (TH) improves neurologic outcome (CPC 1-2) in patients resuscitated from VF. Its effect on neurologic outcome following resuscitation from non-shockable arrest rhythms remains uncertain. Of equal importance is the possibility that TH will improve survival in this group but not neurologic outcome (CPC 3-4). The purpose of this study was to evaluate neurologic outcome in patient resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm.

Methods:
This is a retrospective cohort study of data reported to a single registry from EMS systems serving a population of approximately 10 million and collected between April 1 and Dec 31, 2011. All patients achieving ROSC in the field are transported to designated hospitals with TH protocols and PCI capabilities. The registry includes current Utstein data cells. Patients with an initial non-shockable rhythm were identified. Patients were excluded if they were awake and responsive in the ED. The survival rate and neurologic outcome of those receiving TH were compared to those that did not receive TH. The decision to initiate or withhold TH was determined by the treating physician.

Results:
Outcomes are shown in the table. The OR for a CPC 1 or 2 with TH was 2.4 (95%CI 1.1-5.5)(p=0.01) compared to patients not receiving TH. The proportion of patients with CPC 3 or 4 was not different between groups, unpaired t-test (p=0.6).

Conclusion:
TH improves neurologic outcome in patients resuscitated from initial non-shockable rhythms in a regionalized system for post-resuscitation care. Additionally, the number of surviving but severely neurologically impaired patients is not increased.
Abstract 320: Simulation of Cardiac Arrhythmias in Hospitalized Patients to Measure and Improve Response Time
Authors: Wright Melanie C , Dorsey Kyle W , DeLong Robert , Decker Ronda , Patterson Anita , McBroom Kathryn , Granger Christopher B
Published: April 2024

Introduction: Hospitals have limited means of assessing time to respond to in-hospital life-threatening cardiac arrhythmias. Metrics of time to recognition are lacking and effectiveness of remote monitoring is not well understood. We sought to determine whether it was feasible and valid to measure response time to arrhythmias by inserting simulated arrhythmias into ongoing in-hospital cardiac monitoring.

Hypothesis: We hypothesized that monitoring personnel would perceive a simulated arrhythmia, placed in the slot of a patient, as real and respond as such. We hypothesized that, compared to on-unit local monitoring (of monitors in the care area by direct care nurses), off-unit remote monitoring (of a bank of monitors by technicians), requiring more communication steps, would result in slower response time from arrhythmia onset to nurse-in-room.

Methods: We conducted 50 simulated life-threatening arrhythmias (Vfib or Vtach) at two hospitals. We measured time from start of simulated arrhythmia to nurse-in-room. We asked 40 nurses and 13 monitoring technicians whether they perceived the event to be “real” (not a simulation). We compared nurse-to-room times between 28 locally and 15 remotely-monitored patient arrhythmias using non-parametric Wilcoxon sum of ranks statistics.

Results: The event was interpreted as real by 38 of 40 nurses and 11 of 13 remote technicians. Among a subset (30 nurses, 6 technicians), about one-third, in hindsight, recalled aspects of the rhythm or work environment that could have cued them that the event was not real. Average nurse-to-room time for locally monitored patients was 23 seconds, significantly faster (p = 0.0002) than the 58 seconds required for remotely monitored patients.

Conclusions: This study provides preliminary evidence that arrhythmia simulators may be used to effectively measure recognition and response time to life-threatening cardiac arrhythmias. Careful implementation is required to ensure realism.
Abstract 336: The Novel and Useful Scoring System to Predit Massive Transfusion for Trauma Patients: Traumatic Bleeding Severity Score (TBSS)
Authors: Ogura Takayuki , Nakano Minoru , Nakamura Yoshihiko , Takahashi Eiji , Nakamura Mitsunobu , Miyazaki Dai , Machida Hiroshi , Suzuki Hiroyuki , Fujizuka Kenji , Amemiya Yu , Harasawa Tomofumi
Published: April 2024

Background: There is no clear criterion to activate massive transfusion (MT) for trauma patients. Several studies showed that Trauma Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) Score were high accuracy in predicting the necessity of MT for trauma patients. However, some study showed that the accuracy of these scoring systems for elderly patients was not perfect. In japan, since the population is aging and the number of elderly trauma patient increases, these scoring systems are not useful so much. The aim of this study was to create new scoring system and predict the necessity of MT for trauma patients using it.

Methods: In the first analysis, new scoring system was created. We enrolled 119 severe trauma patients admitted to our center between January 2008 and December 2010. MT predictors were found by statistical methods from clinical and laboratory variables in the Primary Survey. Each MT predictor was converted into the simple score based on each odds ratio in multivariate logistic regression analysis. TBSS was defined as the total of each score.

In the second analysis, the accuracy of TBSS was tested. 114 patients admitted between January 2010 and March 2012 were examined. Receiver operating characteristic curve analysis were performed to compare the accuracy between TBSS and conventional scoring systems (TASH Score and ABC Score).

Results: In the first analysis, five preditors of MT were identified: age (> 60 year-old = 6pts), systolic blood pressure (< 110 mmHg = 4pts, < 100 mmHg = 8pts, < 90 mmHg = 12pts), positive focused assessment with sonography for trauma (FAST) ( [the number of regions with positive FAST] × 3pts), severity of pelvic fracture (stable fracture = 3pts, incomplete unstable fracture = 6pts, complete unstable fracture = 9pts), and lactate (> 2.5 mmol/L = 4pts, > 5.0 mmol/L = 8pts, > 7.5 mmol/L = 12pts).

In the second analysis, TBSS excellently predicted MT (area under the curve (AUC) =0.985, p<0.01). The AUC of TBSS was higher than that of TASH Score (AUC=0.887) and ABC Score (AUC=0.809) (both Bonferoni adjusted p<0.05).

Conclusion: TBSS based on the Primary Survey is high accuracy in predicting the necessity of MT. TBSS provide more useful information to predict MT compared with TASH Score and ABC Score.
Abstract 339: Impact of Left Ventricular Dilatation on Characteristics of Ventricular Fibrillation and ICD Shock Success
Authors: Bonnes Judith L , Jaspers Focks Jeroen , Westra Sjoerd W , Brouwer Marc A , Smeets Joep L
Published: April 2024

Introduction

ICD testing offers a unique setting to study VF characteristics under controlled conditions in humans. Recently, it was observed that myocardial substrate (infarction) affects VF characteristics and shock success in animals. To further study the effect of myocardial pathology on VF, we investigated the association between left ventricular (LV) dilatation and characteristics of induced VF and we determined the impact of dilatation on the success of the first ICD shock.

Methods

Patients who underwent Medtronic ICD implantation with defibrillation testing between 2005-2011 were included. VF frequency characteristics were analyzed using intracardiac recordings of 4 seconds of induced VF before shock delivery (15 joule) and were compared between patients with normal-mildly and moderate-severely dilated LVs. Multivariate linear regression was performed to associate LV dilatation with the respective VF characteristics.

Results

Patients with moderate-severely dilated LVs tended to have a lower first shock success during testing. In addition, the fundamental frequency of VF was lower and the organization index was higher (Table).

The fundamental frequency was independently associated with LV dilatation (β -0.28; p=0.007), amiodarone use (β -0.48; p<0.001) and history of myocardial infarction (MI) (β -0.20; p=0.048).

The organization index was independently associated with LV dilatation (β 0.04; p=0.030) and history of MI (β -0.05; p=0.003).

The median frequency was not associated with any of the tested variables.

Conclusions

Characteristics of induced VF depend on LV dilatation: VF is slower and more regular in dilated LVs. Interestingly, ischemic etiology of cardiac disease and amiodarone also affect VF characteristics. ICD shock success was slightly lower in patients with dilated LVs. To improve future resuscitation strategies, further research is needed to evaluate the interaction between clinical characteristics, VF and shock success.
Abstract 38: Lactate Clearance Is Associated with Improved Survival and Neurological Outcome in Post--Cardiac Arrest
Authors: Donnino Michael W , Salciccioli Justin , Gaieski David F , Abella Benjamin S , Peberdy Mary Ann , Rittenberger Jon C , Callaway Clifton W , Ornato Joseph , Clore John , Giberson Tyler , Cocchi Michael N
Published: April 2024

Introduction: Previous investigations demonstrated an association between lactate clearance and in-hospital mortality in post-cardiac arrest patients. These findings have yet to be validated in a multicenter study.

Objective: To determine the association between lactate clearance and outcomes in post-cardiac arrest

Methods: Four center prospective observational study conducted from 6/11 to 3/12. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after ROSC. The primary outcome was difference in lactate clearance between survivors/non-survivors, and secondary outcome was the difference in lactate clearance between those with good/poor neurological outcome. We compared baseline lactate between survivors and non-survivors using the students t-test. We used multivariate adjustments (age and downtime) with linear mixed-models to assess the trend in lactate clearance over 24-hrs between survivors/non-survivors and good/bad neurological outcome.

Results: 111 patients were analyzed. The median age was 63 years (IQR: 50 - 75) and 41% were female. 97% received TH and overall survival was 47%. Survivors had lower baseline lactate levels compared to non-survivors (5.1 +/- 3.4 versus 7.7 +/- 4.7; p = 0.004). Patients with good neurologic outcomes had lower baseline levels of lactic acid compare to patients with poor neurologic outcomes (4.6 +/- 2.6 versus 7.4 +/- 4.7; p = 0.009). After multivariate adjustments survivors had better lactate clearance than non-survivors (p < 0.001; Figure) and patients with good neurologic status had better lactate clearance compared those with poor neurologic status (p = 0.01).

Conclusion: Lower initial lactate as well as more efficient lactate clearance over the first 24-hours post-CA is associated with improved in-hospital survival and good neurologic outcome.
Abstract 42: CPR with a Pulse: Confusion Among Healthcare Providers
Authors: Giberson Brandon E , Miller Joseph , Gaieski David , Abella Benjamin , Wira Charles , Cocchi Michael , Donnino Michael
Published: April 2024

Background: Healthcare providers nationwide are routinely trained in ACLS, a program from the AHA that teaches participants how to manage cardiac arrest events. Recent changes in ACLS teaching have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that clinicians strictly following the AHA ACLS algorithm may be unsure of the appropriate next action when a resuscitation team member detects a pulse following defibrillation, leading the resuscitator to continue compressions for another two minutes and potentially consider additional medications.

Methods: We constructed an internet survey with scenario-based ACLS questions. The survey link was offered to ACLS providers at 4 major medical centers in the U.S. Inclusion criteria consisted of adult staff member of participating institution with ACLS certification.

Results: A total of 347 surveys met all criteria and were analyzed. The majority (51%) of responders were between the ages of 26-32, and 59.6% were female. Among the analyzed cohort, 54.2 % of responders stated they would continue compressions (+/- other therapies) when a team member detects a pulse following defibrillation whereas 45.8% chose to cease CPR. Of those who chose to continue CPR in patients with a pulse, 42% selected CPR only, 10% selected epinephrine or vasopressin along with CPR, 20% provided amiodarone, and 29% provided both epinephrine and amiodarone. When stratified by profession, 60.2 % of physician participants chose to continue chest compressions in the presence of a pulse, while 47.2 % of nurse responders chose to continue chest compressions.

Conclusion: In this investigation we found that confusion exists as to whether or not CPR and cardiac medications should be continued in the presence of a pulse. Educational initiatives to encourage providers to avoid compressions and medications when a palpable pulse is detected may be necessary.
Abstract 5: Prehospital Hypotension Is Associated with Emergent In-Hospital Procedures and Mortality in Trauma Patients
Authors: Idris Ahamed H , Meier Eric , Brasel Karen J , Daya Mohamud , Egan Debra , Kannas Delores , Kerby Jeffrey D , Lin Steve , McCleod Brent , Minei Joseph , Newgard Craig D , Reiff Donald , Trickett John , van Heest Rardi , Wittwer Lynn K , Bulger Eileen , The Resuscitation Outcomes Consortium Investigators
Published: April 2024

Background: Prehospital vital signs are the basis of many triage and transport guidelines. They serve to activate prehospital and in-hospital trauma systems, and to direct prehospital and in-hospital resuscitation efforts and other interventions.

Objective: The purpose of this study was to determine the relationship of prehospital systolic blood pressure with emergent in-hospital procedures and mortality.

Methods: Included in this secondary analysis of the Resuscitation Outcomes Consortium (ROC) Hypertonic Saline Clinical Trial are patients 15 years or older who were enrolled in the study shock cohort. These patients had traumatic injury and a systolic blood pressure (SBP) ≤70 mm Hg or 71 - 90 mm Hg and a heart rate ≥108 beats/min. Emergent in-hospital procedures are defined as any blood transfusion, thoracotomy, laparotomy, craniotomy, neck exploration, or angiographic control of hemorrhage within 24 hours of emergency department admission or death within 6 hours of admission. We estimated between-group differences for mortality and the likelihood of emergent procedures for lowest SBP categories of <55, 55-64, 65-74, 75-84, and 85-90 (reference) mm Hg using a multiple logistic regression model adjusted for age, sex, Glasgow Coma Scale score, heart rate, penetrating trauma, prehospital advanced airway attempt, and ROC site.

Results: From May 2006 to August 2008, 853 patients were enrolled, 38 were excluded for incomplete data, and 815 form the analyzable cohort. Mean age was 37 years and 78% were male. Mean (±SD) injury severity score was 24±16, 40% required a prehospital advanced airway, 73% required an emergent procedure, and overall mortality was 26%. We observed a significant relationship between lowest prehospital SBP and in-hospital emergent procedures and mortality (Table).

Conclusion: Prehospital hypotension is significantly associated with in-hospital emergent procedures and mortality, especially when SBP is less than 65 mm Hg.
Abstract 18627: Cellular Encapsulation of Mesenchymal Stem Cells Enhances Cardiac Repair in a Rat Model of Myocardial Infarction
Authors: Levit Rebecca D , Landazuri Natalia , Phelps Edward A , Brown Milton E , Garcia Andres , Davis Michael E , Joseph Gigi , Robert Long , Weber Collin J , Safley Susan A , Suever Jonathan D , Lyle Alicia N , Taylor W. Robert
Published: April 2024

Rebecca D Levit, 2012 Finalist and Presenting Author
Abstract 52: CPR Quality and Outcomes in Resuscitation of Suspected Drug-Related Cardiac Arrests
Authors: Koller Allison C , Salcido David D , Callaway Clifton W , Menegazzi James J
Published: April 2024

Introduction: Cardiac arrest resulting from drug overdose (OD) is a significant public health issue and is the cause of many preventable deaths each year. Little is known about actual resuscitation process parameters of ODs and such arrests are often excluded from out-of-hospital cardiac arrest (OHCA) studies. We sought to investigate the characteristics of emergency medical services (EMS)-treated OHCA cases resulting from suspected OD.

Methods: The University of Pittsburgh Institutional Review Board approved this study. Data from EMS-treated non-traumatic OHCAs were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium, a multi-center clinical research consortium with 10 sites across North America. Cases from 2006-2011 were analyzed. Case definition for OD was naloxone administration or drug overdose indicated on the patient care report. Resuscitation parameters including chest compression fraction, compression rate, and compression depth, shock delivery and the administration of resuscitation drugs were collected and compared between OD and non-OD groups. Demographic and outcome variables including age, sex, EMS- or bystander-witnessed status, return of spontaneous circulation and survival to hospital discharge were also compared by OD status. Resuscitation parameters were compared between groups using logistic regression or t-tests with alpha = 0.05.

Results: We identified 180 OD cases and compared them to 2,162 non-OD OHCAs. Both groups were predominantly male (OD: 66%, non-OD: 59%; p = 0.0498). OD OHCAs were on average 20 years younger than non-OD OHCAs (45 vs. 65 years, p < 0.001). OD cases were associated with higher overall CPR fraction than non-OD (66% vs. 63%, p = 0.0158) and survival (19%, vs.11%; OR: 1.82, CI: 1.12 - 2.94, p = 0.015). OD cases were also associated with higher probability of epinephrine (OR: 2.05, CI: 1.33 - 3.15, p < 0.001) and sodium bicarbonate administration (OR: 2.70, CI: 1.98 - 3.68, p < 0.001). Other variables did not differ.

Conclusion: Patients with OD-related OHCA were more likely to receive resuscitation drugs, receive higher CPR fraction, and survive than non-OD OHCAs.
Abstract 11326: In vivo Study by Dynamic Contrast-enhanced Magnetic Resonance Imaging Suggests Biological Link between Adventitial Perfusion and Outward Remodeling
Authors: Sun Jie , Chen Huijun , Kerwin William S , Hippe Daniel S , Hatsukami Thomas S , Yuan Chun
Published: April 2024

Jie Sun, 2012 Finalist and Presenting Author
Abstract 16250: Melamine Impairs Renal and Vascular Function in Rats
Authors: Tak Wong Wing , Xiao Yu Tian , Yi-Xiang Wang , Zhen Yu Chen , Yu Huang
Published: April 2024

Wing Tak Wong, 2012 Finalist and Presenting Author
Abstract 14357: A Reproducible Porcine Model of Thoracic Aortic Aneurysm
Authors: Eckhouse Shaina R , Patel Risha K. , Rice Allison D. , Logdon Christina B. , Oelsen J. Marshall , Stroud Robert E. , Wince William B. , Mukherjee Rupak , Spinale Francis G. , Ikonomidis John S. , Jones Jeffrey A.
Published: April 2024

Shaina R Eckhouse, 2012 Finalist and Presenting Author
Abstract 59: Treatment at a STEMI Center Is Associated with Favorable Outcomes Following Out-of-Hospital Cardiac Arrest
Authors: Mumma Bryn E , Diercks Deborah B , Danielsen Beate , Holmoes James F
Published: April 2024

Introduction: The American Heart Association recommends regionalized post-OOHCA care at cardiac resuscitation centers that are closely aligned with ST elevation myocardial infarction (STEMI) centers. However, the effect of STEMI centers on outcomes following OOHCA remains unknown.

Hypothesis: We hypothesize that treatment at a STEMI center is associated with increased survival and neurologic recovery among OOHCA patients.

Methods: We included patients age 18 years or older with OOHCA in the 2010 California Emergency Medical Services Information Systems (CEMSIS) database whose CEMSIS record was linked to an inpatient record from the California Office of Statewide Health Planning and Development (OHSPD) database. The CEMSIS database is a unified EMS data collection system, and the OSHPD database contains patient-level data for all inpatient and emergency department encounters. We linked CEMSIS and OSHPD records using probabilistic linkage. Multiple logistic regression models including age, sex, race, ethnicity, payer category, hospital size, teaching status, and trauma center status were used to evaluate the association between STEMI center treatment and outcomes. A STEMI center was defined as one with 24-7 percutaneous coronary intervention capability. Good neurologic recovery was defined as discharge to home, residential care facility, psychiatric facility, prison/jail, and against medical advice.

Results: We identified 8481 patients with OOHCA in the CEMSIS database; 3620 were linked to OSHPD inpatient records. The majority (74.0%) were treated at STEMI centers. Median age was 73 years (IQR 60-83). Survival to hospital discharge was similar between the two groups (26.3% vs 25.8%; p=0.76), but good neurologic recovery was higher among those treated at STEMI centers (18.2% vs 10.4%; p<0.0001). In the adjusted analysis, treatment at a STEMI center was associated with survival (OR 1.2, 95% CI 1.0-1.5; p=0.047) and good neurologic recovery (OR 2.1, 95% CI 1.6-2.8; p<0.0001).

Conclusions: Treatment at a STEMI center following OOHCA was associated with favorable outcomes recovery. Our data suggest that regionalized post-OOHCA care in accordance with American Heart Association guidelines may improve neurologic recovery following OOHCA.
Abstract 6: Bone Marrow Mesenchymal Stem Cells Improved Survival in Septic Rats Induced by Cecal Ligation and Puncture
Authors: Fujii Satoru , Taniguchi Takumi , Yamamoto Ken
Published: April 2024

Background: Some studies have suggested that bone marrow mesenchymal stem cells (BMSCs) have beneficial effects on damaged nerves, ischemia/reperfusion injuries and so on. However, their effects on septic shock have never been scrutinized. In this study, we evaluated effects of BMSCs on septic rats

Methods: Forty male Sprague-Dawley rats were randomly assigned to either of the following groups: group C (n=20), no medication following cecal ligation and puncture (CLP); group M (n=20), BMSCs were administered following CLP. BMSCs were collected from right and left femurs of two rats, using a specially designed devise for that purpose and administered to one rat in either group. Rats in both groups were anesthetized with intraperitoneal pentobarbital and then underwent cecal ligation and puncture. The puncture was performed with 18G needle and 2 holes were made to disseminate inflammation. After skin closure, rats in group M were given BMSCs intravenously. All the rats were observed for the following 7 days. Mortality was calculated for the 7-day observation period.

Result: The mortality rates at 7 days in group M and group C were 30 % and 65%, respectively. There was a significant difference in mortality rate between group M and C. (p<0.05)

Conclusions: Bone marrow mesenchymal stem cells improved mortality in septic rats induced by CLP. This result shows us the potential effect of BMSCs to alleviate systematic inflammation that could result in multiple organ failure. Further studies are underway to clarify the underlying mechanism.
Cardiac Imaging: What Can the Future Learn From the Past?
Authors: Brody William
Published: April 2024

Tremendous strides in the understanding of the etiology of atherosclerosis have been greatly facilitated through the introduction of new methods of imaging of the vascular system. Innovations in imaging using ultrasound, single photon and positron emitting isotopes, x-rays and nuclear magnetic resonance have provided profound insights into the anatomic distribution and enabled the development of new treatment methods including bypass surgery and angioplasty. In addition, imaging tools have helped to identify the role of the various risk factors for the development of atherosclerosis.

Despite the profound reduction in morbidity and mortality of heart disease over the past 50 years, significant obstacles remain to achieve further reductions due to the challenges of sudden cardiac death, restenosis following angioplasty and bypass surgery, as well as heart failure. In the cardiovascular arena, new treatment methods have in many cases followed from the introduction of new tools for imaging the distribution and extent of atherosclerotic narrowing. The challenges for the future will be to identify those technologies with the most promise for increasing the specificity and sensitivity imaging the distribution and progression of atherosclerosis. A brief review of the evolution of diagnostic imaging and its role in understanding and treating heart and vascular disease can help define a roadmap for further advances.
The Epidemic of Cardiovascular Disease in the Developing World: Global Implications
Authors: Gersh Bernard
Published: April 2024

Recent data highlight that cardiovascular disease accounts for approximately 16.7 million of total global deaths of 57 million. 87% of worldwide cardiovascular deaths occur in the developing countries and at a younger age than the developed world. In contrast, total deaths due to HIV, tuberculosis, and malaria were approximately 5 million. Future projections are a concern in that it is estimated that death rates from stroke and coronary heart disease in the developing countries would be two to threefold greater than in the developed world. The cost of countries dealing with the dual burdens of communicable and degenerative diseases in terms of loss of productivity and the impact upon the public and private sector is enormous and could be catastrophic. It is likely that the pace of the “epidemiologic transition” underlying at the epidemic will vary according to the rapidity of economic development or the lack thereof and the role of genetic vulnerability needs to be determined.

Nonetheless, the combination of a hostile cardiovascular environment as defined by changing diet, tobacco, lack of exercise, an aging society, air pollution, and the psychosocial and economic stresses in the developing worlds in conjunction with limited national resources and possible genetic vulnerability (the thrifty gene) is likely to lead to an explosion of the epidemic in the next 20 years.

The key question is whether population-based strategies based upon community public health programs and high risk clinic-based strategies can stem the tide or even halt the epidemic. It is likely that the epidemic will involve all developing countries in the future, but the time course is unpredictable, and there is a dire need for prospective data since the implications for resource allocation are profound. Not all developing nations are at the same stage of the “epidemiologic transition“ and the shifting of resources from dealing with communicable diseases to cardiovascular disease needs to be based upon actual as opposed to perceived needs.

The low priority of cardiovascular and chronic diseases on the global health agenda is a cause for concern and integrating the treatment and prevention of chronic diseases into health systems dealing with communicable diseases will contribute to the strengthening of weak health systems and overall community health.
Abstract 62: Direct Comparison of the Effect of Mild Hypothermia and Controlled Normothermia on Reactive Oxygen Metabolites Production and Antioxidant Potential After Cardiac Arrest in a Porcine Model
Authors: Ostadal Petr , Mlcek Mikulas , Kruger Andreas , Horakova Svatava , Holy Frantisek , Svoboda Tomas , Belohlavek Jan , Kittnar Otomar , Neuzil Petr
Published: April 2024

Introduction
. Mild therapeutic hypothermia was implemented in the management of post cardiac arrest syndrome (PCAS) after publication of clinical trials comparing hypothermia with common practice, i.e. usually with hyperthermia. Current evidence on the comparison of mild hypothermia (HT) and controlled normothermia (NT) is, however, still insufficient. We tested the hypothesis that HT is superior to NT in suppression of oxidative stress, which plays probably an important role in the pathogenesis of PCAS.

Methods.
We worked on porcine model (females, 45 kg) in general anesthesia and mechanical ventilation (HT and NT groups, four animals per group). Veno-arterial extracorporeal membrane oxygenation (ECMO) was introduced and on minimal ECMO flow (0.5 L/min) ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of cardiac arrest, circulation was restored by increase of ECMO flow to 4.5 L/min and 90 min of reperfusion followed. Target core temperature (33°C in HT and 36.8°C in NT) was maintained using heat exchanger on oxygenator. Blood levels of reactive oxygen metabolites (ROM) and biological antioxidant potential (BAP) were assessed before cardiac arrest, immediately after restoration of blood flow and at 30, 60, and 90 minutes of reperfusion.

Results
. While the pre-arrest and early post-arrest ROM levels were comparable in both groups, we observed significant differences between HT and NT groups later during the reperfusion: at 30 minutes (HT vs. NT: 277.8 ± 11.4 vs. 363.3 ± 13.4 U Carr, p < 0.01), at 60 minutes (292.8 ± 6.6 vs. 355.8 ± 10.9 U Carr, p < 0.05), and at 90 minutes (278.5 ± 12.3 vs. 340.8 ± 14.1 U Carr, p < 0.05). The levels of BAP were comparable in both groups in all measurements.

Conclusion
. Our results indicate superiority of mild therapeutic hypothermia over controlled normothermia in the suppression of oxidative stress after cardiac arrest.
Abstract 7: Enhancing Glucose Oxidation Following Ventricular Fibrillation Resuscitation Mitigates Cardiac Systolic Dysfunction
Authors: Azam Mohammed Ali , Wagg Cory , Massé Stéphane , Farid Talha , Lai Patrick F , Kusha Marjan , Asta John , Lopaschuk Gary D , Nanthakumar Kumaraswamy
Published: April 2024

Background:
Ventricular fibrillation (VF) is an important cause of cardiac arrest. After initial successful resuscitation, decreased cardiac contractility during reperfusion is a common problem that is poorly understood. In normal hearts the major energy source for cardiac contractility is oxidation of fatty acids (FA), while only a lesser amount of energy originates from glucose oxidation. Previous investigations showed that during and after ischemia, cardiac contractile dysfunction depends on the type of energy substrate metabolized, with increased FA oxidation and decreased glucose oxidation not being beneficial. Increasing glucose oxidation and decreasing FA oxidation has not been evaluated as a strategy to improve contractile dysfunction following VF resuscitation. One such approach could be the use of dichloroacetate (DCA), a metabolic modulator that increases glucose oxidation and decreases FA oxidation.

Methods and Results:
Rat hearts (n=40) were Langendorff-perfused in Tyrode’s buffer and allowed to equilibrate for 15min followed by 15min of global ischemia and 5min of reperfusion. During reperfusion a short duration burst pacing stimulation was used to induce VF. Hearts were divided into two groups; untreated control (n=20) and DCA-treated during reperfusion (1mM; n=20). One minute later VF was terminated. Left ventricular (LV) pressure, heart rate and coronary flow were monitored during the post VF period. The incidence of VF was 60% in untreated controls, and 66% in DCA-treated hearts. LV developed pressure (LVDP) was reduced after VF and post-resuscitation period compared to the baseline period (90.7±3.5mmHg vs 52.3±6.8mmHg, respectively, n=8, p<0.01). DCA improved post-resuscitation LVDP (74.3±6.5mmHg, n=8, p<0.05 vs untreated controls). Post-resuscitation lactate production was reduced in DCA-treated hearts compared to untreated controls (1.0±0.3µM/g/min vs 1.9±0.2µM/g/min, n= 8, p<0.05).

Conclusions:
Cardiac contractility is impaired following resuscitation after VF. Enhancement of glucose oxidation with DCA mitigates post VF cardiac dysfunction and may have a therapeutic role under these conditions.
Abstract 77: Tachycardia During Hypothermia as a Marker of Poor Outcomes in Cardiac Arrest Survivors
Authors: Waters Theresa , Ji Yong , Liakos Matthew , Saour Basil , Khurana Vikash , Torosoff Mikhail
Published: April 2024

Hypothesis: Therapeutic hypothermia in cardiac arrest survivors is typically associated with bradycardia. We investigated clinical and demographic variables and outcomes associated with tachycardia in patients treated with therapeutic hypothermia.

Methods: Demographic and clinical data, and ECGs of 26 consecutive cardiac arrest survivors (9 females, 58+/-18 years old, 5 with history diabetes, and 6 with history of coronary artery disease) on admission, during and after therapeutic hypothermia were reviewed. Analyses of variance, chi-square, and logistic regression were used. The study was approved by the IRB.

Results: Tachycardia (heart rate > 100 bpm, 81% sinus, no VT-VFib) was observed in 40% of ECG tracings before or during hypothermia or after re-warming. Tachycardia was more common in females (55 vs. 32%, p=0.044), patients with pulmonary disease (39 vs. 13%, p=0.009), or when pre-resuscitation rhythm was PEA (60 vs. 27%, p=0.003) or asystole (23 vs. 15%, p=0.003). Diabetes, myocardial ischemia, LV systolic dysfunction, acute infection, renal insufficiency, treatment with ACE inhibitors or diuretics were not associated with tachycardia. There were multiple biochemical abnormalities associated with tachycardia, including decreased pH (p<0.0001) and decreased hemoglobin (p=0.028), increased glucose (p<0.001), sodium (p=0.078), potassium (p=0.044), or creatinine (p=0.108).

Tachycardia was associated with significantly increased hospital mortality (53% vs. 28%, p=0.029), regardless whether it was observed on admission (63 vs. 38%), during hypothermia (67% vs. 33%), or after the re-warming (67 vs. 33%). In multivariate logistic regression analysis only cardiac arrest rhythm (HR of death with PEA-Asystole 11.1, 95%CI 3.2-38.4, p<0.001), but not demographic or biochemical variables or tachycardia (HR 1.7, 95%CI 0.5-5.8, p=0.391) were predictive of mortality.

Conclusion: Tachycardia in cardiac arrest survivors undergoing therapeutic hypothermia is a marker of poor prognosis, likely reflective of severe metabolic abnormalities, especially in patients presenting with pulseless electrical activity or asystole. More studies of this important subject are needed.
Abstract 78: Modified Rankin Score at Hospital Discharge Is Predictive of 1-Year Neurological Function in Survivors After Cardiac Arrest
Authors: Wayne Marvin , Tupper David , Aufderheide Tom , Mahoney Brian , Swor Robert , Domeier Robert , Olinger Michael , Holcomb Richard , Setum Cindy , Frascone Ralph
Published: April 2024

Background:
A randomized multicenter clinical trial compared standard CPR (S-CPR) with active compression decompression CPR plus an inspiratory impedance threshold device (ACD+ITD) in patients with non-traumatic, out-of- hospital cardiac arrest (OHCA) from a presumed cardiac cause. Survival to hospital discharge (HD) with favorable neurologic function, defined as a modified Rankin Score (MRS) ≤3, and one year survival were greater in the ACD+ITD group. We evaluated the concordance of the primary endpoint, HD with MRS ≤3, with multiple secondary neurologic endpoints assessed at one year.

Methods:
A total of 813 patients were enrolled in the S-CPR group and 842 in the ACD+ITD group. MRS at HD, and Cerebral Performance Category (CPC), Overall Performance Category (OPC), Health Utilities Index (HUI) and Cognitive Abilities Screening Instrument (CASI) assessments were based on responses from consented survivors and known deaths at one year. Neurologic assessments were administered by research staff blinded to the CPR treatment. Survival data were available for 98% of subjects. Fisher’s Exact Test, Pearson Chi-Square test, Mann-Whitney U test, and t-test for Equality of Means were used, as applicable, for comparisons. All statistical tests were 2-sided and p-values < 0.05 were regarded as significant.

Results:
The MRS (≤3 vs. >3) neurological assessment at HD was highly predictive of whether or not a patient would be alive with favorable neurological function in both study groups, assessed using the CPC score (<3 vs. ≥3) at one year (98.0% observed agreement, kappa = 0.800, p < 0.001). Similar concordance was also shown with overall survival, OPC, HUI, CASI. Table shows data for MRS and CPC comparisons.

Conclusion:
Neurological status at the time of HD, as measured by MRS, is highly predictive of long-term neurological function at one year. This is the first time that the MRS at the time of HD has demonstrated the ability to predict long-term outcomes for patients with OHCA.