bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 260: Relationship Between the Blood Hemoglobin Level at Hospital Arrival and Post--Cardiac Arrest Neurological Outcome
Authors: Hayashida Kei , Suzuki Masaru , Shiroshita-Takeshita Akiko , Honma Yosuke , Kamura Hiroshi , Hatada Tsuyoshi , Otuka Msafumi , Fujioka Masayuki , Oomura Taku , Murai Akira , Orita Tomohiko , Beppu Satoru , Arimoto Hideki , Nishiyama Kei , Ito Noritoshi , Hori Shingo
Published: April 2024

OBJECTIVE:

Recent studies have revealed that regional brain oxygen saturation (rSO2) is an excellent predictor for a neurological outcome in OHCA. It also has been suggested that brain tissue oxygenation is crucial for a post cardiac arrest syndrome (PCAS). Hemoglobin (Hb) is an indispensable for oxygen delivery to peripheral tissue. Therefore, it is considered that Hb plays an important role in PCAS. In the present study, we aim to elucidate the relationship between blood Hb level and the neurological outcome in PCAS.

METHODS:

The database of the J-POP registry (multicenter observational study) has prospectively enrolled 764 OHCA patients. Of these, 193 PCAS patients admitted to the wards after ROSC were included in this study. Blood Hb level (median 12.0g/dL, [IQR 10.4-13.8]) and rSO2 (35%, [15-55]) were obtained during resuscitation within 3 min after hospital arrival. The neurological outcome was evaluated by CPC at 30 days, and CPC1 and 2 were defined as favorable neurologic outcome.

RESULTS: Among 193 PCAS patients, 27 showed favorable outcome (14%). There was no significant correlation between rSO2 and Hb level (P=0.43). Univariate analyses revealed that the favorable outcome group was characterized as younger, male, witnessed CA, initial shockable rhythm, higher Hb level, rSO2>35%, and shorter transport interval from the scene to the hospital. Coronary angiography (CAG) and therapeutic hypothermia were also associated with the favorable outcome. The multivariate analysis showed that rSO2>35% (OR 35.0 [7.5-163.4]), Hb (1.48 [1.08-2.01]), CAG (45.8 [7.7-271.1]) were independent predictors for the favorable outcome.

CONCLUSIONS:

A higher blood Hb level was associated with a favorable short-term neurological outcome in patients with PCAS regardless of rSO2.
Abstract 266: Effectiveness of a New Method of Pediatric Advanced Life Support Recertification: PALS on Demand
Authors: Kurosawa Hiroshi , Ikeyama Takanari , Achuff Patricia , Perkel Madeline , Watson Christine , Nadkarni Vinay , Nishisaki Akira
Published: April 2024

Background: Recent evidence shows poor retention of PALS provider skills. Frequent refresher training, and in-situ simulation are promising interventions. We developed a “PALS on Demand” (PoD) recertification course by deconstructing the training into six 30-min simulation scenario sessions over 6 months. We hypothesized that PoD is as effective as Standard (STD) PALS 1-day recertification delivered with simulation technology (i.e. non-inferiority study).

Method: We randomized PALS certified Pediatric ICU nurses and respiratory therapists to PoD vs STD strategy. Training effectiveness outcome was prospectively defined as self-reported provider confidence and competence (Likert scale: 1 = lowest to 7=highest). We analyzed using a Mixed effect model, adjusting for baseline differences (p<0.05 as significant).

Results: 36 participants were eligible, completed pre-testing baseline and were randomized: PoD (n=19) and STD (n=17). Median age was 32 (IQR:28-40yrs), discipline: nurses:72%, respiratory therapists:28%, with no significant difference between group demographics . 29 had completed data for baseline, training and post-test scenarios(PoD=17/19 vs STD=16/17). In both PoD and STD groups, self-reported confidence (PoD 0.9, 95%CI, 0.5-1.4, p<0.001, and STD 0.6 95%CI,0.2-1.2, p=0.009) and competence improved(PoD 0.9, 95%CI, 0.6-1.3, p<0.001, and STD 0.8 95%CI, 0.5-1.2, p<0.001). After adjusting for baseline demographics, gender and clinical experience, the PoD vs. STD training strategy was not significantly associated with either confidence (p=0.42) or competence (p=0.65) score improvements.

Conclusion: A Simulation-based “PALS-on-Demand” (PoD) approach is feasible. In this non-inferiority study, both PoD and STD simulation-based recertification strategies improved participants’ self-reported confidence and competence equivalently. Further feasibility and objective effectiveness validation of low-dose, high-frequency training is warranted.
Abstract 270: Use of Transthoracic Impedance to Monitor the Quality of Chest Compressions in a Porcine Model of Cardiac Arrest
Authors: Chen Bihua , Zhang Lei , Zhang Hehua , Yu Tao , Li Yongqin
Published: April 2024

Introduction.
The quality of cardiopulmonary resuscitation (CPR), especially adequate compression depth, is associated with return of spontaneous circulation (ROSC) and is recommended to be measured routinely. Numerous CPR feedback techniques have been employed to monitor the quality of chest compression and demonstrated their utility in improving the effectiveness of CPR. In the current study, we investigated the relationship among transthoracic impedance (TTI) measured from the defibrillation electrodes, chest compression depth, and coronary perfusion pressure (CPP) in a porcine model of cardiac arrest.

Methods.
In 14 male pigs weighing between 28 to 34 kg, ventricular fibrillation (VF) was electrically induced and untreated for 6 mins. Animals were then randomized to either optimal or suboptimal chest compression group. Optimal depth of manual compression in 7 pigs was defined as a decrease of 25% in anterior posterior diameter of the chest during CPR, while suboptimal compression was defined as 70% of the optimal depth. After 2 mins of chest compression, defibrillation was attempted with a 120-J rectilinear biphasic shock. ECG, aortic pressure, right atrial pressure, compression depth, together with TTI were continuously recorded.

Results.
There were no differences in baseline measurements between groups. All animals had ROSC after optimal compressions, this contrasted with suboptimal compressions, after which only 2 of the animals had ROSC (100% vs. 28.57%,
p
= 0.021). The correlation coefficient was 0.89 between TTI amplitude and compression depth (
p
< 0.001), 0.82 between TTI amplitude and CPP (
p
< 0.001).

Conclusion.
Amplitude change of TTI was strongly correlated with chest compression depth and CPP. The TTI measured from defibrillator electrodes, therefore has the potential to serve as a reliable indicator to monitor the quality of chest compression during CPR.
Abstract 277: Cerebral Perfusion Targeted Resuscitation: A Novel Method of Cardiac Arrest Resuscitation
Authors: Parnia Sam , Nasir Asad , Ahn Anna , Richman Paul , Malik Hanan , Dorazi Francis
Published: April 2024

Background:
A major hurdle limiting the ability to improve outcomes from cardiac arrest has been the lack of a non-invasive real-time detection system capable of monitoring the quality of cerebral and other vital organ perfusion and oxygen delivery during cardiopulmonary resuscitation (CPR). Furthermore, although, the detection of poor oxygen delivery is important, the benefits of such a system can only be realized through a system aimed at improving the quality of oxygen delivery to the brain as well as other vital organs in real-time. Here we report on the first application of such a novel system of cerebral perfusion targeted resuscitation.

Method:
We evaluated the role of cerebral oximetry (Equanox, Nonin, USA) as a real-time marker of cerebral perfusion and oxygen delivery in in-hospital cardiac arrest. We then evaluated the impact of perfusion targeted resuscitation by increasing real-time oxygen delivery using an automated mechanical CPR system (A-CPR) (Life Stat, Michigan Instruments, Michigan, USA) on return of spontaneous circulation (ROSC).

Results:
Cerebral oximetry provided real time information regarding the quality of perfusion and oxygen delivery. At baseline there was a significant difference in regional cerebral oxygen (rSO2) (mean% ±SE) in patients who achieved ROSC (n=7) compared to those without ROSC (n=15) (38%±3 vs. 22%±2 p<0.002) using conventional manual CPR (M-CPR). Furthermore at mean rSO2 below 30% nobody achieved ROSC. The use of A-CPR (n=12) led to a significant increase in rSO2 compared to M-CPR (n=22) (49%±3 vs. 27%±2 p<0.0001) as well as a significant increase in ROSC (75% vs. 45% p<0.05) reflecting the impact of improved oxygen delivery.

Discussion:
Real-time recognition and optimization of oxygen balance during resuscitation is critical. While further studies are needed to determine the optimal rSO2 required for longer term outcomes, the novel application of a system of continuous non-invasive real-time monitoring of the quality of oxygen delivery combined with measures aimed at improving this parameter may significantly alter the clinical practice of resuscitation by providing staff with timely information regarding the quality of cerebral oxygen delivery and the means to improve it which has so far been lacking.
Abstract 295: Gas Insufflation in the Stomach During Cardiopulmonary Resuscitation Using Laryngeal Tube Ventilation in Comparison with Bag-Valve-Mask Ventilation
Authors: Yamaga Satoshi , Une Kazunobu , Kyo Michihito , Suzuki Kei , Kobayashi Yasutake , Nakagawa Itsuo , Tanigawa Koichi
Published: April 2024

Background: Gastric gas insufflation is one of the major complications during cardiopulmonary resuscitation (CPR) using bag-valve-mask ventilation (BVM). Among alternative airways, a laryngeal tube (LT) has an esophageal cuff to avoid not only regurgitation of the gastric content, but also gastric gas insufflation. However, the efficacy of this device for preventing the latter complication during CPR remains unknown.

Objective: We aimed to compare the gastric gas volumes of patients with out-of-hospital cardiac arrest (OHCA) who received CPR with either BVM or LT ventilation in a prehospital setting.

Methods: This was a retrospective analysis using patient data. From January 2010 to December 2011, 148 OHCA patients with either BVM or LT ventilation were enrolled. We used computed tomographic (CT) scans to measure the gastric gas volume. The pulmonary infiltrates on CT were also evaluated as an indication of pulmonary aspiration. A nasogastric tube was not placed in the patients before CT.

Results: The patient background data are shown in the table. Fifty-nine (40%) had BVM ventilation (BVM group) and 89 (60%) had LT ventilation (LT group). The time spent at the scene was longer in the LT group than in the BVM group (p<0.001). The mean gas volumes in the stomach in the BVM and LT groups were 370.7±344.2 and 388.5±418.4 ml, respectively, with no significant difference. No significant differences were observed in the incidence of pulmonary infiltrates on CT between the groups.

Conclusions: We did not find any differences in the gastric gas volume and incidence of pulmonary aspiration between the BVM and LT groups. These data question the effectiveness of LT ventilation for preventing gastric gas insufflation during CPR. Further studies are required to confirm these findings.
Abstract 297: Modulation of Ischemia-Resuscitation Injury by TAT-Mediated PTEN Inhibitors
Authors: Zhu Xiangdong , Shao Zuo-Hui , Li Changqing , Li Jing , Zhong Qiang , Meliton Angelo , Meliton Lucille , Leff Alan R , Vanden Hoek Terry L
Published: April 2024

Introduction: Recent work shows that mouse cardiac arrest and heart cell ischemia cause PI3K-Akt deactivation, while cardioprotective cooling appears mediated by Akt. To further test the role of PI3K-Akt during ischemic arrest/resuscitation, we developed novel TAT-p85 fusion proteins designed to enter cells rapidly to modulate Akt activation. p85 can both activate Akt via p110 binding, and via feedback deactivate Akt by PTEN binding. We hypothesized that TAT fused p85 lacking the PTEN binding site (TAT-Delta PTEN p85) would enhance p-Akt cardioprotection. Conversely, TAT fused p85 lacking the p110 binding site (TAT-delta p110p85) would decrease p-Akt and abrogate protection.

Methods: A TAT-delta p110 p85 plasmid was constructed by deletion of nucleotides encoding amino acids 478-513. The TAT-delta PTEN p85 plasmid deleted amino acids 1-313. A TAT-GFP plasmid produced fluorescence-tagged TAT protein for measuring cell penetration kinetics. TAT proteins were expressed in E. Coli and purified. Cardiomyocytes were isolated from C57BL6/J mice and exposed to up to 90 min ischemic arrest with 3 h reperfusion (I/R). Cell viability was evaluated by propidium iodide uptake and p-Akt was measured by Western blot. PTEN activity was measured by Malachite green assay using PIP3 as substrate.

Results: Western blot analysis demonstrated that TAT-delta p110 p85 could be transduced into cardiomyocytes within 5 min and levels maintained for more than 2h. TAT-delta p110 p85 blocked H2O2 induced p-Akt at both S473 and T308 sites in a dose-dependent fashion, while PTEN inhibition using TAT-delta PTEN p85 increased p-Akt. During cardiac cell ischemic arrest, p-Akt decreased within 30 min of arrest time. PTEN activity during ischemia increased 2-fold from baseline and was inversely correlated with Akt phosphorylation during I/R. TAT-delta p110 p85 increased cell death from 44.6 +/- 2.7% to 92.5 +/- 3.4%, while TAT-delta PTEN p85 decreased cell death caused by I/R in a concentration-dependent manner from 47.8 +/- 1.4% to 11.9 +/- 5.3%.

Conclusions: We conclude that TAT-delta PTEN p85 with resulting PTEN inhibition may be a promising strategy to mimic and enhance protective cooling by more rapidly reactivating cellular Akt during heart ischemic arrest and resuscitation.
Abstract 299: The Cardioprotective Mechanism of a Recombinant Atrial Natriuretic Peptide Against Catecholamine-Induced Myocardial Injury in Acute Heart Failure
Authors: Murakami Wakako , Kobayashi Shigeki , Hino Akihiro , Fukuda Masakazu , Kato Takayoshi , Okuda Shinichi , Doi Masahiro , Yamamoto Takeshi , Yano Masafumi , Matsuzaki Masunori
Published: April 2024

Background:
Catecholamine induces intracellular reactive oxygen species (ROS), enhances abnormal Ca
2+
handling and leads to apoptosis in failing cardiomyocytes. We clarified the mechanism by which an exogenous atrial natriuretic peptide (ANP) exerts cardioprotective effect in patients with acute heart failure (HF).

Methods and Results:
Blood sampling from both coronary sinus and aorta showed that cardiac tissue produced 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage, in patients with HF(n=30), but not in control subjects (n=10). Urinary (U) 8-OHdG (ng/mg creatinine) also increased in only patients with HF(Control;8.0±2.0 vs HF; 14.8±2.5, p<0.05). As protocol 1, we examined whether an infusion of ANP (0.025 µg/kg/min) decreased levels of U-8-OHdG during the treatment of HF (n=15, for 3 days), as compared with that of nitroglycerin (NTG) (n=15, for 3 days). Either treatment with ANP or NTG similarly improved hemodynamic parameters and BNP. In ANP-treated group, however, U 8-OHdG significantly decreased as compared with in NTG-treated group (ANP: 9.8±3.5; NTG: 14.5±4.2, p<0.05). As Protocol 2, we investigated the effect of ANP on 1) intracellular ROS production by DCFH-DA, 2) local Ca
2+
release event by confocal microscopy using Fluo 4-AM, 3) myocyte apoptosis (TUNNEL staining) and survival rate after 48h in failing myocytes isolated from LV in canine tachycardia-induced HF(n=6, EF 20 ± 5%). In failing myocytes, isoproterenol (ISO) markedly increased intracellular ROS, concurrently with an increase in the frequency of Ca2+ sparks (SpF:s
-1
•100µm
-1
:HF: 8.0 ± 2.0 , Normal: 1.6 ± 0.5, p<0.01) . Interestingly, in failing myocytes, ANP(1x10
-8
mol/L) significantly suppressed the ISO-induced ROS production, SpF, and myocyte apoptosis respectively. Eventually, the survival rate (%)in failing myocytes was significantly lower in the presence of ISO than in its absence, while it was significantly improved by co-incubation of ISO plus ANP (ISO(-);59±12, ANP(+); 63±8, ISO(+);33±13, ISO plus ANP; 55±5, p<0.01).

Conclusions:
ANP has a potent antioxidant action against catecholamine-induced ROS, which may correct abnormal Ca
2+
release and inhibit myocyte apoptosis, eventually contribute to improvement of myocytes survival in HF.
Abstract 300: No Improved Outcome with Vasopressor Drugs or Sodium Nitroprusside in a 10-Minute Untreated VF Cardiac Arrest Model in Swine
Authors: Zuercher Mathias , Na Sang Hoon , Hilwig Ronald W , Ewy Gordon A , Kern Karl B
Published: April 2024

Background: The use of epinephrine to treat cardiac arrest is increasingly challenged. However, previous investigations have shown minimal favorable outcome without the use of vasopressors or surprisingly positive outcome using sodium-nitroprusside in a modified resuscitation protocol.

Hypothesis: Vasopressor support improves coronary perfusion pressure (CPP) and favorable 24h neurological outcome in prolonged cardiac arrest.

Methods: 35 domestic swine (33.5±5.5 kg) had VF electrically induced and left untreated for 10 minutes. Chest compression only (100/min) advanced life support was given for the first 3 of 7 epochs (2 min each) before ventilation with oxygen was started. Defibrillation attempts were made every 2 minutes. Animals were randomly assigned to one of 5 treatment groups: Placebo, epinephrine (0.045mg/kg), norepinephrine (0.025mg/kg), sodium-nitroprusside (0.0165 mg/kg) plus epinephrine (0.045mg/kg) or sodium-nitroprusside (0.0165 mg/kg). If the rhythm analysis at the beginning of epoch 3 to 7 did not show a perfusing rhythm, the assigned study drug was administered and the protocol continued until ROSC or 25 min, after which the animal was considered non-resuscitated. A swine cerebral performance category (CPC) was determined at 24 hours after onset of cardiac arrest. Data are presented as median and quartiles.

Results: ROSC was achieved in 22 (63%) animals and 12 (34%) survived for 24 hours with a favorable neurological outcome (CPC 1+2) in 10 (29%). There was no significant difference in between drug groups. Of these 10, seven achieved ROSC within the first two epochs before any study drug was administered. In the remaining three a vasopressor drug was administered. CPP (mmHg) was significantly higher in animals with favorable outcome during the first two epochs (Epoch 1: 29 (20/40) vs. 15 (10/19); Epoch 2: 18 (12/25) vs. 7 (3/13); p < 0.05).

Conclusion: Following four minutes of chest compressions and two defibrillation attempts, the administration of epinephrine, norepinephrine, sodium-nitroprusside plus epinephrine or sodium-nitroprusside alone did not influence 24-hour neurological outcome in a swine model of out-of-hospital VF cardiac arrest.
Abstract 311: Early Evaluation Biomarkers-Based of Neurological Prognosis in Hypothermic Post--Cardiac Arrest Patients
Authors: Cacciavillani Luisa , Gasparetto Nicola , Scarpa Daniele , Mion Monica , Brugnaro Luca , Marzari Armando , Zaninotto Martina , Salotti Chiara , Plebani Mario , Iliceto Sabino
Published: April 2024

Early prognosis of neurological outcome in patients resuscitated from cardiac arrest (CA) is a major medical challenge.

High serum levels of both serum neuron-specific enolase (NSE) and S-100B protein are related with brain damage, but the relationship with neurological outcome at hospital discharge, in hypothermic post CA patients, is uncertain.

The aim of this study was to evaluate the prognostic value and cut-off values of NSE and S-100B protein in predicting neurological outcome in comatose patients after CA treated with therapeutic hypothermia (TH).

Methods: We enrolled consecutive patients, between November 2010 and May 2012. NSE and S-100B values were sampled at admission and every 24 hours since discharge from intensive care unit. According to Cerebral Performance Category (CPC) scale, neurological outcome was dichotomized into good (CPC 1-2) or poor (CPC 3-5).

Results: thirty-one patients (25 males; mean age 60±15years). Twenty patients had a favourable outcome. Median values of serum NSE peak and S-100B peak were 25 ug/L (interquartile range, 20.8 to 43.3 ug/L) and 0.3 ug/L (range, 0.15 to 0.7 ug/L) respectively. High peak values of NSE and S-100B were significantly associated with poor neurological outcome (p=0.015 and p=0.007 respectively). Using a regression tree model we found worst neurological recovery for NSE peak value above 64.7 ug/L or S-100B above 0.65 ug/L (p=0.01 and p=0.007 respectively). Good neurological outcome was associated with NSE peak value less than 40.5 ug/L (p=0.012) especially if S-100B was less than 0.23 ug/L (p=0.031) (figure).

Conclusion: Serum peak concentrations of NSE and S-100B result to be highly predictive of neurological outcome, especially when combined. Moreover, our data demonstrate that a good neurological outcome is associated with NSE peak value minor than 40.5 ug/L especially with S-100B minor than 0.23 ug/L. On this basis, determination of NSE and S-100B peak values may be useful in the early evaluation of prognostic neurological outcome to guide clinical decision making, in hypothermic post CA patients.
Abstract 315: Both Systemic and Cerebral Microcirculation Are Reduced During Hypothermia in a Porcine Model
Authors: Ma Linhao , Xu Jiefeng , Lu Xiaoye , Wu Xiaobo , Sun Shijie , Tang Wanchun
Published: April 2024

Introduction:
Mild hypothermia improves neurological outcomes after cardiac arrest. However, systemic microcirculation is reduced with the reduction of body temperature. We investigated the changes of cerebral (CM) and sublingual microcirculation (SM) during hypothermia in a porcine model during spontaneous circulation and following successful cardiopulmonary resuscitation.

Hypothesis:
We hypothesized that during spontaneous circulation and following CPR, SM is reduced with the progress of hypothermia. However, CM is preserved in the range of mild hypothermia.

Methods:
Ten domestic pigs weighing 34±1kg were randomized into spontaneous circulation control or CPR groups. The cerebral cortices were exposed for microcirculation measurement. In CPR group, ventricular fibrillation (VF) was induced and untreated for 5 mins. Defibrillation of 150J was attempted after 5 mins of CPR. Hypothermia was initiated after completion of animal preparation in control group and immediately following successful resuscitation in CPR group. The blood temperature was reduced from 37°C to 35°C, 33°C and 28°C with a cooling blanket. SM and CM was measured at each temperature point with the orthogonal polarization spectral imaging technique.

Results:
Microcirculatory blood flow index and perfused microvessel density of both SM and CM decreased with the progress of hypothermia in both groups. There was no statistical difference between the two groups. (Table)

Conclusion:
CM is reduced with the reduction of body temperature during spontaneous circulation and following CPR. The relationship between reduced CM during hypothermia and improved neurological outcomes following hypothermia remains to be investigated.
Abstract 324: Automated Classification of Proximal Left Anterior Descending and Proximal Right Coronary Artery Occlusion from More Distal Locations in ST-Segment Elevation Myocardial Infarction
Authors: Gregg Richard E , Fiol Miquel , Carrillo Andrés , Chien Cheng-hao S , Nikus Kjell C
Published: April 2024

Background:
Rapid classification of the occlusion location in the coronary artery tree during ST-elevation myocardial infarction (STEMI) can be used for further risk stratification. In this study, we introduce and characterize a complete automated algorithm for classifying occlusion location as left circumflex, or proximal or middle-to-distal in the left anterior descending and right coronary artery in STEMI.

Methods:
The new algorithm was developed and tested on two separate sets of ECGs using multiple decision trees optimized for high specificity. The development set of ECGs came from the emergency department of a large hospital. The test set of ECGs came from a prehospital emergency medical service using inclusion criteria of STEMI and angiogram confirmation of single culprit artery and lesion location (n=132). LBBB and paced ECGs were excluded. All left circumflex (LCx) locations (n=31) were lumped together. The split between proximal right coronary artery (RCA) lesion location (n=51) and middle-to-distal RCA location (n=50) was defined as above the acute marginal branch. Proximal lesion for the left anterior descending (LAD) coronary artery was defined as above the first major diagonal side branch. All patients met current age and gender based STEMI criteria. Accuracy of lesion location prediction was based on sensitivity and specificity calculated from a 2X2 table with the two groups as lesion location and other.

Results:
The automated algorithm classifies proximal LAD lesion location with a sensitivity and specificity of 75% and 94% respectively and sensitivity and specificity of 57% and 99% for proximal RCA lesion location.

Conclusion:
Since proximal lesion location indicates higher risk for both LAD and RCA, the classifier was designed for higher specificity and the specificity within STEMI cases was shown to be 94% and higher. High specificity is necessary for confidence in the classification before altering treatment. An automated algorithm for proximal lesion location allows for rapid risk assessment which should result in a valuable clinical decision support tool.
Abstract 326: Direct Ventricular Compression Improves Mechanical Synchrony of the Acutely Failing Heart
Authors: Schmitt Benjamin A , Garvin Nicholas J , Budharaju Subbaraju , Reynolds David B , Darner Rebecca J , Prochaska Lawrence J , Anstadt Mark P
Published: April 2024

Introduction: Mechanical dyssynchrony during acute cardiac failure contributes to ventricular dysfunction. Direct Mechanical Ventricular Actuation (DMVA) provides non-blood-contacting augmentation of systolic and diastolic ventricular function. The purpose of this study was to determine if DMVA can improve mechanical synchrony in the acutely failing heart.

Methods: New Zealand white rabbits (n = 10) were anesthetized, underwent sternotomy, and instrumented for arterial pressures and aortic flow. A 10 MHz transvascular ultrasound probe acquired two-chambered, long-axis transesophageal ventricular images. Heart failure (50% of baseline cardiac output) was modeled using a titrated Esmolol drip. Phenylephrine maintained mean arterial pressure between 60 -70 mm Hg as needed. LV images were analyzed using Siemens speckle tracking software. The LV was divided into six regions which were analyzed for peak strain rate and time to peak strain rate. Average peak systolic and diastolic strain rates were used to assess global myocardial function. Synchrony was determined by analyzing the standard deviation of regional time differences between peak systolic strain rates (dyssynchrony index).

Results: Systolic and diastolic global strain rates were significantly reduced during failure and significantly augmented to near normal during DMVA support. Following a similar relationship, DMVA significantly improved mechanical synchrony during acute heart failure. Recovery strain rates and synchrony were significantly improved vs. failure but did not return to baseline values.

Conclusion: DMVA effectively augments myocardial function in the acutely failing heart. The improvements in pump function are associated with normalization of mechanical synchrony. DMVA’s ability to restore mechanical synchrony during resuscitative ventricular support has favorable implications on cardiac recovery.
Abstract 328: Translating Guidelines into Practice: A Survey Study to Assess Healthcare Provider Attitudes, Preferences and Beliefs Regarding Pediatric Fluid Resuscitation Practices
Authors: Manan Asmaa , Parker Melissa J
Published: April 2024

Introduction: Children who require fluid resuscitation for the treatment of shock present to tertiary and non-tertiary medical settings. While timely fluid therapy improves survival odds and is accepted as a key component of initial resuscitative care, guidelines are poorly translated into clinical practice.

Objective: To characterize the attitudes, preferences and beliefs of health care providers regarding pediatric fluid resuscitation practices. Hypothesis: Varying attitudes and beliefs concerning pediatric fluid resuscitation performance would exist among providers who frequently resuscitate children. Methods: A single-centre survey study was conducted at McMaster Children’s Hospital from January to May, 2012. The sampling frame (n=111) included nursing staff, physician staff and subspecialty trainees working in Pediatric Emergency Medicine (PEM) or Pediatric Critical Care Medicine (PCCM). A self-administered questionnaire was developed and assessed for face validity prior to distribution. Eligible participants were invited at 0, 2, and 4 weeks to complete a web-based version of the survey. A follow-up survey administration phase utilizing a tablet-based version of the survey was conducted to improve the response rate.

Results: Response rate was 75% (83/111), with 83% identifying themselves as nursing staff and 61% as PCCM providers. Resuscitation experience, frequency of shock management, and years in specialty, were similar between PCCM and PEM responders. Physicians and nurses had differing opinions regarding the most effective method to achieve rapid fluid resuscitation in young children presenting in shock (p<0.001). Disagreement also existed regarding the age and size of patients in whom rapid infuser devices, such as the Level-1 Rapid Infuser, should be used (p<0.001). Providers endorsed a number of potential concerns related to the use of rapid infuser devices in children, and only 14% of physicians and 55% of nursing staff felt that they had received adequate training in the use of such devices (p=0.005).

Conclusions: There is a lack of consensus among health care providers regarding how pediatric fluid resuscitation guidelines should be operationalized, supporting a need for further work to define best practices.
Abstract 338: Abdominal Fat Suspension Device for Maintaining Normal Cardiorespiratory Function in Obese Patients Undergoing Conscious Sedation During Surgery
Authors: Truong Norman F , Yoon Daeun , Ochoa Gabriel , Prevost Marisa , Yun Sehyun , Oden Z Maria , Razavi Mehdi
Published: April 2024

Introduction:
Obese patients undergoing surgical procedures that require conscious sedation have a heightened risk of perioperative morbidity because their excess abdominal tissue limits diaphragmatic excursion. We describe a simple, intuitive device that may help attenuate this increased risk.

Methods:
Our abdominal suspension device consists of 4 suction cups that grip onto the abdomen. The cups are attached to a horizontal beam that is supported by a height-adjustable frame anchored to both sides of the operating table. To confirm the efficacy of abdominal suspension for relieving stress on the heart, we tested 30 healthy subjects of normal weight in the supine position. We measured their heart rates with and without a 40-lb tissue model that was placed on the abdomen to simulate the excess abdominal weight seen in obese patients.

Results:
There was no significant difference in the average blood oxygen saturations before and after weight removal (97.7% vs. 97.5%, respectively;
P
=0.155). However, the decrease in heart rate was significant [76.2 vs. 68.9 beats/min, respectively, before and after weight removal;
P
<0.01 (
P
=4.36×10
-6
)], implying decreased respiratory effort as determined by a 1-tailed paired
t
test.

Conclusion:
By helping to maintain normal cardiorespiratory function in obese patients during surgical procedures requiring conscious sedation, our abdominal suspension device shows great promise for reducing unnecessary cardiac stress and preventing perioperative respiratory complications.
Abstract 45: Medically Educated Bystanders Start CPR Faster than Laypersons and Triple Survival Rates Compared with When No CPR Is Given in OHCA
Authors: Hasselqvist-Ax Ingela , Herlitz Johan , Hollenberg Jacob , Axelsson Christer , Lindqvist Jonny , Svensson Leif
Published: April 2024

Background:
There has been criticism raised against the value of CPR, whether the result of CPR education merely represents a more awareness of the critical situation thus initiating a more prompt call to dispatching centre and earlier start of CPR, rather than the fact that CPR are given.

Aims:
To explore different time frames in regards to whether the bystander is Lay persons or Medical educated, and to compare outcome between the two groups of bystanders.

Methods:
All patients in the Swedish Cardiac Arrest Registry who had a bystander witnessed out-of-hospital cardiac arrest between 1990 and 2010. This survey was divided into three groups: “No bystander CPR”, “Lay person bystander CPR” and “Medical educated bystander CPR”.

Results:
In all 28 888 patients were included and information on delays from collapse to call and start of CPR was available in 80 %. The mean age was highest (76 years) in the “No CPR” group. Cardiac arrest occurred at home more often (73%) in the “No CPR” and “Lay person” (62%) compared to the “Medical educated” group (33%). There were no differences between the groups in regards to delay from collapse to call (median 3 minutes in all). The median delay between collapse and start of CPR was 12 minutes in the “No CPR” , 6 minutes in the “Lay person” and after 3 minutes in the “Medical educated” group. Survival to 1 month was 4.0% (“No CPR”), 8.4% (“Lay person”) and 13.2% in the “Medical educated” group. Adjusted Odds Ratio (OR) for survival (“lay person” versus “No CPR”) was 2.49 [CI:2.13-2.92]. The corresponding figure for “Medical educated group” versus “No CPR” was 2.84 [2.35-3.44]. Adjusted OR (“Medical educated group” versus “Lay person”) was 1.18 [0.98-1.41].

Conclusions:
Bystander CPR was associated with an increase in survival to one month regardless whether it was performed by Medical educated persons or Lay persons. Medical educated persons started CPR more rapidly than Lay persons. When adjusting for confounders CPR given by Medical educated persons did not significantly differ from CPR given by Lay persons in terms of survival to one month.
Abstract 50: Time to Defibrillation in Witnessed Out-of-Hospital Cardiac Arrest: Impact on Survival Chances Between Elderly and Younger Patients
Authors: Keuper W , Brouwer M A , Bonnes J L , Karlsson T , Lindqvist J , Smeets J L , Verheugt F W , Herlitz J
Published: April 2024

Background

Guidelines state that with each minute of delay between the onset of an out-of-hospital cardiac arrest (OHCA) and the first defibrillation survival decreases with 3-4% in case of bystander cardiopulmonary resuscitation (CPR), as compared to 7-10% without CPR. Whether this decrease in survival is more pronounced with aging is unknown. We study how survival varies per minute delay between onset of VF and the first defibrillation in general, and the association with age in particular.

Methods

Patients with a non-crew witnessed OHCA and VF as presenting rhythm were selected from a 50,000 patient cohort, the prospective Swedish Cardiac Arrest Registry. CPR was performed according to guidelines 2000. Predictors of 1-month survival were assessed according to age (< 70 and ≥ 70 years) and bystander CPR status (yes/no). Interactions between age, bystander CPR, time and 1-month survival were studied.

Results

In total 7,158 patients were studied. Bystander CPR was provided in 48% and 1-month survival was 11% (n=772). Independent predictors of survival were age, time from cardiac arrest to bystander CPR and from cardiac arrest to first defibrillation. Per minute delay to defibrillation, the decrease in survival was 11.6% (9.9-13.3%) in patients with bystander CPR and 17.1% (14.1-20.0%) in patients without bystander CPR. For patients < 70 years with bystander CPR the decrease in survival per minute delay was 12.8% (10.6-15.0%) versus 9.9% (7.3-12.4%) for patients ≥ 70 years. Without bystander CPR the decrease in survival per minute delay for patients < 70 and ≥ 70 years was 14.9% (10.6-19.0%) and 19.2% (14.9-23.3%) respectively. No interactions between age, time from cardiac arrest to defibrillation and survival were found.

Conclusion

In this large prospective registry, the relative decrease in survival per minute delay until defibrillation is 10 to 20%, for cases with and without bystander CPR respectively. These figures are much higher than the reported delays in the guidelines, based upon smaller studies. The observed relative decrease in survival per minute delay to first defibrillation did not differ between younger patients and the elderly. Future studies should address these questions for resuscitation according to the 2010 guidelines.
Abstract 17896: Activation of Innate Immunity is Required for Efficient Nuclear Reprogramming and Endothelial Differentiation
Authors: Sayed Nazish , Lee Jieun , Cooke John
Published: April 2024

Nazish Sayed, 2012 Finalist and Presenting Author
Abstract 14763: Hypoxia-Mediated Activation of Notch Signaling Enhances Store-Operated Calcium Entry in Pulmonary Arterial Smooth Muscle Cells
Authors: Smith Kimberly A. , Gou Qiang , Yamamura Aya , Yamamura Hisao , Yuan Jason X.-J
Published: April 2024

Kimberly A. Smith, 2012 Finalist and Presenting Author
Abstract 10794:Intubation Does Not Result in a Survival Advantage in a Swine Hemorrhagic Shock Model Simulating Penetrating Trauma
Authors: Taghavi Sharven , Jayarajan Senthil , Khoche Swapnil , Duran Jason , Milner Rich , Holt-Bright Lewis , Gaughan John , Rappold Joseph , Sjoholm Lars , Dujon Jay , Pathak Abhijit , Santora Thomas , Houser Steven , Goldberg Amy
Published: April 2024

2012 Finalist and Presenting Author
Abstract 51: Prognostic Implication of Initial Coagulopathy in Out-of-Hospital Cardiac Arrest
Authors: Kim Joonghee , Kim Kyuseok , Lee Jae Hyuk , Jo You Hwan , Kim Tae Yun , Rhee Joong Eui , Kang Kyeong Won
Published: April 2024

Objective: We sought to investigate the prognostic implication of early coagulopathy represented by initial DIC score in out-of-hospital cardiac arrest (OHCA).

Methods: OHCA registry was analyzed to identify patients with ROSC without recent use of anticoagulant between 2008 and 2011. Patients were assessed for prehosptial factors, initial laboratory results and therapeutic hypothermia. Outcome variables were survival discharge, 6-month CPC and survival duration within the first week after ROSC. Logistic regression and Cox-proportional hazards model were used for both univariate and multivariate analysis.

Results: Among 273 eligible patients, initial DIC score was available in 252 (92.3%). Higher DIC score was associated with increased inhospital death (odds ratio [OR], 1.89 per unit; 95% confidence interval [CI], 1.48-2.41) and unfavorable long-term outcome (6-month CPC 3-5; OR, 2.21 per unit; 95% CI, 1.60-3.05). The adjusted ORs for both outcomes were 1.61 (95% CI, 1.17-2.22) and 1.84 (95% CI, 1.26-2.67), respectively. We categorized DIC score in five groups as <3, 3, 4, 5 and >5 and analyzed differential mortality risk using Cox- proportional hazards model. Compared with reference group (DIC score <3), the adjusted HR for early mortality in each remaining group was 1.96 (95% CI, 1.13-3.40), 2.26 (95% CI, 1.27-4.02), 2.77 (95% CI, 1.58-4.85) and 4.29 (95% CI, 2.22-8.30), respectively (p-trend <.001). The area under the receiver operating characteristic of DIC score for prediction of unfavorable long-term outcome was 0.79 (95% CI, 0.69-0.88).

Conclusion: Increased initial DIC score in OHCA was an independent predictor for poor outcomes and early mortality risk.

Uploaded image: Kaplan-Meier plots for cumulative 1-week survival of five DIC score groups; Log-rank test for difference (p <.001, p-trend <.001)
Abstract 11976: Left ventricular Mass in Young Healthy Adults Predicts 20-year Clinical Cardiovascular Events Beyond the Global Cardiovascular Framingham 10 Year Risk Score: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Armstrong Anderson C , Gidding Samuel S , Colangelo Laura A , Gjesdal Ola , Liu Kiang , Lewis Cora E , Bibbins-Domingo Kirsten , Sidney Stephen , Schreiner Pamela J , Jacobs David R , Williams O. D , Goff David C , Lima Joao AC.
Published: April 2024

Anderson C Armstrong, 2012 Finalist and Presenting Author
Abstract 17369: Sumoylation Regulates Nuclear Localization and Function of Zinc Finger Transcription Factor ZIC3
Authors: Chen Li , Ma Yanlin , Wang Jun
Published: April 2024

Li Chen, 2012 Finalist and Presenting Author
Abstract 18108: Performing Dual Contrast Cardiac MRI to Determine the Underlying Mechanism of Cell-based Therapy
Authors: Kim Paul J , Ge Xiaohu , Toma Ildiko , Gong Yongquan , Chang Paul , Harnish Phillip , Yang Phillip
Published: April 2024

Paul J Kim, 2012 Finalist and Presenting Author
Abstract 14534: Sarcoplasmic Reticulum Ca2+ Release via Ryanodine Receptor Type-2 Promotes Maintenance to Chronic Atrial Fibrillation
Authors: Li Na , Chiang David Y , Ather Sameer , Schmitz Wilhelm , Müller Frank U , Dobrev Dobromir , Dobrev Dobromir , Wehrens Xander H
Published: April 2024

Na Li, 2012 Finalist and Presenting Author
Abstract 9961: Semaphorin-induced Inflammation Contributes to Insulin Resistance in Dietary Obesity
Authors: Shimizu Ippei , Yoshida Yohko , Moriya Junji , Katsuno Taro , Suda Masayoshi , Kobayashi Yoshio , Minamino Tohru
Published: April 2024

Ippei Shimizu, 2012 Finalist and Presenting Author
Abstract 14415: The Sumo Protease Senp2 Regulates Endothelial Dysfunction and Subsequent Atherosclerosis Formation
Authors: Heo Kyungsun , Chang Eugene , Le Nhat-tu , Cushman Hannah , Yeh Edward T.H. , Fujiwara Keigi , Abe Jun-ichi
Published: April 2024

Kyungsun Heo, 2012 Finalist and Presenting Author
Abstract 15126: Weight and Risk Factor Modification: Impact on Atrial Fibrillation
Authors: Abed Hany S , Gary A Wittert , Melissa E Middledorp , Masoumeh G Shirazi , Bobak Bahrami , Darryl P Leong , Michelle F Lorimer , Dennis H Lau , Anthony G Brooks , Walter P Abhayaratna , Jonathan M Kalman , Prashanthan Sanders
Published: April 2024

Hany S Abed, 2012 Finalist and Presenting Author
Abstract 16619: Bendopnea, a Novel Symptom of Heart Failure, is Mediated via Elevated Left Ventricular Filling Pressures
Authors: Thibodeau Jennifer T. , Aslan T. Turer , Sarah K Gualano , Colby R Ayers , Joseph D. Mishkin , Parag C. Patel , Pradeep P.A. Mammen , David W. Markham , Benjamin D. Levine , Mark H. Drazner
Published: April 2024

Jennifer T. Thibodeau, 2012 Finalist and Presenting Author
Abstract 11298: Aged Human Cells Rejuvenated by Cytokine-Enhancement of Biomaterials for Surgical Ventricular Restoration
Authors: Sun Lu , Kang Kai , Xiao Yun , Li Shu-Hong , Wu Jun , Yau Terrence M , Weisel Richard D , Radisic Milica , Li Ren-Ke
Published: April 2024

Lu Sun, 2012 Finalist and Presenting Author
Adventures (and Misadventures) on the Road to Understand (and Reduce) Disparities in Stroke Mortality
Authors: Howard George
Published: April 2024

Racial and geographic disparities in stroke mortality have existed for over a half-century, and between ages of 45 to 65 are among the largest for any disease. For much of this period, the causes of the disparities have been mysterious; however, investments by NINDS and NHLBI are now providing insights regarding the causes of these disparities.

Diverse and complementary study designs provide information on different aspects of the disparities in stroke. Vital statistics data track temporal patterns in stroke mortality, perhaps the ultimate index of the success in overcoming the disparities. Surveillance studies allow assessment of the contributions of incidence versus case fatality to the disparities in vital statistics mortality data, a distinction critical to effort to reduce the disparities. Finally, cohort studies give insights to the contribution of specific risk factors to disparities in either incidence or case fatality, allowing targeted interventions to be effective.

While deaths from stroke mortality declined by a third over the most recent nine year period, there has been a 35% increase in the black-white disparity and little change in geographic disparities. Surveillance studies suggest that the black-white disparity is primarily attributable to differences in incidence, and also have unmasked Hispanic-white differences in incidence that are not apparent in mortality trends. Longitudinal cohort studies are suggesting multiple targets for intervention such as a multi-dimensional impact of blood pressure on the black-white differences, and indications that diet may be contributing to geographic disparities.

The vital statistics mortality data currently provide a mixed message, with falling stroke mortality for all groups, but a more rapid fall for whites contributing to an increase in the magnitude of racial disparities in stroke. After suffering these disparities over a half-century, information is now emerging to allow us to better understand the underpinnings of the disparities and potentially enter a new era of targeted interventions to reduce these disparities.
Complex Heart Defects of the Neonate: A Personal View
Authors: Norwood William
Published: April 2024

I believe pediatric cardiologists and congenital heart surgeons must and do work hand-in-glove like no other medical/surgical specialists. Helen Brook Taussig and Alfred Blalock were an early testament to such a notion, albeit I understand Doctor Taussig didn't fully embrace the concept of reparative surgery for tetralogy of Fallot late in her career at Johns Hopkins University.

One evening in the late 1970s I walked through the ICU and there in the corner was a normal looking baby swaddled in a blanket. “Who is this,” I asked. “She's a cardiology patient. She's going to die, nothing can be done.” “Really, what's wrong?” “She has HLHS.” Well, believe it or not, I don't recall knowing anything about HLHS before that night. I quizzed my cardiology colleagues who knew more than I, but not a lot more. I'm not going to say much about HLHS surgery other than it flew in the face of a number of strongly held prejudices at the time and that surgery was necessarily performed in the neonatal period facilitated by DHCA.

Innovation is the life's blood of medicine. In 2008 I was invited to attend rounds at Children's Hospital of Boston and was asked whether I thought our earliest efforts with surgery for HLHS would be possible today. I answered, ''Probably not.'' This somewhat pessimistic view does not reflect a belief that the potential for physician-surgeon collaboration that is so essential to innovation is less now than it was in the era of Taussig and Blalock. Rather, it reflects the realities imposed today by a multi-layered bureaucracy of administrators and regulators who “manage” innovation under the watchful eye of trial lawyers.
Asymptomatic Valvular Heart Disease: Can Earlier Intervention Be Justified?
Authors: O'Gara Patrick
Published: April 2024

Advances in cardiac surgical techniques and peri-operative management over the past 2 decades have led to improved patient outcomes and frame-shifted the timing of operation to an earlier stage in the natural history of valvular heart disease. Both US and European guidelines recommend valve replacement surgery for asymptomatic patients with left ventricular systolic dysfunction as defined by the specific valve lesion. The debate regarding the optimal approach to the patient with severe valvular heart disease and preserved systolic function has yet to be informed by prospective randomized trials, performance of which is challenged by lack of equipoise, cost, and funding. Individual considerations in the older population are particularly challenging, given the trade-offs between surgical risk and the desire to maximize the time over which a full, functional recovery might be enjoyed. A mandate that surgery for the asymptomatic patient be performed in centers of excellence cannot be enforced in the absence of clear and transparent definitions. Lastly, the excitement surrounding trans-catheter valve intervention poses a risk for its application in increasingly healthier patient populations. It is hoped that the heart team approach will enable balanced decision-making in collaboration with an informed patient, until properly designed randomized prospective studies are completed. A national effort will be required to reach this goal.