bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 258: Emergency Department Involvement Reduces Subjectivity for Hypothermia
Authors: Ross Heather M , Elias Roger , Harriman David , Andreozzi Anna , Grubman Eric M
Published: April 2024

Background:
Therapeutic hypothermia (TH) is an effective adjunctive therapy to standard post-resuscitation care for neurologically unresponsive survivors of cardiac arrest. TH has been demonstrated to improve survival and functional outcomes in this vulnerable patient population in a variety of academic and community hospital settings. We have previously reported that with an ICU-centered protocol in a community setting, patients who were subjectively deemed healthy prior to cardiac arrest received TH significantly more often than other patients who met TH protocol criteria.

Methods:
A TH protocol was initiated in the intensive care unit (ICU) setting for comatose survivors of cardiac arrest in our 511-bed community teaching hospital for 12 months, January-December 2009. Based on initial outcomes data, the protocol was modified to include Emergency Department (ED) stakeholders beginning January 2010. With IRB approval, we conducted a retrospective chart review to evaluate TH application and outcomes for appropriate patients according to the Utstein style to identify whether ED involvement impacted patient selection for TH from January-December 2010.

Results:
Five of 22 eligible patients received TH under the ICU-only protocol, and 5 of 20 eligible patients received TH under the ICU+ED protocol (p=NS). Comparing baseline assessments of “healthy” prior to cardiac arrest, significantly more healthy patients received TH under the ICU-only protocol (p=.02), whereas there was no significant difference in baseline assessments of healthy for patients receiving TH under the ICU+ED protocol (p=NS).

Conclusion:
In a community teaching hospital with an ICU-centered TH protocol, adding ED stakeholder involvement to the TH protocol did not significantly influence the application of TH to eligible patients. However, this system-wide integration reduced the impact of a subjective assessment of a “healthy” pre-arrest state as an influencing factor for patients to receive TH. These findings warrant further investigation to identify means to better implement TH for appropriate patients, regardless of subjective pre-arrest health assessments.
Abstract 263: Hyperglycemia: A Poor Prognostic Factor for Neurological Recovery in Patients with Sudden Cardiac Arrest
Authors: Lakshmanadoss Umashankar , Eid Shaker , Nazarian Skon M , Vaidya Dhananjay , Stewart Kerry , Sherazi Saadia , Chandra-Strobos Nisha
Published: April 2024

Background:
Hyperglycemia is an independent predictor of mortality in several but not all critically ill populations. Animal cardiac arrest models suggest that hyperglycemia results in poor outcomes. We examined the effects of hyperglycemia in cardiac arrest survivors, focusing on its effects on neurological function.

Methods:
We evaluated 123 survivors of non-traumatic out-of-hospital cardiac arrest .Data were collected following the Utstein guidelines. Hyperglycemia was defined as any value > 180 mg/dl. Patients who had hyperglycemia were treated with intravenous / subcutaneous insulin at the discretion of the health care team. Neurological status was assessed by Cerebral Performance Category (CPC) scores. Fisher's exact two-tailed test, univariate and multivariate logistic regression were used for analyses. Data are reported as percentage, mean + SD.

Results:
Of 123 patients studied, 31% had a history of diabetes; however 72 % (88/123) were hyperglycemic. As noted below, those with hyperglycemia had similar characteristics as compared to those with normoglycemia including a history of diabetes. Hyperglycemia was more common in patients treated with hypothermia as compared to those not cooled: 83% (44/53) vs. 64 %( 44/71) respectively (P= 0.01). Poor neurological recovery (CPC > 2) was also seen more often in those with hyperglycemia as compared to those without hyperglycemia (87% vs. 68%) respectively (P= 0.01). Although univariate analysis identified hyperglycemia to be a predictor of poor neurological recovery, it did not worsen neurological recovery in hypothermia treated patients (pNS). Multivariate regression analyses, failed to identify hyperglycemia as a predictor of poor neurological outcome.

Conclusion:
Hyperglycemia (>180 mg/dl) is extremely common post arrest and is implicated in poor neurological recovery. The early identification and treatment of hyperglycemia is likely justified. Patient Characteristics
Abstract 268: From Advanced Cardiac Life Support (ACLS) to Airway-Circulation-Leadership-Support (A-C-L-S): A Novel Team Training Model for Resuscitation Teams
Authors: Chong Kah-Meng , Yang Chih-Wei , Chou Eric H , Yeh Huang-Fu , Huang Edward P , Wu Cheng-Yi , Wang Hui-Chih , Liu Yueh-Ping , Chiang Wen-Chu , Ko Patrick C , Ma Matthew H
Published: April 2024

INTRODUCTION
The 2010 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care emphasize providers should coordinate and perform chest compressions and ventilations in a team-based approach. We developed a team training model called Airway-Circulation-Leadership-Support (A-C-L-S) to improve resuscitation performance, and presented our preliminary experience of A-C-L-S model in resuscitation team training for emergency department (ED) staff.

METHODS
CPR technical and non-technical tasks were prioritized and bundled into a mnemonic - ‘A-C-L-S’ which comprises 4 domains: Airway (A), Circulation (C), Leadership (L), and Support (S). A-team is assigned to manage airway, avoid hyperventilation, and monitor EtCO2. C-team focuses on rapid defibrillation and high-quality chest compression with feedback from an accelerometer. L-team assumes coordination and situation monitoring. S-team is responsible for intravenous access, drugs administration, time keeping, and recording. Each team training course consists of: (1) a video-assisted lecture on A-C-L-S model; (2) two high-fidelity simulation-based cardiac arrest scenarios before and after the lecture, each followed by (3) video-facilitated debriefing emphasizing the A-C-L-S model. A 10-item questionnaire using 5-point Likert scale was administered to evaluate perception of CPR teamwork before (i.e. prior clinical experiences) and after the course.

RESULTS
Seven A-C-L-S team training courses were delivered to 52 ED staff (17 residents and 35 nurses, all qualified ACLS providers) at a university teaching hospital from April to May 2011. Perception of CPR teamwork improved significantly in leadership (48.9% to 78.7%, p = 0.017), task assignment (34.1% to 74.5%, p = 0.002), role commitment (42.6% to 85.1%, p = 0.000), workload distribution (34.1% to 67.4%, p = 0.024), and shared goal (44.7% to 76.1%, p = 0.002) after the A-C-L-S team training.

CONCLUSIONS
Our novel A-C-L-S team training model can facilitate and reinforce the perception of CPR teamwork among ED staff. Application of this model in different scenarios and disciplines, and its impact on actual resuscitation performance and patient outcomes deserve further study.
Abstract 269: A “Front-Loaded” Rapid Response Team Decreases Non-ICU Arrests and Overall Hospital Mortality
Authors: Ludington Morgan C , Graham Patricia , Lawrence Brenna , Sell Rebecca , Husa Ruchika D , Minokadeh Anush , Davis Daniel
Published: April 2024

Background:
In-hospital cardiopulmonary arrest (CPA) is characterized by progressive hypoxemia and hypotension leading to bradyasystole. Rapid response teams (RRTs) are designed to prevent non-ICU CPA through early detection and therapeutic intervention. However, existing evidence has not consistently demonstrated benefit to RRT programs.

Objective:
To explore the effectiveness of a “front-loaded” RRT program to decrease non-ICU CPA and overall hospital mortality.

Methods:
This study was conducted in two urban university hospitals from 2005 to 2011. In 2007, our hospitals implemented RRT as part of the Advanced Resuscitation Training (ART) program. Our RRT program is “front-loaded” in that charge nurses from each inpatient unit undergo training as RRT members, and all inpatient staff receive annual training in RRT concepts. To evaluate overall effectiveness of RRT, we compared the incidence of non-ICU CPA (per 1,000 patient discharges) before and after program implementation. The incidence of ICU CPA as well as overall hospital mortality were also reported. In addition, the overall number of RRT versus code blue activations for each individual inpatient unit were compared using linear regression. Finally, the annual change in RRT versus code blue activations for each inpatient unit were also compared.

Results:
A total of 546 CPAs were observed from 2005-11; a total of 725 RRT activations were observed from 2007-11. The incidence of non-ICU CPA decreased while the incidence of ICU CPA remained unchanged follow RRT program implementation. Overall hospital mortality also decreased over the study period (2.12% to 1.74%, p<0.001). Inpatient units with a greater number of code blue activations also had more RRT activations (r=0.17, p=0.242). However, units with a year-over-year increase in RRT activations experienced a decrease in code blue activations, while units with a decrease in RRT activations experienced an increase in code blue activations (r=-0.68, p<0.001).

Conclusion:
A front-loaded RRT program decreases the incidence of non-ICU CPA and overall hospital mortality.
Abstract 27: Effects of Early Initiation of Induced Therapeutic Hypothermia
Authors: Castelblanco Francisco
Published: April 2024

Cardiac arrests are responsible for about 325,000 deaths annually in the United States (Heart Rhythm Foundation, 2010). The majority of these cardiac arrests occur outside the hospital setting, with a dismal national survival rate of 8% (American Heart Association, 2010). The Bernard (2002) and HACA (2002) studies demonstrated that by initiating therapeutic hypothermia as a treatment modality for cardiac arrests the survival rate could be as high as 49% and 55% respectively. Therapeutic hypothermia can be initiated in many different settings. The question remains, does the setting of the initiation of therapeutic hypothermia effect patient outcomes? The purpose of this study was to compare the effects of initiation of therapeutic hypothermia by EMS, Emergency Departments, and ICU nurses on cardiac arrest patient outcomes as measured by the Glasgow Coma Scale at discharge. This study utilized a convenience sample of 178 consecutive cardiac arrest patients admitted from 2008-2010 in an 800-bed hospital in Western North Carolina. From the overall sample, 57 patients had a favorable neurological outcome (32% overall survival rate). EMS initiated therapeutic hypothermia in 24 instances with 7 patients surviving to discharge (29% survival rate). The Emergency Department initiated therapeutic hypothermia in 17 instances with 8 patients surviving to discharge (47% survival rate). ICU nurses initiated therapeutic hypothermia in 137 instances with 42 patients surviving to discharge (31% survival rate). Study results reproduced previous findings demonstrating the efficacy of therapeutic hypothermia in the treatment of cardiac arrests. The results also indicate a possible advantage to the initiation of therapeutic hypothermia by Emergency Departments.
Abstract 280: Reversal of Acute Coagulopathy Using Small-Volume 7.5% NaCl with Adenocaine and Mg
2+
Resuscitation in a Rat Model of Severe Hemorrhagic Shock
Authors: Letson Hayley L , Pecheniuk Natalie M , Mhango Lebo P , Dobson Geoffrey P
Published: April 2024

Acute traumatic coagulopathy occurs early in hemorrhagic trauma and is a major contributor to further bleeding, inflammation and mortality. Previously we showed that a small intravenous (IV) bolus of 7.5% NaCl with Adenocaine (adenosine and lidocaine) and Mg2+ could resuscitate mean arterial blood pressure (MAP) to within a permissive hypotensive range. Our aim was to examine the effect of the same fluid on activated partial thromboplastin times (aPTT) and prothrombin times (PT) following 60 min of resuscitation.

Methods:
Male fed Sprague-Dawley rats (444 ± 10g, n=64) were anesthetized, non-heparinized and randomly assigned to one of eight groups: 1) Baseline blood, 2) 20 min bleed, 3) 60 min shock, 4) Untreated resuscitation, 5) 7.5% NaCl, 6) 7.5% NaCl Adenocaine, 7) 7.5% NaCl Mg2+ and 8) 7.5% NaCl, Adenocaine Mg2+. Hemorrhagic shock was induced by phlebotomy until MAP was 35-40 mmHg and continued for 20 min (~40% blood loss). Animals were left in shock for 60 min at 34°C. 0.3 ml IV bolus was injected over 2 sec. Arterial blood pressures, MAP, heart rate and rectal temperature were monitored. Arterial blood was collected in 3.2% Na-citrate tubes, centrifuged and the plasma was snap-frozen (-196°C) and stored at -80°C. aPTT and PT were measured on an Amelung KC4A microcoagulometer.

Results:
Baseline aPTT and PT values were 17 ± 0.5 sec and 28 ± 0.8 sec, and increased significantly to 63 ± 21 and 107 ± 33 sec after blood withdrawal (20 min), and over 10 times baseline after 60 min shock. The large increases during shock were not due to hypothermia. Sixty minutes after 0.3 ml bolus resuscitation, the hypocoagulopathy worsened in all groups with the exception of 7.5% NaCl Adenocaine and Mg2+ with aPTT of 24 ± 1.7 sec and PT of 33 ± 1 sec. A partial restoration occurred with 7.5% NaCl Mg2+ (aPTT of 150 ± 43 and PT of 182 ± 47 sec) but was not significantly different from 7.5% NaCl alone.

Conclusion:
aPTT and PT clotting times significantly increased during bleeding and shock prior to resuscitation. The hypocoagulopathy increased with 7.5% NaCl and was nearly completely reversed with 7.5% NaCl Adenocaine and Mg2+. We speculate that the mechanism(s) of reversal may shed light on understanding acute traumatic coagulopathy in out-of-hospital and far forward military settings.
Abstract 281: Traumatic Brain Injury Accelerates Onset of Hypotension with Less Blood Lost in a Pressure-Guided Model of Polytrauma with Uncontrolled Hemorrhage by Aortic Tear
Authors: White Nathan J , Wang Xu , Bradbury Nicole , Stern Susan
Published: April 2024

Objective:
Traumatic brain injury (TBI) is thought to exacerbate the severity of hemorrhagic shock by interfering with compensatory neurovascular reflexes. However, this effect remains undefined. We use a swine model of uncontrolled hemorrhage by aortic tear to examine the effect of TBI on blood pressure and blood loss during shock. We hypothesize that TBI accelerates onset of hypotension during hemorrhage with less blood lost.

Methods:
Anesthetized domestic swine were hemorrhaged at a controlled rate by arterial catheter to mean arterial pressure (MAP) of 30mmHg and maintained for 15 minutes. Aortic tear allowing free bleeding was made when MAP = 50 mmHg during initial catheter hemorrhage. TBI was achieved by a fluid percussion device applied directly to the Dura just prior to hemorrhage. Time intervals to goal MAP, catheter hemorrhage volumes, and metabolic parameters were recorded during the hemorrhage and shock periods. A control group without TBI was similarly instrumented and hemorrhaged for comparison. Variables were compared in animals with and without TBI using T-tests and associations were examined using correlation.

Results:
N= 30 swine weighing mean (SD) 27(3.4) kg were compared (21 with TBI vs. 9 without TBI). The TBI group achieved goal MAP=30mmHg after aortic tear significantly faster (TBI= 1.0 min vs. No TBI=1.9 min, p=0.016). The TBI group required significantly less additional blood withdrawn to maintain goal MAP during the 15 minute shock period (TBI= 5.8ml/kg vs. No TBI=11.6ml/kg, p=<0.0001). Yet, lactate accumulation was similar between groups (TBI= 4.7mmol/l vs. No TBI=4.4mmol/l, p=0.68). Mean percussive pressure at the Dura = 3.4(0.4) atm in the TBI group. Dural pressure was positively associated with rate of blood pressure change to MAP=50mmHG (R=0.41, p=0.026) and with total lactate concentration at the end of the shock period (R=0.55, p=0.002).

Conclusion:
In this model, animals with TBI demonstrated an altered blood pressure response to hemorrhage. Current guidelines for estimating blood loss using blood pressure may not apply in the setting of hemorrhagic shock with TBI.
Abstract 285: Acute Myocardial Infarction Following Free-Fall Trauma in a 21-Year-Old Male Patient
Authors: Yu Jin , Cheng Hexiang , Guo Wenyi , Li Chengxiang , Luan Ronghua , Wang Haichang
Published: April 2024

A 21-year-old man who was sleeping was fallen from the higher deck of a double-deck bed. 10 minutes after free fall, he experienced chest pain and then took a nonsteroidal antiinflammatory medication, however, which did not relieve the pain. The pain continued to increase, and prompting him to seek medical attention. 6 hours after the trauma, he was admitted to the emergency room of our hospital. Although the accident just caused mild subcutaneous hemorrhage, he felt severe chest pain, headache and left hand pain. He has 4 year's history of cigarette smoking, no history of diabetes mellitus, hypertension, hyperlipidemia coronary artery disease. On admission, physical examination showed blood pressure of 120/80 mm Hg and regular pulse at 100 beat per minute. X ray revealed no bone fracture around the chest. Cardiac examination showed regular heart rhythm without murmurs and pericardial rubs. Electrocardiogram (ECG) performed on admission demonstrated Q wave and 1mm ST segment elevation in leads V1 to V5. Laboratory test results are as follows: serum creatine phosphokinase MB 89.8 U/L, Troponin I 120 ng/ml. Due to the persistent injury pattern on the ECG, the patient underwent emergency cardiac catheterization following the administration of aspirin, Clopidogrel and Atorvastatin etc. CAG showed an acute thrombus induced 99% occlusion in Left Anterior Descending artery and no serious atherosclerotic disease was seen in the remaining coronary arteries. Then, the thrombus has been taken out with a Thrombus Aspiration Catheter. Afterwards, CAG showed the occlusion has been relieved and considering his age, we didn’t implant any artificial stent in the left anterior descending artery. After procedure, the patient felt good and discharged
Abstract 31: The Effect of Hypothermia “Dose” on Vasopressor Requirements and Outcome After Cardiac Arrest
Authors: Rittenberger Jon C , Huynh Nicholas , Kloke John , Gu Chen , Guyette Francis X , Alvarez Rene , Tisherman Samuel A , Callaway Clifton W
Published: April 2024

Introduction
Therapeutic hypothermia (TH) improves outcome after cardiac arrest, but may result in increased vasopressor requirements. We evaluated the association between TH use and cumulative vasopressor and inotrope requirement. The effect of TH “dose” on cumulative vasopressor index, survival and neurologic outcome was also explored.

Methods
Review of chart data from subjects treated after resuscitation from out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrests between 1/1/2005 and 3/15/2010. Data included demographic information, category of post-cardiac arrest illness severity ( (1) awake, (2) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA [Sequential Organ Failure Assessment] cardiac + respiratory score <4), (3) coma + moderate-severe cardiopulmonary dysfunction (SOFA cardiac + respiratory score >=4), and (4) coma without brainstem reflexes), cumulative vasopressor index (CVI) over first 72 hours, inotrope use, and outcomes (survival, good functional outcome). The “dose” of TH (hours*temperature below cut point) was calculated using cut points of ≤34°C and ≤35°C. Data were analyzed using descriptive statistics, Student's-t test, Wilcoxon test, and chi-squared analysis, as appropriate. The effect of hypothermia dose on total CVI, survival and neurologic outcome was assessed using regression.

Results
Among a total of 558 patients, 250 (45%) received induced hypothermia. The rate of administration of vasopressors (measured by CVI) or inotropes was not different between TH and normothermia subjects. Using either a 34°C or 35°C cutoff, only category 4 illness severity or use of inotropic agents in addition to vasopressors predicted total CVI. Survival was not predicted by TH “dose” but was predicted by category 4 illness severity. Neurologic outcome was predicted by category 4 illness severity and OHCA. CVI had no independent effect on survival or neurologic outcome.

Conclusions
TH delivery is not associated with increased vasopressor requirement. The “dose” of hypothermia is not associated with total CVI, survival, or good outcome. Vasopressor or inotropic requirement appears to be unrelated to TH use.
Abstract 32: Cardiac Arrest: Who Goes to the Catheterization Lab?
Authors: Kebed Kalie Y , Schwartz Robert S , Newell Marc C , Browning Joseph A , Sharkey Scott W , Hauser Robert G , Unger Barbara T , Pink Victoria R , Pedersen Wesley R , Chavez Ivan J , Wang Yale L , Mooney Michael R
Published: April 2024

Introduction:
Therapeutic hypothermia (TH) is neuroprotective and increases survival in resuscitated cardiac arrest patients. Approximately 70% of sudden cardiac deaths are caused by coronary heart disease. For patients requiring angiography/PCI, TH can occur simultaneously.

Methods:
“Cool It” is a comprehensive TH protocol integrated into a regional STEMI network. From Feb 2006 to July 2010, 192 consecutive cardiac arrest patients who remained unresponsive following return of spontaneous circulation were enrolled in the Cool It protocol. Those patients with suspicion for ischemic etiology or evidence of STEMI were transferred directly to the cath lab.

Results:
On the 192 patients, angiogram was performed in 144 (75.0%). Patients sent for angiography had higher prevalence of initial rhythm VF/VT 116 (80.6%) vs. 19 (39.6%), cardiogenic shock 66 (45.8%) vs. 11 (22.9%), and ST elevation 54 (37.5%) vs. 1 (2.1%) than the 48 patients not undergoing angiography. PCI was performed in 73 (50.7% of patients undergoing angiogram, 38.0% all patients). Of these 73 patients, 64 (87.7%) had initial rhythm VF/VT, 38 (52.1%) were in cardiogenic shock, and 39 (53.4%) had ST elevation. Identified culprit arteries were LAD n=30 (41.1%), RCA n=24 (32.9%), CMX n=12 (16.4%), left main n=4 (5.5%), and none n=3 (4.1%). Mean pre-PCI TIMI flow was 1.36, and post-PCI TIMI flow was 2.91. BMS was used in 31 (42.5%), DES in 40 (54.8%), and one had balloon angioplasty only. Three were referred for CABG. Survival to hospital discharge was 43/73 (58.9%), and survival with favorable neurologic outcome (cerebral performance category 1 or 2) was 39/73 (53.4%). Patients who underwent angiography but did not receive PCI had the similar outcomes: survival was 46/71 (64.8%) and favorable neurologic outcome was seen in 44/71 (62.0%). Patients who did not undergo angiography had the poorest outcome: survival was 11/48 (22.9%) and with favorable neurologic outcome was seen in 9/48 (18.8%).

Conclusion:
The majority of unresponsive cardiac arrest survivors underwent angiography. Patients who underwent angiography with PCI had the similar outcomes to those with angiography alone. Favorable baseline patient characteristics appear to account for the improved outcomes in the angiography group.
Abstract 37: Calibration of APACHE II Score to Predict Mortality in Out-of-Hospital and In-Hospital Cardiac Arrest
Authors: Donnino Michael W , Salciccioli Justin D , Dejam Andre , Jones-Bamman Caitlin , Giberson Brandon , Cocchi Michael N
Published: April 2024

Introduction:
Severity of illness scores can predict outcomes in critically ill patients. However, the calibration of previously established scores in post-cardiac arrest is poorly established.

Objective:
To assess the calibration of the Acute Physiology and Chronic Health Evaluation (APACHE II) score in out-of-hospital and in-hospital cardiac arrest.

Methods:
A prospective observational study of adult cardiac arrest at an urban tertiary care hospital during the period from 12/2007 to 12/2010. Inclusion criteria: 1. Adult (>18 years); 2. OHCA; 3. Return of spontaneous circulation (RSOC). Traumatic cardiac arrests were excluded. We recorded baseline demographics, arrest event characteristics, follow-up vitals and laboratory data, and in-hospital mortality. APACHE II scores were calculated at the time of ROSC, and at 24hrs, 48hrs, and 72hrs. We used simple descriptive statistics to describe the study population. Univariate logistic regression was used to predict mortality with APACHE II as a continuous predictor variable. Discrimination of APACHE II scores was assessed using the area under the curve (AUC) of the receiver operator characteristic (ROC) curve.

Results:
A total of 229 patients were analyzed. The median age was 70 years (IQR: 56 - 79) and 32% were female. APACHE II score was a significant predictor of mortality for both OHCA and IHCA at baseline and at all follow-up time points (all p < 0.01). Discrimination of the score increased over time and achieved very good discrimination after 24hrs (Table 1).

Conclusion:
The ability of APACHE II score to predict mortality improves over time in the 72-hours following cardiac arrest. These data suggest that after 24-hours, APACHE II scoring is a useful severity of illness score in all post-cardiac arrest patients.
Abstract 44: Evaluation of Knowledge Levels in Basic Life Support of Students from Last Year of Medicine Graduation
Authors: Oliveira Renan G , Gonzalez Maria M , Soares Rafaela F , Pires Lucas J , Vianna Caio B , Abra Thaysa Y , Timerman Sergio
Published: April 2024

Background:
Due to high rates of cardiac arrest in countries like USA, Canada and Brazil, it is very important that students in the health field know the Basic Life Support (BLS), especially medical students.

Hypothesis:
We evaluated the hypothesis that medical students in the last year of medicine graduation of a public university of Sao Paulo, Brazil, would be able to pass the practical test of the course of the American Heart Association BLS.

Methods:
We studied 136 medical students in the last year of medicine graduation. The assessment of knowledge levels of BLS was performed by an experienced instructor with the check-list of the BLS Test of AHA according to the 2005 Guidelines of Cardiopulmonary Resuscitation by AHA. Skills were realized on a BLS manikin.

Results:
The mean age was 24.4 ±1.8 years, 68% were male. Five students had the BLS course certificate by AHA. It was observed that all of the participants did not accomplish, at least, one of the evaluation requirements. According to the criteria of the Test BLS: 94% checked for response, 68% told someone to phone emergency response number and 86% got an AED, 70% opened correctly the airway, 55% checked for no breathing, 45% gave two breaths, 71% evaluated carotid pulse, 64% delivered first cycle of compressions at correct rate, 52% gave two breaths, 46% delivered second cycle of compressions at correct hand position, 56% gave two breaths. Concerning the AED use, 36% turned AED on, 74% selected proper AED pads and places correctly, 40% cleared victim to analyze, 69% cleared victim to shock, 95% restarted chest compressions, 83% kept pads on the chest of the manikin.

Conclusion:
The results showed that an unsatisfactory level of knowledge in BLS is presented in the final year of medicine graduation, and suggests that the BLS course should be part of the curriculum of medical schools.
Abstract 17600: Lipid Phosphate Phosphatase 3 Negatively Regulates Smooth Muscle Cell Phenotypic Modulation and Limits Neotimal Hyperplasia
Authors: Panchatcharam Manikandan , Miriyala Sumitra , Salous Abdelghaffar , Wheeler Jessica , Dong Anping , Sunkara Manjula , Escalante-Alcalde Diana , Morris Andrew J , Smyth Susan S
Published: April 2024

Manikandan Panchatcharam, 2011 Finalist and Presenting Author
Abstract 9178: Cell-Based Prostacyclin Gene Therapy Prevents Pulmonary Arterial Hypertension
Authors: Zhou Lei , Cheng Zhiqiang , Vanderslice Peter , So Shuiping , Ruan Kehe , Willerson James T , Dixon Richard A
Published: April 2024

Lei Zhou, 2011 Finalist and Presenting Author
Abstract 13665: Atrial Fibrillation Patterns in the Community and Risks of Stroke, Heart Failure, or Death
Authors: Lubitz Steven , Moser Carlee , Sullivan Lisa , Rienstra Michiel , Fontes João , Villalon Mark , Pai Manju , Magnani Jared , Yin Xiaoyan , Levy Daniel , Pencina Michael , Larson Martin , Ellinor Patrick , Benjamin Emelia
Published: April 2024

Steven Lubitz, 2011 Finalist and Presenting Author
Abstract 52: The Heart of the Matter: Cardiac Arrest and Public Health Information on Twitter
Authors: Bosley Justin C , Zhao Nina C , Asch David A , Becker Lance , Merchant Raina M
Published: April 2024

Background:
Despite the increasing use of social media, little is known about how it is used to communicate health-related information. Twitter's 300 million users communicate a variety of information via their “tweets” (140 character messages). We sought to characterize the cardiac arrest specific information being shared.

Methods:
A Twitter search engine was used to identify tweets published April 19-May 19 2011 with keywords: “cardiac arrest, CPR, AED, resuscitation, heart arrest, and defib.” A 1% sample of tweets was reviewed independently by three study investigators to characterize content. Tweets were then categorized as relating to cardiac arrest (personal sharing/ information sharing), CPR or AED (personal sharing/ information sharing), health education/news media, or unrelated to resuscitation (e.g., jokes, miscellaneous).

Results:
Of 61,053 analyzed tweets, 25% (15,324) included cardiac arrest specific information, (i.e. not miscellaneous). Of this cohort: 14% of tweets referenced cardiac arrest events, 29% referenced CPR performance/AED use, and 57% included cardiac arrest related health education/news media references or links. Of tweets referencing cardiac arrest events (n=2,172), 5% represented personal sharing (e.g. “when I or a family member/friend/ had a cardiac arrest”) and 9% represented information sharing (e.g. arrest location, interventions, guidelines). Of tweets referencing CPR performance or AED use (n=4,465), 23% represented personal sharing (e.g. actual or classroom provision of CPR/AED, likes/dislikes regarding CPR/AED courses) and 6% represented information sharing (e.g., observation of CPR delivery or AED use, commentary regarding hands-only CPR). Tweets (n=8,687) regarding resuscitation specific education or news articles included content such as: advocacy group events, CPR/AED training events, heart health surveys, and reports of celebrities, athletes, and young adults affected by cardiac arrest.

Conclusion:
Cardiac arrest related information is discussed on Twitter in a variety of categories, with unique opportunities for healthcare provider information sharing, therapeutic intervention guidance (e.g., CPR/AED provision, therapeutic hypothermia), and medical education.
Abstract 16409: Identification and Quantification of Novel Phosphorylation of Cardiac Troponin I in Human Heart Failure
Authors: Zhang Pingbo , Murphy Anne M. , Van Eyk Jennifer E.
Published: April 2024

Pingbo Zhang, 2011 Finalist and Presenting Author
Abstract 8642: A Randomized Controlled Trial of Physician Alerts to Prevent Symptomatic Venous Thromboembolism after Hospital Discharge
Authors: Piazza Gregory , Anderson Frederick A , Ortel Thomas L , Cox Michael J , Rosenberg David J , Rahimian Shahram , Pendergast William J , McLaren Gordon D , Welker James A , Akus Jan J , Stevens Scott M , Elliott C. G , Freeman Andrew L , Patton William F , Dabbagh Ousama , Wyman Allison , Huang Wei , Rao Amanda F , Goldhaber Samuel Z
Published: April 2024

Gregory Piazza, 2011 Finalist and Presenting Author
Abstract 12091: Aldosterone Enhances Cardiac Rupture after Myocardial Infarction through Calcium/Calmodulin-Dependent Protein Kinase II
Authors: He B. Julie , Joiner Mei-ling , Singh Madhu , Dominic Swaminathan Paari , Luczak Elizabeth , Koval Olha , Kutschke William , Allamargot Chantal , Yang Jinying , Guan Xiaoqun , Zimmerman Kathy , Grumbach Isabella , Weiss Robert , Spitz Douglas , Sigmund Curt , Blankesteijn Matthijs , Heymans Stephane , Mohler Peter , Anderson Mark
Published: April 2024

B. Julie He, 2011 Finalist and Presenting Author
Abstract 8445: Outcomes from Symptom and Economic Evaluation of Fluid Restriction in Persons with Heart Failure
Authors: Reilly Carolyn M , Higgins Melinda , Smith Andrew , Culler Steven D. , Dunbar Sandra B.
Published: April 2024

Carolyn M Reilly, 2011 Finalist and Presenting Author
Abstract 8626: Multi Detector CT Accurately Defines Infarct Size, but not Microvascular Obstruction Post Myocardial Infarction, and Sodium Nitrite Increases Microvascular Obstruction Region Blood Flow without Affecting CT Hypoenchancement Area
Authors: O'Sullivan John F , Leblond Anne-Laure , O'Dea John , Hristova Ivalina , Kumar Sujith , Caplice Noel M
Published: April 2024

John F O'Sullivan, 2011 Finalist and Presenting Author
Abstract 15881: Delayed Enhancement in Hypertrophic Cardiomyopathy Is Related to Perfusion Abnormalities: An Ischemia-Fibrosis Connection
Authors: Bravo Paco E , Santaularia Miguel , Zimmerman Stefan , Pinheiro Aurélio , Higuchi Takahiro , Wahl Richard L , Abraham Roselle M , Bengel Frank M , Abraham Theodore
Published: April 2024

Paco E Bravo, 2011 Finalist and Presenting Author
Abstract 16610: High Fat Diet-induced Obesity Is Associated With Increased Ischemia Susceptibility Due To Deregulated Activation Of The Rheb/mTORC1 Pathway And Inhibition Of Autophagy
Authors: Sciarretta Sebastiano , Zhai Peiyong , Shao Dan , Maejima Yasuhiro , Robbins Jeffrey , Volpe Massimo , Sadoshima Junichi
Published: April 2024

Sebastiano Sciarretta, 2011 Finalist and Presenting Author
Abstract 13411: p90RSK Inhibits C Terminus Of Hsc70-interacting Protein (CHIP) Ubiquitin E3 Ligase Activity And Promotes Cardiac Apoptosis Through ERK5-Ser 496 Phosphorylation And Association
Authors: Le Nhat Tu , Takei Yuichiro , Shishido Tetsuro , Woo Chang-Hoon , Lu Yan , McClain Carolyn , Yan Chen , Patterson Cam , Yang Jay , Abe Jun-ichi
Published: April 2024

Nhat Tu Le, 2011 Finalist and Presenting Author
Abstract 55: Intra-arrest Hypothermia Fails to Improve Long-Term Survival and Neurological Outcomes in Akt1-Deficient Mice Following Resuscitation
Authors: Beiser David G , Wang Huashan , Han Mei , Vanden Hoek Terry L
Published: April 2024

INTRODUCTION:
In a mouse model of cardiac arrest, we have previously demonstrated that intra-arrest hypothermia (IH), cooling the body to 30 - 32°C, improves cardiac function and long-term neurologically intact survival rates in C57Bl/6J, wild-type (WT), mice following return of spontaneous circulation (ROSC). Heart Akt is also activated by IH at 4 h post-ROSC. By contrast, IH does not improve post-ROSC cardiac function or increase cardiac Akt activity in Akt1 deficient (Akt1+/-) mice. However, the effect of IH on long-term outcomes in Akt1+/- is unknown.

METHODS:
Anesthetized adult female (n = 20) Akt1+/- mice underwent 8 min of KCl-induced asystolic cardiac arrest. After 6 min, mice were randomized to continued normothermia (NT, 37°C) or IH (30°C) followed by re-warming to 37°C at 60 min post-ROSC. Following ROSC, animals were ventilated and invasively monitored for 2 h. At 2 h, vascular catheters were removed, wounds surgically closed, and animals were weaned from positive pressure ventilation over 4 h. Neurologic assessments were performed at regular intervals over 72 h.

RESULTS:
NT and IH groups were hemodynamically similar at baseline, during CPR, and at 2 h post-ROSC. ROSC rates were similar in the NT and IH groups (9/10 vs. 10/10, p=0.30). Survival rates (see figure) and neurologic function scores were similar between treatment groups at 6 h, 24 h, and 72 h.

CONCLUSION:
The loss of an Akt1 allele abrogates long-term therapeutic benefits of IH in a mouse model of cardiac arrest. These results suggest that Akt1 signaling may play an important role in IH protection.
Abstract 10043: Arteriolar Function in Visceral Adipose Tissue is Impaired in Human Obesity
Authors: Farb Melissa G , Ganley-Leal Lisa , Mott Melanie , Liang YanMei , Widlansky Michael , Bigornia Sherman J , Fiscale Antonino J , Apovian Caroline M , Carmine Brian , Hess Donald T , Vita Joseph A , Gokce Noyan
Published: April 2024

Melissa G Farb, 2011 Finalist and Presenting Author
Abstract 16380: Effects of Red Wine and Vodka on Collateral-Dependent Perfusion and Cardiovascular Function in Hypercholesterolemic Swine
Authors: Chu Louis M , Lassaletta Antonio D , Robich Michael P , Liu Yuhong , Burgess Thomas , Laham Roger J , Sweeney Joseph D , Shen Tun-li , Sellke Frank W
Published: April 2024

Louis M Chu, 2011 Finalist and Presenting Author
Abstract 57: Erythropoietin Selectively Preserves Electron Transport Complex IV Activity During Resuscitation from Cardiac Arrest
Authors: Radhakrishnan Jeejabai , Moy Hawnyeu M , Gazmuri Raúl J
Published: April 2024

Introduction:
We have previously documented in a rat model of VF and closed-chest resuscitation that administration of erythropoietin (EPO) preserves left ventricular distensibility - yielding hemodynamically more effective CPR - and attenuates post-resuscitation myocardial dysfunction.

Hypothesis:
Given that similar functional myocardial benefits can be elicited by preservation of mitochondrial bioenergetic function, we hypothesized that EPO could mediate the aforementioned myocardial effects in part by preserving activity of electron transport complexes I, III, IV and V (FoF1 ATPase).

Methods:
VF was electrically induced in 10 Sprague-Dawley male rats and left untreated for 8 minutes before attempting resuscitation by closed-chest resuscitation and delivery of electrical shocks. Rats were randomized to receive 5,000 U/kg of EPO (n=5) or NaCl 0.9% vehicle (n=5) into the right atrium immediately before starting closed-chest resuscitation, with the investigators blind to the assignment. All rats were resuscitated and survived 120 minutes, time at which hearts were removed storing the left ventricles at -80°C. Mitochondria were isolated from frozen tissue and activity of electron transport complexes I, I & III, IV and V measured spectrophotometrically
via
dichloro indophenol reduction, cytochrome
c
reduction, cytochrome
c
oxidation, and phosphate estimation, respectively.

Results:
Only complex IV activity was significantly higher in EPO compared with NaCl 0.9% treated rats with the levels in EPO rats comparable to the reference levels (Table).

Conclusions:
EPO ameliorated reductions in complex IV activity prompted by cardiac arrest and resuscitation, an effect that could mediate the favorable myocardial effect of EPO observed during resuscitation from cardiac arrest.
Heart Making and Heart Breaking: The Molecular Circuitry of Heart Development, Disease and Regeneration
Authors: Olson Eric
Published: April 2024

Heart disease remains the primary cause of morbidity and mortality in the developed world. A major reason for this is that the adult human heart has limited regenerative capacity following injury. The default healing response in the adult heart following myocardial infarction or other disorders that cause loss of heart muscle cells involves replacement of cardiac muscle with fibrous, noncontractile scar tissue. The consequent loss of contractility diminishes cardiac function and ultimately leads to heart failure and death. In recent studies, we found that the hearts of neonatal mice can fully regenerate after partial surgical resection, but this capacity is lost by 7 days of age. We are currently exploring the molecular underpinnings of the neonatal regenerative response of the heart, with the long-term goal of discovering combinations of genes and drugs that promote cardiac repair and regeneration. We are also optimizing strategies for reprogramming of cardiac fibroblasts toward a cardiomyocyte cell fate as a means of replacing heart muscle following myocardial infarction. It has recently become apparent that microRNAs play key roles in modulating the response of the heart to injury. Because individual microRNAs often regulate the expression of multiple target genes with related functions, modulating the expression of a single microRNA can modify complex disease phenotypes. We have identified signature expression patterns of microRNAs associated with diverse cardiovascular disorders, including pathological cardiac hypertrophy, heart failure, myocardial infarction, vascular stenosis and angiogenesis. Gain- and loss-of-function studies in mice have revealed striking functions for these microRNAs in numerous facets of cardiac biology, including the control of sarcomere formation, fibrosis, hypoxia, myocyte survival, cytoskeletal dynamics and erythropoiesis. Disease-inducing microRNAs can be persistently silenced in vivo through systemic delivery of anti-miRs, allowing for therapeutic modulation of disease mechanisms. Recent advances in understanding the mechanisms of cardiac injury and regeneration as well as strategies for promoting cardiac repair through modulation of intrinsic regenerative mechanisms will be discussed.
Abstract 69: A Tale of Two Cities: The Role of Neighborhood Socioeconomic Status in Spatial Clustering of Bystander CPR in Austin and Houston
Authors: Sasson Comilla , McNally Bryan , Hinchey Paul , Gonzales Louis , Persse David , Root Elisabeth D
Published: April 2024

Objective:
To determine 1) the location of bystander CPR clusters and 2) the effect of neighborhood-level risk factors on clusters.

Methods:
Secondary analysis of the Austin/Travis County and Houston/Harris County Cardiac Arrest Registry to Enhance Survival (CARES) dataset.

Population:
Consecutive arrests from October 1, 2006 to December 31, 2009 (Austin) and from January 1, 2007 to December 31, 2009 (Houston).

Data Analysis:
Spatial scan statistic (SaTScan v9.1) was used to test spatial clusters of bystander CPR stratified by private and public arrest location. A Bernoulli model was used to determine significant clustering of the case (all OHCA with a non-EMS bystander initiated CPR) location distribution as compared to the controls (all other OHCA events) location distribution. “High” clusters indicated areas where the number of bystander CPR events were greater than expected while “low” clusters indicated areas where the number of bystander CPR events were lower than expected.

Results:
Two “high” private and two public (one “low” and one “high”) clusters were identified in Austin. Two “high” private clusters had approximately 1.8-2.6 times more bystander CPR cases than expected, while the “high” public cluster, located in the same area as the private “high” cluster, had 2.0 times more bystander CPR cases than expected. The “low” public cluster was in the Austin city center and contained nearly 80% fewer than expected. Three private (two “high” and one “low) and one “high” public clusters, were identified in Houston. Two “high” private clusters in the south had nearly 4.4 times more than expected, while the “low” private cluster included only 34 cases, 57% fewer than expected. The “high” public cluster was, just west of city center, included 14 cases, 2.5 times more than expected. However, when adjusted for neighborhood median household income, all clusters disappeared in Austin, though only the public arrest cluster disappeared in Houston.

Conclusion:
Our findings suggest that high and low clusters of bystander CPR can be partially explained by median household income. Further research will be required to better understand why such vast disparities in the provision of bystander CPR exist.
Abstract 7: The Impact of Time to Target Temperature on Survival to Hospital Discharge for Patients Undergoing a Comprehensive Postresuscitation Program Following Out-of-Hospital Cardiac Arrest
Authors: Sawyer Kelly N , Kurz Michael C , Gossip Michelle , Roberts Charlotte , Dhindsa Harinder , Reid Renee , Ornato Joseph P , Peberdy Mary Ann
Published: April 2024

Objectives:
A comprehensive post-resuscitation program (CPRP) of care including therapeutic hypothermia (TH) is recommended by the 2010 AHA guidelines to improve survival from out-of-hospital cardiac arrest (OOH-CA). We sought to determine the influence of time to target temperature (T2T) on survival.

Methods:
Adult, non-traumatic, OOH-CA patients surviving to hospital admission and enrolled in our CPRP between January 2008 and January 2011 were included. Structured data including all relevant interval times from OOH-CA to target temperature were collected retrospectively. T2T was measured from ROSC, and TH duration began after reaching target temperature. Data were analyzed using descriptive statistics and logistic regression (significance α = 0.05).

Results:
Of 169 patients enrolled, 56 (33%) were female, 103 (61%) were African American, and mean age was 58.1 years (95% CI 55.83, 60.37). Overall, 84 patients (49.7%) survived to hospital discharge. The odds of survival for VF patients were 6.53 times greater than the PEA patients (95% CI 3.28 to 13.01), so separate analyses were performed. For VF, average T2T was 321.4 ± 180.58 minutes (95% CI 285.41, 357.44), and a longer T2T was a significant predictor for survival (P 0.026). For PEA, the average T2T was 321.7 ± 174.24 minutes (95% CI 279.16, 364.16). There was a trend for a longer T2T to be associated with improved survival in the PEA group (P 0.165).

Conclusions:
A longer T2T is associated with survival in patients treated with therapeutic hypothermia after OOH-CA. Patients with longer T2T have a longer total hypothermic treatment time, which may be an important and unique variable in the application of CPRP.
Abstract 71: Diagnosis of Cardiac Arrest by 911 Call Takers Improved with Education Without Changing Bystander CPR Rates
Authors: Gozman Dina , Sayre Michael R , Koser Shawn , Witosky David , Davis James , Keseg David
Published: April 2024

Context:
In most out-of-hospital cardiac arrest (OHCA) events, a telephone call to 911 is the first action by bystanders. Because the 911 call taker cannot see the victim, accurate diagnosis of cardiac arrest depends on the caller's verbal description. If cardiac arrest is not suspected, then no telephone CPR instructions will be given.

Objective:
We measured the impact of a change in the EMS call taker question sequence on the accuracy of diagnosis of cardiac arrest by 911 call takers.

Methods:
We retrospectively reviewed the Cardiac Arrest Registry to Enhance Survival (CARES) dataset for Jan 1, 2009 through Dec 31, 2010 from a single Midwestern US city, population 750,000 with a longstanding telephone CPR instruction program (APCO). We included OHCA cases of any age who were in arrest prior to the arrival of EMS and for whom resuscitation was attempted. In early 2010, 911 call takers were retrained to follow a revised telephone script that emphasized minimal questioning, assertive control of the callers, and provision of Hands-only telephone CPR instructions. In 2010, call recordings were reviewed regularly with feedback to the call taker. The main outcome measure was sensitivity of the 911 call taker in diagnosing cardiac arrest. We compared 2009 with 2010 using the χ
2
test and odds ratio (OR).

Results:
There were 509 OHCA cases in 2009 and 447 cases in 2010 (64/100,000 population). The mean age was 59 ± 18 years, and 60% were male. Only 26% of events were witnessed. Before the revision, 40% were identified by 911 dispatchers; and after the revised questioning sequence, 74% were identified (OR 4.3, CI95 3.2 - 5.6, p<0.01). The mean time to question callers was 58 seconds before and 54 seconds after (p=NS). False positive rates changed little (676 before and 861 after). Bystander CPR was performed in 37.5% of events before and 37.4% of events after the training (p=NS).

Conclusion:
Emphasis on scripted assessment improved sensitivity without loss of specificity in identifying OHCAs. However, it did not translate to an increase in patients receiving bystander CPR.