bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract Sa1207: Reducing Socioeconomic Disparities in Out-of-Hospital Cardiac Arrests in Denmark through 30-minute, Cost-free Cardiopulmonary Resuscitation Courses
Authors: Knudsen Emma-Emilie , Malta Hansen Carolina , Folke Fredrik , Pervez Sheikh Annam , Ersbøll Annette Kjær , Torp-Pedersen Christian , Juul Grabmayr Anne
Published: November 2024

Background:
The Danish Heart Foundation has offered 30-minute, cost-free, and easily accessible Save-a-Life courses to disseminate CPR training since 2017.

Research Question:
Can Save-a-Life courses effectively reach neighbourhoods with low socioeconomic status and reduce socioeconomic disparities in OHCA?

Aim:
To investigate the distribution of Save-a-Life courses according to area-level educational or income status.

Methods:
We included Save-a-Life courses in residential areas in Denmark (2017-2023). Save-a-Life courses were geocoded using QGIS3 and merged with demographic data organized within 100x100 meter grid cells from the Danish Grid System (2020). Data were provided by the Danish Heart Foundation and Statistics Denmark. Socioeconomic status was assessed by 1) area-level educational status, defined as the percentage of inhabitants with primary or lower secondary school as their highest education (High: 0-25%, Middle: 25-50%, Low: 50-100%), and 2) area-level income status, defined as mean household income divided into quartiles (High, Upper-middle, Lower-middle, Low). We compared course participation (participants/1,000 inhabitants) by educational or income status using a Poisson regression model, presented as risk ratio (RR). Educational status was adjusted for age and ethnicity, while income status was adjusted for age, educational status, and ethnicity.

Results:
A total of 9,123 Save-a-Life courses with 84,641 participants were included, covering 426,225 grid cells with 5,814,763 inhabitants. Areal-level characteristics and distribution of Save-a-Life courses are shown in Tables 1 and 2.

Areas with high educational status had 14 participants/1,000 inhabitants (RR=1, reference); middle had 18 participants/1,000 inhabitants (RR=1.26, 95% CI 1.23-1.28); and low had 23 participants/1,000 inhabitants (RR=1.32, 95% CI 1.24-1.4).

Areas with high income status had 14 participants/1,000 inhabitants (RR=1, reference), upper-middle had 12 participants/1,000 inhabitants (RR=0.84, 95% CI 0.82-0.86), lower-middle had 13 participants/1,000 inhabitants (RR=0.83, 95% CI 0.81-0.84), and low had 16 participants/1,000 inhabitants (RR=1.03, 95% CI 1.01-1.05).

Conclusion:
Areas with low educational or income status had higher course participation compared to high-status areas. This indicates that the distribution strategy for Save-a-Life courses effectively reach neighborhoods with low socioeconomic status, potentially mitigating socioeconomic disparities in OHCA.
Abstract Sa1208: Survive and Thrive: Implementing a Post Cardiac Arrest Workflow in a Rural Regional Hospital
Authors: Gibbons Jacqueline , Nelson Andrea , Galligan Katelyn , Ohnstad Ryan , Ogundeji Shawna , Corser Joseph
Published: November 2024

Throughout the world, neurologically intact survival to discharge remains low. The Joint Commission (TJC) released post resuscitation requirements in January of 2022. Sanford Bemidji reviewed options that would meet the TJC requirements: Transfer the patient or develop a novel way to meet those needs in the current setting. With the latter, the positive impact on patients is significant in that they receive a high care level of care close to home without delay in care.

Sanford Bemidji Medical Center is a rural regional 118-bed hospital in Minnesota with a 14-bed Intensive Care unit. We are unique in that despite our size we serve a large regional footprint of over 100,000 people including three Native American reservations. Our objective was to utilize evidence based guidelines to implement a post cardiac arrest care (PCAC) workflow for adult cardiac arrest patients who obtain return of spontaneous circulation (ROSC) by end of first quarter 2023. The project incorporated low cost equipment and staff training. We used the Plan, Do, Study, Act cycle for our methodology. The outcome metric was neurologically intact survival to hospital discharge. Process metrics included placement and use of the ROSC order set, fever avoidance, rapid EEG completed, MAP over 65, and oxygen saturations of 92-98%. Sixty-one adult patients (both in hospital and out of hospital) suffered cardiac arrest at Sanford Bemidji in the 9 months following project implementation in 2023. Demographics included 3 native americans and 2 caucasians, ages 57-73, 3 males and 2 females. Our overall survival rate remained above the national average. For the few patients who met criteria for ROSC interventions, 4 of 5 (80%) received the ROSC interventions, 2 of 4 (50%) survived hospital to discharge neurologically intact. Results showed an increase in maintaining optimal MAP from 81% in 2022 to 100% in 2023 and achieving oxygen saturation parameters 80% of the time in 2023 compared to 66% in 2022. Real time monitoring and coaching of the order set is needed to increase utilization of the order set in full (fever avoidance was at 20% and rapid EEG completed in 40% of cases with a goal of 100% for both).

More data is needed to ascertain the outcomes of a ROSC workflow in like sized hospitals with similar resources. The novelty of this innovative project is in the implementation of an evidence based PCAC workflow in a 118-bed rural hospital giving all cardiac arrest patients a chance for a full recovery.
Abstract Sa201: Effect of Spontaneous Gasping on Intraventricular Volume and Pressure during Untreated Ventricular Fibrillation
Authors: Pourzand Pouria , Kent Bailey , Suresh Mithun , Moore Johanna , Salverda Bayert , Metzger Anja , Segond Nicolas , Debaty Guillaume , Hai Hamza , Lurie Keith
Published: November 2024

Background:
Spontaneous gasping or agonal respiration during cardiac arrest is an auto-resuscitative reflex. Patients who gasp during cardiac arrest have better outcomes, regardless of the presenting rhythm. The physiological effects of gasping are similar to taking a deep breath: intrathoracic and intracranial pressure decrease, respiratory gas enters the lungs, venous blood refills the right ventricle (RV). Impedance threshold device (ITD) resistance to inspiration, with or without CPR, further reduces intrathoracic pressure. This study tested the hypothesis that gasping during untreated ventricular fibrillation (VF) would increase left ventricular (LV) and RV pressure and volume, and that ITD use would accentuate these effects.

Method:
13 male and female pigs were anesthetized, intubated and mechanically ventilated. VF was induced and left untreated for 10 minutes. Hemodynamics, including biventricular pressure and volume loops using intracardiac conductance catheters were recorded during spontaneous gasping. An ITD, attached to the endotracheal tube, was used intermittently in each pig. Values (mean ± SE) were compared using the mixed-effects model, accounting for animal-to-animal variability and repeated measurements.

Results:
Baseline RV and LV stroke volumes (ml) were 52.2 ± 4.0 and 49.7 ± 6.9, respectively, before VF. A total of 84 gasps were recorded during untreated VF in all animals: 56 without and 28 with an ITD. There were 11.7 ± 1.0 gasps per pig starting 116.5 ± 6.4 seconds after VF. Gasping intensity followed a crescendo/decrescendo pattern with an initial negative inspiratory phase and a positive expiratory phase. ITD use during gasping significantly decreased in airway pressure (-11.0 ± 0.5 vs -1.8 ± 0.5, p<0.01) versus no ITD. The intraventricular volumes and pressures (mmHg) generated during gasping increased significantly from no ITD to ITD use: RV volume 27.8 ± 3.5 vs 41.4 ± 3.8, p<0.01; RV pressure 14.7 ± 2.2. vs 18.7 ± 2.3, p<0.01, and LV volume 15.0 ± 2.5 vs 19.6 ± 2.8 p=0.053; LV pressure 19.3 ± 3.2 vs 25.8 ± 3.5, p<0.01.

Conclusion:
Gasping during untreated VF generated RV and LV volumes and pressures of ~ 55% and 27% of pre-VF diastolic values, respectively, while using an ITD increased generated RV and LV volumes and pressures to ~ 85% and 36% of pre-VF diastolic values, respectively. These findings demonstrate the mechanism by which gasping enhances circulation and the clinical importance of this fundamental auto-reflex.
Abstract Sa203: Association between dynamic cerebral perfusion indices by NIRS and cerebral microvascular flow during CPR in a porcine cardiac arrest model
Authors: Kiguchi Takeyuki , Nishioka Norihiro , Kamo Wataru , Ninomiya Kouhei , Makino Yuto , Kamada tsuyoshi , Maeda Hideki , Iwami Taku
Published: November 2024

Background:
Maintaining cerebral blood flow during cardiopulmonary resuscitation (CPR) significantly impacts the neurological outcome of patients after cardiac arrest. However, dynamic indicator of cerebral blood flow during CPR is not established. Near infrared spectroscopy (NIRS) can continuously detect cerebral blood volume changes in a non-invasive way. The aim of this study is to compare cerebral perfusion during CPR obtained by NIRS-based assessment of continuous cerebral perfusion indices (CPI) with cerebral microvascular flow (CMF) using laser doppler flowmetry (LDF) in a ventricular fibrillation (VF) porcine model with free intracranial pressure (ICP).

Methods:
CPI and CMF during CPR were measured in 5 swine (40± 3 kg). After craniotomy and head up condition to create free ICP environment, NIRS probe was placed on brain surface directly in the middle of the craniotomy. In the upper left or right corner of the craniotomy, an LDF probe was inserted to measure cortical CMF. Aortic blood pressure (ABP) was measured at same time to assess the quality of chest compression. Following baseline measurements, VF was electrically induced. After the interval of 6 min untreated VF, CPR was continued for 24 min, during which mechanical and manual CPR was alternated at every 4 min intervals. To make a variety of cerebral blood flow by chest compressions, high quality CPR was performed during Mechanical CPR while low quality CPR was purposely performed during manual. CPI, CMF and ABP were measured continuously during CPR. Each median value in 5 sec was regarded as trend. Correlations between CPI and CMF, as well as CPI and ABP, were analyzed by Pearson correlation coefficient and Spearman's rank correlation.

Results:
Poor data measurements were observed in 2 out of 5 cases for CPI and in 3 cases for CMF. One of 5 cases were eligible for analysis. The followability of CPI to CMF and ABP during CPR was good. CPI and CMF tended to increase during high quality CPR, while both CPI and CMF decreased during low quality CPR (Figure). Pearson's correlation coefficient and Spearman's rank correlation coefficient between CPI and CMF during CPR of analyzable data were 0.71 (p < 0.001) and 0.52 (p < 0.001), respectively. Similarly, CPI and ABP were 0.86 (p<0.001) and 0.67 (p<0.001).

Conclusions:
It was suggested that CPI by NIRS can reflect the CMF during CPR with free ICP environment.
Abstract Sa406: Stayin’ Alive: Establishing a Rhythm With Resuscitation Data
Authors: Quindipan Christine , Antiporda Michelle , de Haas Natalie , Solorzano Beanet , Marshall Peter , Rivera Bessie
Published: November 2024

An interprofessional care model was implemented in 2020 to improve CPR care outcomes based on AHA’s Get With the Guidelines (GWTG) – Resuscitation program. The program provided measures ensuring high-quality care was delivered during cardiopulmonary arrests (CPA). Compliance required >85% for all four measures, which included: confirmation of airway, time to first shock ≤2 minutes for VF/pulseless VT, time to IV/IO epinephrine ≤5 minutes for asystole/PEA, and percent of pulseless cardiac events monitored. Keck Hospital of USC had lost its GWTG award status several years prior to the establishment of the interprofessional team, which consisted of a Physician Champion, CNS, RN Quality Specialist, LVN Quality Data Abstractors and the director of HIM.

The primary goals of the team were to improve the workflow of data collection, standardize documentation, and ultimately increase compliance of the measures.

The Lean Six Sigma methodology was applied revealing gaps in data collection. HIM and Quality collaborated in developing a systematic method to improve electronic data availability. To decrease documentation variations, the CNS revised CPA forms and the Physician Champion created a standardized electronic Code Blue summary template. Once collected, data was systematically analyzed by the Quality team members to ensure data accuracy and to highlight areas of opportunities for improvement. Findings were then presented on a quarterly basis during the Critical Care and Resuscitation committees chaired by the CNS and Physician Champion.

Additionally, the CNS implemented evidence-based practices which included assigning code roles to ICU personnel, educating ICU staff, performing monthly mock codes, and completing weekly reviews of CPA forms that included communicating documentation discrepancies to clinicians.

Since the implementation of the team, sustained efforts have succeeded in improving resuscitation care outcomes. Substantial progression was evident in the time to first shock and confirmation of airway measures. In 2020, the hospital had a 69.2% compliancy rate for time to first shock. By 2022, we were performing at 89.5%. For confirmation of airway, we began at 72.4% in 2020; and within one year was at a 95.5% compliancy rate. This achievement continued into 2022 with a rate of 94.9%. Lastly, we achieved >85% compliancy for all four measures receiving AHA’s Gold Award for outstanding performance for two consecutive years (2022&2023).
Abstract Sa603: Inhibiting the activation of cGAS-STING signaling pathway can improve brain injury after cardiopulmonary resuscitation
Authors: liu yi , Yao Peng , Liu Zhihao , Cao Yu
Published: November 2024

Background:
Neuroinflammation-induced injury is closely related to poor prognosis in patients with brain injury after cardiopulmonary resuscitation.The cyclic GMP-AMP synthase-stimulator of interferon gene (cGAS-STING) axis is a cytoplasmic double-stranded DNA (dsDNA) sensing pathway has recently emerged as a crucial mediator of neuroinflammation in ischemic stroke. However, the role of the cGAS-STING pathway in regulating inflammation in post-cardiopulmonary resuscitation brain injury and the underlying mechanisms involved remain unclear.

Methods:
The cardiac arrest(CA) model of C57BL/6J male mice was induced by transesophageal electric shock. To evaluate the role of the cGAS-STING pathway in brain injury after cardiac arrest in Sting-deficiency (Sting
-/-
) mice. In addition, intraperitoneally administered STING inhibitor H151 evaluated the role of the cGAS-STING pathway in brain injury after cardiac arrest in mice.

Results:
In the mice CA model, we observed significant activation of the cGAS-STING pathway, mainly in mouse brain neurons and microglia. Brain injury after cardiac arrest triggers the release of dsDNA into the cytoplasm and triggers an inflammatory response by activating the cGAS-STING axis. Knockout of STING can reduce the activation of cGAS-STING pathway and the level of downstream inflammatory cytokines in brain injury after cardiopulmonary resuscitation, while maintaining the expression of blood-brain barrier related proteins (occludin, cluadin-5, ZO-1). In addition, H151 can reduce the activation of cGAS-STING pathway and the level of downstream inflammatory cytokines in brain injury after cardiopulmonary resuscitation in mice, and restore the expression of blood-brain barrier related proteins (occludin, cluadin-5, ZO-1).

Conclusions:
Our data suggest that inhibiting the cGAS-STING pathway reduces the neuroinflammatory burden of brain injury after cardiopulmonary resuscitation, and inhibiting or missing STING preserves blood-brain barrier integrity after cardiac arrest and cardiopulmonary resuscitation, and highlight this approach as a potential treatment strategy for brain injury-mediated pathology after cardiopulmonary resuscitation.

Keywords: Neuroinflammation; STING; cGAS, Blood-brain barrier, Neurons
Abstract Sa702: Gender Differences in Sudden Cardiac Death During Endurance Racing: The Role of Behavioral Responses to Competition ?
Authors: Chabrol Marion , Chocron Richard , Laurenceau Thomas , BEGANTON Frankie , Bougouin Wulfran , Empana Jean-Philippe , Jouven Xavier
Published: November 2024

Background:
Men represent about 95% of Sudden Cardiac Death (SCD) that occur during sport activity. This over representation of men during exercise-related SCD which remains true even after adjustment for sport participation is not explained by biological and physiological factors. We hypothesized that male psychology and related behavioral responses might play a role in this over-representation.

Methods:
Data comes from the Paris Sudden Death Expertise Center. We collected the data from the last 10 years on the three most important running races in Paris: half marathon (HM), full marathon (FM) and 20 km. We analyzed the potential acceleration during the last km in men and women (only available for the HM (445,000 participations)), compared with the speed recorded during the previous 5km, each subject being its own control. We assessed the exact location of the SCD cases for each race. Using Artificial Intelligence (AI) and the electronic health record systematically collected for each subject in France (all drugs prescriptions, examinations and medical diagnoses), we assessed their theoretical risk for SCD.

Results:
Over the last 10 years and among the 1.2 million participants (mean age 38 ±11y, 71.6 % of males), there were 17 SCD (7 in 20km, 5 HM and 5 in FM). Of these, 88% (15/17) were men, with an average age of 42±13y. Incidence in men was 3-fold higher than women (16.9 vs 5.7 cases per million participations, p<1/1000). CPR was initiated by a bystander for 15 subjects ( 88.2%). Initial shockable rhythm was present in 13 subjects (76.5%). All 17 subjects were transported to hospital, either with a return of spontaneous circulation (15 (88.2%)) or in a refractory state (2 (11.8%)). At hospital discharge, 14 (82.4%) were alive with a very good neurological outcome (CPC1). Among all participants, 87%accelerated during the last km, during which 65% (11/17) of SCDs occurred (Figure 1). Compared with the previous 5km, women's speed varied little compared with men's over the last km (Figure 2). Among those who accelerated the most (>2 km/h) in the last km, the proportion of men was 1.96 times (CI 1.86-2.06) higher than that of women. On the basis of their medical history all but one of the subjects were considered as low risk for SCD by the IA algorithm.

Conclusion:
Although direct causality cannot be proven, men’s attitude and behavioral reactions to competition could partly explain their over-representation in sport-related SCD.
Abstract Sa704: Black and Hispanic Patients Have Lower Survival Outcomes Than White Patients in Out-of-Hospital Cardiac Arrests Witnessed by 9-1-1 Responders
Authors: Pande Madhura , Yow Eric , Chan Paul , Blewer Audrey , Mark Daniel , Al-Khalidi Hussein , Sasson Comilla , McNally Bryan , Al-Araji Rabab , Ornato Joseph , Powell Stephen , Starks Monique
Published: November 2024

Introduction:
In the U.S., patients of Black race and Hispanic ethnicity have lower survival from out-of-hospital cardiac arrest (OHCA) when they are not witnessed by 9-1-1 responders than White patients. Whether these racial and ethnic differences also exist for OHCAs witnessed by 9-1-1 responders (first responders and EMS) is unknown.

Hypothesis:
For 9-1-1 responder-witnessed OHCAs, survival is lower among Black and Hispanic patients, as compared to White patients.

Methods:
Using the Cardiac Arrest Registry for Enhanced Survival, we performed a national retrospective analysis of 9-1-1 responder-witnessed OHCA from 2013-2022. Descriptive differences by race and ethnicity were assessed by estimates by absolute standardized difference (%), with ≥10% indicating a meaningful difference. Multivariable logistic regression models with generalized estimating equations were used to quantify the association between race or ethnicity and survival outcomes.

Results:
A total of 75,356 adult patients with OHCA witnessed by first responders or EMS identified as Black (31.6%), Hispanic (8.7%), or White (59.6%) were included. Black and Hispanic patients were younger, less likely to have a shockable rhythm, and more likely to be in lower income census tracts compared with White patients (Table). There were no important treatment differences observed with CPR or AED use, but Black and Hispanic patients were less likely to receive defibrillation (Table). Black patients had lower survival to hospital discharge than White patients (14.7% vs. 18.7%; aOR 0.86, 95% CI 0.81-0.91), whereas survival was similar for Hispanic vs. White patients (15.2% vs. 18.7%; aOR 0.92, 95% CI 0.84-1.00). However, both patients of Black race (aOR 0.71, 95% CI 0.66-0.76) or Hispanic ethnicity (aOR 0.85, 95% CI 0.78-0.93) had lower survival rates to discharge with good neurologic function than White patients.

Conclusion:
Patients of Black race and Hispanic ethnicity have lower survival outcomes for 9-1-1 witnessed OHCAs, as compared to White patients. Whether this is due to unmeasured confounding from comorbidities or differences in care deserves further study.
Abstract Sa801: Physiologic Response To Vasopressin Rescue During Pediatric In-Hospital Cardiac Arrest
Authors: Loaec Morgann , Keim Garrett , Graham Kathryn , Sawhney Samridhi , Donoghue Marion , Cooper Kellimarie , Kienzle Martha , O'Halloran Amanda , Shepard Lindsay , Mehta Sanjiv , Kilbaugh Todd , Topjian Alexis , Berg Robert , Nadkarni Vinay , Sutton Robert , Morgan Ryan
Published: November 2024

Introduction:
The physiologic response to epinephrine during pediatric CPR varies and poor response is associated with worse outcomes. Though vasopressin is not recommended by CPR guidelines, laboratory data show a physiologic response to vasopressin among epinephrine non-responders. We aimed to explore the physiologic response to vasopressin during pediatric IHCA.

Hypothesis:
Vasopressin is associated with an increase in diastolic blood pressure (DBP) compared to epinephrine in patients with ≥1 dose of epinephrine.

Methods:
Single-center retrospective cohort study of pediatric ICU IHCAs with prospectively collected physiologic and arrest event data (2017-2023). Vasopressin subjects received ≥1 dose of epinephrine preceding vasopressin and were matched to patients who received epinephrine at the same time in CPR based on age, illness category (cardiac vs. non-cardiac) and total epinephrine doses prior to the matched dose. DBP response to vasopressor was analyzed with regression discontinuity and the per subject responsiveness (≥5mmHg increase following the dose). A secondary analysis explored time to ROSC from time of vasopressin or epinephrine using Cox regression with censoring of all subjects 20 minutes post-dose.

Results:
Of 556 IHCAs with ≥1 dose epinephrine, 52 received vasopressin, and 41 met inclusion criteria and matched with epinephrine-only subjects. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to study dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin subjects and 15/41 (36%) epinephrine subjects (p=0.34). There was no difference in time to ROSC from study dose (aHR 0.73 [95% CI 0.31 -1.7]). Arterial BP waveform data were evaluable in 12/41 (29%) vasopressin and 7/41 (17%) epinephrine subjects. Vasopressor responsiveness occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine subjects (p=0.60). Figure 1 shows trend in DBP by treatment group around drug delivery, along with regression discontinuity plots of DBP for each drug. Regression discontinuity showed a change in DBP of +2.3mmHg after vasopressin (95% CI: –11.4, 16.0) and -5.67mmHg after epinephrine (–15.13, 3.80).

Conclusion:
In a small cohort of IHCA patients with ≥1 epinephrine dose, we did not detect a DBP response to vasopressin or epinephrine. Prolonged time to vasopressin in this cohort may have played a role in these findings; a larger sample of children receiving vasopressin earlier in IHCA will be required for future work.
Abstract Sa902: Re-arrest Immediately after Return of Spontaneous Circulation
Authors: Unneland Eirik , Norvik Anders , Bergum Daniel , Buckler David , Bhardwaj Abhishek , Eftestol Trygve , ARAMENDI ELISABETE , Nordseth Trond , Abella Benjamin , Kvaloy Jan Terje , Skogvoll Eirik
Published: November 2024

Introduction:
Patients who regain return of spontaneous circulation (ROSC) after in-hospital cardiac arrest are often critically ill and at risk of re-arrest. However, re-arrest is insufficiently studied. Pre-hospital data indicate a re-arrest rate ranging from 3% to 39%. Our study aims to assess the immediate hazard of re-arrest after ROSC, depending on whether the patient’s last observed rhythm before ROSC was shockable or not.

Methods:
We analyzed defibrillator recordings and clinical data from 763 cardiac arrest episodes at four different hospitals. ROSC was defined as an organized ECG rhythm compatible with a pulse, accompanied by the absence of chest compressions for at least one minute. An organized rhythm with a QRS frequency ≥ 12 was categorized as pulseless electrical activity (PEA). Conversely, a QRS frequency < 12 or a flat line represented asystole. Ventricular fibrillation or tachycardia (VF/VT) was identified based on its distinct morphology. We further stratified ROSC based on whether the preceding rhythm was shockable or not. After comparing four different parametric time-to-event models, we chose the most useful one and estimated the immediate hazard of re-arrest along the timeline of resuscitation.

Results:
After the initial event of cardiac arrest, we observed 316 re-arrests. Among these, 68% relapsed to PEA, 25% relapsed to VF/VT, and 7% relapsed to asystole. Summarized in the figure, the initial hazard of re-arrest from ROSC after PEA or asystole to a non-shockable rhythm was 0.02 per minute. By the 9th minute, this hazard decreased to 0.01 per minute. Meanwhile, the hazard for re-arrest to a shockable rhythm remained constant at 0.01 per minute. For re-arrest from ROSC after VF/VT back to VF/VT, the hazard was 0.05 per minute initially, decreasing to 0.03 per minute by the 12th minute. The corresponding hazard for re-arrest to PEA or asystole remained at 0.01 per minute.

Conclusion:
The hazard of re-arrest after return of spontaneous circulation (ROSC) to either pulseless electrical activity (PEA), asystole, or ventricular fibrillation/tachycardia (VF/VT) varies by the last observed state before ROSC. Notably, re-arrest to VF/VT following ROSC after previous VF/VT poses the highest risk. This understanding can assist healthcare professionals in anticipating events during the critical minutes following successful resuscitation and adjusting treatment accordingly.
Abstract Su1002: Association of Post-Arrest Mechanical Ventilation Settings on Survival to Hospital Discharge With Favorable Neurologic Outcome in Children with Cardiac Disease
Authors: Prakash Rithika , Zeida Haar Lucas , Foster Sierra , Li Xilong , Bhaskar Priya , Raman Lakshmi , Lasa Javier , Yu Priscilla
Published: November 2024

Introduction:
There is a lack of evidence on the optimal mechanical ventilation (MV) settings after pediatric cardiac arrest. The purpose of this study is to investigate the impact of MV settings on survival to hospital discharge (SHD) with favorable neurologic outcome (FNO) in the early post cardiac arrest period.

Methods:
We conducted a retrospective cohort study of children admitted to a single center pediatric CICU from 9/2016 - 4/2023. We divided our cohort into two groups: patients who did and did not utilize extracorporeal membrane oxygenation (ECMO
)
during the 48 hours after ROC. We evaluated the association of average values of various MV settings in the 48 hours post
-
ROSC/ROC: tidal volume (TV, defined as exhaled tidal volume per kg of body weight), peak inspiratory pressure (PIP), peak end expiratory pressure (PEEP), mean airway pressure (MAP), and fraction of inspired oxygen (FiO2) with the association of our primary outcome, SHD with FNO. We defined SHD with FNO as Pediatric Cerebral Performance Category (PCPC) of 1,2, or 3 or no change from admission to discharge. Unfavorable outcome was defined as death or SHD with PCPC of 4,5, or 6. We conducted univariate and multivariate logistic regression analyses, controlling for CPR duration and maximum lactate in the 6 hours post ROSC/ROC.

Results:
There were 102 index events during the study period. Patients with SHD with FNO compared to those without had lower CPR duration (6.0 [3.0, 18.0] vs. 22.0 [5.0, 43.0] minutes, p=0.0003), incidence of ECPR use (19/57 (33.33%) vs. 24/45 (53.33%), p=0.04), and epinephrine doses used (2.0 [1.0, 6.0] vs. 6.0 [2.0, 8.0], p=0.001). Table 1 shows the MV settings of patients with and without SHD with FNO by PCPC. We found no associations between TV, PIP, PEEP, MAP, and FiO2 with our primary outcome in both ECMO and non-ECMO cohorts. In patients who utilized ECMO, higher TV was associated with lower chances of SHD with FNO. (See Table 2)

Conclusions:
In this retrospective cohort study of a single center pediatric CICU, early post-arrest TV was associated with SHD with FNO amongst patient supported with ECMO, but not in those who did not utilize ECMO. We did not find an association of PIP, PEEP, MAP, or FiO2 with any outcomes. Future investigations should focus on whether there is a threshold of TV of MV settings that is associated with better outcomes in ECMO patients.
Abstract Su1004: Timing and Mode of Death after Pediatric In- and Out-of-Hospital Cardiac Arrest
Authors: McSherry Megan , Graham Kathryn , Herrmann Jeremy , Kirschen Matthew , Morgan Ryan , Sutton Robert , Topjian Alexis
Published: November 2024

Introduction:
Pediatric cardiac arrest is associated with high mortality and morbidity. Timing and modes of death after pediatric out-of-hospital cardiac arrest (OHCA) varies across centers. Causes of death for children with in-hospital cardiac arrest (IHCA) have not been described.

Aims:
We sought to determine and compare timing and modes of death in children admitted to a PICU following return of circulation (ROC) after IHCA and OHCA.

Hypothesis:
Among children with ROC who did not survive to hospital discharge (SHD), we hypothesized that children with IHCA would more commonly die from withdrawal of life sustaining therapy (WLST) and children with OHCA would more commonly die from brain death (BD).

Methods:
Single center retrospective study of children <18 years old who received >1 minute of chest compressions, achieved ROC for >20 minutes, and were admitted to the PICU from January 2017 - March 2023. We compared modes of death classified as: a) BD, b) WLST, c) circulatory death from recurrent arrest or d) recurrent arrest without attempted resuscitation (DNAR) between IHCA and OHCA using chi squared or Fisher’s exact test. Reason for WLST was categorized from physician notes. Time to death, defined as number of days between arrest and death, was compared between IHCA and OHCA by Wilcoxon rank-sum.

Results:
857 children (median age 1.3 years [IQR 0.4, 8.8], 43% female, 553 (65%) IHCA and 304 (35%) OHCA) were included. In the IHCA cohort, 163/553 (29%) did not SHD (BD 7 [4%], WLST 92 [56%], recurrent arrest 28 [17%], DNAR 34 [21%]). The primary reasons for WLST were poor cardiovascular prognosis (42 [46%]) and poor neurologic prognosis (33 [36%]). In the OHCA cohort, 111/304 (37%) did not SHD (BD 55 [50%], WLST 42 [38%], recurrent arrest 7 [6%], DNAR 7 [6%]). The primary reason for WLST was poor neurologic prognosis (35 [83%]). The median time to death was longer for IHCA vs. OHCA (6 [0,30] vs 2 [1,5] days, p<0.001). After IHCA, children were less likely to die from BD (p<0.001) and more often underwent WLST due to poor cardiovascular prognosis (p<0.01) than children with OHCA.

Conclusions:
Non-survivors after IHCA more frequently died due to WLST and circulatory death in the setting of care limitations, while non-survivors following OHCA died earlier and more frequently from BD. Understanding the timing and mode of death after OHCA and IHCA is critical for framing prognostic, goals-of-care conversations.
Abstract Su1006: Mean Arterial Pressure During the First 72 hours after Extracorporeal Cardiopulmonary Resuscitation is not Associated with Survival to Discharge and Neurologic Outcomes in Children with Cardiac Disease
Authors: Yu Priscilla , Foster Sierra , Bhaskar Priya , Zeida Haar Lucas , Li Xilong , singh sumit , Morriss Michael , SIRSI DEEPA , Burr Tyler , Raman Lakshmi , Lasa Javier
Published: November 2024

Introduction:
While studies have shown an association between post-cardiac arrest hypotension and mortality after conventional CPR in children, there is a lack of evidence regarding optimal mean arterial pressure (MAP) targets after ECPR.

Hypothesis:
Amongst children with cardiac disease undergoing ECPR, the lowest MAP < 5
th
percentile for age during the first 72 hours after return of circulation (ROC) is associated with decreased survival to hospital discharge (SHD) with favorable neurologic outcome (FNO).

Methods:
This is a single center retrospective cohort study of children admitted to a pediatric cardiac intensive care unit (CICU) from 2010 to 2022 that underwent ECPR. Chi-square test was used to analyze the association of the lowest MAP values, percentile adjusted for age, during the 72 hours post-ROC with SHD with FNO (defined by Pediatric Cerebral Performance Category [PCPC] score of 1,2 or 3 or no change in PCPC from baseline). Our secondary outcomes included acute composite injury (defined by the presence of seizures in the first 72 hours or neuroimaging injury within 14 days post arrest), and abnormal EEG background (defined as moderate or severe). As an exploratory analysis, we used Wilcoxon Rank Sum test to analyze the association of burden of MAP < 5
th
percentile for age with our outcomes.

Results:
We analyzed 83 index ECPR events. SHD with FNO was observed for 35 index events (42%). Table 1 displays the characteristics of patients with SHD with FNO compared to those who died or had SHD without FNO. Patients with SHD with FNO had shorter duration of CPR and lower maximum lactate during the first 6 hours post ROC compared to both survivors without FNO and non-survivors. The majority of the cohort (79.5%) experienced a lowest MAP < 5th percentile for age during the first 72 hours post-ROC. Table 2 and 3 reveal no associations between MAP < 5
th
percentile for age and primary or secondary outcomes.

Conclusion:
This retrospective cohort study of children with cardiac disease undergoing ECPR reveals no association between MAP < 5
th
percentile for age during the 72 hours post-ROC and our primary outcome of SHD with FNO as well as secondary outcomes of acute composite injury and abnormal EEG background. Given heterogeneity in the cardiac population as well as the high incidence of hypotension <5
th
percentile for age in our cohort, further investigation is warranted into whether certain subgroups may benefit from targeting higher MAP values after ECPR.
Abstract Su1008: Head-to-Pelvis CT Angiography Compared to Clinical Autopsy in Patients After Out of Hospital Arrest
Authors: Ha Khoi , Sendaydiego Xavier , lacy john , Kudenchuk Peter , Gunn Martin , Johnson Nicholas , Gatewood Medley , Maynard Charles , Sayre Michael , Counts Catherine , Branch Kelley
Published: November 2024

Introduction:
Head-to-pelvis sudden death computed tomography (SDCT) protocol has a high diagnostic yield for causes and complications of out-of-hospital cardiac/circulatory arrest (OHCA). While a gold standard of morbidity and causes of mortality has been autopsy examination, comparative analysis of SDCT has not been explored.

Methods:
Study patients were those resuscitated from OHCA between December 2015 and August 2019 who received 1) SDCT (non-contrast head CT, ECG-gated chest CT, and non-ECG gated venous phase abdominopelvic CT) within 6 hours of hospital arrival and 2) autopsy examination after death. Findings from SDCT readings blinded to autopsy and clinical pathology reports were tabulated. The primary outcome was differences in neural, chest-vascular, pulmonary, and gastrointestinal diagnoses between SDCT and autopsy reports.

Results:
Thirty one patients were included in this prospective cohort whose major clinical findings are reported in the Table. SDCT was performed at a median of 2.4 (IQR 2.1,3.2) hours from OHCA event and death occurred at a median of 2.2 (IQR 1.0,4.7) days. There were 82 clinically important SDCT and 52 autopsy findings with 45 diagnostic discrepancies between the two. Organ procurement caused 5 discrepancies. The most common discrepancies identified by SDCT but not autopsy were pneumothorax, pneumonia, and sternal/rib fractures. Discrepancies identified by autopsy but not SDCT were mostly related to cerebral bleeding and infarction.

Conclusions:
Both concordant and discrepant findings were observed between autopsy and early head-to-pelvis CT after initial resuscitation from OHCA, potentially due to differences in time and treatment between the SDCT and death. These results suggest complementary roles of pre-mortem imaging as well as post-mortem examination to identify important abnormalities after a resuscitated OHCA event.
Abstract Su1104: Examining the Need for Lifesaving Skills Training Among the Homeless Through Review of Homeless-Involved EMS Cases
Authors: Gurmu Netsanet , Gutta Gnanesh , Schnauber Danielle , Gumucio Jorge , WEISS LEONARD , Martin-Gill Christian , Doshi Ankur , Salcido David
Published: November 2024

Background:
Individuals experiencing unsheltered homelessness (those living in encampments) are at greater risk of experiencing health issues, including consequences of cardiovascular disease and opioid abuse, compared to sheltered individuals. They also face more significant barriers to care, one of which may be access to emergency medical care. Many individuals in homeless encampments are concealed within urban areas, often making it challenging for Emergency Medical Services (EMS) to precisely pinpoint their location. Furthermore, the lack of phone access and delays in bystanders notifying EMS can lead to delayed response times and inadequate medical attention.

Objective:
We aimed to categorize EMS calls and analyze EMS unit arrival times for homeless individuals on the street versus those in shelters, focusing on events requiring life-saving skills amenable to bystander intervention.

Methods:
The study is a retrospective review of EMS records for incidents in Allegheny County, PA, from January to July 2023. Cases were included that had documented evidence of a homeless patient treated by EMS, occurring near or in homeless encampments, as well as cases with homeless patients occurring at known homeless shelters as defined by EMS charting. The primary outcome was the response time of 911-initiated EMS (time of dispatch to arrival). Case characteristics and chief complaints were summarized and stratified by sheltered and unsheltered homeless status.

Results:
1204 cases were reviewed, with 424 (35.2%) involving unsheltered and sheltered homeless patients. Unsheltered individuals experienced more traumatic injuries and were disproportionately involved in drug overdose and intoxication incidents, with a mean overdose/intoxication of 20 with 95% CI ( 16.5, 24) compared to the mean of 10.7 with 95% CI (8.1, 14) for sheltered individuals. The mean EMS response time did not significantly differ between unsheltered and sheltered individuals, averaging 7.95 and 8.15 minutes, with a p-value of 0.79 for both groups respectively.

Conclusion:
In Allegheny County, although unsheltered individuals have equal timely access to EMS services, they exhibit higher rates of trauma and drug overdoses, which require timely intervention, and can benefit from trained lay people assisting prior to EMS arrival. Future training in these skills may be of benefit to this population.
Group-common and individual-specific effects of structure–function coupling in human brain networks with graph neural networks
Authors: Chen Peiyu , Yang Hang , Zheng Xin , Jia Hai , Hao Jiachang , Xu Xiaoyu , Li Chao , He Xiaosong , Chen Runsen , Okubo Tatsuo S. , Cui Zaixu
Published: November 2024

The human cerebral cortex is organized into functionally segregated but synchronized regions bridged by the structural connectivity of white matter pathways. While structure–function coupling has been implicated in cognitive development and neuropsychiatric disorders, it remains unclear to what extent the structure–function coupling reflects a group-common characteristic or varies across individuals, at both the global and regional brain levels. By leveraging two independent, high-quality datasets, we found that the graph neural network accurately predicted unseen individuals’ functional connectivity from structural connectivity, reflecting a strong structure–function coupling. This coupling was primarily driven by network topology and was substantially stronger than that of the correlation approaches. Moreover, we observed that structure–function coupling was dominated by group-common effects, with subtle yet significant individual-specific effects. The regional group and individual effects of coupling were hierarchically organized across the cortex along a sensorimotor-association axis, with lower group and higher individual effects in association cortices. These findings emphasize the importance of considering both group and individual effects in understanding cortical structure–function coupling, suggesting insights into interpreting individual differences of the coupling and informing connectivity-guided therapeutics.
‘It was painful then, but I can laugh about it now’
Authors: Ndiang’ui Peter , Aydin Hasan
Published: November 2024

This study investigated the lived experiences of 11 teachers who immigrated recently from four African countries to teach in Florida schools. The study explored their perceptions, expectations, lived experiences and realities during their first year of teaching in US public schools in south-west Florida. In this qualitative, phenomenological research design, using field notes and in-depth individual semistructured interviews with the immigrant teachers, three themes emerged from the thematic analysis. These were: 1) challenges facing immigrant teachers from African countries during their first year of teaching; 2) adaptation to a completely different culture and the related culture shock; and 3) support from their employers (the school district) and local communities.
The King’s House or the Tyrant’s Palace? Rethinking Persia in Herodotus’s History
Authors: Reising Matthew K.
Published: November 2024

This article contributes to the scholarly movement beyond rigid classifications of East and West by arguing that the Persia of Herodotus’s History, commonly understood to be a tyrannical regime, possessed both external and internal freedom. It was once common to argue that, for Herodotus, internal freedom was the exclusive purview of the Greeks. Recent scholarship has shown that Herodotus laced the History with several incriminating parallels between Greek and Barbarian political practices, thereby casting doubt on the claim that Herodotus uncritically supported Greek supremacy. This article reverses that method and argues, contrary to previous scholarship, that Herodotus offers several indications in the History that he knew Persia was a politically free regime. By examining the three prominent theories on the ancient definition of tyranny and showing their inapplicability to Persian government, I offer an even-handed defense of Persia that neither excuses real cruelty nor condemns without justification.
Socratic Contempt for Wealth in Plato’s Republic
Authors: Townsend Mary
Published: November 2024

In the Republic, Plato’s Socrates argues that the wealthy feel contempt for the poor, and the poor feel hatred for the rich. But why is Socrates, leading a life of scandalous poverty, without taking wages for philosophical work, an exception to this rule? Instead of hatred, envy, or no emotion at all, Socrates consistently treats wealth and the wealthy with ridicule and kataphronēsis – active looking-down or contempt – while meditating on the temptation of the poor to appropriate the excess flesh of the wealthy (Resp. 556d). It is contempt that allows Socrates to remain free and wageless, away from the tempting distortion wealth has on the soul (Resp. 330c, 554a–b). Socrates therefore insists his philosopher-kings should be paid only in food, the same reward he proposes for himself in the Apology. Instead of securing freedom from murderous epithumia through moderate property, Socrates implies only contemptuous poverty can safeguard a philosophic life.
Feed Resources for Livestock and Improved Forage Production Status in Enor Woreda, Gurage Zone of Ethiopia
Authors: Adem Kedir
Published: November 2024

This study was conducted with the objective of assessing feed resources for livestock and improved forage production status in Enor woreda. Three kebeles were selected purposively based on livestock potential, 90 forage producer farmers, 30 from each kebele were selected using systematic random sampling from forage participant lists. SPSS (version 20) were used for analyzing the data. Mean land holdings of the area were 2.98 (SD=0.2), 2.86 (SD=0.19) and 2.93 (SD=0.21) in enset, cereal and mixed based farming system, respectively. Cereal dominate system has higher TLU than other two farming system. Feed shortage was the primary challenge in enset-based (Index=0.26), cereal-based (Index=0.32) and mixed (Index=0.32) farming system followed by water shortage problem in both enset and cerealbased system. Natural pasture (28%), crop residues (straw) (23%), hay (17%), improved forages (13%) enset (12%) and by-products from industries (7%) were observed to be the major feed resources in the area. In all the three agro-ecologies, Desho grass (Pennisetum pedicellatum) and Elephant grass (Pennisetum purpureum) were the dominant forage species, whereas Sesbania (Sesbaina sesban) was the dominant in cereal-based system adopted in the area.
Comparative Analysis of Multiple Comparison Tests for Radiation Exposure Subgroups Among Dental Workers At Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria
Authors: Ibrahim Ahmadu
Published: November 2024

Post-hoc analysis is a crucial statistical technique employed to identify specific group differences following a significant ANOVA result. This study delves into the comparative analysis of three commonly used post-hoc tests - Tukey's HSD, LSD, and Scheffe's method - to determine significant differences in radiation exposure levels among dental workers at Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Dental professionals are routinely exposed to ionizing radiation, primarily from X-ray machines. Excessive exposure can lead to various health risks, including cancer. Hence, accurate assessment and comparison of radiation exposure levels among different categories of dental workers are essential for effective radiation protection measures. In this study, the researchers calculated the critical values for each post-hoc test at a significance level of 0.05. The results indicated that the LSD method had the smallest critical value (0.674), followed by Tukey's HSD (1.304) and Scheffe's method (1.566). A lower critical value generally implies a higher sensitivity in detecting significant differences between groups. By conducting pairwise comparisons, the study found that the LSD method was the most effective in identifying statistically significant differences in radiation exposure levels among the dental workers. This suggests that the LSD method is a suitable choice for post-hoc analysis in this specific context. The findings of this study have significant implications for radiation protection practices in dental settings. By employing appropriate post-hoc analysis methods, healthcare institutions can accurately assess radiation exposure risks and implement targeted interventions to minimize exposure and protect the health of dental workers.