bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 212: Association of Glycocalyx Shedding and Outcomes in Patients After Cardiac Arrest: A Prospective Observational Study
Authors: He Dan , Su Chenglei , Yan Xianliang , Xu Tie
Published: December 2023

Background:
The glycocalyx sheds early after cardiac arrest (CA). However, the potential value of elevated serum glycocalyx components remains unknown.

Methods:
This prospective observational study included patients who suffered CA and survived over 24 hours in the ICU of the Affiliated Hospital of Xuzhou Medical University from September 2021 to October 2022. Serum samples were collected 24 hours post CA to assess the concentration of glycocalyx shedding, including Heparan Sulfate (HS), Hyaluronic Acid (HA) and Syndecan-1 (Sdc-1). Patients were followed for 30 days or until death after CA. Outcome measures were 30-day Cerebral Performance Categories scale (CPC≤2, good function group; CPC>2, poor function group), and 30-day mortality. Logistic regression was used to assess the association of glycocalyx shedding with the 30-day CPC scale. COX regression was used to assess the association of glycocalyx shedding with 30-day mortality.

Results:
we included 71 patients. Compared with good function group (n=22), poor function group (n=49) had significantly higher levels of HS. Adjusted logistic regression showed that the high level of HS was associated with poor functional outcome (Figure1A, OR=0.41, 95% CI=0.21-0.79, p<0.01). Compared with the survival group (n=39), non-survival group (n=32) had higher levels of HA. Adjusted Cox regression indicated that high levels of HA was associated with mortality (Figure1B,Figure2, HA: HR=1.69,95%, CI=1.13-2.56, p<0.05).

Conclusions:
Elevated serum HS levels in the early stages post-CA have an association with poor functional outcomes. Increased levels of serum HA post-CA are associated with a higher 30-day mortality.
Abstract 221: Heart Rhythm Analysis During Chest Compressions in Case of Out-of-Hospital Cardiac Arrest: Are Confirmation Analysis a Safety Issue?
Authors: Didon Jean-Philippe , MENETRE Sarah , Derkenne Clement , Frattini Benoit , Hong Tuan Ha Vivien , jost Daniel , Travers Stephane
Published: December 2023

Purpose:
During out-of-hospital cardiac arrest (OHCA), automated external defibrillators (AEDs) can analyze the patient's cardiac rhythm using a Shock Advisory System (SAS) that runs during chest compressions (CC). We aimed to evaluate the safety of a SAS that enables analysis during CC, referred to as Analyze Whilst Compressing (AWC). AWC classifies the cardiac rhythm as shockable (Sh) or non-shockable (NSh) in the presence of CC. If shockable, the rescuer backs off while the AED confirms the rhythm in the absence of CC with a confirmation analysis (CoA). We aimed to verify the safety of AWC when patients present NSh rhythm during CC.

Method:
In this retrospective study, we utilized data from the Paris Fire Brigade collected between 01/01/2021 and 31/01/2022. The inclusion criteria were adult OHCA patients with initial Ventricular Fibrillation analyzed by the AWC algorithm. We analyzed patients' safety by assessing false positive cases in the presence of chest compressions: ill-advised CoA compared to appropriate CoA within the first 10 minutes of intervention. The main outcome was the rate of patients presenting ill-advised CoA.

Results:
We analyzed 285 consecutive OHCA patients, corresponding to 2011 rhythm analyses ; 205 patients had at least 1 CoA, which led to a confirmation rate of 27.7% over 557 analyses; 175 patients had at least one appropriate CoA; 76 patients (26.6%) had at least one ill-advised CoA: 48 (16.8%) had one ill-advised CoA, 19 (6.7%) had two ill-advised CoA, six patients (2.1%) had three ill-advised CoA, two patients (0.7%) had four ill-advised CoA, and one (0.35%) had six ill-advised CoA. The global amount of ill-advised CoA was 118, which leads to an ill-advised confirmation rate of 5.9%. The rhythm distribution implied with ill-advised CoA was: 72 (61%) asystole, 45 (38%) other non-shockable, one (0.85%) transition from Sh to NSh. The hands-off time that each ill-advised CoA generated was 10 [8-18] (median [IQR]) seconds.

Conclusion:
AWC presents comparable results to other methods of analysis during chest compressions in detecting some non-shockable rhythms as false positives. In a majority of patients, CoA was appropriate. Only one patient (0.35%) had up to six ill-advised CoA, making his impact negligible over the cohort.
Abstract 223: What Affects Chest Compression Depth in Out-of-Hospital Cardiac Arrest?
Authors: Russell James K , Lupton Joshua , Leturiondo Mikel , Daya Mohamud R , Ruiz De Gauna Sofia
Published: December 2023

Introduction:
Adherence to CPR guidelines for chest compressions depth (CCD) is poor. Compressors tend to converge on an individualized depth for each patient.

Aim:
Determine the factors affecting CCD in adult out-of-hospital cardiac arrest (OHCA).

Methods:
Patient, event, and EMS characteristics extracted from a regional registry (age, sex, estimated weight, witness status, bystander AED use, location, time to reach patient, initial ECG rhythm, number of shocks delivered, advanced airway use, initial EtCO2, number of EMS responders) were linked to depth and stiffness (force/depth) data from CPR monitors of resuscitation efforts for adult OHCA collected by a first response agency in suburban Portland, Oregon during 2018-21. With generalized linear models we examined the relationship of case-wise CCD in relation to stiffness and arrest characteristics, as well as the determinants of stiffness, a dominant predictor of CCD. Significant univariate predictors (p < 0.05) were combined into multivariate models, where we assessed statistical significance with a limit of 0.05/(number of predictors).

Results:
Case-wise median (IQR) chest compression depth was 50.3 (44.2 - 56.1) mm. Weight and stiffness dominated multivariate predictivity for depth (Table). Age had a modest effect overall and was not predictive in witnessed cases. Depth decreased with increasing stiffness and weight and increased slightly with age. Sex, weight and responder count were predictors of stiffness. Responder count did not predict initial stiffness. Stiffness increased with weight and decreased with number of responders.

Conclusions:
Depth of chest compressions is best predicted by patient stiffness and weight. Age contributes little, sex is non-significant. Responders do not vary depth in relation to other arrest characteristics. Age, weight and number of responders were the best predictors of stiffness.
Abstract 236: Agency Factors Associated With First Response Systems That Improve Out-of-Hospital Cardiac Arrest Outcomes
Authors: Huebinger Ryan , Spring Mary , McNally Bryan F , Humphries Amanda , Persse David , Diggs Dominique , Boerwinkle Eric , Bobrow Bentley
Published: December 2023

Background:
Data are conflicting regarding the association between first responder (FR) cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) with improved outcomes after out-of-hospital cardiac arrest (OHCA). Additionally, little is known about why this association varies between EMS agencies, with FR interventions being associated with better survival for only some agencies.

Hypothesis:
Agency characteristic differ between agencies that do a do not successfully implement FR CPR/AED for OHCA.

Methods:
We studied the 2016-2021 national cardiac arrest registry to enhance survival (CARES) database. We defined the exposures as FR CPR and FR AED. The outcome was survival with favorable neurologic status. We used logistic regression models to evaluate the association between FR CPR/AED and OHCA outcome for each individual agency. Based on each agency’s association between FR AED/CPR and outcomes, we stratified agencies into positive association (95% confidence interval falling entirely above 1) and no association (95% confidence below or including 1). Agencies with poor model fit were excluded. We then compared characteristics between strata.

Results:
For the association between FR CPR and outcomes, 21 agencies caring for 42,856 patients had a positive association; 371 agencies caring for 449,824 OHCAs had no association. For FR AED, 47 agencies caring for 103,120 OHCAs had a positive association;262 agencies caring for 327,761 OHCAs had no association. For FR CPR and compared to the no association strata, agencies with a positive association had more annual OHCAs (+300), a lower rate of FR CPR (-11.3%), and a lower rate of FR AED (-10.8%). For FR AED and compared to the no association strata, agencies with a positive association FR AED and outcomes had more OHCAs per year (+150.5), a lower rate of FR CPR (-6.8%), a lower rate of FR AED (-13.3%), lower response times (-0.6 minutes), and more OHCAs from high-income neighborhoods (+3.7%).

Conclusion:
More agencies had a positive association between FR AED and survival with favorable neurologic outcome than between FR CPR and survival with favorable neurologic outcome. Agencies with better outcomes from FR interventions treated more OHCAs and had lower rates of FR intervention.
Abstract 253: The Recovery of Consciousness via Evidence-Based Medicine and Research Program: An Innovative Paradigm for Advancing Neuroprognostication After Cardiac Arrest
Authors: Fischer David , Abella Benjamin , Bass Geoffrey , Charles Jeremy , Hampton Stephen , Kulick-Soper Catherine , Mendlik Matthew , Mitchell Oscar , Narva Aliza , Pino William , Sikandar Morgan , Sinha Saurabh , Waldman Genna , Ware Jeffrey , Levine Joshua
Published: December 2023

Introduction:
Prognostication of neurologic recovery in post-cardiac arrest coma often dictates whether life-sustaining treatments are continued or withdrawn. However, the conventional approach to prognostication is fragmented and inconsistent, impeding clinical care, research and education.

Goals:
We sought to establish an innovative approach to prognostication -- the
Re
covery of
Co
nsciousness
V
ia
E
vidence-Based Medicine and
R
esearch (RECOVER) program -- that provides specialized, comprehensive, and longitudinal care.

Methods:
Inpatients with post-arrest coma are evaluated by a dedicated RECOVER consult service, which collects data per evidence-based guidelines and advises clinical teams and families. Patients are discussed in a weekly interdisciplinary conference (with neurology, physiatry, radiology, palliative care, social work, physical therapy, ethics, and others) to formulate holistic prognostic determinations and treatment plans. For surviving patients, the RECOVER program provides continuity through partnered post-acute facilities and outpatient clinics. This clinical infrastructure is leveraged to build a registry of clinical data and outcomes. Trainees are incorporated throughout.

Results:
Between August 2022 and June 2023, the RECOVER program evaluated 70 patients with post-arrest coma (mean age 55y [SD = 16]). Of those, 34 (49%) survived to hospital discharge without transition to hospice care. Of the 25 patients ≥3 months from discharge, four have returned to clinic (16%). Functional MRIs are interpreted with the aid of neuroradiology and ethics. Preliminary data suggest high caregiver satisfaction with the RECOVER program (mean of 4.7 on a 5-point Likert scale).

Conclusion:
The RECOVER program enables systematic, guideline-based and interdisciplinary care, provides continuity, and facilitates clinical translation of research in patients with post-arrest coma. The RECOVER program helps provide ongoing healthcare access to this vulnerable population, although clinic retention is low. The RECOVER program also promotes trainee education and serves as an effective platform for data collection. If adopted broadly, the RECOVER program may advance post-arrest care and facilitate multi-center research.
Abstract 262: Mediating Factors Between Community Race/Ethnicity and Initial Shockable Rhythm
Authors: Huebinger Ryan , Power Eric , Del Rios Marina , Bakunas Carrie A , Karfunkle Benjamin , Panczyk Micah , McNally Bryan F , Bobrow Bentley
Published: December 2023

Background:
Initial shockable rhythm is an important predictor of favorable out-of-hospital cardiac arrest (OHCA) outcomes. While patients from minoritized communities suffer from lower rates of initial shockable rhythm, the reason for this disparity is not known.

Hypothesis:
OHCA characteristics contribute to disparities in initial shockable rhythm.

Methods:
We performed a retrospective study of the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival, including adult, non-traumatic OHCAs. Linked to census tract data, we stratified OHCAs based on having a majority of a race/ethnicity: >50% White, >50% Black, and >50% Hispanic/Latino. To evaluate if initial shockable rhythm impacts outcome disparities, we compared logistic regression models between race and OHCA outcomes: 1) unadjusted, 2) adjusted for bystander CPR (bCPR), and 3) adjusted for initial rhythm. Using structural equation modeling, we then performed a mediation analysis between race/ethnicity, OHCA characteristics, and shockable rhythm, reporting the mediations proportions.

Results:
We included 39,596 OHCAs, 16,702 White, 5,461 Black, and 17,433 Hispanic. The rate of shockable rhythm was 19.0% for White, 14.3% for Black, and 14.6% for Hispanic. Odds of favorable neurologic outcome were lower for Black (OR 0.5, 95% CI 0.4-0.6) and Hispanic (OR 0.6, 95% CI 0.6-0.7). While adjusting for bCPR did not change these odds, adjusting for shockable rhythm increased odds for Black (OR 0.6, 95% CI 0.5-0.7) and Hispanic (OR 0.7, 95% CI 0.6-0.8). On mediation analysis, the proportion of initial shockable rhythm mediated for Black census tract were: age>65 (-7.3%), male gender (6.8%), public location (6.9%), healthcare facility location (-17.2%), bystander witnessed (19.2%), bCPR (4.3%), and bystander AED (6.4%). The proportion mediated for Hispanic census tract were: age>65 (-4.8%), male gender (0.5%), public location (-4.0%), healthcare location (-13.5%), bystander witnessed (20.8%), bCPR (8.7%), and bystander AED (6.2%).

Conclusion:
Bystander witnessed arrest was the most significant mediator of shockable rhythm for OHCA in Black and Hispanic communities, while bCPR was a modest mediator of shockable rhythm for Hispanic OHCA victims.
Abstract 277: Characterizing the Components of Impulsiveness for Manual Chest Compressions During Out-of-Hospital Cardiac Arrest
Authors: Urigüen Jose Antonio , Leturiondo Mikel , Redondo Koldo , Gutiérrez Jose Julio , Russell James K , Daya Mohamud R , Ruiz De Gauna Sofia
Published: December 2023

Introduction:
Current resuscitation guidelines recommend depth, rate and complete recoil of chest compressions (CCs) to be monitored as part of CPR quality metrics. The literature also suggests CC impulsiveness as an additional measure of CPR quality. The impulsiveness of CCs has mainly been examined through reduced compression duration, but this fails to incorporate information of the waveform, especially for manual CCs.

Aim:
To retrospectively characterize impulsiveness and its components within manual CC series defined between pauses.

Methods:
Monitor-defibrillator recordings of adult out-of-hospital cardiac arrest cases, attended by TVF&R (OR, USA), containing depth signal, were processed to identify series of CCs between pauses. We calculated the compression impulsiveness index (see figure), CII = IF/DR, of each CC. IF is the impulse factor of the waveform, defined as its maximum depth divided by its mean depth; DR is the duration ratio, defined as the ratio between the duration of the compressive part and the total duration of the compression. We obtained variations of CII, IF and DR within series between pauses for sets of 10 consecutive CCs.

Results:
A total of 6,073 series of median (IQR) length 190 (119-222) CCs were used. Overall, CII was 5.27 (4.80-5.86), IF 2.19 (2.05-2.36) and DR 0.42 (0.38-0.45). From the beginning to the end of the series, median CII, DR and IF decreased 2.01%, 1.53% and 3.41%, respectively; all p
trend
< 0.05. This reflects that CCs change from being spikier to more rounded and shallower (see figure).

Conclusion:
Impulsiveness decreases moderately within CC series, which indicates that rescuers are able to maintain it during each series. The drop in IF is mainly responsible for the loss of impulsiveness, despite the decrease in DR (since IF declines twice as much). Thus, impulsiveness is better characterized by the CC waveform than by its duration. The observed overall variability of all metrics reveals differences between rescuers.
Abstract 285: A Prospective Evaluation of Indicators of Psychological Distress in Surrogates of Cardiac Arrest Survivors
Authors: Tincher Isabella M , Abukhadra Sabine , Rojas Danielle A , Yuan Mina , DeForge Christine , Agarwal Sachin
Published: December 2023

Background:
Family surrogates of cardiac arrest (CA) patients have unique needs due to thesudden, life-threatening, and traumatic nature of the CA. We prospectively assessed the prevalenceof psychological distress among CA surrogates and characterized their preferences for resourcesto reduce uncertainty throughout the illness trajectory of their loved ones.

Methods:
Between August 1, 2021 and May 31, 2023, English-speaking family surrogates (>18years old) of consecutive CA patients were recruited to complete an in-person assessment beforehospital discharge. Indicators of psychological distress were measured using the Post TraumaticStress Disorder (PTSD) Checklist 5 (PCL5; cut-off >33), Generalized Anxiety Disorder-2 (GAD2;cut-off >3), and the Patient Health Questionnaire-8 (PHQ8; cut-off >9). An investigator-developedsurvey of eight unique interventions, composed by a multidisciplinary research team of patient andsurrogate stakeholders, aimed to alleviate the identified measures of psychological distress.Participants ranked their top choice among these eight interventions, focusing on patient-centerededucation and logistical needs (n=4) or on surrogate-centered self-care and psychological supportneeds (n=4).

Results:
Of the 163 family surrogates approached, 83 participated (66% female; age 51±15 years;41% white, 25% black, 31% Hispanic/Latino). Nearly all participants presented withpsychological distress; 66% (n=55) experienced elevated generalized anxiety, 29% (n=24)experienced characteristics of PTSD, and 57% (n=47) had moderate depression. Of the eightinterventions, 22% of surrogates (n=18) ranked increased access to the care team as the mosthelpful intervention. The next most highly prioritized intervention was increased information onpotential recovery, chosen by 20% (n=17).

Conclusion:
Family surrogates experience a high burden of PTSD, anxiety, and moderatedepression symptoms in response to a loved one experiencing CA. Their needs and lack ofresources have yet to be tangibly addressed within the hospital system. Future research shouldexplore the impacts of CA on family surrogates.
Abstract 297: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry
Authors: Yang Jing , Tang Hanqi , Shao Shihuan , Xu Feng , Fu Yangyang , Xu Shengyong , Li Chen , Li Yan , Liu Yang , Walline Joseph , Zhu Huadong , Chen Yuguo , Jun Xu
Published: December 2023

Introduction:
Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC.

Research Questions:
end-tidal carbon dioxide (ETCO
2
) is regarded as an indicator of ROSC in cardiac arrest patients. pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO
2
and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest.

Aims:
This study examined whether ETCO
2
and POP parameters can be used to identify unsustained ROSC.

Methods:
We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO
2
, and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed.

Results:
The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P<0.05). The logistic regression analysis showed that, ΔETCO
2
(difference in ETCO
2
between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P < 0.001). The area under the receiver operating characteristic curve of ΔETCO
2
, ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962).

Conclusion:
Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO
2
and ΔAUCp showed significant predictive value for unsustained ROSC.
Abstract 305: Practice How You Play! An Innovative Two-Pronged Approach at Improving Resident and Allied Health Staff Performance During Code Blue Events
Authors: Fatunde Olubadewa A , Odneal John , Schwind Valarie , Egbe Tiffany , Wright Belinda , Kirbow Karin , Muddana Prithvi , Neidlinger Beth A , Stokes Michelle
Published: December 2023

Introduction/Background:
Cardiopulmonary arrest (Code Blue or CB) is a feared complication of severe medical illnesses. In-hospital CB events (CBE) have been estimated to have a mortality rate of only 30.4%. CBEsare difficult to prepare for and execute due many factors, including their low frequency, high complexity, and unpredictability.

Research Questions/Hypothesis:
Over 6 months (March - September 2019), we tested the effects of both adaptation of a Code Blue (CB) Team Leader (TL) checklist—aimed at improving resident leadership and communication—as well as implementation of an interdisciplinary in-hospital CB simulation to improve the performance of both resident physicians.

Methods/Approach:
Primary outcomes included change in resident confidence leading a CBE (i.e. Level of comfort as TL , confidence of diagnosis and management, confidence in code-related procedural skills), and familiarity with the institutional rapid response protocol. Secondary outcomes included self-reported confidence of nurses to execute their role, and both physician and nurse time to response. Confidence parameters were measured by a 10 point Likert scale. Pre-intervention, baseline cross-sectional survey values of the primary outcome were obtained from 24 internal medicine residents (12 PGY2s, 12 PGY3) over 6 months. Post-intervention, the cross-sectional survey was repeated.

Results/Data (descriptive and inferential statistics):
Statistics for residents displayed in table and figure 1. The level of nurse confidence increased from 7.5 to 8.25 over 5 months. The time to first response by residents has decreased by more than 50%. Conclusion(s) Our project improved the quality and resident level of comfort running Code Blue events among both residents and nurses.
Abstract 330: Severe Adverse Safety Events in Pediatric Out-of-Hospital Cardiac Arrest Resuscitation
Authors: Eriksson Carl , Guise Jeanne-Marie , Hansen Matthew L , Bahr Nathan , Walker-Stevenson Grace , Meckler Garth
Published: December 2023

Introduction:
Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor in spite of improvements in adult OHCA survival.

Hypothesis:
We hypothesized that severe adverse safety events (ASEs) are common during pediatric OHCA resuscitation and that specific patterns can be identified.

Methods:
Retrospective cohort study of patient care reports from 51 Emergency Medical Services (EMS) agencies across the US for children less than 18 years of age with an OHCA where resuscitation was attempted by EMS providers between 2013-2019.

Results:
We evaluated 1,019 encounters of EMS-treated pediatric OHCA; 46% were under 12 months of age. At least one severe ASE occurred in 610 patients (60%), and 310 patients (30%) had two or more. Children under 28 days of age had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (30%), ventilation (14%), and vascular access (19%). Logistic regression modeling found that the only factor consistently associated with severe ASEs was young age. Birth-related OHCA had 4-fold greater odds of a severe ASE compared to adolescents (95% CI 1.7-10.7) and neonates with non-birth-related OHCA had 3.2-fold greater odds of a severe ASE (95% CI 1.1-9.0).

Conclusions:
In this large geographically diverse cohort of children with EMS-treated OHCA, 60% experienced at least one severe ASE. The odds of a severe ASE were over 3-fold higher for neonates than adolescents, and even higher when the cardiac arrest was birth-related. Given the national increase in out of hospital births and ongoing poor outcomes of OHCA in young children, these findings are an important and urgent call to action to focus on improving care delivery and training.
Abstract 352: Automated Deep Learning Algorithms Outperforms Gray-White Matter Ratio for the Detection of Severe Cerebral Edema in Cardiac Arrest Survivors
Authors: Wang Zihao , Dodelson Jacob , Kulpanowski Annelise , Copen William , Hancock Brandon , Rosenthal Eric S , Edlow Brian L , Kimberly W T , Amorim Edilberto , Westover Michael B , Ning Mingming , Schaefer Pamela , Malhotra Rajeev , Giacino Joseph , Greer David M , Wu Ona
Published: December 2023

Introduction:
Significant knowledge gaps remain in predicting neurological outcomes for comatose cardiac arrest survivors. Severe cerebral edema (SCE) development offers an objective imaging surrogate for neurologic injury.

Aim:
We have previously shown that deep learning (DL) algorithms can detect SCE on CT. We aim to determine whether our model will perform equivalently on an independent external cohort. We also compared the performance of the DL model with one based on the gray-white matter ratio (GWR) for detecting SCE.

Method:
We retrospectively analyzed CT data (299 patients, 55±17 years, 71% male, 65 with SCE). Scans whose radiology reports described herniation or more than minimal ventricular effacement were classified as SCE. Datasets were randomly split (balancing for SCE) into training, validation, and testing cohorts. We used transfer learning with a 3D residual neural network framework to train our model. The probability of SCE was calculated. We applied the model to an external cohort (151 patients, 58±17 years, 63% male, 29 with SCE). Regions of interest (ROIs) were drawn in the caudate nuclei (CN) and posterior limbs of the internal capsule (PLIC). GWR was calculated as the ratio of mean x-ray attenuation values in the CN and the PLIC. Areas under the receiver operating curves (AUC) for the DL and GWR models were compared (bootstrap test).

Results:
The optimal model achieved comparable accuracies for the internal validation cohort (84% [95% CI: 78-89%], n=60) and reserved test cohort (83% [95% CI: 76 to 89%], n=61). The external cohort consisted of 175 scans. The model’s accuracy was 87% [95% CI: 81% to 91%], comparable to the results from the testing and internal validation cohorts. AUC for DL was significantly greater than for GWR (92% vs. 73%, P=0.001) (see Figure).

Conclusions:
Our result shows that deep transfer learning is a promising method to automate SCE detection on CT images and outperforms GWR measurements.
Abstract 360: Clinical Characteristics and Outcome in Out-of-Cardiac Arrest Patients With Type A Aortic Dissection Diagnosed by Non-Contrast Computed Tomography
Authors: Komiya Keiichiro , Kawakami Shoji , Matsumoto Yosuke , Kitahara Kenichi , Katasako Aya , Koga Hidenobu , Yamada Tetsuhisa , Miura Nobutoshi , Matsumoto Takashi , Uchida Takayuki , Nishi Jun-ichiro
Published: December 2023

Background:
Although type A aortic dissection (AAD) remains a life-threatening disease, the exact epidemiology of out-of-hospital cardiac arrest (OHCA) with AAD is unclear. It has been reported that the non-contrast computed tomography (CT) is useful for diagnosing AAD in patients whose hemodynamic status was unstable.

Aim:
We evaluated the clinical features and outcome of OHCA patients with AAD diagnosed by non-contrast CT.

Methods:
Between 2017 and 2022, we retrospectively collected Utstein-style data on non-traumatic adult OHCA patients transferred to our hospital and performed non-contrast full-body CT scan. We divided OHCA patients into 3 groups: patients with AAD diagnosed by CT (Group-AAD), patients with non-cardiac cause without AAD (Group-NC), and patients with cardiac cause (Group-C). The diagnostic criteria of AAD by CT were as follows: visible intimal flap; crescentic high attenuation hematoma; and inward shift of calcified intima. The clinical outcome was defined as return of spontaneous circulation (ROSC).

Results:
Of the 1018 non-traumatic adult OHCA patients were registered during the study period, 1015 patients underwent non-contrast CT (Group-AAD, n=79; Group-NC, n=159; Group-C, n=779). The patients who achieved return of spontaneous circulation (ROSC) was 271 (26.8%). The proportion of patients who achieved ROSC in Group-AAD was significantly smaller than the other groups (Group-AAD 10.1%, Group-NC 27.7%, Group-C 28.3%, P=0.002). Multivariable logistic regression analysis revealed that patients with AAD diagnosed by CT independently predicted failure to achieve ROSC. The presence of witnessed arrest and initial shockable rhythm were significant indenpent predictors of achieving ROSC (
Table
).

Conclusion:
OHCA patients with AAD diagnosed with CT were more difficult to obtain ROSC than patients with other cause.
Abstract 361: Effect of Percutaneous Ventricular Assisted Device on a Recovery of Myocardial Function in Swine Model With Prolonged Cardiac Arrest
Authors: Nakashima Takahiro , Tiba Mohamad Hakam , Gottula Adam , Hsu Cindy H , McCracken Brendan , Greer Nicholas , Cramer Traci , Sutton Nadia R , Ward Kevin , Neumar Robert W
Published: December 2023

Background:
Percutaneous ventricular assist device (pLVAD) support and Transient aortic balloon occlusion (AO) can preserve cerebral and cardiac blood flow during cardiopulmonary resuscitation (CPR), but it remains unclear if pLVAD reduces post-cardiac arrest myocardial dysfunction.

Hypothesis:
pLVAD support immediately after the return of spontaneous circulation (ROSC) improves early recovery of myocardial function following prolonged cardiac arrest.

Aims:
Evaluate the association between early post-ROSC pLVAD support and recovery of myocardial function in a swine model of prolonged cardiac arrest.

Methods:
This is a secondary analysis of a subset of animals that achieved ROSC in a study comparing pLVAD, transient AO or both during CPR after prolonged cardiac arrest. pLVAD, aortic occlusion, or both were initiated after 24 minutes of ventricular fibrillation cardiac arrest (8 min no-flow and 16 min mechanical CPR). AO was discontinued post-ROSC, and pLVAD support or standard care were continued. Beginning 60 minutes post-ROSC, pLVAD support was weaned to <1.0 L/min while maintaining a MAP >70 mmHg, and subsequently removed at 4 hours when feasible. The primary outcome was the recovery of cardiac index (CI) and left ventricular ejection fraction (LVEF) at 4 hours post-ROSC. Data are shown as mean (standard error).

Results:
Seventeen animals achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 [8 were removed from pLVAD], and standard care group, n = 6). For the primary outcome, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m2 (p=0.043) and LVEF 60(3) vs. 49(4) % (p=0.029) at 4 hours after ROSC, respectively, when compared with the standard care group. Focusing on the early period within 60 minutes after ROSC when maximum pLVAD flow was maintained, the pLVAD group had significantly higher coronary perfusion pressure (62[4] vs. 47[5] mmHg, p=0.019), lower LV stroke work index (3.9[3.0] vs. 14.9[4.4] cJ/m2, p=0.043), and lower total pulmonary resistance index (13.2[4.8] vs. 21.5[14.4] Wood Unit, p=0.001).

Conclusion:
These results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.
Abstract 365: Prehospital Electrocardiogram Integrated With Computer-Assisted Interpretation Shortens Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction
Authors: Chang Wei-Tien , Wu ZHI-JIA , Lee Bin-Chou , Chen Ying-Ju , Tsai Ming-Chi , Chiu Chien-Kai , Chien Yu-Chun , Hsieh Ming-Ju , Chiang Wen-Chu , HUANG CHIEN-HUA , Chen Wen-Jone , Ma Matthew Huei-Ming
Published: December 2023

Introduction:
Prehospital electrocardiogram (ECG) has been shown to expedite reperfusion therapy and reduce mortality in acute ST-elevation myocardial infarction (STEMI). The most challenge part for prehospital ECG is timely accurate interpretation and early activation for primary coronary intervention (PCI). In this study we aimed at constructing a prehospital ECG platform integrated with computer-assisted interpretation for strategic PCI activation in an Urban EMS system, and evaluating its efficacy and impact on door-to-balloon time in patients with STEMI.

Methods:
A prehospital ECG platform with computer-assisted interpretation and wireless transmission was constructed in 2018 in Taipei, together with EMT training for strategic triage of possible STEMI patients to primary PCI capable hospital. The primary outcomes were door-to-balloon time and scene-to-balloon time compared with those without prehospital ECG at the same period. The secondary outcomes were prehospital management time and transportation time.

Results:
From Feb. 2019 to July 2020, a total of 1670 patients meeting the predesignated criteria received prehospital ECG. Of these, 217 (13.0%) was interpreted as ST elevation out-of-hospital with notification of PCI capable hospital, and 65 (30.0%) was confirmed as STEMI thereafter. The sensitivity of computer-assisted interpretation of STEMI was 96% and specificity was 91%. Compared to the STEMI patients sent by EMS system to the same PCI hospital without prehospital ECG diagnosis and early activation, those with prehospital ECG showed no difference in prehospital management time and transportation time. However, the door-to-balloon-time (58.3
+
10.8 vs. 72.7
+
11.2,
P
<0.01) and scene-to-balloon time (75.1
+
12.1 vs. 90.5
+
16.1,
P
<0.05) were both significantly shorter.

Conclusion:
Prehospital ECG integrated with computer-assisted interpretation enhanced notification of PCI hospital and proper activation of cardiac catheterization team for STEMI patients in an Urban EMS system. Most importantly, it significantly shortens door-to-balloon-time and scene-to-balloon time without lengthening prehospital management and transportation times.
Abstract 375: Resuscitative Endovascular Balloon Occlusion of the Aorta With Downstream Intra-Aortic Irrigation Using Hydrogen-Containing Solution Mitigates Ischemic Injury in a Swine Hemorrhagic Shock With Liver Injury Model
Authors: Matsuoka Tadashi , Homma Koichiro , Tamura Tomoyoshi , Suzuki Sayuri , Yamanaka Takahiro , Kaito Daiki , Ono Soichiro , Maeshima Katsuya , Sasaki Junichi
Published: December 2023

Background:
Recently, the resuscitative endovascular balloon occlusion of the aorta (REBOA) has become widespread in hemorrhagic shock (HS). It temporarily increases the proximal blood pressure (pBP); but sacrifices the distal blood flow to the visceral organs, causing ischemic injury. We previously reported that hydrogen (H
2
) gas inhalation mitigated ischemic injury and improved survival in rats with HS; however, during REBOA use, the H
2
gas was not delivered to the ischemic organs as it is distributed via the bloodstream. Therefore, we hypothesized that intra-aortic irrigation of H
2
-containing solution into the downstream of REBOA would mitigate ischemic injury.

Methods:
Herein, a swine liver injury with volume-regulated HS model was used. The female swine (around 40 kg, n = 16) were divided into two groups; a H
2
-containing solution irrigation (H
2
group) and saline irrigation (C group). After HS induction (20% of estimated total blood volume), the liver injury was initiated (20% of total liver volume). The REBOA was inflated during predefined time (60 min and 90 min) and intra-aortic irrigation to downstream of REBOA was started. The hemodynamic parameters, blood samples, and pathological changes were evaluated.

Results:
The elevation in lactate, interleukin 6, and syndecan levels were significantly suppressed over time in the H
2
group than in C group (p < 0.05). The pBP tended to decrease during REBOA in the C group; however, it remained higher in H
2
group (p < 0.05). Pathologically, the ischemic changes, such as liver sinusoidal enlargement and intestinal villi flattening and inflammatory infiltration were identified in the C group but not in H
2
group.

Conclusion:
The REBOA with downstream intra-aortic irrigation using H
2
-containing solution for liver injury with HS stabilizes hemodynamics, suppresses cellular injury, and mitigates organ damages. These results in large animals can be immediately applied to clinical use in humans.
Abstract 392: TAT-PHLPP9c and TAT-PIF Administration During CPR Synergistically Improves Cardiac Arrest Survival
Authors: Li Jing , Zhu Xiangdong , Lin Shaoxia , Vanden Terry L
Published: December 2023

Introduction:
We have demonstrated that a novel fast-acting peptide TAT-PHLPP9c improves survival in both mouse and swine models of cardiac arrest. The protective effect is mediately by activation of Akt via inhibiting phosphatase PHLPP. We have designed another peptide TAT-PIF to activate Akt by promoting the active conformation of PDK1 via binding to PDK1 Interacting Fragment (PIF).

Hypothesis:
We hypothesize that TAT-PHLPP9c and TAT-PIF synergistically enhance Akt activation and improve cardiac arrest survival when administered intravenously during CPR.

Methods:
Cardiomyocytes were treated with TAT-PHLPP9c (10uM), or TAT-PIF (10uM) or in combination. Akt phosphorylation (p-Akt) at both Thr308 and Ser473 sites were assessed by Western blot. In C57BL/6 retired female mice (n=24), a 12-min asystolic cardiac arrest was induced with KCl followed by CPR and blinded randomized administration of the peptides or saline control. Four experimental groups were included: 1) saline, 2) TAT-PHLPP9c (7.5 mg/kg), 3) TAT-PIF (7.5 mg/kg), 4) TAT-PHLPP9c and TAT-PIF. Survival was evaluated at 4 hour post-ROSC.

Results:
In cardiomyocytes, compared to saline, both TAT-PHLPP9c and TAT-PIF independently increased AktSer473 phosphorylation, and the combined treatment of both peptides synergistically enhanced p-AktSer473. For AktThr308 site, TAT-PIF increased its phosphorylation while TAT-PHLPP9c induced a slight increase of its phosphorylation. Enhanced phosphorylation was also seen with the combined treatment. In mice, compared to saline control, both peptides improved 4-h survival when given alone, but the combined treatment improved 4-h survival synergistically over 30%.

Conclusions:
The cocktail of TAT-PHLPP9c and TAT-PIF may be a novel treatment regimen for improving outcome following cardiac arrest.
Abstract 416: Conversion From Initial Non-Shockable Rhythm to Shockable Rhythm During Resuscitation With a Public Access Defibrillator Compared With Initial Shockable Rhythm; Incidence and Survival Outcomes
Authors: Kernaghan Amy , Harvey Adam , Currie Hannah , Bond Raymond , Finlay Dewar , McEneaney David , Adgey Jennifer
Published: December 2023

Incidence of initial non-shockable rhythm during cardiac arrest is increasing and is associated with poorer outcomes. The aim of this analysis was to study non-shockable to shockable rhythm conversion treated using a public access defibrillator (PAD) and to study survival rates related to initial shockable rhythm. HeartSine PAD data were collected between October 2012 to May 2023. The dataset consisted of data downloaded from PADs, and data recorded in case report forms. Initial rhythm and conversion to shockable rhythm were determined. First shock success (FSS) was defined as the termination of the shockable rhythm for at least 5 seconds. Chi-squared test was applied to determine if there was difference in outcomes between those patients with: a shockable rhythm, non-shockable rhythm that converted to shockable, and non-shockable rhythm that did not convert to a shockable rhythm. Of the 6877 cases submitted initial shockable rhythm could be determined for 6736 cases. For the 30.5% (2053/6736) of cases with an initial shockable rhythm, patient outcome was reported for 1923, and 62.9% (1209/1923) survived to hospital admission. Incidence of initial non-shockable rhythm was 69.5% (4683/6736). Change to a shockable rhythm could be determined for 4664 cases and occurred in 5.0% (233/4664). A shock was delivered in 94.8% (221/233) of these cases. FSS could be determined for 165 cases. FSS was 85.5% (141/165). Patient outcome was reported for 87.6% (204/233) where 22.5% (46/204) resulted in survival to hospital admission. For the 95% (4431/4664) of non-shockable cases that did not convert to a shockable rhythm, patient outcome was reported for 82.2% (3644/4431), where 10.8% (395/3644) of patients survived to hospital admission.Thus, conversion from non-shockable to shockable rhythm had improved survival compared to patients who did not convert. Furthermore, when initial rhythm was shockable significantly higher survival to hospital admission was recorded.
Abstract 428: Clinical and Molecular Characterization of Post-Resuscitation Phenotypes: Cardiac vs. Neurorespiratory Etiology
Authors: Seder David B , Sorcher Mary W , deKay Joanne T , Wishengrad Jeanne , Michalakes Peter , Lord Christine , Searight Meghan , Daley Alison , Bockian Sarah , May Teresa , Riker Richard R , Gagnon David , RYZHOV Sergey
Published: December 2023

Background:
Establishment of clinical and molecular phenotypes is needed to individualize post-resuscitation cardiac arrest (CA) care. Leukocyte subpopulations may characterize ongoing organ injury, and strongly correlate with outcomes. We analyzed patients determined to have a cardiac (COR) vs. neurorespiratory (NR) etiology of CA.

Hypothesis:
Clinical and molecular phenotypes differ according to the etiology of CA.
Goals:
Prospectively characterize clinical and molecular phenotypes of patients with cardiac or neurorespiratory etiology of CA.

Methods:
After IRB approval and informed consent, we collected blood samples at 24, 48, and 72 hours after return of spontaneous circulation. We excluded patients <18 years of age, moribund, Hgb <7mg/dL, or whose CA etiology could not be determined. Flow cytometry was performed on fresh blood; outcomes were established by 6-month telephone call.

Results:
Among patients with COR (n=61) vs. NR (n=42) etiology of CA, COR patients were older (61±14 vs 54 ±14, P=0.021), more often had shockable rhythm (74% vs. 7.1%, P<0.001), had higher initial blood glucose (227±89 vs 195±95, P=0.046), higher incidence of moderate or severe left ventricular dysfunction on presentation (67% vs 33.5%, P=0.004), lower EEG suppression ratio at 6 hours [22 (4,84) vs. 88 (66,93), P<0.001), lower NSE levels [30 (19,140) vs 104 (33,268), P=0.034], higher in-hospital survival (64% vs. 33%, P=0.002), less neurological-etiology death (25% vs 55%, P<0.001) and more CPC 1-2 at 6 months (49% vs 12%, P<0.001). There were no differences in total number of leukocytes, but flow cytometry revealed leukocyte subsets, characterized by variable expression of CD4, CD8, CD10, CD14, CD16, CD54, CXCR1 and other surface proteins, indicating a trend toward enhanced neutrophil maturation and a preserved pool of circulating T cells in COR vs. NR patients.

Conclusions:
Separating CA survivors into a cardiac vs. neurorespiratory etiology reveals different clinical risk profiles and inflammatory responses during the acute phase after resuscitation. Further research should evaluate how specific interventions affect patients with dissimilar risk profiles, and how various therapies modulate the immuno-inflammatory response.
Determination of cystatin C reference interval for children in Croatia
Authors: Turčić Ana , Vogrinc Željka , Cigula Kurajica Vlasta , Galić Slobodan
Published: December 2023

IntroductionCystatin C is considered an early marker of kidney damage. The aim was to determine the reference interval in children since this information was not available from the test manufacturer.Materials and methodsIncluded were children aged 0 to 18 years undergoing routine check without history of any renal disease. Cystatin C was measured by the immunoturbidimetric method, and creatinine by the enzymatic method on a Cobas c501 analyzer (Roche Diagnostics, Manheim, Germany). Reference intervals were determined according to the CLSI C28-A3 guidelines using a robust method and a nonparametric percentile method, depending on the sample size. The Schwartz’s formula was applied to estimate glomerular filtration (eGFR) from cystatin C.ResultsThe cystatin C reference interval for children aged 1-18 years (N = 204, median 8 years) was from 0.61 mg/L (90% CI: 0.53 to 0.64) to 1.08 mg/L (90% CI: 1.07 to 1.14). Differences according to sex were not found. For children aged 0-1 years (N = 29, median 5 months), the reference interval was from 0.60 mg/L (90% CI: 0.48 to 0.72) to 1.49 mg/L (90% CI: 1.36 to 1.61). The sample size was too small to test the difference according to sex. The eGFR was 76 (70-88) mL/min/1.73m2 for males and 83 (74-92) mL/min/1.73m2 for females.ConclusionThe cystatin C reference intervals for Croatian pediatric population according to age were determined. The cystatin C concentrations in children reach adulthood values after the first year. The cystatin C Schwartz’s formula is applicable for eGFR calculation in children.
The W3C Data Catalog Vocabulary, Version 2: Rationale, Design Principles, and Uptake
Authors: Albertoni Riccardo , Browning David , Cox Simon , Gonzalez-Beltran Alejandra N. , Perego Andrea , Winstanley Peter
Published: December 2023

DCAT is an RDF vocabulary designed to facilitate interoperability between data catalogs published on the Web. Since its first release in 2014 as a W3C Recommendation, DCAT has seen a wide adoption across communities and domains, particularly in conjunction with implementing the FAIR data principles (for findable, accessible, interoperable and reusable data). These implementation experiences, besides demonstrating the fitness of DCAT to meet its intended purpose, helped identify existing issues and gaps. Moreover, over the last few years, additional requirements emerged in data catalogs, given the increasing practice of documenting not only datasets but also data services and APIs. This paper illustrates the new version of DCAT, explaining the rationale behind its main revisions and extensions, based on the collected use cases and requirements, and outlines the issues yet to be addressed in future versions of DCAT.