bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 269: Tracheal Intubation During Pediatric CPR: A Videographic Assessment
Authors: Donoghue Aaron , Hsieh Ting-Chang , Hoyte Natasha , Myers Sage , Nishisaki Akira
Published: April 2024

Background:
Pediatric cardiopulmonary resuscitation (CPR) continues to emphasize the inclusion of ventilation along with chest compressions. Tracheal intubation (TI) provides the most stable and effective means of ventilation, but performing TI is frequently associated with interruptions in CPR. Published data describing success with TI during CPR and quantifying CPR interruptions during TI in children is lacking.

Objectives:
To describe the frequency, duration, and outcomes of TI attempts during CPR in children in a tertiary pediatric ED, and to describe the interruptions in CPR associated with TI performance.

Methods:
Resuscitations in a tertiary pediatric ED are videorecorded as part of a continuous quality improvement project. Pediatric patients receiving CPR under videorecorded conditions in whom TI was attempted were prospectively identified and eligible for inclusion. Patients whose airway management did not include laryngoscopy (e.g. fiberoptic, surgical) were excluded. Data on intubation attempts (first attempt success tube placement, laryngoscopy time) and chest compressions (interruptions, duration of pauses) were collected. Univariate analysis of first attempt success was made between TI attempts with and without interruption in compressions.

Results:
Between November 2011 and April 2013, 22 patients had tracheal intubation (TI) attempts performed during cardiac arrest; a total of 44 attempts at TI occurred during CPR. 18/44 (41%) TI attempts had an associated interruption in CPR; the median duration in CPR interruption was 20 seconds (range 7 - 48). TI was successful in 17/20 patients (85%). Overall first attempt success at TI was 7/20 (35%); a median of 2 attempts were made per patient. TI attempts without interruption in CPR were successful in 6/22 (27%) compared to 5/11 (45%) when CPR was paused (p < 0.001). Median laryngoscopy time was 35 seconds (range 13-89).

Conclusions:
Among pediatric ED patients, TI during CPR results in frequent and prolonged interruptions in CPR. Successful TI is more common when CPR is paused. Future studies should examine the relationship between TI and outcomes in pediatric cardiac arrest patients.
Abstract 275: A Randomized Controlled Trial of Compression Rates (COMPRATE trial) During Cardiopulmonary Resuscitation
Authors: Hwang Sung-oh , Cha Kyoung Chul , Kim Kyuseok , Cho You Hwan , Shin Jonghwan , Lee Huijai , Chung Sung Phil , You Je Sung , Park Yoo Seok , Kim Seunghwang , Choi Sang-Cheon , Kim Won Young , Seo Dong Woo , Moon Sungwoo , Han Gapsu , Choi Han Sung , Kang Hyung Goo , Park Seung Min , Kwon Woon Yong , Park Eun Jung
Published: April 2024

Purposes:
This prospective, randomized, multicenter-, controlled trial was conducted to compare the efficacy of CPR with compression rate of 100/min to CPR with compression rate of 120/min in patients with cardiac arrest.

Methods:
Patients with non-traumatic out-of-hospital cardiac arrest whose age is equal and over 19 years old were randomized into two groups when the patient arrived at emergency department. The patients received manual CPR either a compression rate of 100 /min (CPR-100 group) or a compression rate of 120/min (CPR-120 group). Chest compressions were performed by pre-trained AHA certified healthcare providers according to guidance of metronome and a real-time CPR measurement feedback system. Quality of chest compression was assessed by reviewing the depth and rate of compressions recorded in the high quality electronic monitoring system of the defibrillator. The case was excluded if the accuracy of the depth and rate of chest compressions could not be maintained over 90%. The primary outcome measure was sustained return of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, 1-month survival, and 1-month survival with good functional status, categorized as a score of 2 or less on the cerebral performance category.

Results:
470 patients were enrolled in the study. 221 patients were assigned to CPR-100 group and 249 patients assigned to CPR-120 group. A total of 136 patients (61.5 %) in the CPR-100 group and 156 patients (62.7 %) in the CPR-120 group were included in the analysis. In comparison of primary outcome, 69 patients (50.7%) in CPR-100 group and 67 patients (42.9%) in CPR-120 group had ROSC (p=0.183). In secondary outcome measures, the rates of survival discharge from the hospital, 1-month survival, and 1-month survival with good functional status were not different between two groups (16.9% vs. 12.8%, p=0.375; 12.5% vs. 6.4%, p=0.073; 5.9% vs. 2.6%, p=0.154).

Conclusions:
In patients with out-of-hospital non-traumatic cardiac arrest resuscitated in emergency department, no differences in the resuscitation outcomes were found between those who received CPR with a compression rate of 100/min and those who received CPR with a compression rate of 120/min.
Abstract 280: Prehospital ECLS for Refractory Cardiac Arrest: Safety and Feasibility Study
Authors: Lamhaut Lionel , Jouffroy Romain , Dagron Christelle , Deluze Thibaut , Phillipe Pascal , Lejay Marc , An Kim , Spalding Christian , Carli Pierre
Published: April 2024

Background:
Extra Corporeal Life Support (ECLS) has been introduced in the treatment of refractory cardiac arrest (RCA). Several studies have assessed the use of ECLS in RCA once the patient has reached the hospital. The time between RCA and implementation of ECLS (low flow time) is one of the succesfull prognostic factors for survival. Pre hospital ECLS(PH-ECLS) implementation could decrease access time. Hence, we decided to assess the feasibility and safety of PH-ECLS implementation in a pilot study to reduce the low flow time.

Methodology:
We have developed a PH-ECLS team. This team was composed by 2 emergency physicians, 1 nurse, 1 paramedic. Patients were included prospectively and consecutively if the following criteria were gathered: they had a witnessed CA; CPR was initiated within the first 5 minutes and/or there were signs of life during CPR; an PH-ECLS team was available and absence of severe comorbidities.

According to national guideline, RCA was defined failed after 30 minutes of ALS. The ECLS insertion started after this 30 minutes of ACLS. The insertion technics was a surgical opening of the scarpa to repair the vessel. The insertion was done by Seldinger technics.

Results:
From 10/2011 to 01/2013, 17 patients with out of hospital CA were included. Results are resumed in Table 1.

Discussion:
This study shows the safety and feasibility to insert ECLS for OHCA on scene by emergency physician. The success rate and the insertion time are similar compare to the same technic in hospital by surgeon. One of the failed insertions was due to the obesity of the patient. Within this sample, one patient survived without sequel. However this study was not designed for survival, only for the safety and feasibility. One of the limitations in this work was the delay to define a RCA. The defined time of 30 minutes of ALS was too long to hope survivor regarding to the literature. PH-ECLS can be a solution to reduce the low flow time but a randomized study is required to evaluate the effect on survivors.
Abstract 281: Two Thumbs versus Two Fingers Compression in Infant Resuscitation
Authors: Love George
Published: April 2024

Compression Technique Comparison 2010 Standards. We’ve noticed a marked lack of ability in all levels of students performing infant CPR to adequately achieve an adequaterate & depth using two fingers. The groups were tested in three ways: 1. 2010 standard with no variation2. 2010 Standard allowing students to “stack” two fingers onto the two fingers doing compressions.3.Two thumb encircling hands technique allowed for single rescuer. All groups were tested blindly without allowing them to know they were in the study. Group 1: These students were not allowed to vary their finger position from the course video examples and followed the demonstrations completely. Results from this group: All students in this group complained of finger pain and requested to do the two thumbs encircling hands techniques for skills check off. In keeping with AHA standards, all groups used the two finger technique for skills check off. Group 2: Test Results from this group using an additional two fingers stacked atop the two fingers allowed for compressions were: Students in this group improved compression efficiency in depth by over 40% when compared to the first group. Compressions were slightly faster and the hands off time was improved by .2 seconds. Group 3: Test Results from this group using the two thumbs encircling hands technique were: This group showed a 48.9% improvement of depth of compression, 10.5% improvement in complete releases, an almost .4 second decrease in compression time and a .26 second improvement in hands off time. An additional 8 students were tested in this technique to validate the data. All these students were female and all were renewal students. After their initial testing was completed, we allowed them to use the two thumbs encircling hands technique with the following

Results:
An additional group of 9 Heartsaver students were tested at random. Their test results back up the results from the BLS groups in that all had trouble performing sets of 30 compressions with two fingers for a prolonged period of time, in this case 2 minutes. 33% ( 1 of 3) could keep up a passing depth of compressions for two minutes.
Abstract 283: Disparities in Bystander CPR and Neurologic Outcomes From Cardiac Arrest According to Neighborhood Ethnicity Characteristics in Arizona
Authors: Moon Sungwoo , Kortuem Wes , Kisakye Marvis , White Bernadette , Shin Sangdo , Martinez Rogelio , Vadeboncoeur Tyler , Spaite Daniel , Bobrow Bentley
Published: April 2024

Background and Objectives:
There are a growing number of Hispanic citizens in the US and language or other barriers may impede them receiving bystander CPR (BCPR). Our aim was to determine if there are differences in BCPR provision and outcomes for out-of-hospital cardiac arrest (OHCA) occurring in mainly Hispanic neighborhoods compared to mainly White non-Hispanic neighborhoods in Arizona.

Methods:
We analyzed our prospectively-collected statewide Utstein-compliant OHCA database between 1/1/10 - 12/31/11. OHCA cases were geocoded according to the incident address using ArcGIS 10.1 (Esri, Redlands, CA). Census-tract data was used to determine neighborhood characteristics of ethnicity. Neighborhoods were classified as mainly Hispanic or mainly White, non-Hispanic when each population was over 60% in the census-tract.

Results:
There were 4531 adult OHCA victims during the study. Cases were excluded from analysis (n=1380) due to incident location, cause of arrest, or because the arrest occurred after EMS arrival. Among 3151 cases, 2839 cases (90.1%) could be geocoded using incident address. CPR performance and outcomes by neighborhood ethnicity are shown (Table). When compared with patients who arrested in mainly White, non-Hispanic neighborhoods, those in mainly Hispanic neighborhoods were less likely to receive BCPR (odds ratio, 0.67; 95% confidence interval [CI], 0.52 to 0.84). Although no statistically significant differences were identified in the rate of survival to hospital discharge by main neighborhood ethnicity, patients who arrested in mainly Hispanic neighborhoods were less likely to have favorable neurologic outcomes (Cerebral Performance Score 1 or 2) than those in White, non-Hispanic neighborhoods (odds ratio, 0.16; 95% CI, 0.05 - 0.53).

Conclusion:
In Arizona, OHCA victims in mainly Hispanic neighborhoods received BCPR less frequently and had worse neurologic outcomes than those in mainly White, non-Hispanic neighborhoods.
Abstract 284: Load-Distributing-Band CPR for Cardiac Arrest Patients Improves Regional Cerebral Oxygen Saturation
Authors: Ogawa Yoshihito
Published: April 2024

Background:
Despite advances in therapeutic strategies and improved guidelines, morbidity and mortality rates for out-of-hospital cardiac arrest (OHCA) remain high. Especially, neurological prognosis is one of the most important problems although brain protection therapy for patients with OHCA has greatly improved in recent years due to the development of emergency post-cardiac arrest interventions, for example, mild therapeutic hypothermia, early percutaneous coronary intervention and extracorporeal cardiopulmonary resuscitation (CPR). Recently, Regional cerebral Oxygen Saturation (rSO2) have received attention as a valuation method of cerebral oxygenation. We have reported that conventional chest compression could not improve rSO2 of cardiac arrest patients if they did not get return of spontaneous circulation. It is, however, not determined whether the mechanical CPR device is helpful for improvement of rSO2.

Objective:
The purpose of this study is to evaluate the effects of Load-Distributing-Band CPR (LDB-CPR) on rSO2.

Methods:
Prospectively, LDB-CPR was performed for OHCA with AutoPulse from arrival to hospital. During mechanical CPR, rSO2 were recorded continuously from the forehead of the patients. CPR for patients with OHCA was performed according to the JRC-guidelines 2010 except for using AutoPulse instead of manual chest compression.

Results:
From December 2012 to May 2013, 18 patients with OHCA were included in this study. The mean age was 74.5±13.8 years old. Duration of time from recognition of cardiac collapse to arrival to hospital was 28.7±5.3 min. Before starting of LDB-CPR, rSO2 was 42.6±8.4% (baseline). rSO2 was significantly increased from baseline to 4, 8 and 12-minute after initiating LDB-CPR (46.9±7.3%, 46.2±6.8%, 47.3±6.8%, respectively p<0.05).

Conclusion:
LDB-CPR increased rSO2 of cardiac arrest patients.
Abstract 286: Survival to Hospital Discharge With Fixed 360 Joules Versus 200 Escalating to 360 Joules Defibrillation Strategies in Out-of-Hospital Cardiac Arrest of Presumed Cardiac Etiology
Authors: Olsen Jan-Aage , Brunborg Cathrine , Steinberg Mikkel T , Persse David , Souders Chris M , Sterz Fritz , Lozano Michael , Brouwer Marc A , Westfall Mark , Malzer Reinhard , van Grunsven Pierre M , Travis David T , Lerner E Brooke , Wik Lars
Published: April 2024

Background:
There is lack of evidence for fixed or escalating shock energy levels impact on survival to hospital discharge during CPR. According to the 2010 CPR consensus “maintaining the same initial energy level during subsequent shocks is acceptable. It is reasonable to increase the energy level when possible.” We studied shock success and survival to hospital discharge with fixed 360 Joules (J) versus escalating 200 to 360 J shocks, in patients in the Circulation Improving Resuscitation Care (CIRC) trial.

Methods:
Initial rhythm, pre-shock rhythm, rhythm 5 seconds after shock, shock energy levels and number of shocks were recorded. Patients uncategorizable as fixed or escalating shock energy protocol, without any indicated shocks or without any analyzable result from the shock were excluded from analysis. Shock success was defined as VF/VT termination at least 5 seconds after shock. Shock success between groups was calculated using chi-square test. Logistic regression determined the association between defibrillation strategy and survival to hospital discharge, after adjusting for age, initial rhythm, number of shocks, and witnessed arrests.

Results:
In CIRC 1657 (39%) of 4231 patients received at least one shock with analyzable defibrillator data. We included 914 fixed and 411 escalating patients. Median number of shocks per patient was 2 (IQR 1-4) in both groups. These patients received 3819 indicated shocks, 2662 in the fixed group and 1157 in the escalating group. There were 2178 (81.8%) successful shocks in the fixed group versus 963 (83.2%) in the escalating group (OR 0.91, 95% CI 0.76-1.09, p=0.29). A sub-analysis of patients whose initial rhythm was VF/VT found first shock success for 409 (83.1%) of the 492 in the fixed group versus 237 (86.5%) of the 274 in the escalating group (OR 0.77, 95% CI 0.51-1.17, p=0.22). Survival to hospital discharge for patients in the fixed group had an unadjusted OR 0.83, (95% CI 0.62-1.12, p=0.23) and adjusted OR 1.10 (95% CI 0.78-1.54, p=0.61) compared to the escalating group.

Conclusion:
There was no difference in individual shock success between defibrillation strategies. Further, there was no difference in patient survival to hospital discharge between the fixed versus escalating defibrillation strategies.
Abstract 288: Predicting Return of Spontaneous Circulation Using Cerebral Oximetry and End Tidal CO2
Authors: Engel Thomas , Thomas Craig J , Medado Patrick , Reed Brian , Millis Scott , O’Neil Brian J
Published: April 2024

Background:
Previous literature has identified ETCO2 as a good predictor of ROSC. Cerebral Oximetry (CerOx) utilizes near infrared spectroscopy to non-invasively measure regional O2 saturation of the frontal lobes of the brain.

Objectives:
The objective of this study is to compare the predictive value of simultaneously measured ETCO2 and CerOx for ROSC during CPR.

Methods:
We conducted an IRB approved, prospective study on a convenience sample of subjects suffering cardiac arrest. Subjects were monitored with ETCO2 and CerOx simultaneously during CPR performed in the ED. We analyzed the data using logistic regression modeling and ROC curve analysis.

Results:
We analyzed 135 events. Mean age was 64.5±15.6 years. 90 (66.7%) were witnessed arrests with 78 (57.8%) receiving bystander CPR. Average downtime was 24.9±15.0 minutes. ROSC was achieved in 39 (28.9%) of these subjects. Initial rhythm presented as 58 (43.0%) asystole, 52 (38.5%) PEA and 25 (18.5%) VF/VT.

A series of binary logistic regression models were run in which various derivations of ETCO2 and CerOx were simultaneously entered into the model to predict ROSC. CerOx, but not ETCO2, proved to be a significant predictor in determining ROSC for the following variables: regression slope during the full code [CerOx p<0.000, ETCO2 p<0.386], regression slope during the last 5 minutes of the resuscitation [CerOx p<0.000, ETCO2 p<0.749], maximum value recorded during resuscitation [CerOx p<0.000, ETCO2 p<0.858]. Both CerOx and ETCO2 proved to be significant predictors of ROSC for the following variables: last value recorded during resuscitation [CerOx p<0.000, ETCO2 p<0.009], the change from first value recorded to last value recorded [CerOx p<0.000, ETCO2 p<0.000].

CerOx also proved to be a better predictor of ROSC than ETCO2 when utilizing a ROC curve analysis: last values recorded [CerOx, AUC=0.856; ETCO2, AUC=0.761] and maximum values recorded [CerOx, AUC=0.802; ETCO2, AUC=0.630].

Conclusions:
CerOx is a better predictor of ROSC than ETCO2 when analyzed by the whole resuscitation effort, the last five minutes, the maximum value, the last value recorded, and the change in values from first to last recordings during CPR. The maximum and last values of CerOx are good diagnostic tests for predicting ROSC.
Abstract 326: Temperature Distribution During Hypothermia Induction Depends on Cooling Method and Blood Flow
Authors: Lampe Joshua , Bratinov George , Weiland Theodore , Garcia Josiah D , Illindala Uday , Becker Lance B
Published: April 2024

Introduction:
Animal research suggests that intra-arrest therapeutic hypothermia, cooling before return of spontaneous circulation (ROSC), may be more protective than inducing hypothermia after ROSC. Reduced blood flow should slow cooling rates, because the amount of blood flow will determine the amount of convective heat transfer. We hypothesize that intra-arrest cooling will result in significant temperature heterogeneity.

Methods:
18 temperatures (7 brain, 4 surface, 7 thoracic and abdominal) were monitored in 75 domestic swine (~30 Kg) during hypothermia induction. Cooling technologies included: Control, femoral vein (FV) cold saline infusion, FV ice slurry infusion, carotid (CA) cold saline infusion, CA ice slurry infusion, nasopharyngeal cooling, heat exchange catheter cooling, and blanket cooling. Animals were assigned to three blood flow groups: normal circulation, cardiac arrest treated with mechanical chest compressions (CC), and untreated cardiac arrest. CC and hypothermia induction were started after ten minutes of untreated arrest. CC were performed at a rate of 100 cpm and a depth of 1.25”. For all flow states, the experiments were terminated after 60 min of cooling.

Results:
18 Temperatures and cooling rates have been aggregated from 24 experimental groups with six reported time epochs per experiment, resulting in a data set that contains more than 4500 values. Initial analysis indicates that reductions in blood flow led to reduced cooling rates. The highest cooling rate in the right hemisphere of the brain during FV saline induction was -7.83 [[Unable to Display Character: ]]C/hr for normal flow, -4.47 [[Unable to Display Character: ]]C/hr for CPR, and -1.04 [[Unable to Display Character: ]]C/hr during no flow. Compartmentalization of cooling was observed during intra-CPR and intra-arrest cooling.

Conclusions:
Thermokinetics during intra-arrest cooling, even with ongoing CPR, is significantly different than post ROSC thermokinetics. Temperature heterogeneity increases the challenge of patient temperature monitoring, particularly for over-cooling. These data raise questions about how to optimize intra-arrest cooling.
Abstract 348: Defining the ’Golden Hour’: How Much Fluid Do Septic Shock Patients Need in the First Hour?
Authors: Paxton James H , Courage Cheryl , Hunt Nathan , Sherwin Robert L
Published: April 2024

Background:
Early fluid challenge and antimicrobial administration are essential in the treatment of septic shock (SS) patients. Delayed vascular access can prevent appropriate care for SS patients.

Study Objectives:
The primary objective of this study was to determine time to adequate vascular access (AVA; either a central venous line or 2 peripheral IV lines) in the treatment of SS in the emergency department (ED). Secondary objectives included determination of time elapsed to empiric antibiotic and IV fluid challenge from time of ED arrival.

Methods:
A retrospective chart review was conducted including all adult patients admitted to an urban Level II trauma center from the ED with an admission diagnosis of SS between June 1
st
, 2011 and September 31
st
, 2012. Data on time to AVA, fluid administration, and antibiotic administration were obtained from the electronic medical record.

Results:
We identified 96 patients who met inclusion criteria. Median time from diagnosis to AVA was 30.5 minutes (mean=75 min, SD=127.0), with 34% of patients still without AVA 1 hour after SS diagnosis. Median time from diagnosis to antibiotic administration was 69.5 minutes (SD=84.9), and only 43.8% of patients received antibiotics within 1 hour of diagnosis. The median volume of IV fluid infused within 1 hour of SS diagnosis was 18.6 mL/kg (SD=14.6). Patients who survived to hospital discharge received significantly more fluid during their first hour in the ED than patients who died prior to hospital discharge (20.1 ml/kg vs. 12.7 ml/kg;
t
(1)=2.5,
p
<.05). We observed a 41.5% decrease in mortality among patients who received greater than 10 ml/kg of IV fluid within their first hour in the ED (
p
<.01). At later time points (2, 4, or 6 hours after ED arrival), no mortality difference was observed.

Conclusion:
Early fluid resuscitation within 1 hour of ED arrival is associated with reduced inpatient mortality among septic shock patients. Based upon our data, there appears to be a critical threshold for the volume of IV fluid infused that is related to mortality. Strategies for earlier vascular access and antibiotic administration are needed.
Abstract 4: Initial Results for Pre-Hospital Transfusion of Plasma and RBCs in Trauma Patients
Authors: Holcomb John B , Donathan Daryn P , del Junco Deborah J , Brown Georgian , von Wenckstern Toni , Podbielski Jeanette M , Camp Elizabeth A , Hobbs Rhonda , Bai Yu , Brito Michelle , Hartwell Elizabeth , Cotton Bryan A , Wade Charles E
Published: April 2024

Introduction:
Earlier use of plasma has been associated with improved survival in trauma patients with substantial hemorrhage. In September 2011 we placed 2 units each of thawed plasma and RBCs on our helicopters. We hypothesized that pre-hospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival.

METHODS:
Adult trauma patient records were reviewed for patient demographics, shock, coagulopathy, outcomes and blood product utilization from Sept 2011-Dec 2012. Patients arrived by either ground or two different helicopter companies. All patients transfused blood products (either pre or in-hospital) were included in the study. One helicopter system had thawed plasma and RBCs while the other air and ground transport systems used only crystalloid resuscitation. Patients receiving PHT were compared with all other patients meeting entry criteria to the study cohort. All comparisons were adjusted in multi-level regression models.

Results:
6238 adult trauma patients were admitted during the 15 month study period, of which 577 (9.2%) met inclusion criteria. They represented the most severely injured patients (ISS = 24 and mortality = 26%). There were 97 patients who received PHT and 480 in the non PHT control group. 244 units of RBCs and 698 units of plasma were placed on the helicopters, with 1.9% wastage. PHT was associated with reduced risks of 6-hour mortality (adjusted OR=0.08, 95% CI=0.01-0.87, p=0.04) and coagulopathy on arrival (TEG ACT ≥ 128, (adjusted OR=0.40, 95% CI=0.19-0.87, p=0.02) and a 13% non-significant improvement in hospital mortality.

CONCLUSION:
Prehospital plasma and RBC transfusion was associated with improved coagulation status and a reduction in the risk of death in the first 6 hours after admission, with negligible blood products wastage.
Abstract 13017: CD8+ T Cells Elicited by an ApoB-100 Related Peptide Vaccine Protect Against Angiotension II-induced Aortic Aneurysm Formation by Inhibiting Aortic Macrophage Infiltration and Modulating Th17 Polarization
Authors: Honjo Tomoyuki , Dimayuga Paul C. , Chyu Kuang-Yuh , Yano Juliana , Lio Wai Man , Trinidad Portia , Zhao Xioaning , Zhou Jianchang , Cercek Bojan , Shah Prediman K.
Published: April 2024

Tomoyuki Honjo, 2013 Finalist and Presenting Author
Abstract 18830: Mitochondrial Suppression Due to Loss of Sirt3 Deacetylase Activity Causes Pulmonary Arterial Hypertension
Authors: Paulin Roxane , Dromparis Peter , Sutendra Gopinath , Gurtu Vikram , Zervopoulos Sotirios , Bowers Lyndsay , Haromy Alois , Webster Linda , Provencher Steeve , Bonnet Sebastien , Michelakis Evangelos, D.
Published: April 2024

Roxane Paulin, 2013 Finalist and Presenting Author
Abstract 17467: Development and Validation of an Accurate Predictive Equation for Oxygen Consumption in Congenital Heart Disease
Authors: Seckeler Michael D. , Hirsch Russel , Beekman Robert H. , Goldstein Bryan H.
Published: April 2024

Michael D. Seckeler, 2013 Finalist and Presenting Author
Abstract 15882: Effect of HLA Matching on Pediatric Heart Transplant Graft Survival
Authors: Butts Ryan , Scheurer Mark , Atz Andrew , Moussa Omar , Burnette Ali , Hulsey Thomas , Savage Andrew
Published: April 2024

Ryan Butts, 2013 Finalist and Presenting Author
Abstract 15315: Ideal cardiovascular health: associations with biomarkers and subclinical disease, and impact on incidence of cardiovascular disease in the Framingham Offspring Study
Authors: Xanthakis Vanessa , Enserro Danielle , Vasan Ramachandran S.
Published: April 2024

Vanessa Xanthakis, 2013 Finalist and Presenting Author
Abstract 13251: Experimental Endotoxemia Uncovers a Genomic Basis for Thermoregulation: Chr7p11.2 Locus in Inflammatory Febrile Response and Temperature Homeostasis
Authors: Ferguson Jane F. , Meyer Nuala J. , Qu Liming , Xue Chenyi , Liu Yichuan , DerOhannessian Stephanie L. , Rushefski Melanie , Schadt Eric E. , Li Mingyao , Christie Jason D. , Reilly Muredach P.
Published: April 2024

Jane Ferguson, 2013 Finalist and Presenting Author
Abstract 17045: Myocardial Catastrophe: A Case of Severe, Sudden Systolic Dysfunction
Authors: Hucker William , Chatzizisis Yiannis S. , Steigner Michael , Winters Gayle , Kirshenbaum James
Published: April 2024

William Hucker, 2013 Finalist and Presenting Author
Abstract 14336: Rockstar Heart
Authors: Wagle Rohan R. , Hippensteel Joseph , Kazi1 Dhruv S.
Published: April 2024

Rohan Wagle, 2013 Finalist and Presenting Author
Abstract 13003: MicroRNA-133 Promotes Direct Cardiac Reprogramming by Snai1 Repression and Silencing Fibroblast Signatures
Authors: Muraoka Naoto , Yamakawa Hiroyuki , Miyamoto Kazutaka , Sadahiro Taketaro , Inagawa Kohei , Wada Rie , Umei Tomohiko , Nishiyama Takahiko , Kaneda Ruri , Fukuda Toru , Takeda Shu , Suzuki Tomoyuki , Tohyama Shugo , Hashimoto Hisayuki , Fukuda Keiichi , Ieda Masaki
Published: April 2024

Naoto Muraoka, 2013 Finalist and Presenting Author
Abstract 15249: A Text Messaging Intervention to Promote Medication Adherence for Patients with Coronary Heart Disease: A Randomized Controlled Trial
Authors: Park Linda G. , Howie-Esquivel Jill , Chung Misook , Dracup Kathleen
Published: April 2024

Linda G. Park, 2013 Finalist and Presenting Author
Abstract 15127: Association of cardiac structure and function with advanced magnetic resonance cerebral measures: The CARDIA Study
Authors: Armstrong Anderson C. , Muller Majon , Ventakesh Bharath Ambale , Halstead Michael , Kishi Satoru , Bryan Nick , Sidney Stephen , Correia Luís C. L. , Gidding Samuel S. , Launer Lenore J. , Lima João A.C.
Published: April 2024

Anderson C. Armstrong, 2013 Finalist and Presenting Author
Abstract 12575: High Dietary Phosphorus Intake is Associated with All-Cause Mortality: Results from NHANES III
Authors: Chang Alex , Lazo Mariana , Appel Lawrence , Gutierrez Orlando , Grams Morgan
Published: April 2024

Alex Chang, 2013 Finalist and Presenting Author
Abstract 16646 : The Left Atrium Emptying Fraction Improves Diagnosis of Paroxysmal Atrial Fibrillation after Cryptogenic Ischemic Stroke: Results from The SURPRISE Study
Authors: Biering-Sørensen Tor , Christensen Louisa M. , Krieger Derk W. , Mogelvang Rasmus , Jensen Jan Skov , Højberg Søren , Høst Nis , Karlsen Finn Michael , Christensen Hanne
Published: April 2024

Tor Biering- Sorensen, 2013 Finalist and Presenting Author
Hypercholesterolemia and Metabolic Syndrome: Mischievous Partners
Authors: Grundy Scott M.
Published: April 2024

Elevations of two lipoproteins contribute to atherogenic hypercholesterolemia: low density lipoprotein (LDL) and very low density lipoprotein (VLDL). Their atherogenic potential is identified by their cholesterol (C) content. Together they constitute non-HDL-C. In populations and individuals having very low levels of non-HDL-C, atherosclerotic cardiovascular disease (ASCVD) is rare. In persons with severe elevations of non-HDL-C, these lipoproteins can initiate atherogenesis and precipitate ASCVD in the absence of other risk factors. The importance of non-HDL-C for development of ASCVD is dramatically shown by the reduction in risk accompanying cholesterol-lowering therapy. This does not negate the importance of other risk factors. The most common aggregation of these risk factors occurs in a condition called the metabolic syndrome. The prevalence of the metabolic syndrome increases in parallel with the increasing obesity in the population. This condition is characterized by abdominal obesity, insulin resistance and increased risk for type 2 diabetes, elevations in triglycerides, reduction in HDL, elevations in blood pressure, and prothrombotic and proinflammatory states. Epidemiological studies shown that the presence of the metabolic syndrome doubles the risk for ASCVD and carries a 5-fold increase in risk for type 2 diabetes. Most of the metabolic syndrome can be attributed to lifestyle factors, notably, over nutrition and decreased physical activity. Future advances on prevention of ASCVD will depend on new approaches to controlling hypercholesterolemia and to reducing the prevalence of the metabolic syndrome.
The Regression of Atherosclerosis: The Journey From the Liver to the Plaque and Back
Authors: Fisher Edward
Published: April 2024

The Duff Memorial Award Lecture will consist of 3 short stories.  In the first, new developments will be presented on how the production of very low density lipoproteins (VLDL, which become LDL) by the liver is controlled by the degradation of their apolipoprotein B (apoB) component. In particular, our recent results have shown that insulin and niacin, two medically relevant regulators of the plasma levels of VLDL, utilize a process called autophagy to accomplish this. In the second, recent studies on the regression of atherosclerosis in novel mouse models will be presented. Specifically, I will show that to get rid of the cholesterol-filled disease-causing cells from the arterial plaques, new, healthy, monocytes need to be recruited from the circulation. In the third story, the use of natural and synthetic nanoparticles to carry imaging and therapeutic agents directly to atherosclerotic plaques will be presented.
Abstract 71: Comparison of Outcome of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital and In-Hospital Cardiac Arrest
Authors: Chen Yih-Sharng , Chou Nai-Kwoun , Wang Chih-Hsien , Lin Jou-Wei , Yu Hsi-Yu , Chi Nai-Hsin , Huang Shu-Chien , Wang Shoei-Shen , Becker Lance
Published: April 2024

Objectives:
The aim of this study was to investigate the effects of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) and compare the results with those of in-hospital cardiac arrest (IHCA).

Background:
ECPR, considered an adjuvant therapy for IHCA, has been previously applied for OHCA with unsatisfactory results.

Methods:
We reviewed our prospectively collected extracorporeal membrane oxygenation (ECMO) results and analyzed the data for patients who received ECPR for OHCA or IHCA in the last 5 years. Pre-arrest, resuscitation, and post-resuscitative data were evaluated.

Results:
In the last 5 years, ECPR was used 230 times for OHCA (n=31) and IHCA (n=199). The basic demographic data showed significant differences in age, cardiomyopathy, and location of the initial CPR. Duration of ischemia was shorter in the IHCA group (44.4 ± 24.7 min vs. 67.5 ± 30.6 min, p 0.05). Survival was acceptable (about 33%) in both groups when the duration of ischemia was no longer than 75 minutes.

Conclusions:
In addition to having a beneficial effect in IHCA, ECPR can result in an acceptable survival and neurological outcome in selected OHCA patients after prolonged cardiopulmonary resuscitation. Our results suggest that further investigation of the use of ECMO in OHCA is warranted and that ECMO may be an effective adjuvant therapy.
Abstract 73: Changes in AMSA During Controlled Coronary Perfusion by Extracorporeal Circulation in a Swine Model of Ventricular Fibrillation
Authors: Borovnik-Lesjak Vesna , Whitehouse Kasen , Baetiong Alvin , Radhakrishnan Jeejabai , Kaufman Christopher L , Gazmuri Raúl J
Published: April 2024

Background:
Previous VF studies in rats showed that 6 min of CPR was needed before an electrical shock could be successful in reestablishing cardiac activity. During this interval the amplitude spectral area (AMSA) - a method of VF waveform analysis - progressively rose reaching a plateau within the same interval required for enabling successful defibrillation. No previous studies have examined AMSA continuously using a model of tightly controlled CPR.

Methods:
VF was induced and left untreated for 8 min in 16 swine after which extracorporeal circulation (ECC) was maintained for 10 min adjusting its flow to generate a coronary perfusion pressure of 10 mmHg. AMSA was calculated from the VF signal in the frequency domain within 2-48 Hz and analyzed continuously with a 2.1 s timeframe and a Tukey window that moved ahead every 0.5 s.

Results:
AMSA progressively declined during untreated VF. During ECC, AMSA rose from 6.8±1.9 to 12.4±4.1 mV*Hz (p<0.001). The increase occurred early during ECC and plateaued after 4 to 6 minutes (Figure). Individual experiments showed distinct and varying AMSA patterns during ECC. The average peak AMSA was reached 368 ± 127 s after the start of ECC.

Conclusion:
The time course of AMSA varied among animals suggesting variability in the time required for the myocardium to reach the optimal conditions for successful defibrillation and highlights the value of continuous monitoring of AMSA during CPR.
Abstract 74: Sequential Organ Failure Assessment Score at Presentation Predicts Survival in Venoarterial Extracorporeal Membrane Oxygenation
Authors: Czobor Peter , Parikh Kishan , Nathan Sandeep , Karol Janet , Shah Atman P
Published: April 2024

Background:
Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has been reported to improve survival in patients with cardiogenic shock (CS) or cardiac arrest (CA). However, overall mortality remains high and many patients may not benefit from ECMO. The Sequential Organ Failure Assessment (SOFA) score is an assessment of a patient’s organ function in the setting of shock composed of scores for the respiratory, cardiovascular, hepatic, coagulation, renal, and neurologic systems, graded 0 to 4 based on level of dysfunction. We investigated the role of the SOFA score in predicting survival in CS and CA patients treated with ECMO.

Methods:
We performed a retrospective review of all patients treated with percutaneous VA ECMO at the University of Chicago Medical Center from January to December 2012. SOFA score at presentation was calculated using available clinical data. Demographics, clinical characteristics, and outcomes of survivors versus non-survivors were compared using fisher’s exact test. An age adjusted logistic regression model was used to calculate the association between SOFA score and survivor status.

Results:
Percutaneous VA ECMO was initiated in 15 patients. 7 were alive at 30 days after ECMO initiation. Survivors had a significantly lower baseline median SOFA score (9 vs 16, p= 0.03, OR 0.577 ). The only other significant predictors of survival were female sex and smaller cannula size. Major complications included hemorrhage (2), HIT (1) and DIC (1). Limb ischemia was not seen in any patients as all patients underwent anterograde cannulation at the time of ECMO initiation

Conclusions:
The presenting SOFA score predicts survival in patients with CS or CA who undergo VA ECMO. Calculation of the SOFA score at presentation may help physicians decide which patients may derive benefit from ECMO.
Abstract 75: Mouth-to-Face-Shield Ventilation Impairs CPR Quality Compared to Mouth-to-Pocket-Mask Ventilation: A Randomized Study
Authors: Adelborg Kasper , Bjørnshave Katrine , Mortensen Martin B , Espeseth Eirild , Wolff Anne , Løfgren Bo
Published: April 2024

Objective:
Effective ventilations are essential when resuscitating a drowning victim. Ventilation is necessary to treat hypoxia however interruptions in chest compressions should be minimized. Surf lifeguards may be reluctant to perform rescue breathing using mouth-to-mouth ventilation. Using a face shield or face mask may be reasonable. The most optimal ventilation technique among surf lifeguards is currently unknown. The aim of this study was to compare the effect of mouth-to-face-shield ventilation (MFV) and mouth-to-pocket mask ventilation (MPV) on CPR quality.

Methods:
We invited professional paid surf lifeguards to participate in the study. Each surf lifeguard was randomized to perform 2 x 3 minutes of single-rescuer CPR on a resuscitation manikin using MFV (AMBU® LifeKey) and MPV (Laerdal Pocket MaskTM). Data were collected from resuscitation manikin and from video recordings.

Results:
In total 30 surf lifeguards were included (mean age: 25.1 year; 21 male, 9 female). MFV (mean±s.d.: 8.6+/-1.7 s) significantly increased interruptions in chest compressions compared to MPV ventilation (6.9+/-1.2 s, p<0.0001). The proportion of effective ventilations (visible chest rise) was reduced using MFV (82%) compared to MPV (100%, p=0.0002). Tidal volume was higher using MPV (0.45+/-0.20 L) compared to MFV (0.36+/-0.20 L, p= 0.006). No differences in inspiratory times were observed between MFV and MPV.

Conclusion:
MFV increases interruptions in chest compressions, reduces the proportion of effective ventilations and decreases delivered tidal volumes when compared to MPV. This suggests that CPR quality is impaired using MFV compared to MPV among surf lifeguards.
Abstract 87: Lactate and Need for Vasopressors Predicts Mortality After Out-of-Hospital Cardiac Arrest
Authors: Cocchi Michael N , Saindon Brian , Giberson Tyler , Patel Parth V , Donnino Michael W
Published: April 2024

Background:
Early prediction of outcome after out of hospital cardiac arrest (OHCA) is difficult. Previous work has indicated that the combination of lactate and the need for vasopressors may stratify patients and predict outcome.

Hypothesis:
The combination of initial lactate and requirement for vasopressor support will predict survival post-arrest.

Methods:
To validate previous retrospective findings, we conducted a prospective observational study of all OHCA (age >18, non-traumatic) patients presenting to the emergency department of a tertiary care center between June 2006 and July 2013 with ROSC. We conducted a logistic regression model with hypotensive status (yes or no) and lactate level (lactate <5, between 5-10 mmol/L and >10) as predictors of mortality.

Results:
A total of 140 patients were enrolled. Median age of the cohort was 67 (IQR: 53-79.) 72% underwent mild therapeutic hypothermia. Overall mortality rate for the cohort was 60.71%. Patients who received vasopressors had a significantly higher mortality rate than those who did not receive vasopressors (69.4% v. 47.3% ; p=0.009). There was a step-wise increase in mortality associated with increasing lactate levels (37.0% lactate <5, 68.8% lactate 5-10, 95.5% lactate >10; p=0.0001). The AUC for our model was 0.76. Adjusting for hypotensive status, higher lactate levels were associated with increased odds of death compared to lactate 5-10 as the reference group (lactate 5-10 OR = 3.4, 95%CI: 1.6, 7.4; lactate >10 OR = 30.9, 95%CI: 3.8, 249.4). When adjusting for lactate level there was no significant increase in odds of death for patients who were hypotensive compared to patients who were not hypotensive (OR=0.541, 95%CI: 0.3, 1.2).

Conclusion:
In this prospective validation of a previously retrospective finding, the combination of lactate and need for vasopressors in the immediate post-arrest period is predictive of mortality. Future multicenter validation of this tool is warranted.
Abstract 9257: Atrial Fibrillation is Associated With Worse Outcomes in Patients With Diastolic Heart Failure than Patients With Systolic Heart Failure
Authors: Smith Sakima A , Hite Arnold J , Ishola Abiodun , Hasan Ayesha K
Published: April 2024

Introduction:
Atrial fibrillation (AF) is prevalent and is associated with heart failure (HF). HF causes changes in atrial structure and physiology that predispose to AF. Our goal was assess the impact of AF on HF patients with either preserved (HFpEF) or reduced (HFrEF) left ventricular ejection fraction (LVEF).

Hypothesis:
We hypothesized that patients with HFrEF would likely have more adverse events and worse outcomes.

Methods:
This was a retrospective review of 763 patients with HF at baseline who developed AF. We analyzed the CHADS and CHADS-Vasc scores and time to death, time to AF development, time to death from AF development, time to adverse events (figure 1), and length of stay (LOS).

Results:
Patients with HFpEF had significantly longer LOS for AF or HF hospitalizations. While patients with HFrEF on average developed AF four months sooner than patients with HFpEF, those with HFpEF died six months earlier (table 1).

Using multiple linear regression only age was a significant predictor for time to AF development.

There were no significant differences between HFrEF vs HFpEF patients with respect to time to an adverse event. When patients were stratified into younger vs older cohorts (< or ≥ 50 years of age) there was a significant difference for the waiting time to an adverse event between the younger and older patients (figure 1).

Conclusion:
Patients with HFpEF and AF represent a cohort of patients that have a significant burden of disease and poor outcomes. Their increased LOS is likely a product of their multiple co-morbid conditions complicating their underlying HF. Our data also suggests that the most important factor for time to an adverse event for HF patients with AF is age, not the LVEF.
Abstract 9261: Dantrolene May Suppress Arrhythmogenesis by Inhibition of CaMKII-mediated Aberrant Ca2+ Release Within the Ryanodine Receptor in Cardiac Troponin T-related Familial Hypertrophic Cardiomyopathy
Authors: Okuda Shinichi , Fukuda Masakazu , Kato Takayoshi , Nishimura Shigehiko , Kobayashi Shigeki , Yamamoto Takeshi , Yano Masafumi
Published: April 2024

Cardiac troponin T (cTnT) mutations cause Familial Hypertrophic Cardiomyopathy (FHC), which leads to sudden cardiac death. Ca2+ sensitivity in myofilaments was increased, however, the underlying mechanism by which the cTnT mutations lead to lethal arrhythmia and the therapeutic approach remains elusive. Here, we investigated the pathogenic role of phosphorylation-mediated aberrant Ca2+ release via the cardiac ryanodine receptor (RyR2) and the therapeutic effects of dantrolene, which was found to correct inter-domain interactions of RyR2 in failing hearts (i.e. unzipping to zipping), in transgenic mouse (TG) model with FHC-related cTnT mutation (delta160E).

Methods and results:
In 6thmonths of age, there was no appreciable difference in the structural or functional features of the hearts between non-TG and TG mice. In response to isoproterenol (ISO; 10 nmol/L), the Ca2+ spark frequency (SpF: s-1·100μm-1; by fluo4) was much higher in TG cardiomyocytes (ISO-TG: n=11: 7.7±0.7; p<0.01) than in non-TG cardiomyocytes (n=6: 3.5±0.5). It was largely reversed by CaMKII inhibitor {ISO-TG with KN-93(1μM), n=6: 5.2±0.4; p<0.05}}, but not by PKA inhibitor{ISO-TG with H-89(1μM), n=6: 7.3±0.4;n.s}}. ISO-TG (but not ISO-treated non-TG 0/14; n=14) showed spontaneous Ca2+ transient (sCaT) after 5 Hz pacing (12/18; n=13), whereas it was again attenuated by KN-93 (0/5; n=5), but not by H-89 (3/5; n=5)}. These abnormal events in ISO-TG were reproduced by adding EGTA-AM into ISO-treated non-TG, suggesting that increased Ca2+ buffering capacity, causing an increase in diastolic [Ca2+], predisposes to aberrant Ca2+ release events. Moreover, dantrolene (1μM) attenuated SpF (n=6: 5.2±0.3; p<0.05 vs ISO-TG), time from peak to 70% decline of Ca2+ transient and sCaT (3/10; n=10) in ISO-treated TG cardiomyocytes.

Conclusions:
In FHC-linked cTnT mutated hearts, aberrant local Ca2+ release through defective RyR2 was induced by beta-adrenergic stimulation, presumably due to mutation-linked, increased Ca2+ buffering capacity, and subsequent CaMKII activation. The inhibition of CaMKII-mediated aberrant Ca2+ release by stabilizing RyR2 could be a new therapeutic approach to prevent the development of arrhythmias in FHC.