bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 6200: Ethnic Differences in Carotid Artery Distensibility: Multi-Ethnic Study of Atherosclerosis
Authors: Vaidya Dhananjay , Golden Sherita H , Heckbert Susan R , Ouyang Pamela
Published: July 2021

When African-Americans are compared to Whites, there is a greater incidence of diseases associated with stiffer arteries, including hypertension, stroke and heart failure. There is a paucity of data regarding ethnic differences in arterial stiffness, particularly in persons without known cardiovascular disease. We therefore examined arterial distensibility in the Multi-ethnic Study of Atherosclerosis (MESA). At MESA baseline (2000–2002), 6358 Americans without clinical cardiovascular disease of White (W, 38%), Chinese (C, 12%), African (A, 27%), and Hispanic (H, 22%) ethnicities had carotid diameter measurements by ultrasound and brachial blood pressure measurements during systole and diastole. We estimated carotid distensibility as the slope of the arterial diameter versus pressure in mixed model analysis where each individual’s intercept (carotid diameter at the brachial arterial pressure of 100mmHg) and slope were modeled as random effects. Sex-stratified models were adjusted for age, antihypertensive use, and metabolic variables (see table footnote). The table

shows the intercept and distensibility in women and men of different ethnicities. Compared to men, women have smaller diameter and less distensible vessels (both p<0.001). There is ethnic heterogeneity for the diameter intercept (women p<0.001, men p=0.002), and distensibility (both p<0.001). C women have significantly larger carotid diameter than all other ethnicities. W and C men have larger diameter as compared to B and H men. However, W women and W men have greater distensibility than all other ethnicities. In our study, compared with Whites, African-Americans have lower arterial distensibility, which may contribute to greater cardiovascular morbidity and mortality. Lower arterial distensibility in Chinese and Hispanic Americans is a novel finding and would support further study of vascular disease incidence and its prevention in these ethnicities.

Table:

Carotid Diameter and Distensibility (Mean±SEM from Mixed Model) by Sex and Ethnicity
Abstract 6210: The Relation between High Cardiorespiratory Fitness and Low Inflammation is Mediated by Autonomic Nervous System Function
Authors: Jae Sae Young , Heffernan Kevin , Fernhall Bo , Lee Moon-Kyu , Park Won Hah
Published: July 2021

Objective:
Although observational studies have shown an inverse association between high cardiorespiratory fitness (CRF) and low inflammatory markers independent of body fatness, the underlying mechanisms relating CRF to inflammatory markers are not fully understood. There is emerging evidence that autonomic nervous system function is related to inflammation. Because high CRF is related to improved autonomic function, we hypothesized that association between high CRF and low inflammatory markers would be affected by autonomic nervous system function.

Methods:
Cross-sectional analyses were conducted on 2557 (mean age 57 ± 5 yrs) asymptomatic men who participated in a medical checkup program. Fasting blood samples for CVD risk factors including inflammatory markers were analyzed and CRF was measured by maximal exercise treadmill test with expired gas analysis. We used an index of cardiac autonomic imbalance defined as the ratio of resting heart rate with 1 minute of heart rate recovery after exercise (index of RHR/HRR).

Results:
CRF was significantly correlated with age (r=−0.41, p<0.05), body mass index (BMI) (r=−0.11, p<0.05), glucose (r=−0.13, p<0.05), C-reactive protein (CRP) (r=−0.16, p<0.05), white blood cell (WBC) (r=−0.17, p<0.05), and index of RHR/HRR (r=−0.48, p<0.05). Index of RHR/HRR was also significantly correlated with age (r=0.36, p<0.05), glucose (r=0.23, p<0.05), CRP (r=0.25, p<0.05) and WBC (r=0.23, p<0.05). In multivariable linear regression models that adjusted for age, BMI, smoking, diseases, medications, lipid profiles, glucose and systolic blood pressure, CRF was inversely associated with CRP (β=−0.09, p<0.05). However, this relationship was no longer significant after adjusting for index of RHR/HRR in a multivariable linear regression model (β=−0.03, p=0.29).

Conclusion:
These results suggest that autonomic nervous system function significantly mediated the relationship between high cardiorespiratory fitness and inflammation, but further interventional research is needed to confirm this novel finding.
Abstract 6215: Childhood Obesity In Two Communities - Relation to Health Habits and Resources
Authors: Eagle Taylor , Jackson Elizabeth A , Aaronson Susan , Fitzgerald Catherine , Mitchell Lindsey , Gurm Roopa , DuRussel-Weston Jean , Goldberg Caren S , Eagle Kim
Published: July 2021

Background. Middle school children residing in a community with fewer resources may have less opportunity to be physically active or consume a healthy diet which may lead to an increased risk for obesity, and poorer baseline cardiovascular health.

Methods. We compared health status of middle school students (average age 12 years) in two Michigan communities; Ann Arbor (AA) and an adjacent town, Ypsilanti (YPSI) (median household income 77,000 and 28,610, respectively). Blood pressure (BP), cholesterol, blood glucose, body mass index (BMI), and self-reported diet and physical activity habits were collected at baseline in students (n=733) from 5 AA and 2 YPSI middle schools.

Results. The percentage of children receiving free lunch was higher among the YPSI children compared to the AA children (60% vs. 26%, p =0.01). More YPSI children were in the 95
th
percentile for weight compared to the AA children (22.2% vs. 12.6%) and on average had a greater BMI (21.2 ± 4.8 vs. 19.9 ± 4.1, p =0.004) and LDL-cholesterol (99.9 ± 27.5 vs. 91.7 ± 26.9, p =0.005). Compared to AA children, the YPSI children were less likely to consume one or more servings of vegetables/day (67.7% vs. 80.6%, p =0.004) while no difference was observed in fruit consumption. Non-diet soft drink consumption was higher among the YPSI children compared to those from AA (45.9% vs. 30.8%, p =0.002). YPSI children were less likely to report attending a school-based physical education class in the past week (41.4% vs. 9.9%, p<0.001) or to participate on a school-based sports team (65.4% vs. 38.3%, p<0.001). The majority of children in both communities reported watching one or more hours of TV/day; however YPSI children were more likely to watch six or more hours/day compared to AA children (12.8% vs. 4.0%, p<0.001). A similar pattern was observed for video games, with 11.3% of YPSI children reporting six or more hours/day of playing video games compared to 1.9% AA children (p<0.001).

Conclusions. We observed a marked difference in diet, physical activity habits and cardiovascular parameters among children from two neighboring communities with varying resources. The local and national response to childhood obesity must focus on these community resources in order to improve childhood health.
Abstract 6242: Comparison of Facilitated and Primary Percutaneous Coronary Intervention: A Meta-Analysis
Authors: Nawaz Yassir , Adomaityte Jurga , Siddiqui Zishan K , Amer Muhammed , Qayyum Rehan
Published: July 2021

Background:
Facilitated percutaneous coronary intervention (PCI), in which pharmacological agents are administered before coronary angiography, may result in early restoration of myocardial perfusion and can improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). To examine whether facilitated PCI is associated with better myocardial perfusion and clinical outcomes than primary PCI, we performed a meta-analysis of the clinical trials that compared the two strategies.

Methods:
PubMed, EMBASE, and The Cochrane Collaboration databases were searched through June 2008. We included clinical trials that were published in English language peer-reviewed medical journals and randomized patients with STEMI to facilitated or primary PCI. Two investigators independently abstracted data. Random-effects model was used to pool results.

Results:
Of the 419 identified articles, 24 were included (total patients =7997, facilitated PCI =4409, primary PCI =3588, median age=61 years, males=78%). Facilitated PCI increased myocardial perfusion as measured by grade 2 and/or 3 myocardial blush (588 vs. 468, OR=1.66, 95%CI=1.19 to 2.32) and ST segment resolution (1021 vs. 790, OR=1.61, 95%CI=1.25 to 2.09) as compared to primary PCI. Facilitated PCI was similar to primary PCI in reducing mortality (238 vs. 215, OR=1.10, 95%CI=0.88 to 1.37), reinfarction (129 vs. 109, OR=1.16, 95%CI=1.16(0.87 to 1.55), target vessel revascularization (181 vs. 144, OR=1.34, 95%CI=0.88 to 2.04), and stroke (51 vs. 24, OR=1.99, 95%CI=0.85 to 4.66). However, facilitated PCI was associated with increased incidence of major bleeding (236 vs. 151, OR=1.42, 95%CI=1.12, 1.81).

Conclusion:
As compared to primary PCI, facilitated PCI is associated with early restoration of myocardial perfusion, but has no effect on overall mortality, reinfarction, target vessel revascularization, and stroke, and increases risk of major bleeding in patients with STEMI.

Results of meta-analysis comparing facilitated and primary percutneous coronary intervention
Abstract 6246: Impact of Dysglycemia on Left Ventricular Functional Reserve in Acute Myocardial Infarction
Authors: Høfsten Dan E , Løgstrup Brian , Nørager Betina , Møller Jacob E , Egstrup Kenneth
Published: July 2021

Background
Abnormal glucose metabolism is common in patients with acute myocardial infarction (AMI), and is associated with excess morbidity and mortality. The reason for this is unclear but could be associated with an unfavourable effect on left ventricular (LV) functional reserve.

Methods
Low-dose dobutamine stress echocardiography (LDDE) was performed in 165 consecutive patients during admission for AMI. Peak early diastolic mitral annular velocity (E′), peak systolic mitral annular velocity (S′), and LV ejection fraction (LVEF) were measured at rest and during low dose dobutamine infusion. Glucose metabolism was assessed using an oral glucose tolerance test in patients without a previous diagnosis of diabetes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were also measured.

Results
After adjustment for age, gender, hypertension, atrial fibrillation, peak troponin-T levels, diastolic blood pressure, heart rate, and body mass index, an inverse association between glucose metabolism and LV function was observed for E′ (
P
=.005) and S′ (
P
=.008) when measured during LDDE, but not when measured at rest (E′:
P
=.10; S′:
P
=.22). Neither rest nor stress LVEF was significantly associated with the degree of dysglycemia (rest:
P
=.67; LDDE:
P
=.19). All parameters measured during LDDE were significant predictors of NT-proBNP levels after adjustment for resting values (all variables:
P
<.05).

Conclusions
In patients with a recent AMI, abnormal glucose metabolism is associated with impaired LV function during LDDE but not at rest; this is suggestive of depressed functional reserve.
Abstract 6253: Increased Expression of Thioredoxin Interacting Protein Promotes Oxidative Stress and Contributes to the Pathogenesis Of Diabetic Cardiomyopathy
Authors: Connelly Kim A , Kelly Darren J , Zhang Michael , Thai Kerri , Advani Andrew , Krum Henry , Gilbert Richard E
Published: July 2021

Background: Alterations in the thioredoxin (TRX) antioxidant system have been implicated in the pathogenesis of cardiac injury, particularly in the diabetic setting. While constitutively present, TRX activity is reduced by the presence of its endogenous inhibitor, thioredoxin interacting protein (TxnIP). We hypothesized that by increasing TxnIP, diabetes may reduce TRX activity and contribute to oxidative stress.

Methods: Cell culture studies were performed using the H9C2 rat cardiomyoblast cell line and neonatal cardiomyocytes isolated from 1 day old Sprague Dawley rat neonates. In-vivo studies were performed using a hemodynamically-validated rodent model of diabetic diastolic heart failure, the diabetic (mRen-2)27 transgenic rat (Ren-2). Urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) was used as a measure of oxidative stress.

Results: In- vitro, high glucose (25mmol/l) resulted in increased TxnIP mRNA expression in both neonatal cardiomyocytes as well as H92C cells (2.21 ± 0.6 v 1.00 ± 0.19, p<0.05 compared to normoglycaemic conditions) with a 45% reduction in TRX activity (0.11 ± 0.01 v 0.061± 0.003, p<0.01). In-vivo, diabetes led to a 250% rise in TxnIP mRNA expression compared to control (2.54 ± 0.5 v 1.00 ± 0.11, p<0.001) that was accompanied by a three fold rise in urinary 8-OHdG (680 ± 280 v 1395 ± 391 ng/ml, p<0.001).

Conclusion: In both the in vitro and in vivo settings, high glucose leads to TxnIP over-expression associated with reduced TRX activity thereby increasing oxidative stress and implicating this system in the pathogenesis of the cardiac dysfunction that characterizes the diabetic state. Pharmacological manipulation of the TRX-TxnIP system may represent a novel target to reduce diabetic complications.
Abstract 6258: Increased HO-1 Expression Decreases Adipocyte Cell Size, IL6 And TNFα Secretion While Increasing Adiponectin Levels In Obese Zucker Rats And Human Adipocyte Stem Cells
Authors: Kim Dong Hyun , Peterson Stephen , Vanella Luca , Rodella Luigi F , Rezzani Rita , Drummond George , Abraham Nader G
Published: July 2021

Background.

Adiponectin has been shown to provide cytoprotection to both the pancreatic and vascular systems. Our hypothesis is that upregulation of HO-1 expression influences serum adiponectin and ameliorates the levels of inflammatory cytokines in obese Zucker fat (ZF) rats and Zucker lean (ZL) rats via an increase in adiponectin levels and inhibition of adipogenesis in vivo and in adipocyte stem cells.

Methods.

ZF and ZL rats were fed a normal diet until 12–14 weeks of age when they were divided into four groups comprising ZL, ZL-CoPP, ZF and ZF-CoPP. CoPP (subcutaneously, 2mg/Kg weekly) was administered for 6 weeks. Food intake, blood insulin, glucose levels, aorta HO-1, pAMPK, AKT, pAKT protein and O
−
2
were determined. Human bone marrow derived adipocyte mesenchymal stem cells (MSC) were used to measure the effect of HO-1 expression on adipogenesis and droplet size. Plasma adiponectin, TNFα and IL-6 were measured.

Results.

CoPP administration limited weight gain and increased both HO-1 expression and plasma adiponectin (p<0.004). This was associated with a decrease in superoxide levels (p<0.05) when compared to untreated ZF rats. CoPP treatment decreased visceral and subcutaneous fat content and reduced weight gain (p<0.01). TNFα and IL-6 were also decreased (p<0.04 and 0.008 respectively). Human bone marrow-derived adipocytes cultured with CoPP resulted in an increase in HO-1 protein levels and a decrease in superoxide levels. Upregulation of HO-1 caused adipose remodeling, (decreased lipid droplets by 52% while inhibition of HO activity increased lipid droplet size by 128%) and increased adiponectin secretion in the culture medium of human bone marrow-derived adipocytes.

Conclusion

. This study demonstrates that the anti-obesity effects of HO-1 induction result in an increase in adiponectin secretion, both in vivo and in vitro, a decrease in TNFα, IL-6, a reduction in weight gain and decreased adipocyte size resulting in a healthier adipocyte as seen by an increase in adiponectin. This highlights the pivotal role and symbiotic relationship of HO-1 and adiponectin in the modulation of the metabolic syndrome phenotype.
Abstract 6265: A Cluster Randomised Controlled Trial of Oscillometric Versus Manual Sphygmomanometers for Blood Pressure Management in Primary Care (CRAB)
Authors: Nelson Mark R , Quinn Stephen , Bowers-Ingram Linda , Nelson Jan M , Winzenberg Tania M
Published: July 2021

Although mercury sphygmomanometers are seen as the gold standard instrument for blood pressure (BP) measurement they are being withdrawn due to health and safety concerns. This has potential for changes in BP recording and management. CRAB aimed to determine the effect of an oscillometric device on digit preference, BP measurement and antihypertensive drug prescribing. Cluster randomized controlled trial in 24 family practices in Tasmania, Australia. Practices were excluded if they had oscillometric devices. Intervention practices were supplied with OMRON HEM-907 monitors for all clinical rooms and other BP measuring devices were removed. Three practices (2 control & 1 intervention) withdrew. Intervention practices had a 1 week run-in phase for familiarization and novelty reduction. Intervention practices were subsequently audited by a research nurse as prospective collection of data by a family physician may have influenced the outcome measures of interest. Control practice audit periods were matched to intervention practices. All analyses were ITT and adjusted for potential clustering. Differences in BP were analysed using generalised estimating equations. All other outcomes were analysed using multilevel mixed-effects poisson regression. Post hoc analyses were performed to determine the mediators of changes in prescribing behaviour. 3355 records were reviewed with 828 visits having BP recordings. The percentage of BP recordings ending in “0” was significantly lower in intervention vs. control practices [SBP 18% (233/329) vs. 71% (107/587), DBP 20% (229/328) vs. 70% (119/584) p<0.001]. The mean of systolic BP recordings in the intervention group was 7.5 mmHg (95% CI 5.2, 9.9 mmHg) higher than in the control group. Patients taking BP lowering drugs were more likely (IRR 1.3 95% CI 1.1, 1.7) to have a BP lowering drug prescribed if they were in the intervention compared to the control. Post hoc analyses identified systolic BP and not terminal digit preference as mediators of changes in prescribing behaviour. Oscillometric BP devices led to increases in overall prescribing of antihypertensive drugs. This was most likely mediated by reductions in measurement error leading to higher BP recordings.
Abstract 6270: How Many Guidelines Does it Take to Send an Asymptomatic Man to Invasive Angiography?
Authors: Leal Miguel A , Keevil Jon G
Published: July 2021

Modern medical practice utilizes peer-reviewed published guidelines in order to establish if a diagnostic test or therapeutic intervention is appropriate and will likely promote better outcomes in patient care. However, some evidence-based recommendations may lead to incremental health care cost and potential patient harm if applied blindly, without the guidance of clinical judgment. To analyze the epidemiologic impact of applying the diagnostic algorithm for coronary artery disease (CAD) management suggested by the Screening for Heart Attack Prevention and Education (SHAPE) task force. Using data from the National Health and Nutrition Examination Survey (NHANES) and the Multi-Ethnic Study of Atherosclerosis (MESA), we assessed the hypothesis that proceeding with further diagnostic evaluation via stress testing in patients who have a coronary calcium score greater than 400 on CT scanning would lead to a remarkable number of invasive procedures performed in an asymptomatic population who is deemed to have low risk for cardiovascular events according to other published guidelines. According to the MESA database and the NHANES data collected up to 2002, 4.6 million American men between ages 45 and 79-years-old have a calcium score greater than 400 on coronary CT imaging, which corresponds to approximately 12 % of the population in that group. Potentially 10 to 12 % of those asymptomatic individuals could have false positive stress tests, leading to almost half a million cardiac catheterizations performed in asymptomatic adult males, with a sizable absolute number of procedure-related cost and complications. The decision to follow diagnostic algorithms in the care of patients with risk factors for coronary artery disease should focus great attention to the type of population being studied, the pre-test probability of disease, the cost-benefit relationship and the risk-benefit ratio. If these epidemiologic and health policy parameters are ignored or underestimated, the feasibility of medical practice (using coronary artery disease management as an example) could be compromised in the long-term, despite minimal or no deviation from established standards of care.
Abstract 6278: Burden of Chronic Renal Insufficiency in the General Population and Added Predictive Power of GFR to BNP and NT-proBNP in Detection of Altered Ventricular Structure and Function
Authors: Cataliotti Alessandro , Rodeheffer Richard J , Mahoney Douglas W , Lam Carolyn S , Redfield Margaret M , Martin Fernando L , Burnett John C
Published: July 2021

Background: Chronic renal insufficiency (CRI) is a strong predictor of increased mortality in the presence of heart failure (HF) and its prevalence has been increasing in the US. In addition, CRI is a major contributing factor to the progression of HF as it is associated with chronic volume overload, accelerated atherosclerosis and hypertension (HTN). The first aim of the current study was to evaluate the prevalence of CRI in an adult general population. The second aim was to address whether calculated glomerular filtration rate (cGFR) adds value to the cardiac biomarkers BNP and NT-proBNP in detecting early cardiac structural and functional impairments in the general population.

Methods: From 1997 to 1999 medical history, physical examination, echocardiography, BNP (Biosite) and NT-proBNP (Roche) and serum creatinine (SCr) were obtained in 1,982 randomly selected residents of Olmsted County, MN >= 45 years (range 45 – 96 years). GFR was calculated using the Cockroft Gault equation. CRI was defined as a GFR < 60 ml/min. Cardiac structure and function were evaluated by in-depth echocardiographic examination.

Results: The prevalence of cardiovascular co-morbidities was coronary atherosclerosis 12%, HTN 29.5% and diabetes mellitus 7.5%. The prevalence of CRI was 22.8% when cGFR was used for its detection. Importantly, by Chi-Square model, cGFR significantly increased the ability of BNP in detecting left ventricular hypertrophy (LVH) (p=0.004), increased relative wall thickness (p=0.0036), diastolic dysfunction (DDF) (p=0.0001) and HTN (p=0.0002). Similarly, when combined with NT-proBNP, cGFR increased the predictive power of detecting DDF (p=0.0001) and HTN (p=0.0366).

Conclusion: This study reports a higher than predicted prevalence of CRI in this general US population equal to 23% and closely associated with the prevalence of HTN (29.5%). Importantly, this study also demonstrates that cGFR has additive predictive power when used in combination with two cardiac biomarkers of cardiac dysfunction and remodeling, BNP and NT-proBNP. These studies underscore the increasing burden of CRI in the general population and the utility of assessing cardiorenal function by combining renal and cardiac biomarkers in assessment of cardiac structure and function.
Abstract 6279: The Severity of Nonalcoholic Fatty Liver Disease is Associated with Increased Cardiovascular Risk in a Large Cohort of Non-Obese Asian Subjects
Authors: Sung Ki C , Park Jeong B , Ryan Marno C , Wilson Andrew M , Kang Jin H , Kim Bum S , Kim Byung J
Published: July 2021

Bcakgrounds: Non alcoholic fatty liver disease (NAFLD) has been linked independently to cardiovascular disease (CVD) but It is largely unknown if such a relationship between NAFLD and CVD risk relates to severity of liver disease or if it is independent of other potential confounding factors

Methods: This study included 30,172 subjects. Based on the presence or absence of steatosis on ultrasound and serum alanine aminotransferase (ALT), subjects were divided into controls, an increased serum ALT group without steatosis and a group with presumed nonalcoholic fatty liver disease (NAFLD), which included a steatosis alone group and a group with presumed non alcoholic steatohepatitis (NASH) with steatosis and an elevated ALT.

Results: The odds ratio for 10-year risk by total Framingham risk scores ≥10% was 5.3 times higher in NASH groups. The prevalence of diabetes, hypertension, elevated CRP and metabolic syndrome were all increased up to 15 fold over controls, independent of age, BMI, smoking and exercise habits. Overall CVD risk was significantly greater in NASH than in either steatosis or raised ALT alone.

Conclusion: Young, non-obese subjects with NAFLD are at significantly increased CVD risk, especially those with NASH. As well as specific therapy for liver disease, a diagnosis of NAFLD should lead to targeted risk assessment and risk factor modification.

Table 1.

Prevalence of Cardiovascular Risk Factors and 10- year risk

Table 2

Odds Ratios and 95% confidence intervals for Cardiovascular Risk Factors and 10- year risk
Abstract 3: Impact Of Transport To Critical Care Centers Vs. Non-critical Care Hospitals On Outcomes From Out-of-hospital Cardiac Arrest In Osaka, Japan
Authors: Kajino Kentaro , Iwami Taku , Daya Mohamud , Yonemoto Naohiro , Nishiuchi Tatuya , Hayashi Yasuyuki , Irisawa Taro , Ikeuchi Hisashi , Tanaka Hiroshi , Shimazu Takeshi , Hiraide Atushi , Sugimoto Hisashi
Published: July 2021

Background: Recent studies suggest that specialized hospital care including hypothermia and early percutaneous coronary intervention (PCI) influences the outcome of out-of -hospital cardiac arrest (OHCA) patients. In Japan, selected hospitals are certificated as “Critical Care Centers (CCC)” based on their expertise and ability to provide these higher levels of care. We hypothesized that the outcomes of patients with OHCA who were transported to CCC is better than if they were transported to non-critical care hospitals (NCCH) in Osaka, Japan.

Materials and Methods: All adults with OHCA of presumed cardiac etiology, treated by the emergency medical services (EMS) systems, and transported to a hospital in Osaka, Japan from January 1, 2005 to December 31, 2006 were studied using a prospective Utstein style population cohort database. Primary outcome measure was one month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCC were compared to patients transported to NCCH using multiple logistic regression to adjust for the following confounding variables; gender, age, witnessed status, bystander CPR, location, transport time and initial rhythm. We also performed a stratified analysis based on whether the patients achieved ROSC prior to arrival at the hospital.

Results: Of 6,943 OHCA of presumed cardiac etiology, 6,706 cases were transported. Of these, 1,780 were transported to CCC while 4,926 were transported to NCCH. Neurologically favorable survival at one-month was greater in the CCC group [103 (5.8 %) versus 119 (2.4 %), p < 0.001]. Transportation to CCC was a significant predictor [OR = 1.7, 95% CI interval (1.3 – 2.4)] of neurologically favorable survival after adjustment for confounding variables. In the stratified analysis, the impact of the CCC was not significant difference in patients transported after field ROSC. [OR = 1.4, 95% CI interval (0.92 – 2.22)] On the other hand, the impact of the CCC was even greater in patients transported prior to field ROSC. [OR = 2.4, 95% CI interval (1.3 – 4.5)]

Conclusions: The outcomes of patients with OHCA with or without field ROSC who were transported to Critical Care Centers was better than if they were transported to Non-Critical Care Hospitals.
Abstract P22: An Impedance Threshold Device Combined with an Automated Active Compression Decompression CPR Device (LUCAS) Improves the Chances For Survival in Pigs in Cardiac Arrest
Authors: Matsuura Timothy R , McKnite Scott H , Metzger Anja K , Yannopoulos Demetris , Aufderheide Tom P , Lurie Keith G
Published: July 2021

Background: By lowering intrathoracic pressure during the chest recoil phase of CPR, the impedance threshold device (ITD) increases circulation and the rate of return of spontaneous circulation (ROSC). This study evaluated the ITD combined with a new automated CPR device, the US version of the LUCAS, that compresses the chest and then pulls upwards with a 3 lb force.

Methods and Results: After 6 min of untreated ventricular fibrillation, anesthetized female pigs (40.0±0.7 kg) were randomized to 6 min of CPR (100 compressions/min with LUCAS and ventilation: 1.0 FiO2, tidal volume of 10ml/kg, rate 12/min) with an active (−10 cm H2O resistance) (n=12) or sham ITD (n=12), and then shocked once with 120 joules of direct current. Epinephrine (0.04 mg/kg) and more CPR and shocks were used if ROSC was not achieved.

Results (in mmHg) after 6 min of CPR with an active vs. sham ITD were: coronary perfusion pressure (PP) 20.8±1.2 vs. 21.0±0.9 (p=0.94); cerebral PP 8.8±1.0 vs. 10.0±0.9 (p=0.62); and end tidal CO2 38.1±1.5 and 37.1±1.3 (p=0.61). Peak and mean carotid artery blood flow (ml/min) was 323.9±15.2 vs. 256.6±21.1 (p=0.17) and 95.3±5.4 vs. 77.0±6.0 (p=0.22) with an active vs. sham ITD, respectively. Mean endotracheal pressures (mmHg) during chest recoil with an active vs. sham ITD were −2.0±0.5 vs. −0.2±0.2 (p<0.01). Arterial and venous blood gases were similar after 6 min of CPR between groups. ROSC, the primary survival endpoint for comparing the active vs. sham ITD, was 7/12 vs. 2/12 after 1 shock (p= 0.09), 12/12 vs. 5/12 after 2 shocks (p<0.01), and 12/12 vs. 7/12 after 3 shocks (p=0.04). With up to 14 shocks, 10/12 sham animals had a ROSC. All animals with ROSC lived for 30 min. There was no evidence of pulmonary edema or organ damage on autopsy with either ITD.

Conclusions: After 6 min of CPR, LUCAS and active ITD resulted in lower mean airway pressures during chest recoil versus controls but hemodynamic findings were similar. However, ROSC was significantly easier to achieve with an active ITD; with up to 3 shocks twice as many animals were resuscitated with an active ITD. This benefit is most likely explained by carotid blood flows that trended higher with the active ITD. These positive findings and lack of any adverse outcomes support the safety and efficacy of this device combination.
Abstract P26: Intra-CPR Hypothermia with and Without Volume Loading in an Ischemic Model of Cardiac Arrest
Authors: Yannopoulos Demetris , Zviman Menekhem , Kolandaivelu Aravindan , Ranjan Ravi , Dori Yoav , Castro Valeria , Resar Jon R , Brinker Jeffrey A , Wilson Robert F , Halperin Henry R
Published: July 2021

Background: Coronary occlusive ischemic events are responsible for 50 –70% of cardiac arrests in adults. We investigated the effects of intra-CPR mild hypothermia (HTM) (target 32–33°C) with and without volume loading on return to spontaneous circulation (ROSC) and infarction size in a severe, mid-LAD occlusion model of cardiac arrest.

Methods: 46 (27±2.3kg) pigs had their mid LAD balloon occluded and were divided in 5 groups. After 15 minutes, ventricular fibrillation (VF) was electrically induced and 5 minutes of untreated VF were followed by 5 minutes of pneumatic vest CPR with a set compression pressure (250mmHg). If ROSC was obtained, animals were followed for another 95 minutes for a total LAD occlusion time of 120 min. Subsequently the balloon was deflated and 90 min of reperfusion were followed by myocardial staining to define area at risk (AAR) and myocardial infarct size. Group A had no additional intervention. Group B received immediately post ROSC surface cooling with cooling blankets and ice. Group C received intra-CPR 680±23ml of 28°C 0.9% NS via a central femoral venous catheter. Group D received during CPR 673±26 of 4°C NS followed by post ROSC surface cooling as in group B. Group E received intra-CPR and post ROSC volume-sparing HTM with an Endovascular Therapeutic Hypothermia System (ETHS) placed into the right atrium and set at a target of 32°C.

Results: During CPR, coronary perfusion pressure was significantly decreased in groups C and D compared to groups A, B and E but groups D and E had significantly reduced infarct size. Group E had significantly improved EF compared to all other groups. Table

.

Conclusions: Intra-CPR HTM significantly reduces myocardial infarction size. Volume loading during CPR is detrimental for ROSC due to reduction of coronary perfusion pressure. ETHS intra-CPR application improves ROSC and post-resuscitation LV function and minimizes infarction in this ischemia-reperfusion cardiac arrest model.

Results
Abstract P31: The Central Nervous System’s Inflammatory Cytokine Response to Global Ischemia Due to Cardiac Arrest
Authors: Youngquist Scott , Niemann James T , Heyming Ted , Rosborough John P
Published: July 2021

Objective:
Pro-inflammatory cytokines have been implicated as culprits in neurotoxicity following ischemia in small animal models of stroke. The aim of this study was to measure the central nervous system (CNS) cytokine response following resuscitation from ventricular fibrillation (VF) in a porcine model of cardiac arrest and global hypoxic ischemia.

Methods:
VF was induced electrically in eleven anesthetized swine. Following seven minutes of untreated VF, animals were resuscitated. Cerebrospinal fluid (CSF) and serum was sampled prior to VF and at 60, 120, and 180 minutes post-resuscitation from which levels of TNF-α IL-1β, and IL-6 were measured. Levels were also drawn in three sham pigs, instrumented but not fibrillated.

Results:
CSF levels of TNF-α rose following resuscitation (p<0.0001, FIGURE

) and were correlated with CSF levels of IL-1β (Spearman rank correlation r=0.68, p<0.0001) and IL-6 (r=0.55, p=0.0003). Changes in cytokine levels were not observed in sham pigs. Only CSF levels of IL-1β were associated with its serum counterpart (p=0.0006).

Conclusions:
Measurable increases in pro-inflammatory cytokines in the CSF follow resuscitation from cardiac arrest in this porcine model. The CNS response of all three inflammatory cytokines is highly inter-correlated.
Abstract P38: Just-In-Time Simulation Training Improves ICU Physician Trainee Airway Resuscitation Participation without Compromising Procedural Success or Safety
Authors: Nishisaki Akira , Colborn Shawn , Watson Christine , Niles Dana , Ferry Susan , Devale Sujatha , Bishnoi Ram , Donoghue Aaron , Meyer Andrew , Helfaer Mark , Walls Ron , Nadkarni Vinay
Published: July 2021

Introduction
: Competence in orotracheal intubation is a requirement for Pediatric residency. However, opportunities for residents are limited. We hypothesize Just-in-Time simulation-based multi-disciplinary team training for acute airway resuscitation in a pediatric ICU (PICU) would improve physician trainee intubation participation and success, and decrease undesired
T
racheal
I
ntubation
A
ssociated
E
vents (
TIAE
) such as esophageal intubation, or mainstem intubation.

Methods
: With IRB approval, on-call residents in a tertiary PICU received 30 minute airway resuscitation multidisciplinary simulation training before 24 hour on-call duties. Airway resuscitation performance was captured in both simulated and real airway resuscitations using a validated airway registry (NEAR-4-KIDS) tool. Resident participation, success, first attempt success, and the incidence of TIAE were compared before and after this intervention (Pre: Jan 2005–Jun11, 2007; Post: Jun12, 2007–May2008). Analysis by time series analysis, and Fisher’s exact test.

Results
: 150 simulation training sessions were conducted, and 123 consecutive real orotracheal intubations were evaluated. Resident participation significantly increased: Pre 23 % vs Post 36 % (p=0.016). Overall resident airway resuscitation success (58% vs. 68%, p=0.39) and first attempt success (44% vs. 56%, p= 0.30) improvement were not statistically significant. Despite the increased participation by resident trainees, there was no increase in TIAE (23% vs. 21%, p=0.78) in real airway resuscitation.

Conclusion
: Simulation-based “Just-in-Time” multidisciplinary training for pediatric advanced airway resuscitation improved actual resident trainee participation in real ICU intubations, but did not compromise airway resuscitation procedural success or patient safety. Supported by Agency for Healthcare Research and Quality (AHRQ), and CHOP Endowed Chair, Critical Care Medicine
Abstract P42: Active Compression Decompression-CPR in an Infant Manikin Model Using a Novel Adhesive Glove Device
Authors: Udassi Sharda , Udassi Jai P , Lamb Melissa , Theriaque Doug , Zaritsky Arno L , Haque Ikram U
Published: July 2021

Introduction:
In animals Active Compression-Decompression(ACD)-CPR improves hemodynamics compared with standard CPR (S-CPR). We evaluated the feasibility of achieving ACD-CPR with a novel, simple and inexpensive Adhesive Glove Device (AGD) in an infant manikin model using two thumb (TT) chest compression.

Hypothesis:
AGD-ACD CPR provides better chest decompression compared to S-CPR in an infant manikin model without excessive rescuer fatigue.

Methods:
Laerdal
™
Baby ALS Trainer manikin was modified to digitally record compression pressure (CP), compression depth (CD) and decompression depth (DD). The thumb portion of two oven mitts were sewn together and a Velcro adhesive patch was stitched on the underside with an encircling adjustable strap for proper fit to create the AGD. An interlocking Velcro patch was glued to the manikin chest wall. Sixteen BLS or PALS certified healthcare providers were prospectively randomized to perform either two-thumb S-CPR or AGD-ACD-CPR for 5 minutes with a 30:2 compression:ventilation ratio using a crossover design. During AGD-ACD-CPR subjects were asked to pull up during chest decompression. Rescuer heart rate (HR), respiratory rate (RR), recovery time (RT) for HR/RR to return to baseline and actual compressions delivered per minute were recorded. Subjects were blinded to data recordings. Data (mean±SEM) was analyzed using 2 sided paired t-test; p-value ≤0.05 was considered significant.

Results:
Chest decompression was greater with AGD-ACD-CPR; the mean DD difference was 0.11±0.02 inches, p=<0.001. Compressions given per minute were 102±21 in S-CPR group vs. 96±16 in AGD-ACD-CPR group, p=0.04. In AGD-CPR 75% and in S-CPR only 12% of subjects achieved complete recoil to or beyond baseline. There was no significant difference in CD, CP, HR, RR and RT between the groups.

Conclusions:
Active decompression and improved recoil was achievable with the use of our simple, inexpensive AGD in this infant CPR model. Use of our device did not result in excessive rescuer fatigue compared to S-CPR. The clinical significance of 6 less compressions/minute in the AGD-CPR group needs to be determined.
Abstract P48: Preconditioning with Periodic Acceleration Significantly Decreases Infarct Size and Arrhythmias after Left Ventricular Ischemia Reperfusion Injury in Rats
Authors: Uryash Arkady , Wu Heng , Arias Jaqueline , Bassuk Jorge , Kurlansky Paul , Adams Jose A
Published: July 2021

BACKGROUND: Whole body periodic acceleration (pGz) is the sinusoidal head-foot motion in the spinal axis. pGz increases pulsatile vascular shear stress to the endothelium, activates endothelial nitric oxide synthase (eNOS) thus promoting increased release of nitric oxide (NO) in pigs, sheep, rats, isolated aorta, and humans. pGz is cardioprotective via NO release 1 hr prior to CPR or during CPR in pigs with induced ventricular fibrillation. The purpose of this study was to ascertain whether acute and chronic pGz preconditioning is cardioprotective in myocardial ischemia reperfusion (I/R) injury in rats as measured by infarction size, and arrhythmias.

METHODS: Unsedated, restrained, male rats (310±9 g, n=16) were preconditioned with pGz (
f
=6 cps,
a
=3.4 m/s
2
). Rats were randomized to: a) pGz 2 hr for 1 day prior to I/R (PRE-pGz 1D) n=4, b) pGz 2 hrs per day for 3 days prior to I/R (PRE-pGz 3D) n=6 and c) Control (C) n=6. Then, they were anesthetized and underwent focal I/R injury by left coronary artery ligation for 30 minutes followed by 120 min of reperfusion. ECG, and aortic pressure were monitored and infarct size calculated as % area at risk.

RESULTS: PRE-pGz 3D had an infarct sparring effect of 77% of C. Both 1 and 3 days PRE-pGz significantly attenuated ventricular arrhythmias during reperfusion. Figure

below shows % infarct for all groups,
†
P
<0.001 PRE-pGz 3D vs. C, *
P
<0.001 PRE-pGz 1D vs. C, and representative areas of infarct (INF) and at risk (AAR) in PRE-pGz 3D and C.

CONCLUSIONS: pGz preconditioning in rats significantly reduces infarct size and attenuates ventricular arrhythmias. This simple and non-invasive method of cardioprotection for I/R injury warrants human investigations.
Abstract P50: Ischemic Post-Conditioning Following Global Ischemia Due to Cardiac Arrest Failed to Improve Cardiac Function and Survival
Authors: Pytte Morten , Sun Shijie , Tang Wanchun , Weil Max H
Published: July 2021

Introduction
: Repetitive episodes of ischemia and reperfusion following regional myocardial and cerebral ischemia, representing ischemic post-conditioning (IPC), protect against ischemic injury. The possibility that such may have functional application for myocardial injury and survival in settings of cardiac arrest and resuscitation was examined. We hypothesized that repetitive cycles of ventricular fibrillation and reperfusion following resuscitation, representing IPC, would improve cardiovascular function and survival.

Methods
: Ventricular fibrillation (VF) was electrically induced in 10 SD rats weighing 536±15 g and left untreated for 8 minutes prior to 6 minutes of uninterrupted pre-cordial compressions followed by attempted defibrillation. Resuscitated animals were randomized to either IPC or control. IPC was induced at 5 minutes with electrical re-fibrillation lasting 30 sec followed by spontaneous reversion to a perfusing rhythm. The IPC was repeated 5 minutes later. Except for IPC, controls were identically treated. Frontal plane ECG, mean arterial blood pressure, left ventricular pressures and end tidal CO
2
were continuously recorded. Left ventricular ejection fraction (EF) and cardiac output (CO) were measured echocardiographically at hourly intervals together with blood gases for a total of four hours. Survival was documented at the end of 72 hours.

Results
: Baseline values did not differ between the IPC and control group. No statistically significant differences between the groups were demonstrated. A power calculation indicates that a minimum of 240 animals would be required to find a difference that would be potentially significant, accordingly the study was concluded. Table

. Mean values with standard deviation.

Conclusion
: The potential value of ischemic post-conditioning represented by repetitive episodes of VF, under the conditions of global ischemia of cardiac arrest, failed to demonstrate a survival value.
Abstract P65: Community Based Application of Therapeutic Hypothermia for Survivors of Cardiac Arrest
Authors: Getts Roger , Fedor David , Vanston Vincent J , Triano Mary , Prior John
Published: July 2021

Objectives: To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting.

Background: Implementation of therapeutic hypothermia for survivors of cardiac arrest in the US has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community level. Scranton, Pennsylvania is a just such a community. It has 75,000 people served by 3 hospitals with 700 acute care beds.

Methods: At three community hospitals, after return of spontaneous circulation (ROSC) survivors of cardiac arrest were treated with mild therapeutic hypothermia using ice and cooling blankets or suits in order to achieve a goal temperature of 32 to34 degrees C for 24 hours. After ROSC, the timing goals of therapeutic hypothermia were to cool patients within 4 hours, to achieve goal temperature within 8 hours, and to maintain goal temperature for 24 hours.

Results: Beginning in 2004, 27 survivors of cardiac arrest were managed with therapeutic hypothermia. The mean time from ROSC to initiation of therapeutic hypothermia was 2.8 hours (range, 0.4 – 6.3 hours), the mean time from ROSC to goal temperature was 6.9 hours (range, 1.9 –15 hours), and the mean time maintained at goal temperature was 26.7 hours (range, 12–39 hours). Once patients achieved goal temperature, 4.3% of the temperature readings were above 34 degrees C, reflecting undercooling, while 13.4% of the readings were below 32 degrees C, indicative of overcooling. Overall survival until hospital discharge with good neurologic outcome was 52%, compared to only 12% (p < 0.001) among historical controls with cardiac arrest. There were no major complications attributable to the procedure.

Conclusion: A simple protocol of mild therapeutic hypothermia using locally-available resources is technically feasible and safe in a community-based setting.
Abstract P66: Differences in Chest Compressions Provided to Male and Female Victims of Out-of-Hospital Cardiac Arrest
Authors: Kemeny Andre , Silver Annemarie , Quan Weilun , Freeman Gary , Babbs Charles
Published: July 2021

Background:
Prehospital healthcare providers may fear that they will injure patients while performing manual chest compressions (CC). The provider’s perception of a patient’s fragility may influence the aggressiveness with which he/she performs CC. As a consequence, EMS personnel may provide CC of differing forcefulness when treating male versus female patients. The objective of the present study was to compare the depth of CC provided to male and female patients. A secondary objective was to determine whether there were gender differences in delays and interruptions in CC.

Methods:
Data were recorded from the treatment of 203 out-of-hospital cardiac arrest patients (60 female and 143 male) using ZOLL AED Plus devices, which are capable of recording CC depth, shock timing, and CC timing. Mood’s median statistical test was used to compare the proportions of females vs. males receiving less than median CC depth during pre-shock and post-shock sets of CC, less than median CC start delay (time to CC after pad placement), and less than median pre-shock and post-shock CC interruption times. A total of 420 shocks (n=307 for male, n=103 for female) were included in the analysis.

Results:
68% females vs. 45% of males received less than the median pre-shock CC depth of 1.74 in (p=0.002). 58% females vs. 47% of males received less than the median post-shock CC depth of 1.77 in (p=0.07). For delay in starting CC after pad placement, 65% of females vs. 45% of males had below the median delay of 12.95 sec (p<0.0001) and for CC interruption time prior to a shock, 61% females vs. 46% of males had below the median interruption time of 22.87 sec (p=0.009).

Conclusions:
Prehospital healthcare providers are more likely to perform CC of lower depth when treating female compared with male patients, perhaps due to fear of injuring female patients. Although lower depth of CC could negatively impact resuscitation outcome for females, shorter delays in beginning CC and shorter pre-shock interruptions could alternatively improve outcome for female patients.