bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147922: Quality of Life Patient Reported Outcomes for Survival Prediction after Cardiac Resynchronization Therapy
Authors: Demian Joe , Paul Aritra , Varma Niraj , Finet J. Emanuel , Kochar Arshneel , Bader Feras , Wazni Oussama , Tang Wilson , Rickard John
Published: November 2024

Background:
Patient-reported outcomes, such as quality of life (QoL) scores, provide a comprehensive measure of health status from the patient's perspective, which may be relevant for predicting survival after cardiac resynchronization therapy (CRT).

Hypothesis:
We hypothesize that a healthier QoL score at 6 months post-CRT is associated with better long-term survival.

Aim:
To evaluate the association between a validated QoL at 6 months post-CRT and two-year survival in CRT patients.

Methods:
A prospective cohort study recruited 524 patients who received CRT at the Cleveland Clinic between May 2016 and June 2022. The 5-level EuroQol-5 Dimension (EQ-5D-5L) was used to assess QoL at 6 months post-CRT (higher scores indicating worse QoL) and patients were divided into two strata (EQ-5D-5L ≤ or > 10). Our primary endpoint was Event-Free Survival (EFS) – defined by the absence of both significant cardiac interventions (LVAD implantation or heart transplant) and mortality.

Results:
The population had a median (IQR) age of 71 years (IQR: 62-78), with 343 (65.5%) men and 419 (80%) received a defibrillator. Median EQ-5D-5L was 7 (IQR: 5-9). The response rate at 6 months post-CRT was 321 (68.2%), and the 2-year EFS rate was 397 (75.8%). Univariate analysis re revealed that EQ-5D-5L>10 was significantly associated with increased EFS. The Cox proportional hazard model showed it to be an independent predictor of EFS (HR: 2.33, 95% CI [1.53-3.56], p<0.001), after adjusting for potential confounders, including age, gender, diabetes mellitus, ischemic cardiomyopathy, AFib/flutter, history of TIA/CVA, NYHA Class, and COPD. The Kaplan-Meier survival curves demonstrated a significantly lower EFS probability for patients with EQ-5D-5L>10 (log-rank test: p<0.001).

Conclusions:
QoL assessed at 6 months post-CRT is a significant predictor of two-year survival in CRT patients. The EQ-5D-5L score can be a valuable tool to enhance patient risk stratification and management.
Abstract 4147923: Role of Adipocyte Circadian Rhythm in the Exacerbation of Diabetic Ischemic Heart injury
Authors: Tan Huilan , Wu Yalin , Zhao Jianli , Shila Taslima Akter , liu yanwen , Zhang John , Wyatt Kayleigh , Mahmoud Amr , Ma Xinliang-Xin , Young Martin E , Wang Yajing
Published: November 2024

Diabetes worsens myocardial infarction (MI) pathologic progress, termed diabetic exacerbation of ischemic heart failure (IHF), with mechanisms and effective therapies remaining poorly understood. Circadian rhythm (CR) disruption is associated with heart failure, but its impact on diabetic IHF has not been studied. Adipocytes involve in maintaining physiological homeostasis and exhibit diurnal oscillations. However, the effects of circadian rhythm disruption on adipocyte dysfunction and diabetic IHF are unclear.

Adult C57BL6J mice and adipose tissue-specific BMAL1 (master circadian gene) knockout (ABK) adult C57BL6J mice were used as a diabetes model with a high-fat diet (HFD) fed for 12 weeks, and a normal diet (ND) as control. Myocardial ischemia-reperfusion (MI/R) injury was induced at Zeitgeber Time 12 (ZT12) in diabetic and ABK animals. Cardiac function assay revealed that, following MI/R, diabetic mice at ZT12 showed a significant worsening of cardiac ejection fraction (EF) (-5.2±2.2%), fractional shortening (FS), left ventricular radial strain (-4.5%±1.83), longitudinal strain, and radial (-1.31 ±0.54 1/s) and longitudinal strain rates. Mechanistically, the role of adipose circadian oscillation was investigated in ABK animals. Loss of BMAL1 in adipose tissue resulted in an increased cardiac injury, and further reduction of cardiac function in diabetic ABK animals on ZT12. Moreover, myocardial infarction was observed to be enlarged at ZT12 in the diabetic MI/R group compared to the ABK post-MI/R group, as indicated by TTC/Evans blue stain. This finding was further supported by TUNEL staining assays (cardiomyocyte apoptosis). Western blot analysis revealed an upregulation of apoptosis-related proteins, including cleaved caspase-3 and cleaved caspase-9, in the diabetic MI/R group at ZT12. Meanwhile, BMAL1 insufficiency (ABK) led to an increase in cleaved caspase-3 and cleaved caspase-9, with further augmentation observed in diabetic ABK animals post MI/R. Additionally, the amount of EVs was significantly increased at ZT12 in diabetic mice, whereas this phenomenon was not observed in ABK animals.

Our study suggests that disrupted circadian rhythms in adipose tissue promoted heart dysfunction and diabetic exacerbation of ischemic heart failure (IHF). Moreover, we propose that BMAL1 may alter adipose tissue EVs profiles to communicate with cardiomyocytes, with potential implications for improving therapeutic approaches for diabetes-related cardiomyopathy.
Abstract 4147960: Intensive treatment compared to Standard for hypertension in elderly patients, is it safe and effective? A Systematic Review and Meta-Analysis
Authors: da Rocha Guilherme , Pelozzi dos Santos Vinicius , Lima Junior Emilton
Published: November 2024

Introduction:
Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care.

Methods:
The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%.

Results:
The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p <0.001), cardiovascular outcomes (RR = 0.72, 95% CI 0.63 – 0.82, p<0.001), and stroke (RR = 0.71, 95% CI 0.57 – 0.89, p =0.004) and proved to be safe. The heterogeneity was moderate for the first two outcomes (I2 =51%, p = 0.10 and I2= 43%, p = 0.15) and low for stroke (I2 = 0%, p = 0.70). For severe safety outcomes (RR = 0.90, 95 % CI 0.71 – 1.15, p = 0.40) and general safety outcomes (RR = 1.05, 95% CI 1.00 – 1.11, p = 0.05) there was no difference with low heterogeneity (I2 = 0%, p = 0.40 and I2 = 0%, p = 0.44). In the sub-analysis of patients over 70 years old, there was a lower incidence of the composite outcome (RR = 0.66, 95% CI,0.54 – 0.78, p < 0.001) with a high heterogeneity (I2 = 65%, p = 0.04).

Conclusions and Relevance:
Aiming for a systolic blood pressure ≤ 130mmHg in the elderly appears to be more efficacious than the standard therapy and is safe.
Abstract 4147962: Resource Utilization and Short-term Readmissions After Implantation of Left Ventricular Assist Devices and Heart Transplantations in Adults in the United States – A Contemporary Insight from the National Readmission Database: 2018 - 2021
Authors: Mogga Phanidhar , Raol Karanrajsinh , Pillai Ashwin , Singh Kerry , Mudduluru prathyusha , Saholi Aditya , Jedeon Zeina , kambam Greeshma , Jaiswal Abhishek
Published: November 2024

Introduction:
Heart transplants (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. We sought to describe outcomes with each modality, highlighting each option's strengths and clinical utility.

Aim:
To assess costs related to index hospitalization, 30-day (30DRC) and 90-day (90DRC) readmission categories for both subgroups.

Method:
We analyzed the National Readmission Database (NRD) from January 1, 2018, to December 31, 2021, identifying patients with HT and LVAD via ICD-10-CM codes. We selected this recent time frame to limit the influence of older LVAD technology and heart allocation schemes. We excluded patients <18 and patients with HT and LVAD during the index hospitalization. The primary outcomes were 30-day and 90-day readmission rates after index hospital discharge. Secondary outcomes included the cost of hospitalization during the index hospitalization and readmissions.

Results:
We identified 27,308 weighted index hospital admissions from January to December 2018-2021; LVAD was implanted in 14295 (52.4%). The median index admission cost is lower in the HT subgroup than in the LVAD subgroup across all studied years (Figure 1a). Both groups, however, show an increase in median costs from 2018 to 2021, with an 11.8% rise in the LVAD subgroup and a 32.42% rise in the HT subgroup. In the 30DRC, we identified 22,723 index hospitalizations, of which 11378 (50.07%) were LVAD recipients. LVAD recipients were significantly more likely to be hospitalized within 30 days (3164, 27.8% vs 2838, 25.01%; p=0.001). However, the HT group had higher readmission costs [$16660 ($9483 - $31173) vs$11732 ($6037 - $27059)), p=0.001]. Similar findings were noted in the 90DRC group (Figure 1b and Figure 2).

Conclusion:
Both LVAD and HT had comparable burdens on resource and short-term rehospitalization risk. Index hospitalization costs were higher for the LVAD group, whereas HT was associated with higher readmission-related costs.
Abstract 4148046: A Comparison of Anxiety and Depression in Patients with Symptoms of Palpitations Compared to High Risk Arrythmia Patients.
Authors: Treuth Mark , Patel Kunnal , Rissmiller Justin , Holdai Veera
Published: November 2024

Background:
Palpitations are the second most common presenting symptom for cardiology visits. The prevalence of anxiety and depressive disorders in patients with symptoms of arrhythmia, palpitations, is well documented but how this compares to patients at the greatest risk for major cardiac arrythmia is unknown.

Objectives:
The purpose of this study was to determine the prevalence of anxiety or depression in patients with symptomatic palpitations vs patients at risk for major cardiac arrhythmia (congestive heart failure) and further evaluate the effects on their quality of life using the SF-36 assessment tool.

Methods:
Patients with palpitations (50 subjects) or prior ICD (50 subjects) were given the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) and the Short Form Health Survey (SF-36).

Results:
There was an insignificant trend for increased anxiety, with a mean GAD-7 score in palpitations group of 4.14 vs 3.04 in CHF group with anxiety prevalence in 40% palpitations and 28% of ICD patients. The mean score of PHQ-9 in palpitations group is 4.84 vs 4.96 in CHF group with 38% of the palpitation group having depression compared to 44% of the ICD group. The SF-36 physical function domain showed that the palpitations group was more functional than the ICD group with a mean score of 0.709 in palpitations group vs 0.513 in CHF group (P <0.05.) Subjective frequency of palpitations had a mean of 3.47 in the palpitation group vs 1.5 in the CHF group with P<0.05.

Conclusions:
Patients presenting with symptomatic palpitations have more symptoms of anxiety than patients at risk for major arrythmia, but have less functional limitations than the ICD group, as expected. There is a non-significant trend to more anxiety in the palpitations group, but both groups are far above populations norms of 2-4%. Depression is not different between the groups but both groups are far above the population averages of 5-6%. Patients with palpitations have fewer physical limitations but have at least an equal amount of anxiety and depression as a far more ill group of patients. It is a standard of care to treat symptomatic palpitations due to PVCs with beta blockers; this will not help symptoms of anxiety and it may worsen depression. When seeing patients presenting with palpitations, or patients with chronic heart disease and an ICD, we should consider an evaluation for anxiety and depression.
Abstract 4148051: Comparative Efficacy of Dual Antiplatelet Therapy Durations in Acute Coronary Syndrome Patients Undergoing PCI: A Network Meta-Analysis
Authors: Erdem Saliha , Hamza Muhammad , Younas Hafiz Muhammad Waqar , Bahar Abdul Rasheed , Basit Jawad , Karamat Mubashar
Published: November 2024

Background:
Dual antiplatelet therapy, involving aspirin and a P2Y12 inhibitor, is essential for preventing ischemic events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Only limited number of studies challenge the optimal duration of DAPT in patients with ACS undergoing PCI.

Methods:
Pubmed and EMBASE databases were queried up to June 2024, and 7 eligible randomized clinical trials were included in our final analysis. We compared the efficacy and safety of different durations of DAPT in patients with ACS who underwent PCI.

Outcomes studied included all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), stent thrombosis, and clinically significant bleeding. We used a network meta-analysis module with inverse variance and random effects model in CRAN-R software to compute pooled risk ratios (RR) with 95% confidence intervals (CI) for statistical significance, using the 12-month DAPT strategy as a reference. Higgin’s I2 was used to test heterogeneity.

Results:
When compared to 12 months of DAPT therapy, there was no difference in all causes of mortality, CV death, MI, stroke, MACE, and stent thrombosis with a shorter duration of DAPT (1 month and 3 months). However, there was a lower risk of bleeding with 1 month and 3 months of DAPT therapy (Table 1).

Conclusion:
Shorter durations of DAPT (1 month and 3 months) are as effective as the traditional 12-month regimen in preventing all-cause mortality, CV death, MI, stroke, MACE, and stent thrombosis in patients with ACS undergoing PCI. Importantly, shorter DAPT durations are associated with a significantly lower risk of bleeding.
Abstract 4148101: Prevalence and Characteristics of Hypertrophic Cardiomyopathy Phenotype in Patients with Cardiac Sarcoidosis
Authors: Zia Abdul , Lal Mallika , Nazer Babak , Levin Benjamin , Masri Ahmad
Published: November 2024

Introduction:
Hypertrophic cardiomyopathy (HCM) and cardiac sarcoidosis (CS) are distinct cardiomyopathies that can lead to heart failure and arrhythmias. Both diseases are under-diagnosed in the general population and often misdiagnosed due to overlapping phenotype.

Research Question:
This study aimed to investigate the co-occurrence of HCM and CS, define the expected prevalence, and outline their co-existent phenotypes.

Goals:
To define the prevalence and characteristics of coexistent HCM and CS.

Methods:
We calculated the expected population prevalence of CS and of HCM. We identified consecutive cases of patients with a CS diagnosis at OHSU and included those meeting CS criteria based on the Heart Rhythm Society (HRS) 2014 guidelines. These patients were then screened for HCM phenotype which was determined by the presence of left ventricular wall thickness greater than or equal to 15 mm that is otherwise unexplained, left ventricular outflow tract obstruction (LVOTO), pathogenic or likely pathogenic genetic variant and findings on cardiac magnetic resonance imaging (CMR). The diagnosis of CS and HCM were based on comprehensive detailed evaluation by expert multidisciplinary team with histological confirmation frequently employed.

Results:
Among the 46 patients meeting HRS criteria, 7 (15%) were identified with concomitant HCM phenotype. Based on published literature, the expected prevalence of HCM is 0.2%-0.4% and assuming independence between CS and HCM, we should have had 1 or no patients with HCM in our cohort. Notably, patients with the HCM-CS phenotype were predominantly male compared to the CS cohort (85.7% vs. 48.7%), had higher left ventricular (LV) ejection fraction (63.9%±3.8% vs 49.7±15.0%), and higher LV wall thickness (18.7±4.7 mm vs 10.7±2.3 mm). Among the HCM-CS patients, LV hypertrophy was asymmetric in 71.4%, and 71.4% had LV outflow tract obstruction. Characteristics of the two populations are shown in Table.

Conclusions:
Our data suggest a potential overlap between HCM and CS beyond the expected prevalence. Larger and more detailed pathologic studies will elucidate whether CS can have HCM phenotype versus the presence of common pathobiological processes linking the two entities.
Abstract 4148133: Association between small pre-implant left ventricular end diastolic diameter and post left ventricular assist device implantation all-cause mortality: A systematic review and meta-analysis
Authors: Pingili Adhvithi , Vadiyala Mounika Reddy , Anmol Kumar , Jain Muskan , Varghese Jeffy Susan , Ahluwalia Vibhor , Prajapati Kesar , Chalasani Vardhan , Desai Rupak , Feller Erika
Published: November 2024

Background:
Left ventricular assist devices (LVADs) are crucial for the management of advanced heart failure patients acting, both as a bridge to heart transplant or destination therapy. Existing studies revealed mixed results on the impact of pre-implant left ventricular end-diastolic diameter (LVEDD) on post-LVAD mortality. Some studies found smaller LVEDD increases mortality, while others revealed no significant impact. Due to the limited evidence, this meta-analysis aims to determine the association between pre-LVEDD and post-LVAD implantation mortality through a systematic review and meta-analysis.

Method:
We systematically reviewed articles until May 2024 examining the association between pre-implant LVEDD and post-LVAD implantation mortality using PubMed, Google Scholar, Embase, and Scopus. A random effects model was used to calculate the pooled adjusted odds ratio (aOR). We used I
2
statistics to determine the heterogeneity of studies. Leave-one-out sensitivity analysis was done to evaluate each study's effect on the overall estimate, with statistical significance set at p<0.05.

Results:
We included four studies in our meta-analysis, three from the USA and one multicountry study, totaling 16,548 LVAD recipients (13,110 males and 3,438 females). We examined the relationship between pre-implant left ventricular end-diastolic diameter (LVEDD) and mortality following continuous LVAD implantation. The random-effects model revealed a significant association between smaller LVEDD and increased mortality, with a pooled adjusted odds ratio (aOR) of 1.29 [95% confidence interval (CI): 1.10 – 1.53, p < 0.01]. Leave-one-out sensitivity analysis validated the robustness of our findings, identifying the study by Dual et al. as the most influential. We observed low heterogeneity among the included studies (I
2
=22.38 %, P=0.28), suggesting consistent results across different populations and settings.

Conclusion:
Our study demonstrates a significant association between small pre-implant LVEDD and higher post-LVAD implantation mortality when compared to large pre-implant LVEDD. Overall, our results underscore the need for careful assessment of LVEDD in clinical decision-making and patient management for those undergoing LVAD implantation.
Abstract 4148148: Acute Myocardial Infarction outcomes in patients on single anticoagulation versus combined anticoagulation and antiplatelet therapy
Authors: Rosario Manuel , Vasquez Moises , Garcia Gustavo , Wojtas Caroline , Vargas Ian , Behers Benjamin
Published: November 2024

Introduction:
Current guidelines recommend single anticoagulation (AC) therapy over combined AC plus anti-platelet (AP) therapy in patients with established cardiovascular disease (CVD) and concomitant indication for AC. Data on the in-hospital outcomes of acute myocardial infarction (AMI) in patients on single versus combined therapy is scarce.

Methods:
The National Inpatient Sample was used to identify adult patients with established CVD on AC and a primary diagnosis of AMI between 2016 and 2020. Data was stratified between patients on single AC and patients on combined AC and AP therapy. In-hospital outcomes were compared after case-control matching for significant comorbidities.

Results:
A total of 122,975 patients admitted for AMI were included, of which 57,220 (46.5%) were previously on combined therapy. PCI rates were similar in both groups (34.9% vs 34.6%, P=0.247). After matching (15,140 patients in each group), combined therapy was associated with decreased odds of in-hospital mortality, discharge to skilled nursing facilities (SNF), increased odds of mechanical circulatory support (MCS) use, and similar odds of in-hospital cardiovascular and bleeding complications compared to patients on single AC therapy (Figure 1).

Conclusion:
Combined AC plus AP therapy was associated with decreased in-hospital mortality, increase MCS use, and less SNF discharges compared to patients on single AC therapy admitted for AMI. There was no difference in in-hospital cardiac or bleeding complications.
Abstract 4148214: Missing the Point: Readability Analysis of Online Patient Information for Cardiac Amyloidosis
Authors: Byer Stefano , Grewal Udhayvir
Published: November 2024

Background:
Advancements in diagnostics and increased awareness have led to higher identification of cardiac amyloidosis. This condition, characterized by the abnormal deposition of amyloid proteins in the heart, has created a greater need for comprehensive educational materials for patients and their families. Patients with cardiac amyloidosis often require specialized care from subspecialists at academic medical centers (AMCs). Our study aims to evaluate whether the readability of patient education materials provided by AMCs meets the National Institutes of Health (NIH) standard of an 8th-grade reading level or below.

Methods:
We conducted a Google search to find educational materials on cardiac amyloidosis from AMCs. Text from these websites was analyzed using 10 readability assessment tools, including Flesch-Kincaid Grade Level and Gunning Fog Index. We used simple linear regression to assess the relationship between readability scores and independent variables such as word count, U.S. News ranking, and Google Search ranking.

Results:
We identified 32 AMC websites with information on cardiac amyloidosis. The overall median reading level was 11.3 (IQR 10.5 – 11.9). There was no significant correlation between readability scores and word count (r2= 0.00, p = 0.95), Google ranking (r2 = 0.021, p = 0.42), or U.S. News ranking (r2 = 0.013, p = 0.65). This indicates that the readability of the materials is independent of text length and AMC authority.

Conclusion:
This study is the first to examine the readability of patient educational materials on cardiac amyloidosis. The 32 AMC websites had a median reading grade level of 11.3, which does not meet the NIH readability standard. The lack of significant correlation between readability and Google or U.S. News rankings suggests that AMC status does not affect communication effectiveness. The absence of a relationship between word count and readability highlights the need for better content quality. There is a critical shortage of accessible patient education materials on cardiac amyloidosis. Providing materials that meet NIH readability standards is essential to alleviate patient anxieties and improve adherence to treatment protocols. Academic medical centers, along with cardiology and oncology groups, should ensure patient education materials are both accessible and informative, enhancing patient outcomes and quality of life.
Abstract Or104: At What Time Point is Delay to First Bystander Cardiopulmonary Resuscitation Not Associated with Survival for Out-of-Hospital Cardiac Arrest?
Authors: O'Keefe Evan , Nguyen Dan , kennedy kevin , Abdel Jawad Mohammad , Ikemura Nobuhiro , Chan Paul
Published: November 2024

Background:
Bystander cardiopulmonary resuscitation (CPR) is a critical link in the chain of survival for out-of-hospital cardiac arrest (OHCA).

Hypothesis:
Although bystander CPR improves survival for OHCA, there may be a time threshold beyond which bystander CPR may no longer be associated with improved OHCA survival.

Aims:
To determine the time interval for when initiation of bystander CPR may no longer be associated with OHCA survival.

Methods:
Within the Cardiac Arrest Registry to Enhance Survival, we identified 198,869 witnessed OHCAs during 2013-2022. Time to initiation of bystander CPR was categorized in 2-minute intervals (0-1, 2-3, 4-5, 6-7, 8-9, 10+ minutes). We used multivariable hierarchical logistic regression to evaluate the association between each time interval for initiation of bystander CPR, as compared with no bystander CPR, for survival to discharge and favorable neurological survival.

Results:
Mean age was 64.3±15.9 years and 68,085 (34.2%) were women. For those that did not receive bystander CPR, 11.9% survived to discharge and 9.3% had favorable neurological survival (Figure). Individuals receiving CPR within 2 minutes of OHCA had relatively higher rates of survival to discharge (OR: 1.85 [95% CI: 1.79-1.92; p<0.001]) and favorable neurological survival (OR: 1.99 [95% CI: 1.92-2.07; p<0.001]). The survival benefit of bystander CPR, as compared with no bystander CPR, decreased with each subsequent time interval and was no longer associated with improved survival when bystander CPR was initiated 10 or more minutes after the onset of OHCA (Table).

Conclusions:
Bystander CPR is critical for enhancing survival in OHCA. Under 10 minutes of OHCA, there was a graded inverse relationship between time to bystander CPR and survival outcomes. After 10 minutes there was no longer an association for bystander CPR, underscoring the importance of improving the timeliness of this intervention to improve overall OHCA survival.
Abstract Or110: Baseline Measurements of Cellular Respiration Affect the Response to Thiamine Treatment in Post-arrest Patients
Authors: Vine Jacob , Lee John , Balaji Lakshman , Berlin Noa , Simpson Michael , Moskowitz Ari , Liu Xiaowen , Berg Katherine , Grossestreuer Anne , Donnino Michael
Published: November 2024

Introduction:
Lactic acidosis and impaired oxygen extraction due to mitochondrial dysfunction are common post-arrest. Thiamine, a cofactor for pyruvate dehydrogenase, is necessary for aerobic metabolism. In two randomized controlled trials (RCTs) testing the effect of thiamine vs. placebo in out-of-hospital and in-hospital post-arrest patients (NCT03450707 and NCT02974257), no relationship was found between thiamine treatment and the primary outcome of change in lactate over 24 hours. Cellular oxygen consumption rates (OCRs) were measured in a subset of patients at baseline. Maximal and spare OCRs measure the capacity of mitochondria to increase cellular respiration from their basal state when stimulated, and may identify patients likely to benefit from thiamine. We conducted a post-hoc analysis of the two RCTs to evaluate the primary outcome in subgroups defined by baseline OCRs.

Hypothesis:
Patients with higher maximal and spare OCRs at baseline are more likely to benefit from thiamine treatment, as indicated by lower lactate levels.

Methods:
Basal, maximal and spare OCRs, collected at enrollment, were measured in peripheral blood mononuclear cells using an XFe96 Extracellular Flux Analyzer and XF Cell Mito Stress Test Kit (Seahorse Bioscience). Lactates (at 6, 12, and 24 hours) were log-transformed and analyzed using a linear mixed model controlling for baseline lactate. In patients who expired <24 hours, lactate was imputed using the last available value with a 20% increase. Subgroups were defined by baseline OCR values above or below the median. The primary outcome was lactate at 24 hours, presented as a geometric mean difference (GMD).

Results:
A total of 74 patients had baseline OCR measurements. There was no statistically significant difference in lactate at 24 hours between placebo and thiamine in all patients (p=0.179) or in the low OCR (below median) groups. In patients with baseline maximum or spare OCRs above the median, lactate levels were significantly lower in those receiving thiamine (24 hour GMDs of 0.61 (95% CI: 0.45-0.82; p=0.001), and 0.53 (95% CI: 0.38-0.74; p<0.001), respectively; Figure 1).

Conclusion:
In a post-hoc analysis of two RCTs, thiamine significantly improved the primary outcome in the subgroup of patients with higher spare and maximal oxygen consumption rates at baseline. Baseline OCRs could potentially identify post-arrest patients likely to benefit from thiamine.
Abstract Or111: Association of hypertonic saline treatment with change in cerebral oxygen extraction after cardiac arrest
Authors: Faiver Laura , Coppler Patrick , Ratay Cecelia , chae minjung , Flickinger Kate , Eun Lee , Kang Changshin , Tam Jonathan , Elmer Jonathan
Published: November 2024

Introduction:
Elevated jugular bulb venous oxygen saturation (SjvO2) after cardiac arrest may occur because of diffusion-limited oxygen extraction secondary to perivascular edema. This edema may respond to treatment with hypertonic saline (HTS), thereby decreasing the barrier to oxygen diffusion. Alternatively, SjvO2 can rise when cerebral metabolic rate decreases, which is not affected by HTS. Electroencephalography (EEG) may differentiate between these etiologies and thus identify patients for whom treatment with HTS will improve oxygen extraction.

Hypothesis:
Post-arrest patients with elevated SjvO2 would have improved oxygen extraction after treatment with HTS and qualitative EEG could be used to predict treatment responsiveness.

Methods:
We conducted a retrospective multicenter cohort study including comatose survivors of cardiac arrest who had intermittent SjvO2 monitoring. We performed a Kruskal Wallis test comparing mean SjvO2 values within the first 24 hours after arrest between survivors and non-survivors. In the subgroup of patients who were treated with HTS for SjvO2 >75% and were EEG monitored, we quantified compared SjvO2 before and after HTS using a multivariable mixed-effects regression treating HTS as a fixed effect, adjusting for mean arterial pressure, partial pressure of arterial oxygen and partial pressure of carbon dioxide. We classified pre-treatment EEG patterns as benign or indicative of potential metabolic failure (generalized suppression, burst suppression, or discontinuous with superimposed rhythmic or periodic patterns) and tested for an interaction of EEG with HTS.

Results:
We included 131 patients of whom 115 had SjvO2 data within 24 hours. Mean SjvO2 was higher (p = 0.0002) in non-survivors (77% [SD ±11]) than survivors (71% [SD ±11]). Twenty-one subjects received 28 HTS treatments. We found an independent association of HTS with decreased SjvO2 (ß = -3.8%; 95% CI, -6.4 to -1.2; p = 0.004). There was no interaction between pre-treatment EEG and HTS predicting SjvO2.

Conclusions:
Early elevated SjvO2 is associated with mortality at hospital discharge. SjvO2 decreased following treatment with HTS, suggesting diffusion limited oxygen extraction secondary to modifiable perivascular edema. As mechanisms of secondary brain injury after cardiac arrest vary among patients, a precision approach to treatment is essential; however, we did not identify evidence to support the use of qualitative EEG to guide patient selection for treatment.
Abstract Or112: Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest: Trends and Association with Survival
Authors: Shepard Lindsay , Reeder Ron , Hsu Jesse , Keim Garrett , Berg Robert , Sutton Robert , Topjian Alexis , Yehya Nadir , Morgan Ryan
Published: November 2024

Background:
Pediatric life support guidelines defer recommendation for or against intra-arrest intubation during IHCA. A prior observational study (2000-2014) identified an association of intra-arrest intubation with lower rates of survival to hospital discharge (SHD). Changes in clinical practice (e.g., patient selection, delaying intubation, CPR quality) may have mitigated potential harm.

Aim:
Determine the association between intra-arrest intubation and SHD in a recent cohort of children with IHCA.

Hypothesis:
Intra-arrest intubation is associated with increased odds of SHD.

Methods:
Retrospective cohort study of children with index IHCA without an invasive airway at time of CPR in the Get with the Guidelines registry from 2000-2022. We performed a time-dependent propensity-score matched analysis. Patients intubated in a given minute were matched with patients at-risk of intubation in the same minute based on a propensity score derived from multiple patient, arrest and hospital characteristics, with forced matching on stratification variables (age group, illness category) and replacement of controls. We assessed the association between intra-arrest intubation and SHD using a mixed-effects logistic regression model, with random effects to account for matched data and clustering by hospital, and weighting for the number of times a patient was included as a control.

Results:
Of 3,262 patients with median age 1 [IQR: 0.3, 8] years, 2,164 (66.3%) were intubated, and 1,748 (53.6%) survived to hospital discharge. Intubation rates decreased from 84.6% to 66.7% across the study period (Figure 1, non-parametric test for trend, p<0.001). Median time to intubation was 7 [4, 12] minutes and increased across the study period (p<0.001). In the recent cohort (2017-2022, n=1192), there was no association between intra-arrest intubation and SHD (aOR 1.18, 95% CI: 0.90, 1.53). In a subgroup analysis of children >8 years, being intubated compared to not being intubated in a given minute was associated with increased odds of SHD (aOR 1.91, 95% CI: 1.09, 3.33) (Figure 2).

Conclusions:
In a recent (2017-2022) cohort of children with IHCA, intra-arrest intubation was not associated with increased odds of survival to hospital discharge. In a subgroup of children >8 years, intra-arrest intubation was associated with increased odds of survival. We speculate that secular changes in airway management may partially explain the lack of harm identified in our recent cohort.
Abstract Sa1001: Epinephrine for In-hospital Cardiac Arrest: Effect and Time to Return of Spontaneous Circulation
Authors: Norvik Anders , Unneland Eirik , Kvaloy Jan Terje , Bergum Daniel , Loennechen Jan Pål , ARAMENDI ELISABETE , Urteaga Jon , Skogvoll Eirik
Published: November 2024

Introduction:
Epinephrine is the mainstay of drug treatment during cardiac arrest and it is firmly established that it promotes Return of Spontaneous Circulation (ROSC). In this study we aimed to describe the effect and occurrence of ROSC after administering epinephrine to hospitalized patients with primary pulseless electrical activity (PEA), i.e., administered during PEA as the first recorded arrest rhythm.

Method:
We investigated 78 episodes of primary PEA registered between Aug. 2018 and Oct. 2022 at St. Olav University Hospital (Trondheim, Norway). In 36 episodes, the first dose of epinephrine was administered during primary PEA and registered with minute precision. We created different time dependent covariate profiles for the effect of epinephrine, starting at 0 (time of administration), rising linearly to 1 (presumed maximum effect) and decreasing to 0 immediately thereafter. Time to presumed maximum effect started at 5 seconds (s) after administration and increased in steps of 5s until 300s. We entered each of these different covariate profiles into separate Cox regression models using time to ROSC as outcome obtaining in total 60 Hazard ratios (HR) from all the models.

Results:
Median time to epinephrine administration was 185s (range 80 to 310) after start of resuscitation. In total, 23 patients obtained ROSC after the administration of epinephrine and 15 patients obtained ROSC without epinephrine. The different hazard ratios (y-axis) were plotted against the location of the maximum point of the covariate profile (x-axis) in Fig. 1. HR peaked twice, at 70 and 155s, 11.4(p< 0.001) and 4.1(p= 0.013), respectively.

Discussion:
This study indicates a strong effect of epinephrine during primary PEA 1-2 min after administration. This information may provide the treating team with useful insight on what to expect after administering epinephrine. In addition, the actual effect may be even larger, as the sickest patients (expected to respond less well to epinephrine) are more often monitored and thus recieve epinephrine earlier.
Abstract Sa101: Prehospital advanced airway management across age groups in out-of-hospital cardiac arrest: Registry-based cohort study from the Resuscitation Outcomes Consortium Epidemiologic Registry
Authors: Izawa Junichi , Komukai Sho , Callaway Clifton , Okubo Masashi
Published: November 2024

Background:
Emergency medical services clinicians commonly perform advanced airway management (AAM: i.e., supraglottic airway placement and endotracheal intubation) for out-of-hospital cardiac arrest (OHCA). Nevertheless, the heterogeneity of the treatment effect of prehospital AAM across age groups is still unclear.

Aim:
To determine the association between prehospital AAM and survival after OHCA, compared with no AAM, across age groups.

Methods:
This cohort study used the Resuscitation Outcomes Consortium Epidemiologic Registry database, a prospective OHCA registry at ten sites in the US and Canada from 2011 through 2015. Patients were stratified into ten sub-cohorts based on their first documented rhythm (shockable or non-shockable) and five age groups (0-9 years; 10-24; 25-44; 45-64; or ≥65) given the potential impact of rhythm and age on effect modification. To address resuscitation time bias, patients who received AAM during cardiopulmonary resuscitation (CPR) were sequentially matched with patients at risk of receiving AAM within the same minute based on time-dependent propensity scores. Matching was performed in each sub-cohort, and the matched sub-cohorts were integrated for the main analysis. The primary outcome was survival to hospital discharge.

Results:
Of the 44,403 eligible patients, 39,157 (88.2%) received prehospital AAM during CPR. After time-dependent propensity score sequential matching, 29,973 who received AAM were matched with patients who had not yet received AAM at the same minute. AAM was associated with survival: 5.4% vs 4.8%, risk ratio (RR) 1.40 (95% CI 1.30-1.51). The associations were similar toward better survival in both the shockable (RR 1.27 [95% CI 1.17-1.38]) and non-shockable (RR 1.75 [95% CI 1.53-2.01]) cohorts. There was no apparent heterogeneity of the treatment effect of AAM on survival in all age groups: 0-9 years, RR 1.07 (95% CI 0.45-2.56); 10-24 years, 1.61 (1.07-2.45); 25-44 years, 1.68 (1.35-2.10); 45-64 years, 1.33 (1.19-1.48); 65 years or older, 1.40 (1.23-1.59).

Conclusions:
In this study of the large multicenter OHCA registry in North America, prehospital AAM was associated with survival to hospital discharge regardless of the first documented rhythm. No apparent heterogeneity was found in the associations between AAM and survival among all age groups, suggesting that both pediatric and adult populations might benefit from prehospital AAM.
Abstract Sa105: Comparing of the pre-hospital advanced airway managements in cardiac arrest : Supraglottic airway vs. Direct laryngoscope vs. Video Laryngoscope
Authors: KIM MINWOO , Park Jeong Ho , Shin Sang Do , Song Kyoung , Ro Young Sun , Hong Kijeong , Jeong Joo , Kim Tae Han , Kim Ki Hong , Kim Yoonjic , Choi Yeongho , LEE Stephen Gyung Won , Choi Seulki
Published: November 2024

After the implemetation of special emergency services, advanced airway management(AAM) in cardiac arrest has been tried actively. We aim to compare the success rates and patient outcomes of supraglottic airway(SGA), endotracheal intubation with direct laryngoscope(ETI with DL), and endotracheal intubation with video laryngoscope(ETI with VL) in patients with sudden cardiac arrest, and evaluate the effectiveness of the video laryngoscope in the pre-hospital stage.

This study was conducted on cardiac arrest patients who transferred to ED by EMS from July 2019 to December 2021. Using the Korean OHCA registry, EMS ambulance runsheet, and cardiac arrest in-depth registry, patients with sudden cardiac arrest over 18 years old, caused by medical cause, and who were treated by the special EMS team at the site and got AAM were enrolled. Cases with unknown information on AAM success or time of arrival/death were excluded. Pre-hospital ROSC, 72 hr survival, survival to discharge, good neurological outcome were compared among SGA, ETI with DL and ETI with VL using multivariable logistic regression. Initial AAM success and final success rates were also compared.

10,587 cases were enrolled in the study, of which 9379 cases got SGA, 493 ETI with DL, and 985 ETI with VL. In the first attempt, the insertion success rate is higher with SGA, but the overall success is higher with VL. For any prehospital ROSC, compared to SGA, ETI with DL was 1.33 (1.00-1.75), and ETI with VL was 1.92 (1.57-2.34). Compared to SGA, aOR for survival within 72 hours was 1.13 (0.81-1.56), 1.34 (1.06-1.70), survival to discharge was 1.05 (0.64-1.65), 1.06 (0.74-1.49), and good neurological outcome was 0.64 (0.31-1.25), 1.17(0.71-1.86) in ETI with DL or ETI with VL respectively. Compared to the SGA, aOR of the initial success was 0.44 (0.32-0.61) and 0.48 (0.38-0.62) in the ETI with DL and ETI with VL groups, respectively, and the final success rate was 0.78 (0.45-1.44), 1.14 (0.72-1.94).

Endotracheal intubation in EMS showed the lower initial success rate than SGA, but when using a video-laryngoscope, the final success rate rises to a sufficiently similar level, and the pre-hospital ROSC success rate is higher than that of SGA.
Abstract Sa106: Effect of Prehospital Advanced Airway Management on Arterial Blood Gases in the Pragmatic Airway Resuscitation Trial
Authors: Sullivan Grace , Wang Henry , Gage Christopher , Powell Jonathan , ARAMENDI ELISABETE , Jaureguibeitia Xabier , Elola Andoni , Idris Ahamed , Daya Mohamud , Stephens Shannon , Carlson Jestin , Nichol Graham , Aufderheide Tom , Panchal Ashish , Nassal Michelle
Published: November 2024

Background:
While prehospital advanced airway devices are commonly used in out-of-hospital cardiac arrest (OHCA), whether gas exchange differs between devices is unknown.

Objective:
To characterize arterial blood gas (ABG) differences between patients receiving laryngeal tube (LT) or endotracheal intubation (ETI) in the Pragmatic Airway Resuscitation Trial (PART).

Methods:
We included adult OHCA enrolled in PART with first ABG collected ≤ 90 minutes after emergency department (ED) arrival. We identified 1) last prehospital airway technique used (LT vs. ETI), 2) average end-tidal capnography (EtCO
2
) values for the last 5 minutes of prehospital care, 3) return of spontaneous circulation (ROSC) in the ED, and 4) ED ABG measurements (pH, PaO
2
, PaCO
2
). We compared ABG values between LT and ETI using the Mann-Whitney test, stratifying by ROSC vs. non-ROSC. We also determined the correlation between last 5-minute mean prehospital EtCO
2
and PaCO
2
using Pearson’s correlation. We also compared absolute difference between EtCO
2
and PaCO
2
(PaCO
2
- EtCO
2
) using the Mann-Whitney test. All blood gas and EtCO
2
values are reported in mmHg.

Results:
Of 3004 patients enrolled in the parent trial, 483 had an ABG ≤ 90 minutes after ED arrival; 276 LT, 129 ETI, 76 no advanced airway, and 2 unknown. Among patients with ROSC in the ED, pH did not differ between LT and ETI (7.1 vs. 7.2, p=0.10), PaO
2
showed a tendency toward lower values in LT than ETI (142 vs. 170, p=0.07), and PaCO
2
was significantly higher in LT compared to ETI (59 vs. 50, p=0.002). Among patients without ROSC, pH did not differ between LT and ETI (7.0 vs. 7.0, p=0.55), PaO
2
was significantly lower in LT than ETI (85 vs. 123, p=0.03), and PaCO
2
did not differ between LT and ETI (64 vs. 60.5, p=0.58). EtCO
2
did not correlate with PaCO
2
in any airway device/ROSC combination: [LT+ROSC] r=0.02, [ETI+ROSC] r=0.14, [LT+non-ROSC] r=-0.11, [ETI+non-ROSC] r=0.51. PaCO
2
- EtCO
2
was significantly wider in non-ROSC than ROSC cases (27 vs. 18, p=0.03) but did not differ by airway device.

Conclusions:
ABG values may vary by prehospital advanced airway management methods. The correlation between EtCO
2
and PaCO
2
in patients with OHCA remains unclear.
Abstract Sa1206: Chicago improves its Out-of-Hospital Cardiac Arrest Survival
Authors: Khosla Shaveta , Schwerin O'Reilly Courtney , Kotini-Shah Pavitra , Froelich Elizabeth , Markul Eddie , Tataris Katie , Campbell Teri , Del Rios Marina , Weber Joseph , Vanden Hoek Terry
Published: November 2024

Background:
Illinois Heart Rescue began monitoring out-of-hospital cardiac arrest (OHCA) data in 2013, and since then the program has expanded from one Emergency Medical Services (EMS) agency to 110 agencies and 118 hospitals in Illinois that report to Cardiac Arrest Registry to Enhance Survival (CARES). In Chicago, apart from community bystander cardiopulmonary resuscitation trainings and resuscitation academy trainings, the program provides audits and feedback for 911 calls, and critical insights to the hospitals.

Aim:
Our aim was to assess OHCA survival rates in Chicago for 2023 and compare those to prior years.

Methods:
We included non-traumatic adult OHCA served by Chicago EMS and reported to CARES between 2013 to 2023. Cases that occurred in a healthcare facility or a nursing home were excluded. Rates were generated; percentage changes and trends were assessed.

Results:
Of the 23,688 cases from 2013-2023 in Chicago, 2470 cases occurred in 2023. The highest rates of survival to hospital admission (STHA, 30.6%), survival to hospital discharge (STHD, 10.6%), favorable neurologic survival (6.6%) and Utstein survival to hospital discharge (37.8%) since 2013 were recorded in 2023, and particularly since 2020 the survival rates increased consistently. From 2020 to 2023, the STHA increased by 44% (p for trend=0.048), STHD by 76% (p=0.03), favorable neurologic survival by 91% (p=0.03), and Utstein survival by 93% (p=0.02). Overall survival rates were similarly increased in both men and women for the most part. STHD increased in men by 95%, and in women by 48% from 2020 to 2023, with the survival rate becoming comparable in the two genders in 2023 (10.8% in men vs. 10.2% in women). Similarly, the rate of favorable neurologic survival increased in both, but the increase was steeper in men with a higher survival rate in men (7.2% vs. 5.7% in women) in 2023. Utstein survival also improved significantly in men and reached 40% in 2023 (with an increase of 152% from 2020 to 2023, p=0.004). By race and ethnicity, STHD and favorable neurologic survival increased consistently in Hispanic and Black cases from 2020 to 2023.

Conclusion:
Chicago experienced a significant increase in OHCA survival. This is a result of concerted efforts of Chicago Fire Department/EMS, hospitals and community with the support of Illinois Heart Rescue. As a result of these efforts, the survival rates in Chicago are now comparable to or exceed the national rates.