bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 238: Ability to Activate the Eicosanoid and Polyunsaturated Fatty Acid Pathways Predicts Survival After Cardiac Arrest
Authors: Peberdy Mary Ann , Wijesinghe Dayanjan S , Ornato Joseph P , Thacker Leroy R , Callaway Clifton W , Rittenberger Jon C , Donnino Michael W , Cocchi Michael N , Gaieski David F , Abella Benjamin S , Chalfant Charles E ,   for the National Post Arrest Rsch Consortium Investigators
Published: April 2024

Background:
Cardiac arrest (CA) and ROSC are associated with profound oxidative stress and systemic inflammation which is, in part, modulated by eicosanoid pathways. Docosahexaenoic acid (DHA) has anti-inflammatory properties, reduces cytokines, and is the precursor for D-resolvins and protectins which actively resolve inflammation. 5-Hydroxyeicosatetraenoic acid (5-HETE) is produced by the oxidation of arachadonic acid and is considered a “biomarker” of the inflammatory status of the body. It is linked to outcomes in trauma and sepsis.

Hypothesis:
DHA and 5-HETE levels after ROSC will be associated with outcome after CA

Methods:
Ninety-two pts from the 4 center Characterization of Mitochondrial Injury After Cardiac Arrest (COMICA) study had serial plasma samples analyzed for DHA and 5-HETE by mass spectroscopy at Time 0 (T0) upon arrival to the hospital, and 12, 24, 36, and 48 hours post ROSC. A repeated measures ANOVA was fit with a between subjects factor (Group: Survived, Expired), a within subjects factor (Time: 0, 12, 24, 38, 48) and the interaction between these two factors. Values are presented as mean ± SEM.

Results:
The figure shows the relationship between 5-HETE and DHA, respectively, vs. time in pts who survived and died. There was a significant Group x Time interaction for both DHA and 5HETE (p=0.0055 and p=0.0016). Post-Hoc tests revealed that the T0 5HETE level was significantly higher in those who survived vs. expired (p = 0.0003). There was a strong trend (p=0.058) for the T0 DHA level to be higher in survivors.

Conclusions:
Non-survivors have lower levels of 5-HETE and DHA than survivors immediately following hospital admission after ROSC from CA. Severe oxidative stress may deplete the lipid precursor pool. Survivors appear to have an intact polyunsaturated fatty acid system that is associated with recovery. Lipid biomarkers may serve as an early marker of outcome and potential area for therapeutic intervention after CA.
Abstract 244: Ethnic Differences among Middle Eastern Arabs and South Asians with In-Hospital Cardiac Arrest: A 20-Year Experience From a Middle-Eastern Country (1991-2010)
Authors: Salam Amar M , AlBinali Hajar , Singh Rajvir , Al-Qahtani Awad , Al Suwaidi Jassim
Published: April 2024

Objectives:
Most of the published research on in-hospital cardiac arrest (IHCA) is limited to studies in the developed world and included mainly Caucasian and African-American patients. The world literature on the clinical epidemiology of IHCA in other ethnic groups is very scarce. The aim of this study was to compare the clinical characteristics, risk profiles and outcome of Middle Eastern Arabs compared to South Asians patients with IHCA using a 20-year national cardiology registry in a Middle-Eastern Country.

Methods:
Retrospective analysis of all patients that developed IHCA in Qatar from 1991 through 2010 was made. Patients were compared according to ethnicity. Clinical characteristics, management and outcomes were analyzed.

Results:
During the 20-years period 41,436 patients were hospitalized to the cardiology service in Qatar from 1991 to end of 2010. Of these 22755 were Arabs and 13905 South Asians. The remaining patients were from many other ethnicities and were excluded for the purpose of this study. Of the 2 study groups 1529 patients developed IHCA during hospitalization; 1079 Arabs (4.7%) and 450 South Asians (3.2%), p = 0.001. Arabs with IHCA were 13 years older and had a higher body mass index compared to Asians. Arabs had significantly higher prevalence of hypertension, diabetes mellitus, chronic renal impairment and prior myocardial infarction while current smoking status and acute coronary syndromes were significantly more common in Asians. The in-hospital mortality rate was significantly higher in Arabs with IHCA compared to Asians (82.8% versus 78%; p=003) [table].

Conclusions:
Our study demonstrates that Arabs have a higher incidence of IHCA compared to South Asians and that this is associated with a lower in-hospital survival rates and a higher cardiovascular risk profiles in Arabs. The current study underscores the need to study IHCA among various ethnicities around the world.
Abstract 249: Neurocardiac Triage: A Classification Scheme to Guide Post Resuscitation Cardiac Arrest Care
Authors: Seder David B , Dziodzio John , Smith Kahsi , Hickey Paige , Bolduc Brittany , Stone Philip , McCrum Barbara , May Teresa , Fraser GIlles , Riker Richard R
Published: April 2024

Introduction:
We previously described use of the bispectral index (BIS), a processed EEG modality that integrates EEG power, reactivity, and suppression ratio, to assess severity of hypoxic-ischemic brain injury (HIE) very early after cardiac arrest. We now propose a neurocardiac triage model based on bispectral index and coronary risk, and describe patient outcomes accordingly.

Methods:
Patients from our prospective cardiac arrest database were retrospectively classified by four cardiac risk groups: STEMI, VT/VF with shock, VT/VF without shock, and PEA/asystole. Neurological injury was described by the “BISi”-the BIS score recorded immediately after the first dose of neuromuscular blockade, and classified as mild (BISi>20), moderate (BISi 10-20), or severe (BISi<10).

Results:
The BISi was determined at (270±186) minutes after resuscitation (ROSC). Thirty-three patients presented with STEMI; 9 of these had severe HIE - 6 later died of neurological and 1 of cardiac causes. Sixteen patients with STEMI had mild HIE: none died of neurological and 1 of cardiac cause. Fifteen patients presented with VT/VF and shock: 5 had severe HIE - 4 died of neurological and 1 of cardiac etiology. Nine patients with VT/VF and shock had mild HIE: none died of neurological and 4 of cardiac etiology. Of 41 patients with VT/VF and without shock, 16 had severe HIE: 10 died of neurological and 2 of cardiac etiology, 22 had mild brain injury - 2 each died of neurological and cardiac causes. Finally, 80 patients had PEA/asystole; 36 of these had severe HIE - 34 died of neurological and 2 of cardiac causes. Thirty-four patients with PEA/asystole had mild HIE - 8 died of neurological and 9 of cardiac causes. Thirty-eight patients in the total cohort underwent urgent cardiac catheterization (CC) - 8 (21.1%) subsequently died of neurological causes; 5 of those 8 were identified as severe HIE by BISi. Of 56 non-STEMI patients with VT/VF (with or without shock), 24 were identified as having mild HIE yet did not undergo urgent CC - 5 (20.8%) of those patients subsequently died of a cardiac cause.

Conclusion:
A neurocardiac triage model based on early processed EEG and cardiac risk class suggested possible utility in selecting appropriate patients for urgent coronary angiography and PCI after cardiac arrest.
Abstract 256: Cerebral Oximetry and End Tidal CO2 as Predictors of Futility During Cardiopulmonary Resuscitation
Authors: Thomas Craig , Engel Thomas , Reed Brian , Medado Patrick , Millis Scott , O’Neil Brian
Published: April 2024

Background:
There is currently no validated predictor of futility, defined as the inability to obtain ROSC, (IOR), and therefore no specific guidelines for cessation of resuscitation. Previous literature suggests that ETCO2 values of ?10 are predictive of IOR. Cerebral Oximetry (CerOx) uses near infrared light to non-invasively measure regional O2 saturation in the frontal lobes of the brain. CerOx has been shown in pilot studies to identify ROSC in 85% of arrests.

Objective:
The study’s objective was to compare ETCO2 and CerOx measurements during CPR to predict futility.

Methods:
We prospectively enrolled a convenience sample of subjects suffering from OHCA and ED cardiac arrest. Data was analyzed utilizing linear regression with Receiver Operating Characteristic (ROC) curves on the max and last readings of both ETCO2 and CerOx during CPR.

Results:
We analyzed 169 events with 48 (28%) obtaining ROSC. The average age was 64.5 ± 15.6. The average downtime was 24.6 ± 15.0 minutes, 113 (66.7%) of the events were witnessed, and 95 (56%) of the events had bystander CPR. The initial rhythms were asystole in 48%, PEA 35%, and V-Fib/V-Tach in 17% of cases.

ROC curve analysis was used to determine the best discriminating variable in predicting IOR. Area under the curve (AUC) for the last value [CerOx AUC=.856, ETCO2 AUC= .761] and max value [CerOx, AUC=.802, ETCO2 AUC=.630] obtained prior to death showed CerOx to be a better predictor or IOR than ETCO2. All subjects who failed to obtain a max ETCO2 value of 15 had IOR, while five subjects with a max CerOx of 15 had ROSC. Sensitivity/Specificity for select values in Table 1.

Conclusion:
The max and last CerOx value was overall a better predictor of futility than the max and last value of ETCO2. However at lower ranges ETCO2 proved to be more specific than CerOx.
Abstract 257: Plasma PBEF Correlates With Cardiac Arrest Outcome in Mice and Humans
Authors: Vanden Hoek Terry L , Li Jing , Ornato Joseph P , Donnino Michael W , Cocchi Michael N , Gaieski David F , Benjamin Abella , Callaway Clifton W , Rittenberger Jon C , Peberdy Mary A ,   for the National Post Arrest Rsch Consortium Investigators
Published: April 2024

Introduction:
Pre-B-cell colony enhancing factor (PBEF) is a 52 kDa cytokine that has recently been associated with cardiac dysfunction and insulin resistance in heart failure patients. Such cardiac dysfunction and insulin resistance are also seen after clinical cardiac arrest (CA) and are associated with later death and poor neurologic outcome. We hypothesized that elevated plasma PBEF could serve as a marker of tissue injury in both patients and mice after sudden cardiac arrest.

Methods:
Human plasma samples after CA resuscitation were collected at four centers of excellence in the care of CA patients (Virginia Commonwealth University, Beth Israel Deaconess Medical Center, University of Pennsylvania and University of Pittsburgh). All patients studied received standardized post-CA care that for most patients included therapeutic hypothermia (TH). Blood was collected within 90 min after return of spontaneous circulation (ROSC) and at 12, 24, and 48 h post-ROSC and plasma PBEF measured by ELISA. Mouse plasma samples taken after KCl-induced CA for 8 min in mice treated with TH versus normothermia after CPR, and in Akt1 partial knockout mice that fail to demonstrate TH protection.

Results:
CA patients who survived to hospital discharge (n=12) had serial PBEF concentrations that dropped by 40% within 12 h post-ROSC. In both human and mouse samples, the highest PBEF concentrations were seen within the first hour after ROSC. In human samples, plasma PBEF exceeded ~240 ng/ml, well above the PBEF concentrations associated with acute decompensation of heart failure and acute myocardial infarction. In CA patients who did not survive to hospital discharge (n=12), the fall-off of plasma PBEF was less than 20% from the initial level seen. After mouse CA, plasma PBEF at 30 min post-ROSC was significantly lower in TH mice compared to normothermic mice (p < 0.05). Conversely, it was higher in Akt1+/- mice (hypothermia non-responders), over 4-fold, compared to wild type responders (p < 0.05).

Conclusions:
Plasma PBEF is increased early after CA and may be associated with poor outcome. Further work is needed to test PBEF plasma clearance in cardiac arrest survivors versus non-survivors and understand the mechanism of PBEF release after CA.
Abstract 258: The Effectiveness of Therapeutic Hypothermia in Patients Suffering From Asphyxia Cardiac Arrest
Authors: Wee Jung Hee , Park Jeong Ho , Youn Chun Song , Park Kyu Nam , Choi Seung Pill , Investigators Korean Hypothermia Network
Published: April 2024

Introduction:
Therapeutic hypothermia (TH) is recommended for comatose survivors of cardiac arrest; however, the effectiveness of TH provided to asphyxial cardiac arrest has not been studied. So, we aimed to describe the characteristics and outcome among patients with out-of-cardiac-arrest caused by asphyxia, who were treated with TH.

Patients and methods:
We performed a multicenter retrospective registry-based study of adult OHCA patients treated with TH presenting to 24 hospitals across South Korea during the period from January 2007 to December 2012. Comatose survivors who were treated with TH after asphyxial cardiac arrest were included, but hanging and gas intoxication were excluded.

Results:
Of a total of 930 OHCA patients entered in the registry, 111 patients were enrolled in this study. The mean age was 65.8±16.3 years and old age (≥65) was 68 cases (61.3%). Most cases (85, 76.6%) were witness cardiac arrest, but few were provided bystander CPR (26, 23.4%). First monitored rhythms were almost non-shockable (80, 72.1%), and 23 (20.7%) had previous lung disease. TH were started within 121.9 (±152.4) min after ROSC, target temperature were achieved in 168 (±173.3) min, and maintained 23.6 (±10.6) hr. Intravascular cooling technique was performed in 34 cases (30.6%). 52 patients (46.8%) were survived and good neurologic outcome (CPC 1, 2) was 6 cases (5.4%). Witnessed status, age, previous lung disease, bystander CPR and any time factor were not correlated with survival and good neurologic outcome except ROSC time from detection in favorable outcome (p=0.005).

Conclusion:
The effectiveness of TH in axphyxial cardiac arrest was low, but quick achievement of ROSC would increase the favorable neurologic outcome proportion. proportion.
Abstract 266: The Impact of Chest Compression Release Velocity on Outcomes From Out-of-Hospital Cardiac Arrest
Authors: Cheskes Sheldon , Byers Adam , zhan cathy , Silver Annemarie , Morrison Laurie
Published: April 2024

BACKGROUND:
Previous studies have demonstrated significant relationships between CPR quality metrics and survival to hospital discharge from out-of hospital (OHCA) cardiac arrest. Recently a new metric, chest compression release velocity (CCRV) has been associated with improved survival from OHCA.

OBJECTIVE:
To determine the impact of CCRV on clinical outcomes from OHCA.

METHODS:
We performed a retrospective review of prospectively collected data on all treated adult OHCA occurring over a one year period (Jan 2012 - Jan 2013) in two Canadian EMS agencies. CPR metrics of chest compression fraction (CCF), compression rate, compression depth, shock pause duration and CCRV were abstracted from impedance channel measurements during each resuscitation. Cases of public access defibrillation, EMS witnessed arrest and those missing any Utstein variable or discharge status data were excluded. We performed a multivariable regression analysis to determine the impact of CCRV on survival to hospital discharge. Secondary outcome measures were the impact of CCRV on return of spontaneous circulation (ROSC) and neurologically intact survival (MRS ≤ 3).

RESULTS:
Among 908 treated OHCA, 611met inclusion criteria. The median (IQR) age was 71.7 (60.7, 81.6) with 395 (64.6%) being male. 140 (22.9%) presented in ventricular fibrillation, 122 (20%) pulseless electrical activity and 349 (57.1%) asystole. The median (IQR) CPR quality metrics were: CCF 0.81 (0.73, 0.85), compression rate 105/minute (101, 115), compression depth 49.9 mm (42.5, 56.7), pre-shock pause 13.5 secs (8, 19) and post-shock pause 3.5 secs (2.8, 5). The median (IQR) CCRV (mm/sec) amongst 49 survivors was 135.9 (115.4, 156.5) compared to 120 (102.9, 140) in 562 non survivors (p=0.009). When adjusted for CPR metrics and Utstein variables, the odds of survival to hospital discharge for each 5 mm/sec increase in CCRV was 1.02 (95% CI: 0.97, 1.08). Similarly the odds of ROSC and neurologically intact survival were 1.02 (95% CI: 0.99, 1.05) and 1.03 (95% CI: 0.98, 1.08), respectively.

CONCLUSIONS:
When adjusted for Utstein variables and CPR quality metrics, CCRV was not significantly associated with outcomes from OHCA. Our findings may have been impacted by the sample size of our study.
Abstract 272: Association Between Pre-hospital Intubation, Epinephrine And Neurological Outcome Following Out-of-hospital Cardiac Arrest In Japan: Sos-kanto 2012 Study Interim Report
Authors: Homma Yosuke , Shiga Takashi , Funakoshi Hiraku , Miyazaki Dai , Tahara Yoshio , Nagao Ken , Yaguchi Arino , Morimura Naoto ,   SOS-KANTO 2012 study group
Published: April 2024

Background:
Emergency medical technicians (EMT) typically perform endotracheal intubation (ETI) and administer epinephrine for out-of-hospital cardiac arrest (OHCA) patients. However, the clinical effectiveness of these procedures is still controversial, especially in regards to neurological outcomes in patients subsequently receiving intensive care after hospitalization.

Study Objectives:
The aim of this study was to evaluate the effectiveness of ETI and epinephrine administration in the pre-hospital setting on neurological outcomes following OHCA.

Methods:
This was a multicenter retrospective cohort study in Japan from January 2012 to February 2013. We used data from the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2012 (SOS-KANTO 2012) database. Collected variables included age, gender, witnessed status, bystander CPR, first documented rhythm, hospital arrival time, and type of ICU care received after admission. To address selection bias, those who had early return of spontaneous circulation (ROSC) without ETI and epinephrine were excluded. Multivariate logistic regression was performed to investigate the association between EMT interventions and 1) hospitalization with ROSC, 2) 7-day survival, and 3) favorable neurological outcome, defined as 1-month cerebral performance category score of 1 or 2.

Results:
Of 6,019 OHCAs, 5,111 met the inclusion criteria (male, 57%; mean age, 71 years). 932 patients (18%) underwent ETI and 251 patients (4.9%) received epinephrine. 1,062 patients (20.8%) were hospitalized after ROSC. Multivariate logistic regression showed that OHCA patients who received pre-hospital epinephrine had a higher rate of hospital admission after ROSC (odds ratio [OR]=1.63, 95% confidence interval [CI] 1.35-1.97, P<0.001). However, they demonstrated poorer neurological outcomes (OR=0.31, 95%CI 0.12-0.82, P=0.02). OHCA patients undergoing pre-hospital ETI did not demonstrate significantly different outcomes.

Conclusion:
These findings suggest that pre-hospital procedures may not be necessary for increasing favorable neurological outcomes.
Abstract 276: Prehospital Advanced Airway Management Without Intravenous Access May Negatively Affect Favorable Neurological Outcome in Children With Out-of-Hospital Cardiac Arrest
Authors: Inoue Nobuaki , Shimizu Naoki , Ohta Kunio , Nitta Masahiko , Yonemoto Naohiro , Nonogi Hiroshi , Nagao Ken , Kimura Takeshi ,   Japan Pediatric Resuscitation Study (PResS) group,   JCS-ResS group
Published: April 2024

Background:
Although advanced airway management and intravenous (IV) access for patients with out-of-hospital cardiac arrest (OHCA) are thought to be lifesaving procedures at prehospital settings, recent data suggested that these procedures might lead to poorer neurological outcome for adult population. This association needs to be studied further for pediatric population as well.

Methods:
Data were collected through a Japanese nationwide, population-based registration form for OHCA from 2005 to 2011 involving 13,159 consecutive children aged less than 18 years old. Data regarding OHCA patients such as age, etiology, bystander CPR, and others were collected. Main outcome measure was favorable neurological outcome at one month from OHCA event, which was defined as cerebral performance category 1 or 2. OHCA patients who did not receive any resuscitative intervention by prehospital personnel were excluded from the analysis.

Results:
12,510 OHCA pediatric patients were eligible to the analysis. Among these, 465 (3.7%) patients had both IV access and advanced airway (IV+/AA+), 328 (2.6%) patients had only IV access (IV+/AA-), 1,685 (13.5%) patients had only advanced airway (IV-/AA+), and 10,032 (80.2%) patients had neither of them (IV-/AA-). Devices of advanced airway management were esophageal obturator airway (60%), laryngeal mask (30%), and endotracheal tube (10%). Favorable neurological outcome at one month from OHCA event for IV-/AA- group (4.2% [412/10,032]) was compared with other groups. IV-/AA+ group had the worst outcome (1.9% [32/1685]; OR 0.45, 95% CI; 0.31 - 0.64) followed by IV+/AA+ group (3.4% [16/465]; OR 0.82, 95%CI; 0.49 - 1.37) and IV+/AA- group (3.7% [12/328]; OR 0.88, 95% CI; 0.49 - 1.57). Baseline characteristics for these groups were not significantly different except for age distribution as IV-/AA- group were younger than others. There was no statistical difference in neurological outcome between IV-/AA+ group and IV+/AA+ group.

Conclusion:
Advanced airway management without IV access seems to negatively affect pediatric OHCA patients. Obtaining IV access and further intervention by prehosital personnel may compensate this effect.
Abstract 294: Community-Based, Targeted CPR Education to Improve Survival From Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods
Authors: Sasson Comilla , Tran May , Carmona Merida , Tran Tuan , Nassel Ariann , Califf Thomas
Published: April 2024

Background:
High-risk neighborhoods, defined as having a low prevalence of bystander CPR and high incidence of out-of-hospital cardiac arrest (OHCA), may be targets for community-based interventions. The HANDDS Program(identifying
H
igh
A
rrest
N
eighborhoods to
D
ecrease
D
isparities in
S
urvival) is a novel intervention to target these neighborhoods to increase CPR awareness.

Objective:
Conduct a community-based clinical trial in Denver’s high-risk neighborhoods.

Methods Population:
Convenience sample of 344 participants recruited from target neighborhoods during 12-week study period.
Intervention:
Participants completed a pre-test survey to assess baseline knowledge of CPR. A group hands-only CPR training lasting 1 hour was conducted with the CPR Anytime kit, which includes an educational DVD and hands-on practical skills training. Participants then completed a survey to assess their post-training knowledge and were asked to use the kits to train others. A $10 incentive was given to participants. Two-sample
t
-tests were conducted to assess for differences in CPR knowledge pre- and post training.

Results:
Participants were Asian (50.0%), Black (35.6%), female (68.0%), had completed high school (26.8%), and had an annual income of less than $30,000 (37.1%). After the CPR intervention, the mean number of questions answered correctly on CPR knowledge increased (
Table 1):
Majority of participants (84.6%) felt comfortable performing hands-only CPR after the intervention. Information was returned by 154 (44.8%) participants, with an additional 836 friends and family trained.

Conclusion:
A total of 1180 people were trained in hands-only CPR (average 3.43 people/kit). At $35 per CPR Anytime kit, this comes to a cost $10.20 for each person trained. Participants demonstrated increased knowledge of CPR and enthusiasm to train others. The HANDDS Program is a feasible method for increasing bystander CPR training in high-risk neighborhoods.
Abstract 300: Implementation of the Combination of CAB Algorithm and CC-Only CPR Does Not Worsen the Outcomes of Paediatric Out-of-Hospital Cardiac Arrests: Nation Wide Population Based Study
Authors: Shimizu Naoki , Ohta Kunio , Nitta Masahiko , Inoue Nobuaki , Yonemoto Naohiro , Nonogi Hiroshi , Nagao Ken , Kimura Takeshi ,   Japanese Paediatric Resuscitation Study (PResS) group,   Japanese Circulation Society with ResuscitationScience Study (JCS-ReSS) group
Published: April 2024

Backgrounds:
Although cardiac arrest with respiratory origin is dominant in children, CAB algorithm was implemented in guidelines 2010 on top of chest compression only cardiopulmonary resuscitation (CC-only CPR) to let citizen BLS be simple. There is no evaluation done on paediatric outcomes after these changes.

Methods:
In a nationwide out-of-hospital cardiac arrest registration from 2005 to 2011, we enrolled 13,159 children aged less than 18 years old. Data collected including the date of the event, age of victim, type of CPR, time from collapse to initiate CPR, and several outcomes (return of spontaneous circulation; ROSC, one-month survival, neurological outcome). Favorable outcome was defined as cerebral performance category 1 or 2. Data was analyzed in chronological fashion in each year.

Results:
Resuscitation was attempted on 12,594 children during this period. In each year, total cases were 1,799 per year in average (range of 1,619-2,074), ROSC was achieved in 114 cases (6.3[5.8-7.7]%), one-month survival in 72 (4.0[3.2-5.2]%), and good neurological outcome in 46 (2.6[2.0-3.1]%). In witnessed victims, total cases were 465 per year in average (range of 412-531), ROSC was achieved in 59 (13[11-15]%), one-month survival in 41 (8.8[6.5-12]%), and good neurological outcome in 30 (6.4[4.4-7.9]%). Bystander CPR was done in 234 (50%) cases per year and no trend of chronological change, however, CC-only CPR tend to be done more recently (27% in 2005 vs. 62% in 2011). With these backgrounds, there was no significant improvement of time from collapse to start CPR, but no deterioration of outcomes either, so far. Analysis after excluding infants showed same trends, and one month survival has a tendency to get better (p=0.08).

Conclusions:
The combination of CAB algorithm and CC-only CPR did not worsen the outcomes of paediatric out-of-hospital cardiac arrest based on the nation wide population based study. Enhancement of bystander CPR and further encouragement of shortening the time to initiate CPR is warranted.
Abstract 302: Chest Compressions Should Be Performed on Arresting Patients with Left Ventricular Assist Devices (LVAD)
Authors: Shinar Zachary , Stahovich Marcia , Cheskes Sheldon , Bellezzo Joseph , Dembitsky Walter
Published: April 2024

Introduction:
Patients with implanted Left ventricular assist devices (LVAD) are being assessed by an increasing number of health care providers. Despite a lack of evidence, many emergency medical systems and hospitals have discouraged providers from performing chest compressions in these patients when they present in cardiac arrest. This deviation from conventional resuscitation algorithms is secondary to concern that chest compressions could dislodge the LVAD.

Objective:
To determine the rate of cannula dislodgment for patients presenting in cardiac arrest with known implanted LVAD devices receiving standard chest compression cardiopulmonary resuscitation.

Methods:
We retrospectively analyzed the outcomes of all patients who received chest compressions for cardiac arrest over a 4 year period in a large urban hospital. Eight cases were reviewed for both cannula integrity and outcomes.

Results:
Using autopsy and adequate flow through device as proxy for intact inflow/outflow cannulas, none of the eight patients receiving chest compressions had cannula dislodgment. Four of the 8 patients had return of neurologic function. Two additional patients had return of effective circulation without return of neurologic function. One patient had documented flow on the device without return of native heart function. The final patient did not have documented flow during resuscitation but autopsy showed no dislodgment.

Conclusions:
In this small retrospective study, standard chest compressions in patients with LVADs appear to be safe, without evidence of cannula dislodgment. Standard chest compressions for LVAD patients in circulatory arrest should be performed.
Abstract 308: There is a Correlation Between Neurologic Score and Discharge Location for Patients With Out-of-Hospital Cardiac Arrest of Presumed Cardiac Origin
Authors: Wik Lars , Olsen Jan-Aage , Persse David , Sterz Fritz , Lozano Michael , Brouwer Marc A , Westfall Mark , Souders Chris M , Malzer Reinhard , van Grunsven Pierre M , Travis David T , Herken Ulrich R , Brunborg Cathrine , Lerner E Brooke
Published: April 2024

Background:
The Circulation Improving Resuscitation Care (CIRC) Trial found equivalent survival in out-of-hospital cardiac arrest (OHCA) patients who received integrated AutoPulse CPR (iA-CPR) compared to high quality Manual CPR (M-CPR), and no difference in neurologic outcome. However, neurologic outcome was not available for some patients, and discharge location may serve as a proxy for neurologic outcome. The objective of this study was to determine if there is a correlation between modified Rankin Scale (mRS) Score at discharge and discharge location, and to determine the association between discharge location and study intervention.

Methods:
A subgroup-analysis of the CIRC randomized clinical trial comparing iA-CPR to M-CPR was conducted on patients who were discharged from hospital. Neurologic outcome was categorized as good (mRS ≤3), not good (mRS ≥4), or unknown, and according to discharge location of home or rehabilitation, nursing home or assisted living, and unknown or awaiting care, respectively. Spearman correlation was used to determine the relationship between mRS score and discharge location. Logistic Regression was used to compare iA-CPR to M-CPR in predicting neurologic outcome using discharge location and adjusting for the study covariates (study site, patient age, witnessed arrest, and initial rhythm).

Results:
CIRC enrolled 4,231 patients and 429 (10%) survived to hospital discharge. mRS score was known for 310 of those patients and discharge location for 300 patients, both were known for 292. A Spearman correlation analysis between mRS score and discharge location was statistically significant (r=0.622, p<0.001). iA-CPR was documented to increase survival to hospital discharge with good neurologic outcome (using discharge location as a surrogate) compared to M-CPR (unadjusted OR 2.25, 95% CI 1.21-4.17, p=0.009). When adjusted for covariates there was a trend in favor of iA-CPR (OR 1.82, 95% CI 0.91-3.63, p=0.09).

Conclusion:
There was a correlation between mRS score and discharge location. More patients were discharged to a location with limited assistance and consequently potential better neurologic outcome in the iA-CPR group compared to the high quality M-CPR group.
Abstract 312: Hospital Personnel Interactions With Wearable Cardioverter Defibrillators During Sudden Cardiac Arrest: A Case Series Review
Authors: Wan Chingping , Szymkiewicz Steven J
Published: April 2024

Purpose:
The wearable cardioverter defibrillator (WCD) automatically detects and treats lethal ventricular tachyarrhythmias (VT/VF). However, intervention during an event by medical personnel to resuscitate a patient may delay or even prevent WCD treatment during sudden cardiac arrest (SCA). This study assessed hospital staff and WCD interactions, and the impact on in-hospital SCA outcomes.

Methods:
All shockable SCA events experienced by patients wearing a WCD between 11/2003 and 4/2013 were identified and retrospectively retrieved from the manufacturer’s post-market database. A shockable SCA event was defined as all sustained VT/VF during a single 24-hour period. Only events that occurred during hospitalization or emergency room visit were reviewed in this study. Interactions with medical personnel included 1) belt disconnection or garment removal prior to WCD therapy or 2) use of response buttons (RBs) by someone other than the patient. Device recordings and customer call reports were reviewed for event details and 24 hour survival (acute survival).

Results:
A total of 209 in-hospital SCA events were included. Overall, 51 (24.4%) were on telemetry and 76 (36.4%) were witnessed. Acute survival was 82.8%. The WCD delivered at least 1 shock in 181 (86.6%) events with a median arrhythmia onset-to-shock (OS) time of 47 seconds (mean=90.4±307.48 seconds). When hospital staff used RBs (n=15, 7.2%), the OS time was longer (median=62.5 seconds, p<0.01). Three (1.7%) conscious patients were advised not to use RBs during sustained VT. No WCD therapy occurred in 28 (13.4%) events due to belt disconnection in 18 (64.3%), VT/VF rate below the pre-programed threshold in 8 (28.6%), RBs use by hospital staff in 6 (21.4%), resuscitation efforts creating ECG interference in 5 (17.9%), and device damage in 2 (7.1%). Only 4 (14.3%) patients survived acutely when WCD therapy was prevented, although 13 received defibrillation from hospital defibrillators.

Conclusions:
WCD therapy during in-hospital SCA resulted in a high acute survival rate. Interventions during an event by medical personnel to resuscitate a patient reduced the number of WCD therapies delivered and may have affected acute survival.
Abstract 321: Goal Directed Resuscitation in Post Cardiac Arrest Patient and Differences in Outcomes
Authors: Vaghasia Nishit , Coppler Patrick , Kadir Sajid , Janiczek Jonathan , Sheth Monish , Joshi Kunal , Patel Vishal , Jogu Hanumantha , Michael Pinsky , Cameron Dezfulian
Published: April 2024

Background:
There is no consensus about the optimal strategy of hemodynamic support after cardiac arrest (CA) though some preclinical work supports higher perfusion pressures. We hypothesized that goal directed resuscitation after ROSC aimed at improving cardiac index (CI) ≥2 lpm/m
2
and achieving mean arterial pressures (MAP) ≥80 mm Hg could improve lactate clearance and potentially clinical outcomes.

Methods:
We began a quality improvement initiative within all ICUs of a single hospital by designing and educating staff about a hemodynamic resuscitation protocol. Patients on protocol had cardiac index (CI) and stroke volume variability (SVV) calculated using pulse pressure analysis of their arterial waveform (Vigeleo, Edwards Scientific). Patients received volume boluses (SVV≥13%) or inotropes (SVV<13%; CI<2) or vasopressors (SVV<13%; MAP<80) to achieve goals. Lactate levels were checked q2 hour for initial 6h then q6 h for the next 24h. Fluid intake and output were recorded hourly. These were ICU standards. 18 patients managed on the protocol were propensity matched with 18 historical controls from the last year on the basis of initial lactate, MAP, cumulative vasopressor index (CVI) and Pittsburgh Cardiac Arrest Category (PCAC). 6h lactate clearance, mean MAP and CVI, fluid balance and inotrope use were measured as well as survival to hospital discharge. Comparisons were by Mann Whitney U test.

Results:
Protocol patients were well matched with controls (
Table 1):
Protocol patients showed trends towards better lactate clearance and higher MAP, attributable to higher fluid delivery and lower vasopressor and inotrope use. Survival between groups was unchanged (27.8% protocol Vs 22.2% control).

Conclusion:
Goal directed resuscitation to optimize CI and MAP resulted in more fluid administration achieving higher blood pressures with less inotrope and pressor use. Greater power is needed to conclude clinical benefit but the strategy is promising.
Abstract 330: Intralipid Rescues Delayed Cooling and Restores Contractions in Ischemia-Stunned Heart Cells
Authors: Li Jing , Chen Sy-Jou , Shao Zuohui , Zhu Xiangdong , Li Changqing , Wang Huashan , Harty Shaun , Fettiplace Michael , Weinberg Guy , Vanden Hoek Terry L
Published: April 2024

Introduction:
Cooling is a promising treatment for cardiac arrest. However, delayed cooling (DC) can result in loss of protection against ischemia/reperfusion (I/R) injury. We sought to develop drugs that mimic or augment cooling protection. Intralipid (ILP), a soy-based fat emulsion that is widely used in different clinical setting for parenteral nutrition, has been recently introduced as an antidote against local anesthetic-induced cardiotoxicity. In this study, we utilized a stunned mouse cardiomyocyte model to study the effect of ILP on improving contractile function and its potential role in rescuing abnormal contractility.

Methods:
Cardiomyocytes, isolated from 1-2-day old C57Bl6/J mice were used. Protocols: 1) Stunning: cells were exposed to 30 min simulated ischemia and 90 min reperfusion followed by 10 min isoproterenol (10 μM). 2) ILP treatment: ILP (0.25%) was administered during 90 min reperfusion. 3) Delayed ILP treatment: ILP was given at 20 min of reperfusion. 4) DC: cooling (32оC) was initiated at 20 min of reperfusion and lasted for 40 min, followed by 30 min re-warming. 5) DC + ILP: ILP was given at start of reperfusion for 90 min in DC. The contraction velocity was measured using Matlab software. Akt phosphorylation was analyzed by Western blot.

Results:
ILP administration at the onset of reperfusion significantly increased the contraction velocity in stunned cells (66.0 +/- 3.9 % vs. 40.6 +/- 1.7%, P < 0.001) and enhanced the cell response to isoproterenol. The contractile function was not recovered when ILP administration was delayed. Intra-ischemic cooling (IC) improved contractile function that was abolished by DC. Co-treatment of ILP and DC significantly enhanced contractility (43.3 +/- 3.0 % vs. 20.1 +/- 3.9 %, P < 0.01). Akt phosphorylation (p-Akt) was increased by ILP, but decreased when ILP was delayed. Similarly, DC attenuated p-Akt which was increased by ILP+DC. This ILP-induced p-Akt was blocked by API-2, an Akt inhibitor.

Conclusion:
Our results suggest that optimal ILP treatment improved contractile function and contractile preservation that was mediated by Akt in stunned mouse cardiomyocytes. ILP may serve as a therapeutic agent or adjunct agent to delayed cooling in patients after cardiac arrest.
Abstract 337: Impact of High Glucose Level at Admission on Thirty Days Clinical Outcomes for the Out-of-Hospital Cardiac Arrest Patients With Acute Coronary Event Undergoing Coronary Intervention With Hypothermia Therapy
Authors: Shimotakahara Junichi , Shirai Shinichi , Nagao Ken , Nonogi Hiroshi , Yokoyama Hiroyuki , Yonemoto Naohiro ,   J-Pulse Hypo Investigator
Published: April 2024

Background:
The aim of this study was to evaluate the effect of hyperglycemia at admission on the 30-days clinical outcomes of the patients (pts) with cardiac arrest due to acute coronary event (ACE) undergoing PCI with mild therapeutic hypothermia (MHT).

Methods:
Data over a five-year period (2005-2009) were obtained for 452 patients treated with MHT from a multicenter registry in Japan. Of these patients, all of 185 pts were diagnosed with ACE by emergency angiography immediately after recovery of spontaneous circulation (ROSC), and were subsequently treated with MHT and PCI. These patients were divided into groups based on the blood glucose (BS) at admission by receiver operating characteristics; Group A: BS at admission >=306mg/dl and Group B: BS at admission <306mg/dl. Cerebral performance category (CPC) with levels 1 (Normal mental performance), 2 (moderate disability), 3 (severe disability), 4 (vegetative state), 5 (death) was used at 30days. Poor neurologic outcome was defined in CPC 3, 4 and 5.

Results:
Patient demographics of Group A (n=67) were younger (mean age 57 vs. 63, p<0.0001), longer time from arrest to ROSC (35min. vs. 24 min., p=0.0004). The proportions of shockable rhythm and the time to achieve target temperature were not different. The rates of STEMI was more seen in Group A (76.1%) compared with Group B (63.6%); however, there was no significant differences (p=0.0781). There was no significantly different in mortality rate (25.4% vs. 17.8%, p=0.2202) between the two groups, however, neurologic outcome was significantly better in group B compared with group A (35.8% vs. 65.3%, p=0.0001). Logistic regression analysis revealed that the predictors of poor neurologic outcome were unshockable rhythm (Odds ratio [OR]: 3.82, p=0.0026), age over 70 (OR: 9.3, p<0.0001), time from collapse to ROSC (OR 1.04, p<0.0001), and BS at admission over 306mg/dl (OR: 3.8, p=0.0005).

Conclusions:
High glucose level at admission did not affect the mortality; however, had an impact on neurologic outcome for the patients with ROSC after cardiac arrest due to ACS undergoing PCI with MHT.
Abstract 342: Comparison of Fractional Flow Reserve (FFR) and Cardiac Stress Testing in Prediction of Coronary Ischemia
Authors: Shahrivari Mahan , Kumar Preetham , Kurklinsky Andrew K , Levy Michael S , Shapiro Brian P , Moussa Issam D
Published: April 2024

Introduction:
Clinical outcomes of FFR-guided PCI have been superior to those of angiographically guided PCI, with or without prior cardiac stress testing. Based on these findings, we hypothesized that the accuracy of stress testing is inferior to that of FFR in determining the physiologic significance of angiographic coronary artery disease.

Method:
To that end, we studied 243 consecutive patients who underwent coronary angiography and FFR assessment between September 2010 and April 2013 at Mayo Clinic, Florida. Out of this group, we excluded 143 patients due to absence of stress testing in the preceding 6 months. We assessed demographics, coronary risk factors, symptoms, stress test variables, angiographic data, and FFR measurements. FFR values ≤0.80 were considered to be positive for ischemia. We evaluated the diagnostic performance of stress testing vs. FFR.

Result:
Out of the 100 patients included in the study, FFR was measured in the Left Main coronary artery in 3(3%), in the Left Anterior Descending artery (LAD) in 67(67%), in the left circumflex territory in 11(11%), in the Right Coronary Artery (RCA) in 18(18%). The diagnostic performance of stress testing vs. FFR is summarized in the table, with regards to presence of ischemia in any vascular territory and with regards to a specific vascular territory.

Conclusion:
Compared to FFR, cardiac stress testing has reasonable NPV but poor PPV in determining the presence of absence of overall ischemia in a given patient. Most concerning, however, is that stress testing has poor PPV and NPV when used to determine the site of ischemia in a specific vascular territory.
Abstract 349: Effects of Continuous Plasma Diafiltration Therapy in Septic Shock With Acute Liver Failure
Authors: Taniguchi Takumi , Okajima Masaki
Published: April 2024

Background:
Plasma diafiltration (PDF) is blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows outside the hollow fibers. Several studies demonstrated that PDF therapy is one of the most useful blood purification therapies for use in cases of acute liver failure or severe sepsis. However, PDF therapy is very difficult to undergo in septic shock patients with acute liver failure because of unstable hemodynamics. Moreover, it is likely to deteriorate in acute liver failure immediately after PDF therapy. We have experienced that

continuous PDF (CPDF)

therapy can undergo in unstable patients with acute liver failure. Therefore, we evaluated the effects of

CPDF

therapy in septic shock patients with acute liver failure.

Hypothesis:
We hypothesis that

CPDF

therapy has beneficial effects for septic shock patients with acute liver failure.

Methods:
Nine patients (M/F 7/2, mean age 55 years) with septic shock, who combined acute liver failure, renal failure and respiratory failure, underwent

CPDF

therapy. The

CPDF

therapy was undergone for 7 days. Primary outcomes were changes in hemodynamics and inflammatory responses after

CPDF

therapy, and secondary outcomes were changes in liver functions and SOFA scores at 7 days after therapy and survival rate at 14days after therapy.

Results:
In primary outcomes, hemodynamics in all patients improved at one day after

CPDF

therapy. WBC counts improved (22,634 to 9,893; p<0.05), C-reactive protein levels decreased (11.0 to 2.0 mg/dL; p<0.05), and procalcitonin levels decreased (31.6 to 2.9 ng/mL; p<0.05) at 7days after

CPDF

therapy.

In secondary outcomes, total bilirubin decreased (8.3 to 3.4 mg/dL; p<0.05) and PT-INR did not decreased (1.22 to 1.19) at 7 days after

CPDF

therapy. SOFA scores decreased (13.0 to 8.0; p<0.05) at 7 days after

CPDF

therapy.

All patients recovered and discharged in ICU.

Conclusion:
In the present study,

CPDF

therapy significant improved hemodynamics, inflammatory responses and severity in septic shock patients with acute liver failure.
Abstract 356: Resuscitation With Different Infusion Solutions does not Influence Binding of Dabigatran to its Specific Antidote in a Pig Model of Hemorrhagic Shock
Authors: Grottke Oliver , van Ryn Joanne , Zentai Christian , ten Cate Hugo , Rossaint Rolf , Spronk Henri
Published: April 2024

Introduction:
A specific antibody fragment (Fab) is currently in development to reverse the effects of dabigatran in cases of life-threatening bleeding or emergency surgery. In trauma, different volume expanders are used for resuscitation to compensate for blood loss and hemorrhagic shock, but it is unknown if these volume expanders can influence binding of dabigatran to the Fab. In this study we investigated whether frequently used infusion solutions affect binding of dabigatran to its antidote.

Methods:
After ethical approval, pigs were treated for 3 days with dabigatran etexilate (DE, 30 mg/kg bid). Prior to hemorrhagic shock a 90 min infusion of dabigatran (30 min; 0.77mg/kg/h; 60 min: 0.26 mg/kg/min) was performed in anesthetized pigs. Then ~50% (100 mL/min) of total blood volume was removed. Animals were randomized to (n=5/group): balanced Ringer’s solution, 6% HES 130/0.4, 6% HES 200/0.5, 4% gelatin, transfusion of washed red blood cells (RBC) or control (no hemodilution). Resuscitation consisted of 1:1 to blood loss for crystalloids, 25 mL/kg for colloids, and 12 mL/kg for RBC. Antidote was then given (30 mg/kg iv) and serial blood samples were taken for up to 24 hrs to measure active dabigatran as diluted thrombin time (dTT) and total dabigatran (bound to antidote and free drug) by LC-MS/MS. Antidote concentrations were measured by ELISA and the half-life calculated in each group. Data expressed as mean ± SE and analyzed with ANOVA.

Results:
Hemodilution caused a substantial reduction of hematological parameters (hemoglobin, platelets etc) with all agents, except after RBC transfusion and control. Mean plasma dabigatran levels were 640 ± 60 ng/mL after infusion and 625 ± 123 ng/mL after the ~50% hemodilution without significant differences between groups. Administration of 30 mg/kg iv Fab resulted in a comparable reduction of active dabigatran in all groups. In addition the amount of total dabigatran (bound to antidote and free drug) was not significantly different across groups. Half-life of Fab was 3.2 ± 0.1 hrs in control animals and was not significantly different in animals with hemodilution.

Conclusions:
Clinically used infusion solutions for volume resuscitation do not interfere with binding of dabigatran to its specific antidote.