bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19659: Long Term Left Ventricular Assist Device Therapy: Renal Response to Pulsatile vs Continuous Flow
Authors: Sajgalik Pavol , Soon J Park , Edwards Brooks S , Kuswaha Sudrih , Daly Richard , Joyce Lyle D , Nemec Peter , Kara Tomas , Brunett John C , Boilson Barry , Chen Horng , Schirger John A
Published: April 2024

Background:
Left ventricle assist device (LVAD) support, a well established therapy in advanced CHF, improves renal function assessed by creatinine. While renal function in large numbers of continuous flow (CF) LVADs vs pulsatile flow (PF) LVADs has been evaluated at 3 mo., long term studies are needed with large numbers of CF vs PF devices. To date longer term analysis comparing renal function in CF vs PF devices have relied on a small number of CF devices. We evaluated renal function assessed by creatinine in a large number of CF (HM II) (n=119) devices and compared this to renal function in a group of subjects treated with PF devices (HM XVE) (n=8) at 6 mo. post implant. Our aim was to evaluate change in creatinine between 3 and 6 months in these groups.

Methods and Results:
Plasma creatinine was evaluated at 3 and 6 months in two groups: subjects with CF HM II (n=119) and PF LVAD (HM XVE, n=8). The data were collected from two centers in patients undergoing implant for destination or bridge to transplant therapy. Baseline creatinine was higher in the HM XVE group at baseline (BL), and decreased at 3 mo. (1.7 [1.1-2.1] vs 1.1 [0.8-1.5] mg/dL, p<0.05). BL creatine in the HM II group decreased at 3 mo as well (1.2 [1-1.5] vs 1.1 [0.9-1.3] mg/dL, p,0.05). Between 3 and 6 months there was no difference in degree of creatinine change in CF vs PF, however both groups had an increase in Creatinine in this time frame: PF (1.1 [0.8-1.5] vs 1.35 [1.05-1.9] mg/dL, p<0.05); CF (1.1 [0.9-1.3] vs 1.2 [0.92-1.4] mg/dL, p<0.05).

Conclusion:
This is the first study to demonstrate with large numbers of CF LVAD that creatinine does not incrementally increase between 3 and 6 mo. in comparison to PF LVAD. Further studies are required with large numbers of continuos flow LVADs evaluating the comparative effect of long term continuous flow vs pulsatile flow. Additionally, it remains important to identify surrogates of pulsatility in subjects with continuous flow devices and evaluate prognostic impact on renal function long term.
Abstract 19664: Clinical Characteristics and Cardiac Magnetic Resonance for the Patients Received Repeating Alcohol Septal Ablation in Refractory Hypertrophic Obstructive Cardiomyopathy
Authors: Kitamura Mitsunobu , Takayama Morimasa , Matsuda Junya , Nakamura Syunichi , Takagi Gen , Takano Hitoshi , Asai Kuniya , Mizuno Kyoichi
Published: April 2024

Backgound
: Alcohol septal ablation (ASA) is an alternative option to surgical myectomy, however, there are problems regarding the residual gradient and repeating septal reduction. Therefore, we investigated the patients’ characteristics needed repeating ASA with geometric analysis by cardiac magnetic resonance (CMR).

Method:
We performed 174 ASA from 1998 to 2012, and there were 28 cases (Group R) needed repeating procedures because of recurrent drug-refractory symptoms due to intraventricular obstruction. We investigated the procedural details and the CMR findings to pursue the predictive factor of unsatisfied ASA result, in comparison with 36 patients (Group S) with successful procedures, in which the symptom improved to NYHA class I and there was no repeating ASA until 5 years from the first procedure.

Results:
The time interval of both ASA procedures in group R was 584±496 days, and 16 patients (57%) received 2nd procedure within 1 years. In group R, the patients were younger (55±16 in group R and 65±13 years-old in group S, p=0.006), and similar to gender (Female 25 and 18), baseline pressure gradient (PG) (81±51 and 82±38 mmHg), ethanol dosage (2.2±1.0 and 2.2±0.9ml) than group S. Notably, the PG after ASA in group R was significantly higher (35±34 and 16±18mmHg, p=0.011), moreover the peak CPK was significantly lower (804±388 and 1206±533U/l, p=0.001). From CMR findings, the left ventricular mass, the left atrial diameter, the geometry of the left ventricle and late gadolinium enhancement were similar in both groups.

Conclusion:
Younger patients, high PG after ASA and low peak CPK were likely to need repeating procedure. Therefore, sufficient ablation for culplit septal myocardium was desirable.
Abstract 197: Initial Base Deficit and Arterial Carbon Dioxide Level Associated with Survival in Postarrest Patients
Authors: Gaieski David F , Grossestreuer Anne V , Perman Sarah M , Leary Marion , Napoli Anthony M , Neumar Robert W , Becker Lance B , Abella Benjamin S
Published: April 2024

Introduction:
Serial arterial blood gases (ABG) are typically monitored in post-arrest patients treated with therapeutic hypothermia (TH). The relationship between arterial carbon dioxide (PaCO
2
) levels, degree of base deficit (BD), neurologic outcome, and survival is unclear.

Hypothesis:
Lower PaCO
2
, as a surrogate for hyperventilation, and larger BD, correlating with ongoing acidosis, may be associated with decreased survival and worse neurologic outcomes in post-arrest TH patients.

Methods:
We conducted a retrospective chart review of post-arrest patients treated with TH from the PATH database representing 11 institutions. Demographic variables were analyzed using chi-square tests. Unadjusted logistic regression analyses were performed to assess the relationship between hypocapnea (PaCO
2
< 30 mmHg), normocapnea (PaCO
2
30-45 mmHg), hypercapnea (PaCO
2
> 45 mmHg), mean BD, with respect to mortality or neurologic outcome at 1
st
post-arrest ABG and at 6 hrs, 12 hrs, and 24 hrs post-arrest.

Results:
A total of 179 patients were enrolled. Patients were 59.6 ± 16.4 years, 54% male, and VF/VT was present in 31% of patients. Sixty-six (37%) survived to discharge, of which 76% (50/66) had a good neurologic outcome (CPC 1 or 2). Survivors had a lower mean initial PCO
2
value than non-survivors (49.0 vs. 57.5 mmHg; p=0.03); survival was significantly higher in patients who had normocapnea (51%) on their initial ABG when compared to those who were hypocapneic (25%) or hypercapneic (28%) (p=0.007), however, there was no significant difference in survival at the other time points. When adjusting for gender and initial rhythm, hypocapnea and hypercapnea had lower odds for survival in comparison to normocapnea (OR 0.23, 95% CI 0.03-2.01, p=0.18 and OR 0.72, 95% CI 0.35-1.5, p=0.38). Survivors had less severe BD than non-survivors at initial ABG (-8.0 vs. -11.3; p=0.005) and at all subsequent time points. There was no difference between PCO
2
or BD values between patients with good vs. bad neurologic outcomes.

Conclusions:
Patients who were normocapneic on initial ABG had improved survival. Survivors had lower initial PaCO
2
levels and less severe BD than non-survivors. There was no difference in PaCO
2
or BD values in patients with good vs. poor neurologic outcomes.
Abstract 19706: Increasing Survival and Decreasing Sudden Death Rate from Commotio Cordis
Authors: Maron Barry , Haas Tammy , Ahluwalia Aneesha , Garberich Ross , Estes N.A. Mark , Link Mark
Published: April 2024

Introduction.
Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) in competitive and recreational sports and normal daily activities. Despite normal cardiac structure, these events have been considered predominantly fatal with survival rates of < 20%.

Hypothesis.
To determine whether there has been a change in the expected mortality rate for commotio cordis over time, associated with (or due to) greater public visibility of this condition.

Methods.
U.S. Commotio Cordis Registry was accessed to tabulate the frequency of resuscitated cardiac arrest or SD from 1970 to 2012.

Results.
At the time of their commotio cordis event, 215 study patients were 1 to 50 years old, mean 15; 95% were male. Death due to commotio cordis occurred in 156 individuals (73%), and the other 59 (27%) survived. Notably, the proportion of commotio cordis survivors increased steadily with a concomitant decrease in fatal events over 43 years: for the first 24 years (1970-1993) only 6 of 59 survived (10%) while in the most recent 19 years (1994-2012), 53/156 (34%) survived (p < 0.001). From 2006-2012, survival was 30/52 (58%), at which point the survivor and non-survivor curves crossed (Figure). Survival from commotio cordis was lower in African-Americans (1/24; 4%) compared to whites (53/165; 32%; p=0.007), and less common in recreational sports (16%)/daily activities (12%) than during competitive sports (39%; p < 0.001). Multivariate analysis showed adverse independent predictors of survival to be black race (p=0.051), recreational sports (p=0.019), and daily activities (p=0.012), while the onsite use of AEDs was protective vs. SD (p=0.006).

Conclusions.
Survival from commotio cordis has become significantly more common, largely due to public access defibrillation and greater public awareness. Racial disparity in survival is a notable concern.
Abstract 19740: Epicardial Left Ventricular Lead Placement: Unfavorable Lead Location and Impact on Clinical Response
Authors: Reddy Madhu , Biria Mazda , Subramanyam Prem , Pillarisetti Jayasree , Boolani Hemant , Reddy Namrata , Atkins Donita , Lakkireddy Dhanunjaya
Published: April 2024

Background:
Epicardial placement of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) is performed in patients with failed percutaneous placement or prophylactically in patients undergoing open heart surgery and having a high likelihood of needing a LV lead in future. We indended to evaluate the incidence of unfavorable epicardial LV lead location and the correlation with the type of procedure and clinical response.

Methods:
We performed a retrospective evaluation of all consecutive patients undergoing LV lead placement epicardially in a large academic hospital. Baseline characteristics, procedural variables, lead locations as identified on two-view chest-X rays and clinical follow-up data were collected and analyzed. Apical and anterior lead locations were considered unfavorable locations.

Results:
A total of 148 patients underwent epicardial LV lead placement of which lead locations were available in 134 patients. Mean age of the population was 65 years with 75% males. Ischemic cardiomyopathy was seen in 64% of the patients. Mean left ventricular ejection fraction (LVEF) was 29% and mean QRS duration was 141msec. Leads were placed with a lateral minithoracotomy (MT) in 52 (39%) and open heart surgery (OH) in the remaining 82 (61%) patients. Unfavorable lead locations were seen in 32 (24%) of the patients. Patients undergoing MT were much more likely to have an unfavorable lead location compared to the OH surgery patients (42% vs 12%; p<0.001). The maximum distance between the electrodes was much shorter in MT patients compared to OH surgery patients 2.06 vs 3.16; p=0.005). Complete follow-up data with clinical response (increase in LVEF by 5% and or improvement in heart failure functional class) was available in 108 patients. Overall positive CRT response was seen in 62% of the patients with no significant difference between patients with or without an unfavorable location of the LV leads (63% vs 61%; p=0.873).

Conclusions:
Patients undergoing LV lead placement by minithoracotomy are more likely to have an unfavorable location of the lead with no significant deleterious impact on the CRT response rate.
Abstract 19761: P27 Inhibits IkBa-Degradation, Attenuates Inflammation, Improves Cardiac Function and Increases Survival Following LPS
Authors: Konecny Filip , Zou Jian , Antony Charlene , Husain Mansoor , von Harsdorf Rudiger
Published: April 2024

Background

: A previous cardiac protein interaction screen suggested that cell cycle inhibitor p27 interacts with IKKα, a kinase that regulates phosphorylation-dependent degradation of IκBα, the inhibitor of NF-κB. Bacterial toxin LPS promotes NF-κB-induced myocarditis. Here we test if p27 can interfere with LPS-induced cardiac dysfunction
in vivo
.

Methods

: At 1 and 6 h post-LPS (30 mg/kg i.p.), an HA-tagged TAT-conjugated p27 fusion protein (TAT.p27), a TAT.lacZ control or an equal volume of saline was delivered (20 mg/kg i.p.) to 8-wk old C57BL6 mice. This dose of TAT.p27 was shown capable of entering the heart and increasing total cardiac p27 levels as determined by immunofluorescence for HA-tag and Western blot (WB) for p27. Cardiac structure and function were assessed by 2D-echo and pressure-volume catheters. WBs of heart homogenates for cleaved caspase-3 and Bcl-2, as well as IκBα, were used to assess apoptosis and IκBα turnover. Expression of inflammatory cytokines IL-1β and IL-6 was measured by RT-PCR. Survival was analyzed by Kaplan-Meier plots.

Results

: Delivery of TAT.p27 at 1 h post-LPS preserved myocardial levels of IκBα at 1.5, 2 and 4 h post-LPS. Co-immunoprecipitation experiments in intact heart showed an interaction between p27 and IκBα. Delivery of TAT.p27 at 6 h post-LPS resulted in improvements vs. saline and TAT.lacZ controls in fractional shortening (%: 38.2±1.2
vs.
29.1±1.5, P<0.01; vs. 27.3±1.8, P<0.001), cardiac output (µl/min: 17332±4619 vs. 12279± 5304, p<0.05; vs. 12959±3221; p<0.01), stroke volume (µl: 28±7 vs. 21±8, p<0.01; vs. 20±5 µl, p<0.05) and stroke work (mJ: 2121±909 vs. 1472±721, p<0.05; vs. 1366±522, p<0.05). For each above result, N≥13 per group. Apoptosis was significantly decreased in TAT.p27-treated mice subjected to LPS, as were mRNA levels of IL-1β and IL-6 as compared to controls. Importantly, these improvements were associated with better survival in TAT.p27-treated mice
vs
. saline- and TAT.lacZ-treated controls.

Conclusion

: These data suggest that the p27-IκBα and or IKKα interactions, possibly by preserving cardiac IκBα levels and preventing NFκB activation post-LPS, attenuate inflammation, limit cardiomyocyte apoptosis, and improve survival in a model of endotoxin-induced cardiac dysfunction.
Abstract 19780: Mammalian Cardiac Renewal by Preexisting Cardiomyocytes
Authors: Senyo Samuel E , Steinhauser Matthew L , Pizzimenti Christie L , Yang Vicky K , Wang Mei , Cai Lei , Wu Ting-Di , Guerquin-Kern Jean-Luc , Lechene Claude P , Lee Richard T
Published: April 2024

Although recent studies have revealed that adult heart cells are generated after birth in mammals, the frequency and source of these new heart cells is unclear. Here we combined two different pulse-chase approaches--genetic fate-mapping and stable isotope labeling with Multi-isotope Imaging Mass Spectrometry (MIMS)--to determine the origin of cardiomyocytes in adult mice. MIMS allows quantitative imaging of stable isotope reporters in domains smaller than a micron cubed. The nuclear incorporation of a 15N stable isotope-enriched tracer here as 15N-thymidine is detectable with high precision by an increase in the 15N/14N ratio above natural abundance (0.37%) in a pattern resembling chromatin evident in cells having divided during a labeling period. We administered 15N-thymidine for 8 weeks to three age groups of C57BL6 mice starting at day-4 (neonate), at 10-weeks (young adult) and at 22-months (old adult) and extrapolated DNA synthesis yields a yearly rate of 5.5% in the young adult that declines further to 2.6% in advanced aged mice. Fig1a. To evaluate the origin of newly generated cardiomyocytes, we performed 15N-thymidine labeling of double-transgenic MerCreMer/ZEG mice, which we previously developed for genetic lineage mapping. Fig1b. After treatment with 4OH-tamoxifen, we show that DNA synthesis occurs at a low rate in predominantly pre-existing cardiomyocytes [77% expressed GFP, a frequency essentially identical to that of surrounding 15N- cardiomyocytes (15N, 77% vs 15N-, 84%; Fisher’s exact=n.s.)]. Fig1c. Cell cycle activity in cardiomyocytes led to polyploidy and multinucleation, and to new diploid, mononucleated cardiomyocytes [17% of total; predominantly GFP+ (83% vs 82%, p=n.s.)]. Fig1d. Our results support a low rate of cell division of cardiomyocytes as the origin of mammalian adult cardiogenesis and are inconsistent with a high rate of stem cell activity in the normal mammalian myocardium.
Abstract 19819: Genetic Pre-Participation Screening in Selected Athletes: A New Tool for the Prevention of Sudden Cardiac Death?
Authors: Frisso Giulia , Limongelli Giuseppe , Assorgi Riccardo , Mazzaccara Cristina , Cordella Angela , Detta Nicola , D'Andrea Antonello , Romano Silvio , Penco Maria , Pelliccia Antonio , Salvatore Francesco , Calabrò Raffaele
Published: April 2024

Background:
Sudden cardiac death (SCD) of athletes is a topical issue. Borderline cardiac abnormalities may result in SCD, which in turn may be genetically based; thus, genetic analysis may help to identify potentially pathological cardiac abnormalities.

Aim:
We performed phenotype-guided genetic analysis in athletes who, pre-participation, showed ECG and/or Echo borderline abnormalities, to discriminate subjects at a greater risk of SCD.

Subjects and Methods:
We studied 24 elite athletes referred by the National Federation of Olympic Sports; and 25 subjects seeking eligibility to practice agonistic sport referred by the Osservatorio Epidemiologico della Medicina dello Sport, Regione Campania. Inclusion criteria were: a) borderline ECG repolarization abnormalities; b) benign ventricular arrhythmias; c) LVWT in the grey zone of physiology versus pathology (MWT 12-15 mm in females; 13-16 mm in males). Based on the suspected phenotype, we screened subjects for LMNA gene, 8 sarcomeric genes, 5 desmosomal genes, and cardiac calcium, sodium and potassium channel disease genes.

Results:
Genetic analysis was completed in 37 out of 49 athletes, 22 competitive and 27 non-competitive athletes, showing borderline clinical markers suggestive of hypertrophic cardiomyopathy (HCM n 24), dilated cardiomyopathy (n 4), arrhythmogenic right ventricular dysplasia/catecholaminergic polymorphic ventricular tachycardia (ARVD/CPVT n 11), long QT syndrome (LQTS n 4), sick sinus syndrome (SSS n 5), or Brugada syndrome (BrS n 1). We identified 11 mutations in 9 athletes (an ARVD athlete was a compound heterozygote for the PKP2 gene and an HCM athlete was a double heterozygote for the MYBPC3 and TNNT2 genes): 3 known mutations related to LQTS, HCM and ARVD, respectively, and 8 novel mutations, located in the SCN5A, RyR2, PKP2, MYBPC3 and ACTC1 genes. The new mutations were absent from ∼800 normal chromosomes and were predicted probably damaging by in silico analysis. Patch clamp analysis in channelopathies indicated that some mutations were associated with abnormal biophysical behavior of the corresponding mutant protein.

Conclusion:
Genetic analysis may help distinguish between physiology and pathology in athletes with suspected familial or sporadic heart disease.
Abstract 199: Automated External Defibrillator Awareness and Knowledge Among the Lay Public in a Busy Urban Transportation System
Authors: Gonzalez Mariana R , Cinousis Marisa J , Ward Michael A , DiPuppo Tucker Kathryn , Becker Lance B , Leary Marion , Abella Benjamin S
Published: April 2024

Background: The prompt utilization of automatic external defibrillators (AEDs) by bystanders can greatly improve survival from sudden cardiac arrest occurring in public locations. A recent study of laypersons in a European transportation hub has suggested public knowledge and surrounding AED use is lacking; we sought to confirm and extend these findings in similar settings in the US. We hypothesized that awareness of AEDs and who can use them will be low among the general public.

Objectives: To characterize layperson knowledge about AED use and emergency response in a major US metropolitan area transportation system.

Methods: A survey instrument was adapted from a prior investigation performed in Europe. Trained survey personnel administered this oral survey (approx. five minute duration) to adult laypersons at two public transportation centers in a large US city during May 2012. The participants were asked questions relating to their knowledge of AEDs and who is permitted to use them, as well as their willingness to utilize an AED in an emergency.

Results: Surveys were completed by 222 individuals. Mean age of respondents was 49.4±17.1 y, 44% were female and 25% reported prior CPR training within the past 5 years. When presented with a hypothetical cardiac arrest scenario, 63% said they would call for help and/or dial 911, but only 8% of respondents spontaneously suggested using an AED when prompted for other actions. When an AED was described, 59% of participants were aware that AEDs are available in public places, but only 38% were aware that AEDs can be used by laypersons. When informed regarding the availability for layperson use, 60% of respondents said that they would be willing to use an AED in an emergency situation.

Conclusions: Though the majority of layperson respondents were willing to use an AED in an emergency when educated, few respondents considered an AED in their immediate response and the minority were aware that AEDs could be accessed by the general public. Additional broad efforts to educate the US public about AED availability and use should be prioritized.
Abstract 2: Orexin-A Improves Arousal from Post--Cardiac Arrest Coma in a Rodent Model
Authors: Akbari Yama , Maybhate Anil , Chen Cheng , Greenwald Elliot , Liang Lydia , Buitrago-Blanco Manuel , Jia Xiaofeng , Thakor Nitish , Geocadin Romergryko
Published: April 2024

Introduction: Coma after cardiac arrest (CA) is common and leads to suffering for patients while being an emotional and financial burden to families and society. Other than hypothermia, there is currently no therapy to improve neurological outcome after CA. The hypothalamic Orexin pathway provides a potential pharmacologic target towards improving arousal after coma.

Hypothesis: Post-resuscitaion, Orexin-A intracerebroventricular (icv) infusion after bolus injection will provide immediate and long term term arousal after CA which can be assessed by quantitative EEG (qEEG) and behavioral testing (neurologic deficit scale; NDS).

Methods: Rats (N=17; Adult Male Wistar; 300-350gms) were implanted with icv cannula attached to an osmotic pump. One week later, rats underwent baseline EEG followed by intubation, mechanical ventilation, cannulation of the femoral vessels, followed by 7 minutes of asphyxial cardiac arrest. Forty-five minutes after the resuscitation, rats were randomized to either Orexin-A (n=8) or saline (n=9) icv bolus and infusion. EEG was monitored continuously for 4 hours after CA, and for 30 minutes at 24hrs, 48hrs, 72hrs, and 12 days post-CA. NDS was also conducted at these times. EEG was analyzed using a custom algorithm to analyze the information quantity (IQ), an entropy based nonlinear measure for the entire frequency domain and clinical sub-bands.

Results: Orexin-A treated rats demonstrated higher normalized IQ immediately after receiving the Orexin-A in comparison to saline (0.731±0.028[AM1] vs. 0.613±0.021; p<0.01). This acute improvement in IQ sustained for 4hrs Post-CA. Moreover, the band-specific analysis [RG2] showed that Orexin-A improved the IQ in β-band at 72hrs (1.160±0.039 vs. 1.052±0.029; p<0.05). Behaviorally, Orexin-A allows rats to perform significantly better on the NDS at 4hrs (38.3±3.2 vs. 30.1±1.9; p<0.05); 24hrs (67.1±4.1 vs. 49.8±3.8; p<0.01); 48hrs (73.4±4.3 vs. 61.0±3.6; p<0.05), and 72hrs (75.0±3.3 vs. 65.2±2.9; p<0.05).

Conclusions: Rats receiving icv Orexin-A post-CA showed better arousal on both qEEG and behavioral (NDS) testing. Orexin-A may have therapeutic potential in disorders of arousal and coma after CA.
Abstract 205: Are All Codes the Same? House Staff Perceptions of Cardiopulmonary Resuscitation in the Cardiac Catheterization Laboratory
Authors: Karol Janet , Borak Meredith , Beiser David G , Edelson Dana , Deal Nathan , Nathan Sandeep , Paul Jonathan , Babcock Christine , Shah Atman P
Published: April 2024

Background:

Patients who are resuscitated after cardiac arrest (ROSC) are increasingly being taken to the cardiac catheterization laboratory (CCL) for diagnostic procedures and ventricular support. These critically ill patients may suffer a second arrest and need cardiopulmonary resuscitation (CPR) during their CCL procedure. The goal of this study was to assess housestaff perceptions of these codes and subsequent management.

Methods:

All codes at our institution are run by housestaff. Seventy-five internal medicine and emergency medicine residents at a single tertiary care university hospital were sent a web-based survey. Residents were asked their level of training, the quality of the CPR in the CCL compared to other clinical areas, and the top reason why they felt quality CPR was hindered in the CCL. The identities of the respondents were anonymous, but the respondents self-identified training program was recorded.

Results:

Fifty of the residents responded (66.7%). Compared to codes in the ICU, 40% felt that the CPR in the CCL was worse while 46% reported that it was the same and 14% felt that the codes were better. Compared to codes in the Emergency Department, 28% felt that the CPR was worse while 44% felt it was the same and 28% felt it was better. The top three reasons that CPR was felt to be compromised was the physical interference of the imaging equipment, the need for frequent stops of CPR, and the fear of radiation exposure (Table 1).

Conclusions:

This study identified perceived obstacles to resusitative efforts in the CCL. Standardization of care, identification of obstacles and removing these barriers are key to effective CPR and patient survival.
Abstract 211: Poor AED Availability Despite Improved AED Dissemination: A Challenge for Public Access Defibrillation
Authors: Malta Hansen Carolina , Wissenberg Mads , Weeke Peter , Ruwald Martin H , Lamberts Morten , Lippert Freddy , Gislason Gunnar H , Nielsen Soren L , Kober Lars , Torp-Pedersen Christian , Folke Fredrik
Published: April 2024

Background

Strategic AED placement and availability are paramount for successful public access defibrillation (PAD). However, analyses of AED coverage in relation to location and incidence of cardiac arrest in community settings are limited. We assessed AED placement and coverage according to workday, weekends and hour of day in relation to out-of-hospital cardiac arrests (OHCAs) in public.

Methods

All OHCAs in public places from 1994-2011 and all publicly available AEDs in Copenhagen, Denmark, were geographically located. OHCA high-risk areas were defined as those with ≥1 arrest every 2 years, within a 100-meter radius. All OHCAs occurring within a 100-meter radius were counted as well as the number of AEDs in these areas. AEDs available for PAD were registered in a nationwide network with the following information: location, time and weekday availability.

Results

A total of 2151 OHCAs occurred in public locations. The mean age was 61.7 (SD±17.7) years (74.8% males). High-risk areas accounted for 1.1% (n=112) of the city and 16.5% (n=360) of all arrests. A significant proportion of arrests occurred on weekends and between 6 p.m. and 8 a.m (65.8%). The number of AEDs increased from 36 in 2007 to 555 by the end of 2011. Of these, 5.8% (n=32) covered 44.6% of the high-risk areas and 96.2%, 31.9% and 9.7% were available all weekdays during daytime, evening and nighttime, respectively. On weekends 29.4%, 17.7% and 9.2% of all AEDs were available in daytime, evening and nighttime, respectively. Only 18.8% (n=6) AEDs in high-risk areas had 24-hour and all-week availability.

Conclusion

Despite a large increase in public AEDs, the coverage of OHCA high-risk areas remains insufficient. Further, only 18.8% of AEDs in OHCA high-risk areas were available at all times although 65.8% of arrests occurred outside working hours. Hence, a much greater proportion of AEDs should offer 24-hour and all-week availability to cover the actual incidence of cardiac arrest.
Abstract 212: Can Return of Spontaneous Circulation Be Achieved Faster in a Resuscitation Algorithm that Directs the Duration of Postshock Chest Compressions According to the Preshock Value of the Amplitude-Spectral Area? A Study of Ventricular Fibrillation Cardiac Arrest in Normal Swine
Authors: McGovern Meghan , Allen Daniel , Chaudhry Fahd , Hilwig Ronald , Kern Karl B , Indik Julia
Published: April 2024

Background: It has been previously demonstrated in a swine model of cardiac arrest due to ventricular fibrillation (VF) that a return of spontaneous circulation (ROSC) following a shock is predicted by the amplitude spectral area (AMSA), a quantitative measure of the VF waveform. These prior studies were a retrospective analysis of the VF waveform prior to shocks. We hypothesize that AMSA can be utilized in a prospective fashion as part of a resuscitation algorithm to direct the duration of post-shock chest compressions (CC). Specifically, we have tested whether such an AMSA-directed algorithm will shorten the time needed to achieve ROSC in normal swine.

Methods: VF was induced electrically in normal swine and untreated for 10 minutes. Resuscitation was commenced with 1 minute of CC, resumption of mechanical ventilation, followed by the first shock and administration of epinephrine. Subsequently, animals were randomized to a traditional or waveform guided group. In the traditional group, all shocks were followed by 2 minutes of post-shock CC. In the waveform guided group, AMSA was measured prior to each shock and if AMSA>20 mV-Hz then post shock CC duration was shortened to 1 minute. ROSC was defined as a systolic aortic pressure greater than 50 mm Hg and pulse pressure > 20 mm Hg lasting at least one minute. Time to ROSC was compared with a Kruskal-Wallis rank test. AMSA was compared between groups using regression analysis with random effects to account for multiple shocks within the same animal.

Results: A total of N=8 animals were assigned to the traditional group with 22 shocks delivered, and N=8 animals to the waveform guided group with 21 shocks delivered. Time to ROSC (from induction of VF) was 14.5 ±1.2 minutes in the traditional group and 13.5± 1.2 minutes in the waveform guided group, (P=0.2). There was a trend for higher AMSA values in the waveform guided group: 48 ± 15 versus 39 ± 16 mV-Hz (P=0.1).

Conclusions: A resuscitation algorithm that tailors the duration of post-shock chest compressions to the value of AMSA is feasible. In this study of normal swine we found small, but non-significant, reductions in the times to achieve ROSC and higher values of AMSA in swine treated with a waveform guided approach.
Abstract 214: Drivers of In-Hospital Cardiac Arrest Survival Rates: A Risk-Adjusted Model
Authors: Merchant Raina M , Berg Robert A , Groeneveld Peter W , Yang Lin , Becker Lance B , Asch David A , Chan Paul S
Published: April 2024

Background
Cardiac arrest in hospitalized patients is common and often fatal. Factors which predict which patients will survive arrest to discharge or die in the hospital are unknown. This gap in our understanding precludes hospitals from characterizing their relative in-hospital cardiac arrest (IHCA) outcome rates relative to other hospitals and identifying their individual needs for quality improvement.

Methods
Using data from the Get With the Guidelines-Registry, years 2000-2010, we identified patients with IHCA. Excluded were patients <18 or >110 years of age, arrests in hospital visitors or employees, and events with missing variables. A regression model was used to identify predictors of survival rates across hospitals. The sequential model included demographics ( age, race, gender), then pre-arrest comorbidities, and then intra-arrest factors (e.g. initial rhythm, in-place interventions, arrest: etiology, location, time). The outcome measure was survival to discharge. Unadjusted and risk-adjusted survival rates per hospital were calculated.

Results
We evaluated 136,663 IHCA at 588 hospitals. IHCA survival to discharge rates varied across hospitals; unadjusted: median: 0.19 (IQR 0.14-0.24); adjusted: median 0.18 (IQR 0.16-0.21). The regression model showed several predictors explained some but not all of the variability in outcomes (c-statistic =0.74). Several predictors of variability in survival outcomes included age 41-65 (OR 1.5; 95% CI 1.5-1.6, p<.01), female sex (OR 1.1; 95% CI 1.0-1.1 p<.01), black race (OR 0.83; 95% CI 0.79-0.87, p<.01), prior arrhythmia (OR 1.25; 95% CI 1.2-1.3, p<.01), cardiac arrest etiology (OR 1.2; 95% CI 1.2-1.3, p<.01), toxicologic arrest etiology (OR 2.4,95% CI 2.1-2.8, p<0.01), monitored bed status (OR 1.7; 95%CI 1.6-1.8, p<.01), and pre-arrest anti-arrhythmic drugs (OR 1.2; 95% CI 1.2-1.3, p<.01).

Conclusion
There is significant variability in IHCA outcomes across hospitals although not all explained by patient level risk-adjustment of available variables. Further research is needed to investigate additional drives (e.g. hospital structure and process measures, patient level variables in other datasets) of this variability in order to develop valid comparisons of outcomes across hospitals.
Abstract 222: Does Gender Matter for Postarrest Care?
Authors: Rac Valeria E , Dorian Paul , Slutsky Arthur S , Abramson Beth , Fowler Robert , Parsons Janet A , Kiss Alex , Dainty Katie N , Zwarenstein Merrick , Zhan Cathy C , Morrison Laurie J
Published: April 2024

Introduction: Studies have shown that after cardiac arrest women have lower survival to discharge rates than men. These differences are surprising, considering that women are more often successfully resuscitated in the prehospital setting. Differences in survival to discharge rates might be partially attributed to disparity in post arrest care, similar to what is seen in myocardial infarction (MI).

Hypothesis: There is gender disparity in the provision of targeted post arrest care interventions.

Methods: This prospective study explores gender disparity in a prospective Canadian data set of non-traumatic, EMS treated, out of hospital cardiac arrest (OHCA) patients presenting to hospitals in the Strategies for Post Arrest Care (SPARC) network between March 16, 2010 and March 31, 2012. All patients with sustained return of spontaneous circulation (palpable pulse for >20 mins) were included in the analysis. Unadjusted chi square tests and logistic regression models were employed to examine the relationship between gender, and provision of post arrest care interventions (coronary angiography, percutaneous coronary intervention (PCI), therapeutic hypothermia, electrical physiology consultation and internal cardiac defibrillator (ICD) placement and two or more neuroprognostic testing ≥ 72 hours).

Results: From a total of 2,199 OHCA patients (1,447 men, 752 women), 992 had sustained return of spontaneous circulation (36.6% women, mean age 68.2 years; 63.4% men, mean age 63.9). There were gender differences in utilization of coronary angiography (12.1% in women vs. 20.8% in men, adjusted OR 0.53, 95% CI 0.36 to 0.77, p=0.013) and PCI (3.7% in women vs. 5.8% in men, adjusted OR 0.63, 95% CI 0.41 to 0.98, p=0.042). ICD was less utilized in women, but differences were not significantly different (4.9% in women vs. 8.1% in men, adjusted OR 0.59, 95% CI 0.33 to 1.02 p=0.062). There were no gender differences in utilization of therapeutic hypothermia and neuroprognostic testing ≥ 72 hours.

Conclusion: The observed gender differences in utilization of coronary angiography and PCI intervention may be due to disparity in care and/or differences in underlying pathophysiology of cardiac arrest between men and women contributing to women’s unfavorable outcomes.
Abstract 225: Incidence, Timing and Effect of Fever on Outcomes Following Resuscitation from Cardiac Arrest
Authors: Gebhardt Kory , Guyette Francis X , Doshi Ankur , Callaway Clifton , Rittenberger Jon C
Published: April 2024

Background

Fever after cardiac arrest is associated with poor outcomes. We hypothesized that the association of fever and outcome would differ between patients treated with therapeutic hypothermia (TH) and those not.

Methods

We included 338 comatose patients who survived >48 hours after admission to a single center between 1/1/2005 and 6/30/2010. Fever was defined as T≥ 38.0°C within 48 hours of arrest. Categories of post-cardiac arrest illness severity were defined by neurological examination and sequential organ failure assessment (SOFA) score on presentation: 1) awake, 2) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), 3) coma + moderate-severe cardiopulmonary dysfunction (SOFA cardiac + respiratory score >=4), and 4) coma without brainstem reflexes. Logistic regression measured association of fever and clinical variables with survival and good outcome (discharge to home or to acute rehabilitation facility).

Results

Mean age was 60 years (SD 16), 212(63%) had out-of-hospital cardiac arrest (OHCA), and 220 (65%) received TH. Ventricular fibrillation/ventricular tachycardia (VF/VT) was the primary rhythm for 133 (40%). Post arrest illness severity was category II in 119 (38%) , category III in 62 (20%), and category IV in 133 (42%). One hundred twenty eight (38%) survived; 75 (22%) with good outcomes. Fever was present in 142 (42%) of patients, with a median onset of 15 hours post-arrest in the non-TH cohort and 36 hours in TH cohort. Survival was associated with VF/VT (OR 2.60, CI 1.56-4.32) and category IV (OR 0.15, CI 0.08-0.27). Good outcome was associated with OHCA (OR 4.08, CI 1.99-8.39) and category IV (OR 0.13, CI 0.06-0.27). Fever was not associated with survival (OR 0.99, CI 0.57;1.70) or good outcome (OR 0.90, CI 0.47; 1.75) overall. Fever was negatively associated with survival in non-TH cohort (OR 0.38, CI 0.17;0.84) but not within the TH cohort (OR 1.48, CI 0.73; 2.97). Fever was not associated with good outcomes in the TH cohort (OR 1.34, CI 0.59; 3.06) or non-TH cohort (OR 0.36, 0.11; 1.13).

Conclusions

Fever is common in both TH and non-TH patients. Onset time is later after TH. Fever is negatively associated with survival in non-TH patients but not in TH patients.
Abstract 236: Administration of Amiodarone During Resuscitation Is Associated with Higher TNF-? Levels in the Early Postarrest Period in the Swine Model of Ischemic Ventricular Fibrillation
Authors: Youngquist Scott T , Niemann James T , Shah Atman P , Thomas Joseph L , Rosborough John P
Published: April 2024

Introduction: While amiodarone (AMIO) improves ROSC from cardiac arrest due to VF when compared to lidocaine (L), no long-term survival benefit has been demonstrated. Conflicting data exist regarding the effects of AMIO on serum TNF-alpha levels in settings such as cardiopulmonary bypass and CHF. We hypothesized that AMIO administration during resuscitation from VF would result in a TNF-alpha response comparable to L in the early post-arrest period.

Methods: Balloon occlusion of the LAD was used to induce VF in anesthetized, instrumented swine. After 7 min, conventional ACLS was begun. Animals were randomized to either bolus AMIO (5 mg/kg, n=13) or L (1 mg/kg, n=14) for recurrent or refractory VF. Following ROSC, TNF-alpha levels were drawn at 30 and 60 min for analysis.

Results: Groups demonstrated comparable prearrest hemodynamics and resuscitation variables. Prearrest TNF-alpha levels were higher, however, in animals ultimately treated with AMIO (geometric mean of 103.0 vs. 58.8 pg/mL, p=0.01). In the postarrest period, TNF-alpha levels were significantly higher in AMIO than L treated animals at 30 min (2.2 fold higher, 95% CI 1.4-3.4 fold higher, p=0.0016) and at 60 min (2.65 fold higher, 95% CI 1.1-6.3 fold higher, p=0.03). The rate of rise in TNF-alpha among AMIO-treated animals was higher than that in L treated animals by, on average, 1 pg/mL/minute, but this difference in slope was not statistically significant (p=0.4). (Figure)

Conclusion: Higher post arrest TNF-alpha levels in AMIO treated animals may mean that improved rates of ROSC seen with AMIO come at the expense of a heightened pro-inflammatory state in the post-cardiac arrest period.
Abstract 241: Neurocognitive Functioning and Quality of Life After Successful Resuscitation from Cardiac Arrest
Authors: Beesems Stefanie G , Wittebrood Kim M , de Haan Rob J , Koster Rudolph W
Published: April 2024

Objective Neurocognitive function (NCF) and Quality of Life (QoL) of patients (pts) with an out-of-hospital cardiac arrest (OHCA) may have improved since an increasing number of pts are managed with an AED and Therapeutic Hypothermia (TH) is universally applied. We studied the NCF and QoL of consecutive pts 6-12 months after OHCA and the QoL of their relatives.

Materials and methods The study population comprises all consecutive pts (>18 year) who survived 6-12 months after OHCA from mid-2010 to mid-2011. Pts and relatives were interviewed by telephone. The questionnaires used were validated for telephonic application with a validated cut-off score. The QoL was measured with the SF-12, NCF with the Telephonic Interview Cognitive Status (TICS), level of independence with the Modified Rankin Scale (MRS). If needed, the IQ-code was used as proxy-questionnaire to measure the NCF of the pt. The Caregiver Strain Index (CSI) was used to measure QoL of the relatives. The elderly (≥ 80 years) were compared to an open Dutch population of ≥ 80 years. Treatment effect was calculated with an effect size θ. Effect sizes near 0 are small, >0.8 or <-0.8 are considered as significant and relevant.

Results The proportion of the pts who scored normal on the questionnaires is shown in the table. When TICS and IQ-code are added up, 180 of 220 pts (82%) had a normal NCF. The mean score of elderly on the mental SF-12 was 40.5 and on the physical SF-12 53.2, while the compatible population scored 38.1 (θ =-0.20) and 54.4 (θ =0.15), respectively. Pts with TH scored 54.2 on the mental SF-12, while pts without TH scored 52 (θ=0.26). The mean score on the physical SF-12 of pts with TH was 46.4 and without the need of TH 44.8 (θ=0.16), respectively.

Conclusion QoL, NCF and independency in daily-life 6-12 months after OHCA is normal in the great majority of pts. Mental QoL is better compared to physical QoL. Pts ≥80 years score equal to age comparable persons of the normal population. Outcome after TH is equal to those not needing TH.
Abstract 258: Coronary Perfusion Pressure Response to Administration of Intraosseous Epinephrine After Prolonged Cardiac Arrest
Authors: Harris Joshua L , Coute Ryan A , Millay Scot A , Kellogg Adam R , Mader Timothy J
Published: April 2024

Background:
While provision of vasopressors during attempted resuscitation of OHCA victims has never been shown to improve neurologically intact survival, its short-term benefits are clear. Despite evidence that the IO dose should be substantially higher than that given IV to achieve pharmacokinetic and hemodynamic equivalency, current guidelines still recommend a dose of 0.01 mg/kg regardless of delivery route (IO or IV).

Objective:
To compare the effect of epinephrine 0.1 mg/kg (HDE) IO with 0.01 mg/kg (SDE) IV on coronary perfusion pressure (CPP) during resuscitation in a swine model of prolonged VF.

Methods:
This was a secondary analysis of prospectively collected data from two IACUC approved protocols. Seventy-nine Yorkshire swine (25-30 kg) were surgically instrumented under anesthesia and VF was electrically induced. After 10 minutes of untreated VF in the IO study (n=26) and 12 minutes of untreated VF in the IV study (n=53), resuscitation commenced with precordial chest compressions. After 30 seconds of initial chest compressions, a single dose of epinephrine (HDE IO or SDE IV, respectively) was given followed by a large volume saline flush. An additional 2.5 minutes of compressions were provided after injection to circulate the medication before the first rescue shock (RS) was delivered. CPR and RS attempts were standardized for all animals. The CPP was defined as aortic diastolic pressure minus right atrial diastolic pressure and the values were extracted immediately following the last compression before defibrillation for the first RS in each animal. Descriptive statistics were used to analyze the data.

Results:
After 10 minutes of untreated VF, HDE IO epinephrine resulted in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9) just prior to RS1. After 12 minutes of untreated VF, SDE IV epinephrine resulted in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4) just prior to RS1.

Conclusion:
This observation study reaffirms the assertion that HDE may be required to generate CPP values similar to SDE delivered IV during resuscitation of prolonged VF. A randomized comparison of HDE and SDE IO in the metabolic phase of VF is needed to test this hypothesis and to determine the impact on ROSC and short-term survival.
Abstract 26: Impact of Total Occlusion of the Coronary Artery and the Amount of Infarct-Related Myocardium in Patients with Refractory Cardiac Arrest due to Acute Coronary Syndrome
Authors: Kagawa Eisuke , Dote Keigo , Kato Masaya , Sasaki Shota , Nakano Yoshinori , Itakura Kiho , Ochiumi Yusuke , Takiguchi Yu , Honda Hideko , Inoue Ichiro , Kawagoe Takuji , Ishihara Masaharu , Kihara Yasuki
Published: April 2024

Introduction: Acute coronary syndrome (ACS) is a leading cause of sudden cardiac arrest. Percutaneous coronary intervention (PCI) may provide improved outcomes for resuscitated patients; however, prognosis in refractory cardiac arrest patients remains poor. Hypothesis: We assessed the hypothesis that total occlusion of the culprit coronary artery is associated with refractory

cardiac arrest that is unresponsive to conventional cardiopulmonary resuscitation (CPR).

Methods: Adult out-of-hospital cardiac arrest patients who underwent emergency coronary angiography and were diagnosed with ACS were enrolled in this retrospective study. We divided the patients into 2 groups: patients who achieved return of spontaneous circulation by conventional CPR (group 1) and patients with refractory cardiac arrest who were unresponsive to conventional CPR and were treated with extracorporeal CPR (group 2). Data about thrombolysis in myocardial infarction flow grade were collected at initial coronary angiography. P < 0.05 was defined as statistically significant. Results: We enrolled 54 patients (group 1; n = 35), median age of the patients was 61 y (interquartile range 54-72 y), 87% patients were male, 81% patients were witnessed cardiac arrest, 57% patients were received CPR initiated by by-standers, and 67% patients showed shockable initial recorded rhythm. The rate of culprit lesion in the left main trunk was higher in group 2 than in group 1 (3% vs. 21%, P = 0.04), and that in the left circumflex artery was lower in group 2 (20% vs. 0%, P = 0.04). Thrombolysis in myocardial infarction flow grade 3 was observed in 29% of group 1 and 16% of group 2 patients (P = 0.34), and thrombolysis in myocardial infarction flow grade 0 or 1 was observed in 57% of group 1 and 84% of group 2 patients (P = 0.04). Coronary reperfusion therapy by PCI was performed in 81% of the patients, and all of whom achieved return of spontaneous heart-beat.

Conclusions: Total occlusion of the coronary artery and a large amount of infarct related myocardium may be associated with refractory cardiac arrest due to ACS. Coronary reperfusion therapy could achieve higher rate of return of spontaneous heart-beat and may improve outcomes in patients with refractory cardiac arrest.