bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19069: Empagliflozin Improves Right Ventricular Remodeling and Right Ventricular Systolic Function in Non-Diabetic Hfref: Insights From Porcine and Human Studies
Authors: Santosgallego Carlos G , Requena-Ibanez Juan Antonio , Vargas Delgado Ariana Patricia , Ishikawa Kiyotake , Sanz Javier , Lala Anuradha , Contreras Johanna P , Mancini Donna M , Pinney Sean , Bhatt Deepak , Fuster Valentin , Badimon Juan J
Published: December 2023

Background
On top of improving heart failure outcomes, we and others have demonstrated that SGLT2 inhibitors induce reverse cardiac remodeling in HFrEF. However, these studies have focused on the left ventricle, while no information is available on the potential benefits of SGLT2i on the right ventricle (RV). Therefore, our objective is to investigate the effect of empagliflozin on RV remodeling and RV systolic function in non-diabetic HFrEF

Methods Animal study:
HFrEF was induced by means of proximal LAD occlusions for 2 hours in non-diabetic pigs. Pigs were then randomized to empagliflozin 10mg daily or placebo for 2 months (8/group). Pigs were evaluated with cardiac MRI. We previously reported that empagliflozin reduces LV volumes and improve LVEF (Santos-Gallego, JACC 2019)
Human study
: The EMPATROPISM clinical trial ((NCT03485222) randomized non-diabetic HFrEF patients to empagliflozin 10mg daily or placebo. All patients were evaluated with MRI. We previously reported that empagliflozin reduces LV volumes, while also improving peakVO2, LVEF, and quality of life (Santos-Gallego, JACC 2021)

Results Animal study:
Both groups were similar at baseline (RVESV 16.1±3.2 vs 15.8±2.1mL; RVEF 51.9±5.6 vs 52.7±4.7%; p=NS). Cardiac MRI showed that empagliflozin-treated pigs exhibited smaller RVEDV and RVESV at 2 months compared with control. Also treated animals exhibited better RVEF and better right ventriculoarterial coupling (Ees/Ea) vs control (Table) Human study: Both groups were similar at baseline (RVESV 87.4±35.6 vs 76.4±32.4 mL; RVEF 47.1±7.9 vs 49.2±9.1%; p=NS). Cardiac MRI showed that empagliflozin-treated patients experienced a reduction in RVESV vs placebo. Furthermore, empagliflozin-treated patients exhibited improvement in RVEF and in right ventriculoarterial coupling (Ees/Ea) vs control (Table)

Conclusions
Empagliflozin improves right ventricular remodeling and right ventricular systolic function in non-diabetic HFrEF
Abstract 19071: An Agitated Young Heart: A Rare Presentation With a Favorable Outcome Under the Right Circumstances
Authors: Pillai Pranav , Zheng ShengNan , AlAdili Bahjat , Raza Munis , IKRAM SOHAIL
Published: December 2023

Introduction:
Commotio cordis (Latin: agitation of heart) is sudden death triggered by a blunt, often innocent-appearing blow to the chest. It is the third most common cause of sudden cardiac death (SCD) in young athletes, after hypertrophy cardiomyopathy, and coronary anomalies. Around 10-20 cases are added to the Commotio Cordis (CC) registry annually. Ventricular fibrillation seems to be the most common arrhythmia in commotio cordis in 40% of cases.

Case Presentation:
A 22-year-old male with no known medical illness presented after sudden cardiac arrest. According to a bystander, he fell to the ground and lost consciousness within a few seconds of being “elbowed in his chest” during a basketball game. EMS provided bag valve mask ventilation for respiratory distress but were unable to record the rhythm. On initial presentation to the emergency room, he was found to be in ventricular tachycardia (VT) with hemodynamic instability. He was cardioverted, and his VT deteriorated to ventricular fibrillation. He was intubated for airway protection, received two rounds of CPR and another 200 J defibrillation that restored his sinus rhythm with return ofspontaneous circulation (ROSC). Bedside echocardiogram revealed global hypokinesis with EF 30-35%. EKG showed marked ST elevation in AvR with deep ST depression in other leads. Code STEMI was activated, and an emergent coronary angiogram was done which revealed normal coronary arteries and anatomy. Subsequent EKG within an hour was essentially normal. A repeat echocardiogram on the next day showed an improved EF of 65%.

Discussion:
Commotio cordis is fatal, with only about 25% of the cases on CC registry resulting in survival. A chest blow must be confined to a small area of the precordium within a 20 msec window during upstroke of T wave that results in ventricular fibrillation. Sustained ventricular tachycardia is even rare, with only one case report found on literature review. It is likely that his VT favored a better prognosis.
Abstract 19080: The Ketogenic Diet Aggravates the Ischemic Response in Mouse Hearts
Authors: Walborn Luca , Coleman Noah , Chin Alexandria , Cunningham CJ , Tobin Aiden , DiGiuseppe Nicholas , Saadoun Jacob , Ponzo Paige , Locke Erica , Kolwicz Stephen C
Published: December 2023

Ketone bodies, particularly beta-hydroxybutyrate (B-OHB), have been identified as an important fuel source during physiological and pathological stress. Although controversial, consumption of a ketogenic diet (KD) may be used as a method to increase B-OHB availability. Since the KD is a high-fat, low carbohydrate diet, the diet may have harmful effects on the heart especially during ischemic injury. Therefore, the objective of this study was to investigate the effects of short- term consumption of the KD on cardiac ischemia-reperfusion injury. Male (n=14) and female (n=13) were randomly assigned to KD (90% calories from fat) or normal chow diet. Serum B-OHB and cholesterol were significantly higher in both male and females fed the KD. KD did not increase body weight in male and female mice but significantly increased adipose tissue mass by 2.7 and 1.9 fold, respectively. KD increased hepatic triglyceride content in both males and females and increased cardiac triglycerides only in male mice. Cardiac function was assessed in isolated perfused hearts on a mixed substrate buffer consisting of 0.4mM fatty acids, 5.5mM glucose, 50uU/ml insulin, 1.2mM lactate, and 0.5mM B-OHB. Baseline function was monitored for 15 minutes followed by 18 minutes of global ischemia and 36 minutes of reperfusion. Baseline LV developed pressure (LVDevP) and heart rate (HR) were not affected by the KD in either male or female mice. During ischemia, the end diastolic pressure (EDP) was significantly higher in both male and female KD hearts. Time to peak contracture was accelerated in male and female KD hearts (P<0.05 vs chow), with a delay in female hearts (13.12 ± 1.06 vs. 9.27 ± 0.80 min, P<0.05 vs KD male). At the end of reperfusion, rate pressure product (RPP, the product of LVDevP and HR) was lower in male KD vs male chow (P<0.05) whereas RPP was similar in female KD and female chow. Moreover, RPP in female KD was significantly higher than male KD (6190 ± 929 vs 2133 ± 533 mmHg/min). These findings suggest that the KD may increase vulnerability of the heart to ischemia and may reduce recovery from ischemia, particularly in males. Overall, this study highlights potential sex differences and negative consequences of short-term consumption of the KD.
Abstract 19092: Endothelial Caveolin-1 Deficiency Increases Susceptibility to Lethal Heart Failure in Male Mice With Hypoxia-Induced Pulmonary Hypertension
Authors: Chen Jiwang , Yerlioglu Kayla L , Fantauzzi Andres , Lee Sam , Tang Ming , Li Haibin , Castellon Maricela , Oliveira Suellen Darc , Minshall Richard D
Published: December 2023

Introduction:
Pulmonary arterial hypertension (PAH) is an incurable disease with high mortality. Reduced endothelial cell caveolin-1 (EC Cav1) expression contributes to idiopathic PAH, and in animal models, can be alleviated by inhibiting or deleting endothelial nitric oxide synthase (eNOS).

Hypothesis:
As females are at greater risk of developing PAH but exhibit a more favorable outcome compared to males, we hypothesized that EC Cav1 deficiency in male mice would contribute to EC Cav1-dependent sex differences following chronic hypoxia exposure.

Methods:
EC-Cav1
-/-
mice (

Cdh5.Cre
ERT2
;mTmG;Cav1
f/f

injected with tamoxifen; ECKO) vs. wild-type liter mates injected with oil (ECWT), and Cav1 KO, Cav1-RC, and WT mice (6-8 week old) were exposed to 10% O
2
for up to 8 weeks (hypoxia-induced PH (HPH)). Echocardiography, right ventricular systolic pressure (RVSP) and hypertrophy (RVH), lung histology, Western blot, and survival were used to quantify pulmonary and cardiac function. Data were analyzed by two-way ANOVA and Tukey’s post hoc analysis.

Results:
After 8-weeks of hypoxia exposure, over 90% of male and 40% of female Cav1 KO became moribund, whereas lethality was less than 10% for WT and Cav1 RC mice (p < 0.01). Cav1 ECKO mice exhibited 30% lethality, whereas all ECWT siblings survived. Both Cav1 KO and ECKO mice exhibited a significant increase in pulmonary artery wall thickness, RVH, and RVSP. Hypoxia also reduced PAT and TAPSE, as well as LV systolic and diastolic function, including IVRT, CO, EF, FS, and global longitudinal strain in Cav1 KO and ECKO as compared to WT, ECWT, and Cav1-RC mice indicating EC Cav1 expression is cardioprotective in the context of HPH. In whole lung lysates, we observed reduced eNOS dimerization and an increase in eNOS pSer1179 indicative of eNOS dysfunction under normoxia which was exaggerated following hypoxia exposure to a greater extent in male Cav1 KO and ECKO as compared to Cav1-RC or WT mice.

Conclusions:
Chronic hypoxia-induced PH and mortality observed in Cav1 KO and ECKO mice is associated with both RV and LV failure and eNOS dysfunction to a greater extent in male mice, which was largely prevented by EC Cav1 expression.
Abstract 219: Prediction of Shock-Refractory Ventricular Fibrillation Amidst Continuous Chest Compressions During Out-of-Hospital Cardiac Arrest Resuscitation
Authors: Coult Jason , Kwok Heemun , Yang Betty , Kutz J. Nathan , Blackwood Jennifer E , Kudenchuk Peter J , Rea Thomas
Published: December 2023

Background:
Shock-refractory (SR) ventricular fibrillation (VF) patients (requiring ≥ 3 shocks) have relatively poor outcomes. Prediction of SR-VF may enable preemptive interventions targeted to improve SR-VF outcomes, such as earlier antiarrhythmics, alternative shock delivery strategies, or early transport for hospital-based interventions. We recently demonstrated prediction of SR-VF in the context of current practice whereby chest compressions (CCs) are interrupted for electrocardiogram (ECG) analysis prior to the initial shock. However, since pausing CCs is detrimental to outcome, ideally next-generation defibrillator algorithms will analyze during uninterrupted CCs, precluding CC interruption for SR-VF prediction.

Aim:
We designed a machine learning algorithm to predict SR-VF based on ECGs surrounding the first shock during CCs.

Methods:
We performed a retrospective study of adult out-of-hospital VF cardiac arrests treated by paramedics from 2008-2020 in King County WA. From each patient we collected a pair of 3-s VF ECG segments during uninterrupted CCs prior to and 1 minute following the first shock. Patients were randomized into 80%/20% groups for training/test. A random forest classifier was trained to predict SR-VF using dimensionally-reduced ECG scalograms. Performance was assessed by area under the receiver operating characteristic curve (AUC) and sensitivity for >90% specificity.

Results:
Of 940 included patients, 584 (62%) had SR-VF, median age was 62, 206 (22%) were female, and 429 (46%) survived to hospital discharge. AUC for predicting SR-VF was 0.80 (95% CI: 0.72-0.85) in 188 test patients (Figure), with specificity of 92% and sensitivity of 52%.

Conclusion:
Automated SR-VF prediction during ongoing CCs is possible using the ECG surrounding the initial shock. Early identification of SR-VF during CCs could prompt preemptive, patient-specific treatments without compromising CPR, potentially improving resuscitation outcome.
Abstract 247: Assessing Feasibility of Proposed Extracorporeal Cardiopulmonary Resuscitation Programs in Scotland via Geospatial Modelling
Authors: Leung K.H. Benjamin , Hartley Louise , Gillon Stuart , Moncur Lyle , Chan Timothy , Short Steven , Clegg Gareth
Published: December 2023

Introduction:
Extracorporeal cardiopulmonary resuscitation (ECPR) may improve outcomes for out-of-hospital cardiac arrest (OHCA) where return of spontaneous circulation (ROSC) is not achieved. We estimated the number of patients who may benefit from proposed in-hospital or pre-hospital ECPR programs in Scotland.

Methods:
EMS-treated atraumatic OHCAs occurring in Scotland between Apr. 2017-Mar. 2022 were included. We identified those likely to benefit (age 16-70, initial rhythm VF/pVT, no ROSC) and those possibly likely to benefit (age 16-70, initial rhythm PEA, no ROSC) from ECPR. To achieve timely ECPR initiation within 60 mins, we computed the number of eligible OHCAs within 15 mins’ drive time surrounding each of the 3 ECPR-capable hospitals, 6 percutaneous coronary intervention (PCI)-capable hospitals, and 28 adult emergency departments (ED) for in-hospital ECPR programs. We then computed the number of eligible OHCAs within a 45-minute drive time surrounding each of the 28 EDs and 140 ambulance stations and determined locations allowing one dedicated pre-hospital ECPR service to reach the greatest number of eligible OHCAs. We accounted for service availability based on 8 and 16-hour availability on weekdays and 24/7 availability.

Results:
Of the 8,962 OHCAs included, 1,108 (12.3%) were classified likely to benefit, 4,675 (52.2%) possibly likely to benefit, and 3,179 (35.5%) unlikely to benefit from ECPR. In-hospital ECPR scenarios covered up to 12.5% of eligible OHCAs at ECPR-capable hospitals, 20.9% at PCI-capable hospitals, and 64.6% at all EDs. Pre-hospital ECPR scenarios with one crew covered up to 51.0% and 54.1% when based at an ED or ambulance station respectively, which were higher than respective in-hospital scenarios at ECPR-capable or PCI-capable hospitals, and were generally comparable to ECPR availability at all 28 EDs.

Conclusion:
A pre-hospital ECPR service can generally reach greater numbers of OHCAs compared to in-hospital ECPR programs.
Abstract 266: Texas Out of Hospital Cardiac Arrest Gender Disparities From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project
Authors: Karfunkle Benjamin L , Huebinger Ryan , Witkov Richard , Schulz Kevin , Gill Joseph , Bakunas Carrie A , Waller-Delarosa John , Panczyk Micah , Villa Normandy W , Bobrow Bentley
Published: December 2023

Introduction:
Female out-of-hospital cardiac arrest (OHCA) victims experience differences in care and worse rates of survival compared to male victims. Gender differences in time spent by prehospital care teams on scene with patients has not been studied.

Hypothesis:
There are gender disparities in scene time and outcomes. Increased scene time is associated with worse outcomes for Males and Females.

Methods:
We performed a retrospective, cohort study of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-201. We included adult OHCAs not witnessed by prehospital personnel that included scene time data and did not result in return of spontaneous circulation in the field that were transferred to emergency departments for ongoing resuscitation. We described OHCA demographics. We evaluated the association between gender and scene time. Using multivariable logistic regression, we evaluated the association of scene time with favorable neurologic outcome, (cerebral performance category (CPC) of 1 or 2).

Results:
We include 11,782 encounters with OHCA not witnessed by prehospital personnel, of these 7,185 were male and 4,597 female. Female OHCAs were older than male (mean 63.7 vs 61.3, p < 0.01). Female patients had slightly longer scene times than males (mean 29.2 vs 27.9). Female patients were less likely to have favorable neurologic outcomes (12.5% women vs 17.3% men, p < 0.01 by chi2). Adjusting for age, gender, race, initial rhythm and bystander CPR in the multivariable model, increased scene time remained associated with a lower odds of favorable neurologic outcome (OR 0.96, 95%CI 0.95-0.96).

Conclusions:
OHCAs with longer duration scene time were associated with a lower likelihood of favorable neurologic outcome. Female patients were likely to have longer scene time duration and worse rate of favorable neurologic outcome.
Abstract 274: Association of Tracheal Intubation Associated Interruptions in Cardiopulmonary Resuscitation and Chest Compression Fraction During Pediatric Cardiac Arrest: A Report From the Videography in Pediatric Resuscitation Collaborative
Authors: Donoghue Aaron , Neubrand Tara , Myers Sage , Kerrey Benjamin , O'Connell Karen
Published: December 2023

Background:
Performing tracheal intubation during pediatric cardiopulmonary resuscitation has been consistently associated with worsened clinical outcomes in observational studies. One theoretical explanation for these differences is that pauses in chest compressions during attempt(s) at TI result in a decreased chest compression fraction (CCF).

Objective:
To examine the impact of TI attempts on CCF in children during CPR in a network of tertiary pediatric EDs.

Methods:
Prospective observation study from the Videography In Pediatric Resuscitation (VIPER) Collaborative. All patients receiving CPR under videorecorded conditions were eligible for enrollment. Using video review, data was collected on CPR duration, TI attempts, and the occurrence and duration of CPR interruptions during TI attempts. CCF was calculated as the total duration of CPR (100%) minus the total time of all CPR interruptions (including pauses for TI). Using nonparametric methods, univariate comparison was made between CPR events with TI-associated CPR interruptions versus CPR events without TI associated interruptions (i.e. CPR event with CPR uninterrupted during TI attempts or with no TI attempts made).

Results:
111 CPR events across four sites were analyzed. The median CCF across all events was 92% (IQR 87 - 94%). At least one TI attempt was made in 40/111 (36%) of CPR events; 29/40 (75%) of these CPR events had at least 1 CPR interruption associated with TI attempt(s). There was no significant difference in CCF between CPR events with at least one TI attempt and CPR events without any TI-associated pauses (89% vs. 92%, p=0.06).

Conclusions:
Pediatric cardiac arrests with TI attempts made during CPR did not have significantly shorter CCF than arrests without TI attempts. Our findings refute the hypothesis that worsened clinical outcomes in children who undergo TI during CPR are due to poorer CCF, and further research should try to examine other explanations for the association between TI during CPR and poor outcomes.
Abstract 276: Characterization of Chest Dynamics During Out-of-Hospital Manual Cardiopulmonary Resuscitation
Authors: Urigüen Jose Antonio , Redondo Koldo , Gutiérrez Jose Julio , Azcarate Izaskun , Russell James K , Daya Mohamud R , Ruiz De Gauna Sofia
Published: December 2023

Introduction:
Viscoelastic models are widely accepted in modern literature to explain the non-linear relationship between the force applied by the rescuer and the chest displacement that occurs during chest compressions (CCs). Various studies have shown that applying CCs for prolonged periods of time changes chest properties, but proposed models have mostly been tested under laboratory settings with few patients or during short CPR intervals.

Aim:
To retrospectively characterize the mechanical dynamics of the chest during manual CCs in pre-hospital cardiopulmonary resuscitation using a simple viscoelastic model.

Methods:
Force and acceleration signals were extracted from CPR monitors used during pre-hospital resuscitation efforts by TVF&R (OR, USA) on adult patients (≥ 18yo), from which individual CCs and series of CCs between pauses were identified. The model decomposes the measured force as the sum of an elastic term and a damped term, specifically
F
=
k·x
+
d·v
. We characterized each full cycle with a spring coefficient
k
(N/cm) to measure the stiffness of the chest; and with separated compression and recoil damping coefficients,

d
c

and

d
r

(N·s/cm), to measure its viscosity. Parameters were averaged for sets of 10 CCs. We characterized the variations of the model parameters within each series. We also assessed the chest recovery between consecutive series by comparing the values obtained at the end of each series with the beginning of the next series.

Results:
A total of 1,156,608 CCs from 615 patients were analysed. From these, 6,073 series of median (IQR) length 190 (119-222) CCs were selected. All parameters decreased within the series, with decreases of the median after 20 sets of 10 CCs of 9.8%, 7.1% and 11.1% for
k
,

d
c

and

d
r

, respectively (p
trend
< 0.05). When examining the first 5 series for all cases,
k
presented a mean recovery of 7%,

d
c

of 5%, and

d
r

of 5%.

Conclusion:
The proposed model allows the observation of a reduction in stiffness and viscosity of the chest within CC series. It further allows for evaluating the dynamics of the chest around pauses, showing recovery of its properties during the pause. Overall, the model reveals a gradual reduction in chest stiffness and viscosity during CPR.
Abstract 286: Assessing the Needs of Caregivers of Cardiac Arrest Survivors: A Qualitative Study
Authors: Tincher Isabella M , Holderness Mary , Abukhadra Sabine , Rojas Danielle , Cespedes Lizbeth , Agarwal Sachin
Published: December 2023

Background:
Interventions addressing highly prevalent psychological distress in caregivers of cardiac arrest (CA) survivors are lacking.We conducted a prospective study to confirm our previous findings of information-based needs as the highest priority in a cross-sectionalsurvey of caregivers of CA survivors.

Methods:
Adult caregivers of CA survivors hospitalized at Columbia University Medical Center were eligible for recruitment.Caregivers completed an interview after transfer from the intensive care unit (ICU) to inpatient floors and a follow-up interview 1-monthpost-discharge. Interviews allowed for initial free response, followed by prompts for opinions on eight potential interventions addressingpatient-centered needs (i.e., CA education, information on neurological recovery or rehabilitation, having a designated member of thecare team) and caregiver-centered needs (i.e., peer-to-peer support, hospital-based resources, formal psychotherapy, self-care). Interviewtranscripts were used to identify top-ranked needs and temporal changes between post-ICU and 1-month post-discharge.

Results:
Of 33 caregivers who participated in post-ICU interviews between August 2021-July 2022, 22 who also completed 1-monthinterviews were analyzed. The highest ranked need during acute care (n=10; 45.5%) and 1-month post-discharge (n=8; 36.4%) wasaccess to a designated member of the patient’s medical care team to answer the caregiver’s questions throughout hospitalization and thetransition home. Patient-centered needs accounted for 81.8% (n=18) of caregiver desire for interventions at both time points. 37% (n=8)of caregivers shifted focus between patient- and caregiver-centered needs, observed in both directions, between the two interviews.

Conclusions:
Caregivers of CA survivors self-reported their greatest need during hospitalization and a month after hospital dischargeas access to trusted resources about their loved one’s medical condition. Studies with a longer follow-up to understand caregivers’journeys and timing of the switch from patient-to caregiver-centered needs are warranted.
Abstract 296: Comparison of Prognostic Performance Using Quantitative Analysis of Head Computed Tomography and Apparent Diffusion Coefficient Imaging Before Target Temperature Management in Out-of-Hospital Cardiac Arrest Survivors
Authors: Yoon Jung A A , Park Jung Soo , Yeonho You , Changshin Kang , Jin Hong Min , In Yong Nam
Published: December 2023

Aim:
We compared head computed tomography (HCT) and diffusion-weighted magnetic resonance imaging (DW-MRI) findings before target temperature management (TTM) to predict neurological outcomes in out-of-hospital cardiac arrest survivors.

Methods:
Using prospectively collected data from a TTM registry, we included patients who underwent HCT and DW-MRI within 6 h of return of spontaneous circulation (ROSC). We examined the gray-to-white matter ratio (GWR) on HCT and apparent diffusion coefficient (ADC) values obtained through voxel-based analysis of DW-MRI. We analyzed the mean ADC value and the % voxels of ADC thresholds (percentage of voxels below ADC thresholds per total voxel) at 50-step intervals ranging from 200 to 1200 х 10
-6
mm/s, identifying thresholds that differentiate between good and poor neurological outcomes. Additionally, we analyzed the combination of pupillary light reflex (PLR) and neuron-specific enolase (NSE) values acquired at the same time points to predict the neurological outcomes. The primary outcome measure was the dichotomized cerebral performance category (CPC) at six months, defined as good (CPC 1-2) or poor (CPC 3-5).

Results:
Of 131 patients (26% female), 74 (57%) had poor outcomes. The time from ROSC to HCT and DW-MRI scans was 1.7h and 3.2h, respectively. The group with a good outcome had higher GWR (1.26 vs. 1.20) and mean ADC (787.10 vs. 697.49) values, but lower values in all ranges (250-1150) of ADC values (all P<0.001). Mean ADC and ADC values in the range of 350-650 demonstrated better predictive performance for poor outcomes than the GWR (P < 0.05). The mean ADC value had the highest sensitivity of 51.3% (95% CI 39.4-63.1; cutoff value ≤ 739.2 х 10
–6
mm
2
/s) when the false positive rate (FPR) was 0%. Furthermore, when combined with PLR and NSE values, the prognostic performance was significantly improved compared to using Mean ADC alone (0.83 vs 0.92; P<0.01).

Conclusions:
In this cohort study, early voxel-based quantitative ADC analysis after ROSC (i.e., before TTM) was associated with poor neurological outcomes 6 months after cardiac arrest. We found that the Mean ADC value showed the highest sensitivity when the FPR was 0% and that combining the NSE and PLR values resulted in an even better prognostic performance.
Abstract 308: Comparison of Cardiopulmonary Resuscitation Performance Between Integrated CPR Device Performing Chest Compression and External Defibrillation versus LUCAS3 With Automated External Defibrillator: A Animal and Manikin-Based Pilot Study
Authors: Jung Woo Jin , Roh Young-Il , Hwang Sung Oh , Im Hyeonyoung , Lee Yujin , Im Dahye , Cha Kyoung-Chul
Published: December 2023

Background:
Early chest compression and defibrillation are important components for successful resuscitation. The use of mechanical CPR has increased after the outbreak of COVID-19, and this trend continued in the post-pandemic period. We developed an automatic CPR performing chest compression and external defibrillation simultaneously following current CPR algorithm.

Methods:
This study was designed as a study to compare the performance of CPR and AED between automatic CPR apparatus (A-CPR) and commercially proven mechanical CPR device (LUCAS3) plus AED (C-CPR) during CPR in swine cardiac arrest model and the study to evaluate feasibility of A-CPR in simulated cardiac arrest model.

Results:
There were no significant differences in hemodynamic variables between the groups. Time to ECG analysis [38.0 sec in A-CPR, 48.0 sec in C-CPR,
p
=0.010], time to initial shock advice plus subsequent chest compression [46.0 sec in A-CPR, 57.0 sec in C-CPR,
p
=0.017], time to first defibrillation [48.5 sec in A-CPR, 65.0 sec in C-CPR,
p
=0.004], charge to shock interval [3.0 sec in A-CPR, 8.0 sec in C-CPR,
p
=0.001], and hands-off time [11.0 sec in A-CPR, 22.5 sec in C-CPR,
p
=0.001] were significantly shorter in A-CPR group than C-CPR group. In the simulation study, the pure chest compression time [101 sec in A-CPR, 110 sec in C-CPR,
p<
0.001], hands-off time [75 sec in A-CPR, 94 sec in C-CPR,
p<
0.001], time from power-on to first chest compression [55 sec in A-CPR, 82 sec in C-CPR,
p<
0.001], time to first shock delivery [40 sec in A-CPR, 51 sec in C-CPR,
p=
0.001] were significantly shorter in A-CPR group than C-CPR group, respectively. Chest compression fraction showed a significant higher in A-CPR than C-CPR [57% in A-CPR, 54% in C-CPR,
p
<0.001].

Conclusions:
The A-CPR device demonstrated significant time savings effect than conventional mechanical CPR device and automated external defibrillation device. In addition, A-CPR and C-CPR showed similar hemodynamic effects and resuscitation outcomes in a swine model of cardiac arrest
Abstract 309: The Hiccup Method for BLS HPCPR for Pediatric Cardiac Arrest: Description of Technique and Quality Metrics in Simulated Pediatric Out of Hospital Cardiac Arrest (OHCA)
Authors: O'Connell Karen , Anders Jennifer , Anderson Camille , Wright Johnson Cyndy
Published: December 2023

Key principles of high-performance CPR (HPCPR) include optimizing rate and depth of chest compressions, and minimizing pauses. Maryland EMS sought compromise to translate existing adult HPCPR protocol to accommodate AHA 15:2 compression: ventilation ratio pediatric recommendations. The resulting “Maryland Hiccup” method of HPCPR delivers 1 ventilation on each upstrokes after compressions 14 and 15, resulting in nearly continuous compressions. We sought to determine how the Maryland Hiccup (MH) style of CPR compares to the standard AHA 15:2 (AHA) style in simulated pediatric CPR performed by EMS clinicians.

Methods:
Teams of 2-person EMS providers utilized a child -size medium fidelity manikin to perform four-minute cycles of HPCPR. Teams were randomly assigned 2 cycles in either MH or AHA style, then crossed over to the other style. HPCPR performance metrics were compared: compression fraction, no flow time, rate, depth, and ventilation rate and volume using student’s t-test.

Results:
Thirty-eight clinicians (22 BLS, 16 ALS) participated. Both compression fraction (80% with AHA vs 98% with MH, p < .001) and no flow time (2.79 seconds with AHA vs 0.16 seconds with MH, p<.001) were improved with MH technique. Overall compressions were deeper than the recommended 2 inches or 5 cm, with AHA than MH (63mm vs 60mm respectively, p=0.01, Table 1). No differences were noted in compression rate, ventilation rate or ventilation volume.

Conclusions:
The Maryland Hiccup style of HPCPR with synchronized ventilations interspersed with chest compressions significantly improves CPR quality metrics in simulated pediatric CPR by EMS clinicians. While the CCF was superior with the MH method (98%), the chest compression depth was shallower than the AHA method by 3mm. How this translates to changes in actual patient outcomes has yet to be determined. Further study is warranted to explore physiologic benefits and patient outcome.
Abstract 326: The Impact of a Critical Care Outreach Team on the Collection of In-Hospital Cardiac Arrest Resuscitation Quality Data
Authors: Shipley Kipp , Shifrin Megan M , Roach Kathryn
Published: December 2023

Introduction:
Critical Care Outreach Teams (CCOTs) serve to recognize clinical deterioration and respond to rapid response activations prior to in-hospital cardiac arrest (IHCA) in non-intensive care unit (ICU) patient care areas. In some hospitals, the CCOT operates separately from the IHCA resuscitation team. However, limited data exist regarding the outcomes of CCOT and IHCA resuscitation team collaboration during IHCA.

Research Question:
The purpose of this pilot study was to determine if the addition of a CCOT member to an IHCA resuscitation team would improve the collection of quality metrics during adult IHCA resuscitations.

Goals:
The primary goal of this study was to increase the documentation of two quality metrics identified by the American Heart Association’s Get with the Guidelines®-Resuscitation (AHA GWT-R) program during adult IHCAs in non-ICU patient care areas: 1) documentation of initial pulseless rhythm and 2) documentation of time to first intervention (epinephrine or defibrillation). The secondary goal was to increase the percentage of completed IHCA records/code sheets integrated into the electronic medical record (EMR).

Methods:
All non-ICU IHCAs that occurred prior to the intervention during a year-long period (June 1
st
, 2021, to May 31
st
, 2022) were used to establish baseline resuscitation quality metrics. During the intervention period (June 1
st
, 2022, to May 31, 2023), a member of the CCOT responded to inpatient IHCA activations to serve as the designated event recorder and assist with the resuscitation. At the end of the study period, all IHCA activations were reviewed.

Results:
There were 74 IHCAs in the pre-intervention group and 76 IHCAs in the post-intervention group. In the post-intervention group, integration of IHCA records/code sheets into the EMR increased in the post-intervention group from 56.8% (42/74) to 96% (73/76). In the post-intervention group, there was also an increase in the documentation of initial pulseless rhythm from 75.7% (56/74) to 96% (73/76) and documentation of the first intervention from 71.4% (n=40) to 98.6% (n=72).

Conclusions:
This pilot demonstrated that adding a CCOT member to non-ICU IHCA resuscitations improves the accuracy of IHCA documentation and AHA GWT-R quality metrics.
Abstract 338: Temporal Characteristics of a Smartphone Alert System for CPR in a Mid-Sized Metropolitan Area
Authors: Kates Leo , Gumucio Jorge A , Chiaberta Alexandria , DeMaio Ryann , Weiss Leonard , Doshi Ankur A , Salcido David
Published: December 2023

Introduction:
Smartphone alert systems (SAS) mobilize trained volunteers to initiate CPR prior to Emergency Medical Services (EMS) arrival. Among the potential factors affecting the probability of a successful response is time; time of day, day of the week, and season each present plausible barriers to response. We sought to examine the temporal characteristics of an SAS in order to better understand this relationship between time and system performance.

Methods:
Operational records were obtained from the PulsePoint deployment in Allegheny County, Pennsylvania, USA for the period June 2016 to May 2023. PulsePoint sends alerts including nearby AED locations to volunteer responders within a 400m radius of public cardiac arrest events. Case data included alert time and number of responders and AEDs within range of the event. We associated each PulsePoint event with an 8-hour Timeframe (TF) {1 (00:00-07:59), 2 (08:00-15:59), and 3 (16:00-23:59)}, a day of the week, and a season. For each, we calculated the median number of associated responders and AEDs, and the total number of events. We then compared each across each time variable with a Mann-Whitney U-test or Kruskal-Wallis test.

Results:
There were a total of 2354 events in the capture period. Alerts were least common on Sundays (12.4%) and most common on Tuesday (15.6%). Alerts most frequently occurred in TF2 (45.6% vs TF1: 18.3, TF3: 36.1) and were similar between seasons. Weekday alerts had a higher median number of responders than weekend alerts {3 (1-5) vs 2 (1-4), p=0.004}. Responder count was lower for TF1 than TF2 and TF3 {2 (1-4) vs 3(1-5) vs 3(1-5), p < 0.001}. Count of proximal AEDs did not vary by any of the temporal characteristics.

Conclusion:
Both event frequency and number of notified responders were associated with day of the week and time of day. Either feature is more complicated than meets the eye, and may include associations with diurnal population movement cycles, overall patterns in emergency services utilization, and responder device configuration preferences. All could be influential in optimizing such SAS deployments.
Abstract 340: Automated External Defibrillator Utilization After Out-of-Hospital Cardiac Arrest at Recreational Facilities in the United States
Authors: Kolkailah Ahmed A , Chan Paul S , Li Qiang , Uzendu Anezi , Khan Mirza , Girotra Saket
Published: December 2023

Background:
Given the importance of public access defibrillation, some U.S. states have passed laws requiring an automatic external defibrillator (AED) to be available on-site at athletic facilities. However, rates of bystander AED application during out-of-hospital cardiac arrest (OHCA) in states with and without such laws remain unknown.

Research Question:
What are the rates of bystander AED application during OHCA at recreational facilities in U.S. states that mandate AEDs availability at such locations?

Aim:
To examine the rates of bystander AED application for OHCA at recreational facilities in states with and without laws mandating the presence of AEDs at athletic facilities.

Methods:
We included adults (≥18 years) in the Cardiac Arrest Registry to Enhance Survival (CARES) registry with a non-traumatic OHCA during 2013-2021 at a recreational facility in the U.S. The primary outcome was bystander AED application during OHCA. Secondary outcomes included survival to hospital admission and survival to hospital discharge. We examined the rates of bystander AED application and survival outcomes in states with laws that mandate AEDs at athletic facilities and in states without such laws.

Results:
Overall, there were 4,145 OHCAs cases at recreational facilities in 13 states that mandated AEDs at athletic facilities and 5,145 cases in 27 states that did not. In states with laws, the median rate of bystander AED application was 19.0%, with large between-state variation (IQR: 15.1%-22.0%). The median rate of survival to hospital admission was 44.5% (IQR 39.4%-56.9%) and survival to hospital discharge was 31.0% (IQR 25.2%-32.8%). In non-law states, the median rate of bystander AED application was 18.2% (IQR: 13.9%-25.0%). The median rate of survival to hospital admission was 45.0% (IQR 38.4%-52.1%) and survival to hospital discharge was 28.4% (IQR 25.9%-37.5%).

Conclusions:
Despite state laws that mandate on-site availability of an AED, rates of bystander AED application for OHCA at recreational facilities in such states remain low, with notable state-level variability. Our findings highlight that improving bystander AED application during OHCA will need to go beyond making AEDs available on-site.
Abstract 341: Regional Variation in Cardiac Arrest Response and Outcomes in North Carolina - A Call to Action
Authors: Krychtiuk Konstantin , Kaltenbach Lisa , Yow Eric S , Monk Lisa , Vandeventer Steve , Malta Hansen Carolina , Sharpe Edward , Rea Thomas , McNally Bryan F , Nelson Darrell , Sasson Comilla , Al-Khatib Sana M , Jollis James , Mark Daniel B , Al-Khalidi Hussein , Starks Monique A , Granger Christopher
Published: December 2023

Background:
In the United States, despite advances in cardiac arrest systems of care, out of hospital cardiac arrest (OHCA) treatment and survival are highly variable. In North Carolina, intensive efforts to improve prehospital care are ongoing. We sought to investigate the variation in OHCA community response and outcomes in North Carolina (NC), and to assess underlying differences in system-, patient- and county-level characteristics in an effort to optimize regional cardiac arrest care.

Methods:
All adult (age >18 years) OHCAs from 2016-2020 in 36 counties of North Carolina were included from the Cardiac Arrest Registry to Enhance Survival. We excluded cases that were EMS witnessed and that occurred in nursing homes. Response and outcome variation as well as county characteristics were described according to tertile of survival with good neurologic outcome (CPC 1/2).

Results:
Overall, 18,563 OHCAs occurred of which 22.4% had a shockable rhythm, 84.7% occurred at home and 50.7% were witnessed. Overall survival to hospital discharge with good neurologic outcome was 8.1%, with a state-wide variation among counties between 0% and 21.2% while Utstein survival was 26.1% overall, ranging between 0% and 47.8%. Bystander CPR rates were 41.8% (variation between 22.6% - 64.5%). First responder or bystander AED application was 42.9% of cases (variation between 8.6% - 66.6%) and 11.1% (variation between 2.7% and 19.7%) received defibrillation before EMS arrival. Counties within the highest tertile of survival were characterized by higher population density, lower unemployment rates and higher average household income. Such counties were further characterized by higher rates of bystander and first responder CPR and AED use prior to EMS arrival (Table 1).

Conclusion:
In NC, cardiac arrest response metrics and survival rates showed a dramatic regional variation, with particularly low survival in rural settings, calling for regional efforts to optimize cardiac arrest care.
Abstract 346: Deep Learning Approach for Predicting Good Neurological Outcome for Out-of-Hospital Cardiac Arrest Patients
Authors: Shah Pavitra K , Razo Martha , Khosla Shaveta , Del Rios Marina , Li Jing , Buhimschi Irina A , Vanden Terry L , Darabi Houshang
Published: December 2023

Background:
Cardiac arrest continues to pose a significant public health burden, with over 350,000 cases of out-of-hospital cardiac arrests (OHCA) occurring each year in the United States, and nearly 90% of them being fatal. The objective of this work was to develop a deep learning model that can accurately predict the Cerebral Performance Category (CPC) in adult OHCA cases.

Methods:
Adult OHCA cases at an urban academic emergency department were enrolled between 2018-2023. We evaluated data collected post return of spontaneous circulation (ROSC) at the first hour. Six different groups of data were tested for the prediction of CPC score: (1) Post-Rosc Vitals, (2) Pre-hospital & ED data points, and (3) Hospital Admission data points. The second group of exploratory research variables include: (4) ultrasound variables, (5) biomarkers and (6) Sex steroid hormones. The figure below illustrates the prediction framework for cardiac arrest patients, post ROSC, admitted to the hospital.

Results:
Of the total of 109 cases that were enrolled, 45% were female and 48% were Black. More than one-third (35%) were discharged alive but only 20% had a CPC of 1-2. While the base model with clinical and demographic variables had an AUC of 0.54, addition of subsequent variables improved the AUC substantially. The AUC improved to 0.59, 0.67 and 0.78 when hormones, ultrasound and biomarker variables were added, respectively, to the base model. However, the optimal model included all variables, resulting in a noteworthy AUC score of 0.861.

Conclusion:
Our findings emphasize the significance of incorporating novel variables to comprehensively evaluate the outcomes of cardiac arrest patients so that better prediction models can be developed, potentially aiding in modifying procedures and any necessary measures to shift the outcome in favor of preserving patients' lives after OHCA.
Abstract 347: Artificial Intelligence for Targeted and Personalized Prediction of Sudden Cardiac Death in the General Population: A Machine Learning Study Based on Electronic Health Records
Authors: Youssfi Younes , Bougouin Wulfran , BEGANTON Frankie , Empana Jean-Philippe , Chopin Nicolas , Jouven Xavier
Published: December 2023

Background:
Identification of subjects from the general population with an increased risk of Sudden Cardiac Death (SCD) remains highly challenging, particularly at an individual level.

Methods:
Every case of SCD + 18 y.o. that occurred since 2011 in Paris and its inner suburbs was prospectively included in the Paris Sudden Death Expertise Center (SDEC) registry (6.7M inhabitants). SCD cases were matched by age, sex, and residence area with a control group (70000) sampled from the general population. All data from the French National Health Insurance database (SNDS) were collected: prescribed drugs, examinations and diagnoses that occurred up to 10 y. before the event, including cardiovascular and non-cardiovascular variables (10000). We provide a detailed explanation of the prediction at the individual level. For each subject, we computed the Shapley scores from the supervised learning model (CatBoost) to evaluate the contribution of variables to its predicted risk. The model used was derived from 12338 SCD cases and matched controls cohort (2011-15) and validated on 11620 cases cohort (2016-20).

Results:
A total of 23958 equations have been built with personalized variables and coefficients, achieving an AUC of 0.80 in the derivation cohort (with a PPV=77%, sensitivity=68%). One example is shown below, with an individual predicted risk of SCD at 3 months (89.3%), and the most important factors that increase (red) or decrease (blue) the risk of SCD.

Conclusions:
For the first time, we provide a personalized prediction model of SCD, which explains the predicted risk at the individual level. These findings offer a new step toward personalized prevention and global public health interventions
Abstract 353: The Uncertainty Principle in Cardiac Arrest and Critical Care Trials
Authors: Vine Jacob , Balaji Lakshman , Berg Katherine , Li Franklin , Moskowitz Ari , Grossestreuer Anne V , Donnino Michael
Published: December 2023

Introduction:
A challenge with clinical trials is the capacity to identify a population that may potentially benefit from the intervention that is not “too well” (will recover) or “too sick” (will not survive) regardless of intervention. While inclusion criteria attempt to obtain this, populations enrolled in trials include pts in which bedside clinicians would be able to categorize in terms of likelihood of survival independent of study intervention. We further hypothesize that patients categorized as having an uncertain outcome would be most likely to benefit from the intervention.

Methods:
We present subgroup analyses of patients from the Thiamine as a Metabolic Resuscitator in Cardiac Arrest (THACA) trial in patients with out of hospital cardiac arrest and the Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) trial in patients with septic shock. The treating physician predicted at the time of enrollment whether the patient is “very likely”, “very unlikely”, or ”uncertain” to be alive at 30 days.

Results:
Among 31 pts in the THACA trial with physician predictions, 12/31 (39%) were predicted very unlikely to be alive on day 30, 3/31 (10%) very likely, and 16/31 (52%) uncertain. Among 200 pts in the ACTS trial, 13/200 (7%) of patients were predicted as very unlikely, 72/201 (36%) very likely and 115/201 (57%) uncertain. Predicted mortality was associated with observed mortality in both trials(p = 0.04, p<0.001). When evaluating the primary outcome in the population categorized as uncertain, there was a non-significant shift in favor of the intervention in THACA (p = 0.69); and a difference favoring the intervention in ACTS (p = 0.03) as opposed to the overall cohort which did not reach statistical significance (p = 0.12).

Conclusion:
In two RCTs in patients with cardiac arrest and septic shock, physicians reliably predicted mortality. Restricting analyses to pts with an uncertain outcome, the primary outcome in one trial changed from trending toward favoring the intervention to a statistically significant difference. The second trial shifted in favor of the outcome but did not reach statistical significance. These findings suggest that physician prediction may be a potential method to target patients with the greatest chance to benefit from clinical trials.