bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17416: miR-1468-3p Regulates Development of Cardiac Fibrosis
Authors: Lin Ruizhu , Rahtu-Korpela Lea , Magga Johanna , Pakanen Lasse , Porvari Katja , Junttila Juhani , Huikuri Heikki , Kerkelä Risto
Published: July 2021

Background:
Accumulation of extracellular matrix disturbs the electrical conduction and stiffens myocardium, leading to higher risk for arrhythmias and diastolic dysfunction. MicroRNAs (miRNAs) function in post-translational gene regulation, and aberrant alteration of miRNAs level has been implicated in cardiac pathologies.

Methods and Results:
RNA sequencing of RNA samples of sudden cardiac death (SCD) victims with idiopathic myocardial fibrosis (IMF) for differentially expressed miRNAs identified miR-1468-3p. qPCR analysis validated that expression of miR-1468-3p is upregulated in hearts of SCD victims with IMF comparing to control subjects. However, the role and molecular function of miR-1468-3p in cardiac fibrosis are not known. We utilized human cardiac fibroblasts (hCFs) and gain- and loss-of-function approaches to study the role of miR-1468-3p in modulating fibroblast function. Overexpressing miR-1468-3p in hCFs resulted in an increase in expression of several fibrotic genes compared with hCFs transfected with control mir-mimic. Western blot analysis showed that miR-1468-3p mimic was sufficient to drive expression of collagen I and CTGF protein expression. Treatment of hCFs with miR-1468-3p antagomir did not alter expression of fibrosis-related gene at basal level, whereas miR-1468-3p inhibition significantly attenuated TGF-β1-induced collagen I and collagen III expression. Treatment of hCFs with miR-1468-3p antagomir blunted TGF-β1-induced collagen I and CTGF protein expression, but not TGF-β1-induced αSMA expression. Employing Sirius Red/Fast Green assay, we validated that depletion of miR-1468-3p antagonized both TGF-β1-triggered collagen and non-collagen protein production. Finally, we found that miR-1468-3p antagomir downregulated TGF-β1-induced collagen expression partially through the interference of TGF-β1/MAPK signals (p38 and JNK) and Integrin signaling.

Conclusions:
Our data indicate a pro-fibrotic role of miR-1468-3p in modulating cardiac fibrosis, and manipulating the expression of miR-1468-3p may provide a therapeutic strategy for treatment of cardiac fibrosis.
Abstract 09: Ultra-Fast Hypothermia Inhibit Early Cerebral Consumption of Lactate After Experimental Cardiac Arrest in Rabbits : A Microdialysis Study
Authors: Kohlhauer Matthias , Demelos Alexandra , Boissady Emilie , Ghaleh Bijan , Tissier Renaud
Published: July 2021

Introduction:
Ultra-fast hypothermia through total liquid ventilation (TLV) has been shown to be neuroprotective after cardiac arrest.

Hypothesis:
The mechanism could involve a modification in brain metabolic substrat.

Method:
Anesthetized rabbits were instrumented with a carotid flow probe as well as arterial and jugular venous catheters. A microdialysis catether was implanted in the right brain cortex. Animals were then submitted to 10 min of ventricular fibrillation and cardiopulmonary resuscitation. After resumption of spontaneous circulation (ROSC), they were randomly submitted to ultra-fast cooling to 32°C by TLV (TLV group) or normothermic follow-up (Control) during 4h. Cerebral consumption of lactate, glucose and O
2
was calculated using arteriovenous differences in their content times mean carotid blood flow.

Results:
In Control, cerebral blood flow was significantly and sustainly decreased after ROSC (61±6 vs 101±6 ml/min after 240 min vs baseline), with a further decrease with hypothermia in TLV group (23±2 ml/min after 240 min, p<0.05). As compared to Control, TLV reduced the cerebral consumption of glucose (-69% at 240 min) and O
2
(-73% at 240 min). Importantly, Control animals showed a dramatic but transient cerebral consumption of lactate during the first 120 min after cardiac arrest (e.g. 124±31 mmol/min at 60 min). Concomitantly, this was associated with an increase in pyruvate extracellular stocks in brain (e.g. 57±10 μmol/L at 30 min). In TLV group, hypothermia blunted this initial burst of lactate consumption (e.g. 41±12 mmol/min at 60 min, p<0,05) and led to an accumulation in extracellular lactate (
e.g.
2053±68
vs
1246±278 μmol/L at 60 min, in TLV and Control respectively). This early build-up of lactate was then progressively consumed after 120 min in TLV group, allowing a delayed accumulation in pyruvate extracellular stocks from 120 min until the end of follow-up (103±19 and 17±4 μmol/L of pyruvate at 240 min in TLV
vs
Control respectively).

Conclusion:
Ultra-fast hypothermia reduces the cerebral consumption of lactate during the first 120 min after ROSC, allowing a delayed renewal in pyruvate stocks. This could explain the potent benefit of hypothermia during this early therapeutic window of 120 min.
Abstract 109: Pediatric CPR in the Emergency Department: Initial Findings From the Videography in Pediatric Emergency Research Collaborative
Authors: O’Connell Karen J , Kerrey Benjamin T , Myers Sage R , Sandler Alexis B , Hanna Richard , Watanabe Ichiro , Frey Mary E , Donoghue Aaron J
Published: July 2021

Introduction:
Cardiopulmonary resuscitation (CPR) is frequently performed in a manner inconsistent with American Heart Association (AHA) guidelines. Published studies on CPR quality during pediatric cardiac arrest using chest compression (CC) monitor devices have reported data in aggregate form from entire CPR events. The addition of video review allows precise measurement of CPR quality at the level of individual providers.

Hypothesis:
To measure individual healthcare providers’ (HCP) CPR quality during pediatric cardiac arrest events in actual patients in the emergency department (PED) and describe adherence to AHA guidelines.

Methods:
A report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational database from three tertiary PEDs. All study sites videorecord and review resuscitations and use a pressure sensor/monitor device during CPR. All events where chest compressions (CC) were performed under videorecorded conditions with the monitor device in use were eligible for inclusion. Data on CPR performance was collected by a combination of video review and monitor device; CC rate and depth and ventilation rate were extracted in time periods corresponding to individual CPR providers. CPR segments were defined as ‘high-quality’ if all AHA guidelines were achieved (CC rate 100-120 cpm; CC depth >= 1.5 inches for infants or >= 2 inches for children; ventilation rate 8-12 bpm, no pauses > 10 seconds).

Results:
Between August 2016 and April 2018, complete data was available for 31 events (infants: n=5; older children: n=6). 279 compression segments were analyzed. Median CC rate was 119 cpm (IQR 110 – 129); median depth was 1.0 inches in infants (IQR 0.85 – 1.2) and 2.1 inches in older children (IQR 1.4 – 2.4). Median ventilation rate was 15 bpm (IQR 10 - 30). 22/279 (8%) compression segments met all criteria for high-quality CPR.

Conclusions:
PED HCPs infrequently met AHA guidelines for CPR quality. Future studies using video review and CC monitor data collection should examine the impact of specific training strategies on provider-level CPR performance during pediatric cardiac arrest.
Abstract 110: The Dynamic Clinical Course of Resuscitation in Children With Cardiac Arrest
Authors: Nordseth Trond , Niles Dana , Eftestøl Trygve , Nadkarni Vinay , Sutton Robert , Berg Robert , Irusta Unai , Kvaløy Jan T , Abella Benjamin S , Skogvoll Eirik
Published: July 2021

Background:
During cardiac arrest, a child may be in one of five clinical states (“rhythms”): 1) Bradycardia with poor perfusion; 2) Pulseless Electrical Activity (PEA); 3) Ventricular Fibrillation or Pulseless Ventricular Tachycardia (VF/VT); 4) Asystole; or 5) Spontaneous Circulation (ROSC). The aim of study was to investigate and quantify the dynamic characteristics of this process.

Methods:
We prospectively acquired data on rhythm and clinical states using recording defibrillators during active CPR. Recordings were analyzed as a multi-state statistical model, focusing on transitions between PEA (including bradycardia with poor perfusion), VF/VT, Asystole, and ROSC (defined as an organized electrical rhythm without chest compressions >= 1 minute). Instantaneous transition rates were obtained by smoothing the Nelson-Aalen estimator of cumulative intensities.

Results:
In 74 Cardiac Arrest events with evaluable data, median patient age was 15 years [range 1.75 to 22.9; IQR 11 to 17]. Fifty percent had a respiratory etiology and 51 % were female. PEA was the most frequent presenting cardiac arrest rhythm (38 %); followed by VF/VT (24 %), bradycardia (22 %), and asystole (16 %). Starting from time of defibrillator attachment (median 3 minutes into the event) as shown in the figure that shows 45 minutes of CPR, the prevalence of sustained ROSC reached an asymptotic value of 30 % at 20 minutes. We observed a temporary surge of PEA at about 12 minutes, resulting from a doubling (from 0.1 to 0.2 transitions/min) of the instantaneous transition rate of ROSC to PEA during this period.

Conclusion:
We provide a quantitative overview of the dynamic process of clinical state transitions during in-hospital cardiac arrest and resuscitation in older children and adolescents. A notable feature was a temporary increase in the prevalence of PEA at 12 minutes.
Abstract 135: Integration of Social Media With Targeted Emails and interviews for Exception From Informed Consent Community Consultation
Authors: Hsu Cindy H , Fowler Jennifer , Cranford James A , Thomas Michael P , Neumar Robert W
Published: July 2021

Introduction:
Exception from informed consent (EFIC) enables the enrollment of subjects with emergent conditions for clinical trials without prior consent. All EFIC studies are required to include community consultation (CC). However, CC implementation is often challenged by significant cost and scarce community engagement.

Hypothesis:
We hypothesize that the utilization of social media, targeted emails, and interviews of at-risk individuals and their caretakers can lead to more effective EFIC CC.

Methods:
We utilized social media and targeted emails/interviews for the EFIC CC of the ACCESS to the Cardiac Catheterization Laboratory in Patients Without ST-Segment Elevation Myocardial Infarction Resuscitated From Out-of-hospital Ventricular Fibrillation Cardiac Arrest Trial. We disseminated study advertisements with survey links and opt-out option using Facebook/Instagram to our communities and targeted emails to prehospital and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Between-group comparisons of proportions were tested using modified chi-squared tests for small sample size.

Results:
We collected 559 fully or partially completed surveys over an eight-week period. The majority of the surveys (70.5%) were obtained using social media. The mean age was 45 years; 90% were white and 61% were female. Overall, 91.3% believed ACCESS is an important study. The interview group had significantly more loved ones with cardiac arrest than the social media (50% vs 36.7%, p < 0.05) or targeted email (50% vs 23.6%, p < 0.005) group. Compared to the interview group, more from social media (81.8% vs 63.3%, p < 0.05) and targeted email (77.4% vs 63.3, p < 0.05) groups said they would include their loved ones in the study. More from the interview group believed that their opinion would be considered seriously compared to the social media (75.9% vs 62.6%, p < 0.05) and targeted email (75.9% vs 54.5%, p < 0.05) groups. No one opted out from the study.

Conclusions:
The integration of social media with targeted emails and interviews is an effective approach for EFIC CC. Future work is necessary to determine the perception and best utilization of these strategies for EFIC studies.
Abstract 140: Utilization of Mechanical CPR Is Highly Variable Within the National EMS Information System Dataset
Authors: Buckler David G , Abdulhay Nabil , Totolos Konstantinos , Abella Benjamin
Published: July 2021

Background:
Randomized controlled trials have demonstrated neither survival benefit nor harm from use of mechanical CPR (mCPR). Retrospective analyses have shown an association between mCPR and worse survival outcomes, even when controlling for differences in patient mix and arrest duration. Nonetheless, studies have suggested mCPR use increased from 2013 to 2016.

Objective:
We sought to quantify the proportion of out-of-hospital cardiac arrest (OHCA) cases in the US with utilization of mCPR and use in conjunction with other procedures.

Methods:
Using Emergency Medical Services (EMS) call data from the National EMS Information System (NEMSIS) Dataset, we identified non-traumatic OHCA with EMS resuscitation. Procedure codes were classified as “Mechanical CPR”, “Advanced Airway”, “IO”, “IV”, “Defibrillation”, “Other” and “No Procedures”. The NEMSIS Dataset includes US Census Region, Division, and urbanicity for each call.

Results:
In 2016, there were 29,919,652 EMS activations reported, 151,333 met inclusion criteria and 138,555 included procedure codes. Of the OHCA cohort, the mean age was 63±20 yrs, 39% were female, 86% occurred prior to EMS arrival, 62% occurred in a home/residence, 18% in public, and 14% in healthcare facilities. mCPR was used in 10% of all cases. Reported regional utilization varied from 4.8% in the Northeast to 14.9% in the South (p<0.001). mCPR did not vary significantly based on urbanicity (range: 10.4% to 11.4%, p=0.34). In multiple logistic regression controlling for age, gender, location of arrest, race and ethnicity, and region, mCPR utilization was more likely if an advanced airway was placed (OR: 1.74, CI: 1.58-1.91), and less likely if an IV or IO was placed (IV: OR 0.75, CI 0.71 - 0.79; IO: OR 0.37, CI 0.28 - 0.48). 4,928 cases contained information on survival to admission. Of these, overall survival to admission was 27%, with no significant difference between mCPR and no mCPR groups. Survival to discharge data was available for 2,476 subjects (1.8% of OHCA cohort). Survival to discharge was higher among the non-mCPR group (13.8% vs. 10.3%, p = 0.011).

Conclusion:
In NEMSIS, reported mCPR utilization is highly variable across the US. The overall proportion of cases receiving mCPR is lower than previous registry-based studies.
Abstract 152: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm
Authors: Ashida Tadashi , Yagi Tsukasa , Nagao Ken , Tani Shigemasa , Tachibana Eizo , Chiba Nobutaka , Yonemoto Naohiro , Takayama Morimasa , Nonogi Hiroshi , Matsumoto Naoya , Okumura Yasuo
Published: July 2021

Background:
The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. However, the 2010 guidelines showed that induced therapeutic hypothermia may be considered for comatose adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) with an initial rhythm of non-shockable (Class IIb). It is unknown whether the post-cardiac arrest care for patients with non-shockable cardiac arrest contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to non-shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA.

Methods:
From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital non-shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The endpoint was favorable neurological outcome at 30 days after OHCA.

Results:
The 31,204 patients who met the inclusion criteria comprised 25,045 with ROSC before arrival at the hospital and 6,259 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure).

Conclusion:
In the patients with ROSC after out-of-hospital non-shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.
Abstract 163: Type of Prehospital Airway Management Does Not Affect Chest X-Ray Abnormality in Resuscitated Out-of-Hospital Cardiac Arrest Patients
Authors: Naito Hiromichi , Nakao Atsunori , Weissman Alexandra , Elmer Jonathan , Martin-Gill Christian , Rittenberger Jon C , Guyette Francis X , Gozansky Elliott K , Andrews Glenn S , Callaway Clifton W
Published: July 2021

Introduction:
Chest x-ray (CXR) abnormalities after cardiopulmonary resuscitation are common. Mechanisms by which these abnormalities develop are not fully elucidated, but aspiration of secretions and regurgitated gastric contents during prehospital airway management may be an important modifiable cause.

Hypothesis:
We hypothesized that endotracheal intubation (ETI) is associated with decreased incidence of CXR abnormalities after out-of-hospital cardiac arrest (OHCA), as compared to bag-valve-mask (BVM) or supraglottic airway (SGA) use.

Methods:
We conducted a retrospective review including resuscitated OHCA patients treated at a single academic medical center from 2010-2015. We included patients that had an initial CXR obtained within 66 hours of arrival. We excluded patients with tracheostomy, patients without positive pressure ventilation on emergency department (ED) arrival, or missing initial airway management data. We classified patients by airway management at the time of ED arrival into three groups: BVM, SGA, and ETI. Board certified thoracic imaging radiologists determined if there was any CXR abnormality, and if the observed abnormality was likely due to aspiration. The incidence of any abnormality and aspiration were compared between groups. A multivariable logistic regression model was used to adjust for baseline clinical characteristics.

Results:
Of the 766 subjects included in the study, 22 (3%) had BVM, 68 (9%) had SGA, and 676 (88%) had ETI. Most 58% were male, 34% had initial rhythm VF/VT, and 61% had a witnessed arrest. Any abnormality on CXR was identified in 543 (71%) cases, and likely aspiration was observed in 205 (27%) cases. Incidence of CXR abnormality was not significantly different between groups: BVM group 18/22 (82%), reference; SGA group 52/68 (76%), OR 0.75, 95% CI 0.13-4.31; ETI group 473/676 (70%), OR 0.81, 95% CI 0.16-4.01. Incidence of aspiration on CXR was also not different between groups: BVM group 6/22 (27%), reference; SGA group 19/68 (28%), OR 1.04, 95% CI 0.18-6.22; ETI group 180/676 (27%), OR 1.26, 95% CI 0.25-6.32.

Conclusion:
Prehospital airway management strategy for resuscitated OHCA patients was not associated with a significant difference in the incidence of any abnormality or aspiration on CXR.
Abstract 168: Association Between Prehospital Advanced Airway Management for Pediatric Out-of-Hospital Cardiac Arrest and Survival
Authors: Okubo Masashi , Komukai Sho , Izawa Junichi , Gibo Koichiro , Kiyohara Kosuke , Matsuyama Tasuku , Iwami Taku , Callaway Clifton W , Kitamura Tetsuhisa
Published: July 2021

Introduction:
It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes.

Objective:
To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes.

Methods:
We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (<18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event.

Results:
We included 2,548 patients; 1,017 (39.9%) were infants (<1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]).

Conclusions:
Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.
Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest
Authors: Chonde Meshe , Escajeda Jeremiah , Elmer Jonathan , Guyette Frank X , Boujoukos Arthur , Kormos Robert L , Sappington Penny L , Smith Anson J , Schmidhofer Mark , Sciortino Christopher M , Callaway Clifton
Published: July 2021

Introduction:
Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation.

Hypothesis:
Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates.

Methods:
We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital.

Results:
From October 2015 to March 31
st
2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min.

Conclusions:
ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.
Abstract 204: Conventional vs. Compression-Only Cardiopulmonary Resuscitation for Geriatric Out-of-Hospital Cardiac Arrest
Authors: Ueyama Hiroki , Homma Yosuke , Shimizu Hiroyasu , Inoue Tetsuya , Funakoshi Hiraku
Published: July 2021

Introduction:
Compression-only cardiopulmonary resuscitation (CPR) and conventional CPR (30:2, chest compression and rescue breathing) performed by bystanders are known to have similar outcomes in adults. This study aimed to investigate if this difference is applicable in geriatric populations as well.

Methods:
We conducted a prospective observational study using the All-Japan Utstein Registry to enroll geriatric patients (≥75 years) who experienced out-of-hospital cardiac arrest that was witnessed by bystanders in Japan from January 1, 2009 to December 31, 2013. The primary outcome was favorable neurological function 1 month after the event, which was defined as a Cerebral Performance Category Scale score of 1 or 2. The secondary outcomes were return of spontaneous circulation (ROSC), 1-month survival, and favorable overall function 1 month after the event, which was defined as an Overall Performance Category Scale score of 1 or 2. Outcomes of compression-only CPR and conventional CPR were compared using multivariable logistic regression analyses.

Results:
Of the 58,072 enrolled patients, 13,248 (22.8%) received conventional CPR whereas 44,824 (77.2%) received compression-only CPR. Favorable neurological outcomes were achieved in 708 (5.3%) patients receiving CPR and 1799 (4.0%) patients receiving compression-only CPR. A crude analysis of neurologically favorable survival revealed superiority of conventional CPR [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.24–1.48; P < 0.001]], but it was no longer statistically significant after multivariable adjustment (OR, 1.09; 95% CI, 0.93–1.27; P = 0.29). Similarly, multivariable adjusted analysis of favorable overall function survival showed no significant difference (OR, 1.08; 95% CI, 0.92–1.26; P = 0.38) between conventional and compression-only CPR. Conventional CPR demonstrated better outcomes in multivariable adjusted analysis of ROSC and 1 month survival (OR, 1.30; 95% CI, 1.22–1.40; P < 0.001 and OR, 1.13. 95% CI, 1.04–1.23; P = 0.003, respectively).

Conclusions:
The superiority of conventional CPR in geriatric populations was not proven. Thus, we conclude that compression-only CPR is an adequate means of resuscitation in geriatric populations.
Abstract 206: Cardiopulmonary Resuscitation Process Measures Associated With Return of Spontaneous Circulation in Non-Shockable Out-of-Hospital Cardiac Arrest
Authors: Juarez Jose M , Koller Allison C , Schmicker Robert H , Park Seo Young , Salcido David D , Menegazzi James J
Published: July 2021

Purpose:
Survival rates after non-shockable out-of-hospital cardiac arrest (OHCA) remain low despite advances in resuscitation. Cardiopulmonary resuscitation (CPR) process measures may inform treatment strategies. We hypothesized that CPR process measures would be associated with return of spontaneous circulation (ROSC) and patient electrocardiogram (ECG) transitions.

Methods:
We obtained defibrillator monitor data for emergency medical service (EMS)-treated non-shockable OHCA from the Resuscitation Outcomes Consortium (ROC), an OHCA research network (U.S./Canada). We extracted ECG data from EMS defibrillator files and parsed cases into compression-free analyzable segments using custom MATLAB software. Two data abstractors classified segment rhythms as PEA, asystole, ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), or ROSC. We calculated CPR process measures (average rate, depth, duration, leaning proportion, chest compression fraction, and duty cycle) for CPR bouts preceding every ECG segment. We used mixed effects models controlling for subject to test associations between individual CPR process measures and the bout-level outcomes ROSC and shockable rhythm.

Results:
We analyzed 1893 cases consisting of 7981 CPR bouts. Case initial rhythms were asystole (68.2%), PEA (24.9%), or NSA-AED (6.9%). Segment rhythm classifications were asystole (78.1%), PEA (20.4%), ROSC (5.5%), VF (1.4%), and PVT (0.07%). Regression model results are shown in Table 1. Chest compression fraction was most strongly associated with ROSC and shockable rhythm. Depth was also associated with shockable rhythm. Leaning proportion and duty cycle were not associated with either outcome.

Conclusions:
In cases of non-shockable OHCA, CPR quality measures were associated with ROSC and transition to a shockable rhythm at the bout level.
Abstract 216: Renal Failure After Cardiac Arrest and the role of Targeted Temperature Management
Authors: Bhardwaj Abhishek , Balian Steve , Buckler David G , Abella Benjamin S
Published: July 2021

Introduction:
While Acute Kidney Injury (AKI) is a common complication of cardiac arrest (CA), the incidence of AKI and Chronic Kidney Disease (CKD) following resuscitation are not well studied. Further, the association of Targeted Temperature Management (TTM) with AKI and CKD incidence has not been extensively studied.

Aim:
We compared the incidence of post-arrest AKI and CKD among patients who received TTM and those who did not receive TTM.

Methods:
In this retrospective cohort study, we studied adult patients following resuscitation from out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Serum creatinine (Cr) data for post-arrest patients were extracted from the electronic medical record. Baseline serum Cr was defined as the most recent pre-arrest Cr value or the lowest Cr value within 6 hrs of arrest. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, AKI was defined as an increase in Cr by > 0.3 mg/dL within 48 hrs or an increase in serum Cr by 1.5x the baseline value within a one-week period. CKD was defined as a GFR of < 60 mL/min per 1.73 m
2
3 months post-arrest.

Results:
From 1/2005 to 12/2017, 1099 patients had serial post-arrest creatinine values available. Median age at arrest was 63 (IQR 25), 58% were male, survival to discharge was 20%, with a 17 % favorable CPC score of 1 or 2. Of these, 240 patients had documented TTM status (89 received TTM and 151 did not). Of the patients who received TTM, 31% developed AKI compared to 40 % who did not receive TTM (P=NS). The incidence of CKD was 56% in the TTM group and 45% in the non-TTM group. McNemar’s test for CKD at baseline and at 3 months post-arrest showed a significant increase in the incidence of CKD post arrest (45% vs. 49%, p = 0.031).

Conclusions:
Post cardiac arrest, AKI and CKD are common complications. The use of TTM was not associated with the incidence of AKI or CKD. Further research is needed to study factors that affect AKI and CKD in CA.
Abstract 259: Characteristics of Patients With Sudden in Hospital Cardiac Arrest With a Shockable Initial Rhythm in a System With Mature Rapid Response and Code Blue Teams
Authors: Chong Stephen , Brenner Nicole , Benz Paul , Woo Stephanie , Wilson Matthew , Titus Sheryl , Dubin Jeffrey , Goyal Munish
Published: July 2021

Study Objectives:
Every year 33,000 people suffer an IHCA with an initial shockable rhythm in the US. Rapid Response Teams may increase time to defibrillation and are not associated with lower in-hospital mortality. We sought to describe characteristics of sudden IHCAs with a shockable initial rhythm in a system with mature Rapid Response and Code Blue teams, in particular, time to defibrillation.

Methods:
Retrospective chart review at a large, urban teaching hospital with mature Rapid Response and Code Blue teams. Adults in whom a “Code Blue” was called with confirmed cardiac arrest between Jan 2017 and Mar 2018 were included. Codes with incomplete data or that occurred in the ED or ICU were excluded. The “Code Blue” team consists of 1-3 Nurse Responders, a nursing supervisor, a respiratory therapist, Anesthesiology, a critical care resident, and a surgical resident. Each ward has a defibrillator and standardized code cart. Trained and supervised research assistants used a standardized data collection tool to extract demographic information, comorbidities and event related data from code sheets, history and physical, progress notes, discharge and death summaries. Events were categorized by initial rhythm as shockable or non-shockable. Time to defibrillation was defined as the interval from reported time of initial recognition of cardiac arrest to the reported time of first attempted defibrillation. Fisher’s exact testing was used to test for statistical significance.

Results:
A total of 183 “Code Blues” met criteria. Demographics: 71% black; mean age 65; and 46% women. Fifty-five (30%) survived to hospital discharge. Forty (21.3%) had an initial shockable rhythm of whom 21 (52.5%) survived to hospital discharge. Of the 40 patients that had an initial shockable rhythm, 36 were defibrillated. Median time to defibrillation was 2 minutes [IQR = 1-4]. Of those defibrillated within 2 minutes, survival was 64% vs 33% (P = 0.102) among those defibrillated in > 2 minutes. Of the 143 patients that had a nonshockable initial rhythm, 34 (23.8%) survived to hospital discharge.

Conclusion:
In a system with mature Rapid Response and Code Blue teams, time to defibrillation among IHCA patients with a shockable initial rhythm is 2 minutes.
Abstract 287: Simulating the Effects of Sudden Cardiac Arrest Responders Embedded in a Marathon Cohort
Authors: Salerno Jessica E , Willson Connor J , Weiss Leonard S , Salcido David D
Published: July 2021

Introduction:
Risk of sudden cardiac arrest may increase during distance running. In marathons, this risk is typically mitigated by deployment of medical resources, e.g. automated external defibrillators (AED), at fixed locations, potentially leaving racers vulnerable for periods of the race. We investigated utilization of marathon runners themselves as mobile emergency resources (R-AEDs). We hypothesized that systematic R-AED deployment would increase AED coverage of a race cohort over baseline coverage from static public AEDs.

Methods:
A simulation was constructed in MATLAB (vR2018a) incorporating the route of the 2018 Pittsburgh Marathon, detailed publicly available runner performance data from a nearby local marathon (N=1536), and known locations of S-AEDs with 1/8
th
mile of any part of the Pittsburgh Marathon course (N = 47). During each simulation run, participants were randomly selected based on several distribution schemes (including age, pace category and pure chance) to carry an R-AED. R-AED coverage was assessed per minute by determining the proportion of racers up to 3 minutes ahead of each R-AED. S-AED coverage was calculated similarly based on whether runners were within 3-minutes of a public AED. All simulation variants were repeated 100 times and aggregated.

Results:
At baseline, 44% of the Pittsburgh Marathon course was within 3-minute walking distance of a public AED. Full coverage could be achieved with an additional 54 S-AEDs. Of the schemes we tested, when R-AEDs were deployed to random participants, optimal overall coverage was achieved with 1 R-AED per 25 runners (61 total for 57%), with 10% of race time achieving over 95% coverage. Weighted distribution of R-AEDs within age categories or pace categories achieved 72% coverage (155 AEDs) and 71% coverage, and over 95% coverage for 33% and 32% of the race duration, respectively.

Conclusion:
R-AEDs provided varying levels of additional coverage over baseline public access AED coverage during a simulated marathon. More work is necessary to fully determine the practical utility of this approach.
Abstract 304: The Impact of the National Heart Foundation’s Warning Signs Campaign on Health-Seeking Behaviour in Acute Coronary Syndrome Patients
Authors: Bray Janet , Nehme Ziad , Finn Judith , Smith Karen , Lim Michael , Bladin Christopher , Stub Dion , Cameron Peter
Published: July 2021

Introduction:
Improving acute coronary syndrome (ACS) patient’s recognition and response to symptoms is key to reducing prehospital deaths. Between 2009 and 2013, the Heart Foundation of Australia ran paid mass media campaigns to improve Australians awareness of ACS symptoms and to call emergency medical services (EMS) if symptoms were experienced. This study aimed to examine the impact of this campaign on EMS use and referrals from general practitioners (GPs) in emergency department (ED) presentations in Victoria (Australia).

Methods:
The Department of Health and Human Services provided data from 39 public EDs contributing data to the Victorian Emergency Minimum Dataset between 2003 and 2015. We included admissions diagnosed with ACS in the dataset, and excluded presentations from aged-care facilities and inter-hospital transfers. We used logistic regression to examine the association between the campaign period and 1) EMS use and 2) patients referred to ED by GPs. Models were adjusted for the increasing population size and known predictors available in the dataset (age, sex, preferred language of English, resident of major city and presentation in winter).

Results:
Over the study period, there were 127,176 eligible ACS presentations (66,555 acute myocardial infarctions): 64% were male, 58% were aged over 64 years, 70% were a resident of a major city and in 90% English was their preferred language. Overall, 62% of ACS patients arrived by EMS and 8% presented via GPs. After adjusting for confounders, a significant increase in EMS use was seen during the period of campaign activity in ACS patients: adjusted odds ratio (AOR) =1.05 (95% CI:1.02-1.09, p=0.003). While, ACS ED presentations via GPs were seen to decrease (AOR=0.89, 95%CI:0.84-0.95, p<0.001). Patients presenting via their GP were less likely to arrive by EMS (42% vs. 64%, p<0.001).

Conclusion:
The Warning Signs Campaign was associated with an increase in EMS use and a decrease in ED presentations via GPs in ACS patients. Our study supports the use of public campaigns to change health seeking-behaviour for ACS. Future interventions need to focus on improving EMS use in patients presenting to GPs.
Abstract 309: A Novel Method to Predict Survival From Ventricular Fibrillation Arrest During Chest Compressions
Authors: Coult Jason , Sherman Lawrence D , Blackwood Jennifer , Kwok Heemun , Kudenchuk Peter J , Rea Thomas D
Published: July 2021

Background:
Quantitative measures of the ventricular fibrillation (VF) electrocardiogram (ECG) such as Amplitude Spectrum Area (AMSA) assess myocardial physiology and predict cardiac arrest outcomes, offering the potential to guide resuscitation care. Guidelines recommend minimally-interrupted chest compressions (CCs) during resuscitation, but CCs corrupt the ECG and must be paused for analysis. We therefore sought to develop a novel measure to predict survival without requiring CC pause.

Methods and Results:
Five-second VF ECG segments were collected with CCs and without CCs prior to 2755 defibrillation shocks in 1151 patients with out-of-hospital cardiac arrest. The cohort was divided into a training set to develop the measure and a test set to evaluate performance. Using segments from 460 training patients, we designed an adaptive filter to remove CC artifacts based on chest impedance and ECG characteristics, derived novel time-frequency and amplitude features of the filtered VF ECG, and trained a Support Vector Machine (SVM) model combining these novel features to predict survival with favorable neurologic status. In 691 test cases, area under the receiver operating characteristic curve (AUC) for predicting survival using the SVM was 0.74 (95% CI: 0.71-0.77) with CCs and 0.74 (95% CI: 0.71-0.76) without CCs (Figure 1). By comparison, AUC for predicting survival using AMSA was 0.70 (95% CI: 0.67-0.73) with CCs (p=0.001 for difference versus SVM) and 0.73 (95% CI: 0.71-0.76) without CCs (p=0.68 for difference versus SVM).

Conclusions:
VF waveform measures such as AMSA predict functional survival when obtained during ongoing CCs, but prognostic performance is reduced compared to CC-free analysis. However, an SVM-based measure combining novel VF waveform features enabled similar prediction with and without CCs. Machine learning combinations of features optimized for use during CCs may thus afford a means for VF prognosis during uninterrupted CCs.
Abstract 338: Impact of No-Flow Time on the Coagulopathy of Prolonged Cardiac Arrest
Authors: Hala Pavel , Caceres Matias , Prater Aaron , VanZalen Jensyn , Jung Joshua , McCracken Brendan M , Tiba Mohamad H , Hsu Cindy H , Pitcher Jake , Harvey Stephen , Shpilband Katia , Cummings Brandon C , Bartlett Robert H , Rojas-Pena Alvaro , Neumar Robert W
Published: July 2021

Introduction:
Prolonged cardiac arrest (CA) eligible for ECPR has pathologic features that are more pronounced than CA durations in which ROSC is typically achieved. One such feature is consumptive coagulopathy resulting in microvascular thrombosis and no-reflow. In this study we examined the impact of no-flow time on CA coagulopathy during prolong CPR in swine

Hypothesis:
No-flow time amplifies the coagulopathy of prolonged cardiac arrest.

Methods:
Animals were anesthetized and instrumented for hemodynamic monitoring. After 4 or 8 min of untreated ventricular fibrillation (groups CA-4 and CA-8, n=5/group), goal-directed CPR was initiated and continued for a total arrest time of 45 minutes. Viscoelastic properties of clot formation and fibrinolysis were measured by TEG in whole blood at baseline and at the end of resuscitation protocol. Rate of fibrin activation (Angle alpha), Maximum amplitude (MA), Time to MA (TMA), and reduction of clot after 30 min (CL30) were measured to describe coagulation status.

Results:
TEG showed reduction in clot strength after the CPR protocol. For groups CA-4 and CA-8, Alpha declined from 71(4) to 55(7) and from 68(5) to 51(9) deg, MA reduced from 75(2) to 58(7) and from 73(3) to 53(11) mm and TMA prolonged from 21(2) to 27(4) and from 20(4) to 25(2) min. CL30 increased from 95(2) to 97(2) and from 96(2) to 100(1) % (all p<0.05). Clot lysis was more reduced in CA-8 (p<0.05) but other parameters did not significantly vary between groups. Overall, platelets declined from 328(86) to 138(81) thousands/mm3 while hematocrit increased (all p<0.01).

Conclusion:
In this clinically relevant model of prolonged CA with consumptive coagulopathy, the reduction of clot formation and clot strength after 45 minutes of CA and CPR was not significantly different with 4 and 8 min no-flow time. However, clot lysis was more reduced after 8-min no-flow. Further studies are needed to determine the impact of no-flow time on CA coagulopathy at the microvascular level.
Abstract 341: Urine Output and Blood Urea Nitrogen Predict Mortality After Out-of-Hospital Cardiac Arrest
Authors: Jentzer Jacob C , Ternus Bradley , Barsness Gregory W , Kashani Kianoush B
Published: July 2021

Introduction:
Renal dysfunction, as defined by elevated serum creatinine, is associated with decreased survival among patients resuscitated after out-of-hospital cardiac arrest (OHCA). Less is known about other measures of renal function and outcomes after OHCA.

Hypothesis:
BUN and urine output will predict mortality after OHCA.

Methods:
Retrospective single-center cohort study of 276 adult OHCA patients treated with targeted temperature management after OHCA between December 2005 and September 2016. Fluid balance and urine output were recorded for the first 6, 12 and 24 hours. Initial laboratory values were determined from electronic records. Hospital survivors and non-survivors were compared using the Wilcoxon test, and multivariate analysis was performed to determine predictors of hospital death.

Results:
Mean age was 63±12 years, and 204 (73%) were male; shockable rhythm occurred in 241 (87%). Inpatient death occurred in 111 (40%). Hospital survivors had lower initial BUN (13 vs. 20 mg/dL) and creatinine (1.1 vs. 1.5 mg/dL); all p <.001. Hospital survivors had higher (p <.001) urine output during the first 6 hours (1,091 vs. 559 ml), 12 hours (1,583 vs. 843 ml), and 24 hours (2,215 vs. 1,294 ml). Higher initial BUN (OR 1.12, 95% CI 1.07-1.18) and creatinine (OR 3.036, 95% CI 1.65-5.59) predicted hospital mortality; all p <.001. Urine output during the first 24 hours was associated with hospital mortality (OR 0.57 per each 1 L, 95% CI 0.45-0.72, p <.001; AUROC 0.73, optimal cut-off 1 L). Patients with 24-hour urine output <1 L were at increased risk of hospital death (66.3% vs. 26.0%, unadjusted OR 5.61, 95% CI 3.27-9.63, p <.001). Initial BUN (adjusted OR 1.09, 95% CI 1.01-1.16, p=.02) and urine output during the first 24 hours (adjusted OR 0.71 per each 1 L; 95% CI 0.52-0.97, p=.03) remained predictive of hospital mortality after adjustment for patient characteristics and illness severity.

Conclusions:
Lower 24-hour urine output and higher initial BUN were associated with higher hospital mortality among patients resuscitated from OHCA, even after adjustment for illness severity. Serum creatinine was not a significant predictor of mortality. This emphasizes the importance of low urine output as a prognostic marker and therapeutic target after OHCA.
Abstract 345: The Effects of Epinephrine on the Outcomes of Patients With Out-of-Hospital Cardiac Arrest Based on a Propensity Analysis: A Nationwide Observational Study
Authors: Lee YuSung , Ro YoungSun , Song KyoungJun , Shin SangDo
Published: July 2021

Background:
Although prehospital epinephrine is frequently used in patients with out-of-hospital cardiac arrest (OHCA), its evidence is unclear. Recent studies have shown that the use of prehospital epinephrine increased the rate of return of spontaneous circulation but has a negative impact on outcomes. The aim of this study was to investigate the effect of prehospital epinephrine on the outcomes of OHCA.

Methods:
This study was a cross-sectional study using nationwide OHCA registry in Korea from 2015 to 2016. All EMS-treated adults OHCAs with presumed cardiac etiology were included. Patients who were witnessed by EMS provider were excluded. The primary outcome was neurologically favorable survival to discharge. We compared the primary outcomes between the prehospital epinephrine group and non-prehospital epinephrine group using a propensity score matching analysis and a multivariable logistic regression.

Results:
Among 58922 patients with OHCA, 37635 were included in the analysis. There were 3256 patients who received prehospital epinephrine. In the propensity score matching analysis, 3239 patients were enrolled in each group. Survival to discharge and good neurologic recovery were 5.0% and 2.5% in prehospital epinephrine group and 9.4% and 5.9% in non-prehospital epinephrine group (all p-value<o.o1). There was significant difference in good neurologic recovery between prehospital epinephrine group and non-prehospital epinephrine group after adjusting for covariates (adjusted OR, 0.38, 95% CI, 0.28-0.51). Similar results were observed for survival to discharge (adjusted OR, 0.47, 95% CI, 0.38-0.58).

Conclusions:
In Korean patients with OHCA, prehospital epinephrine increased the probability of ROSC, but decreased good neurologic recovery and survival to discharge.
The Archaeological Expeditions to Afghanistan (1949-1951) by the American Museum of Natural History (New York) and their Orphaned Archaeological Collections
Authors: Miller Heidi J.
Published: July 2021

This article examines the research potential of archaeological collections gathered in 1949–1951 in southern Afghanistan and currently stored in the United States. Included in these materials is an unpublished archaeological survey from the area south of the modern-day city of Kandahar, as well as assemblages from test excavations at the sites of Deh Morasi Ghundai and Said Qala, which have not been studied. An argument is made for a new study of this material along with a reanalysis of the Shamshir Ghar collection in order to question the paradigm of Afghanistan as only a reflection of other cultures in the ancient world.