bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 262: Impact of the Motive of Participants on Training Effect of CPR
Authors: Kato Suzuka , Suzuki Masaru , Hori Shingo ,   Tokyo Fire Dept, Japan,   Tokyo Disaster Prevention and Emergency Med Service Association
Published: April 2024

Introduction: CPR by lay people improves survival in out-of-hospital cardiac arrest (OHCA). CPR training for lay people plays a crucial role to maximize an opportunity of an effective bystander CPR. Fire Department has concentrated its efforts on growing the training popular in citizens in Japan.Some people participated in the training of their own accord, while others participated by the direction of their business companies. Aim was to elucidate a relationship between the motive of the participated people to the first aid training held by the fire department and the training effects.

Methods: Tokyo Disaster Prevention and Emergency Medical Service Associate has conducted the first aid training for common people including CPR and AED training, in which a total of 3,862 adults were participated into the training between January and April 2012. Of those, 1,203 adult office workers (age: 20-49 years, 783 male, 723 compulsory participants and 420 participants of their own accord) were analyzed in this study. An anonymous questionnaire survey including their satisfaction for the course and trainer, self-checking of skill performances regarding to CPR and intention to perform bystander CPR was conducted.

Results: Satisfaction with the course and the trainer was higher in the participants of their own accord compared to the compulsory participants (Kruskal-Wallis test P=0.001, P=0.001). When skills of chest compression and artificial breathing were evaluated by themselves, the evaluations were better in the participants of their own accord (P=0.04, P=0.01). Comparing their perceptions regarding their AED skills, there was no significant difference (P=0.13). Answers to the question about their intensions to perform CPR for OHCA demonstrated that the participants of their own accord would actually perform CPR more frequently (17.9% vs 11.3%, P<0.001).

Conclusion: Expectation that a common lay people actually perform CPR during OHCA event is likely to depend on their motivation of the CPR ability. Their motivation also related with their perceptions of the CPR skills. It suggested that continued appealing works to the willing and perception of participants is indispensable to maximize the effectiveness of CPR training.
Abstract 263: Changes in Cerebral Oxygen Metabolism and Hemodynamics During ECPR with Therapeutic Hypothermia Measured by Near Infrared Spectroscopy
Authors: Kawamorita Tsuyoshi , Yagi Tsukasa , Soga Taketomo , Hirose Harumi , Watanabe Kazuhiro , Kikushima Kimio , Yoshino Atsuo , Sakatani Kaoru , Nagao Ken
Published: April 2024

(Background) For protection of the brain, hypothermia is a helpful therapeutic approach in patients who remain comatose after return of spontaneous circulation (ROSC). The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated change of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS).

(Methods) Between November 2009 and June 2011, we employed NIRS (NIRO-200NX, Hamamatsu Photonics, Japan) to measure CBO in the bilateral frontal lobe in patients transported to the ER after out-of-hospital cardiac arrest. Enrollment criteria were: aged 18-74 years; cardiac arrest witnessed by bystanders; presumed cardiac etiology of cardiac arrest according to the Utstein style guidelines; estimated time interval from collapse to paramedic’s arrival at patient’s side within 15 min; defibrillation using automated external defibrillator by bystander and/or emergency medical personnel; and persistent cardiac arrest on arrival at the ER.

(Results) Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5%. This increased to 67.8% during ECPR (P<0.001). The patients whose TOI subsequently decreased had a favourable neurological outcome (figure).

(Conclusion) The increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while the decrease of TOI after ECPR might reflect oxygen utilization of the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.
Abstract 265: For How Long a Period Have Medical Students and Nurses Retained ACLS Skills?
Authors: Kikuchi Migaku , Matsushima Hisao , Tosaki Yukiko , Tomizawa Ikue , Taguchi Isao , Abe Shichiro , Ono Kazuyuki , Inoue Teruo
Published: April 2024

OBJECTIVE: To evaluate whether the period of retention of ACLS skills is different between medical students and registered nurses.

METHODS: A prospective observational study was performed. Medical students and registered nurses were trained both BLS and ACLS based on the American Heart Association (AHA) 2005 Guidelines tools, and evaluated by skill performance tests based on the AHA 2005 BLS and ACLS tools in simulated environment, at immediately and 3 months after training. The registered nurses were similarly evaluated also at 9 months after training.

RESULTS: A total of 197 medical students enrolled was trained, being assigned to 30 groups. Twenty four registered nurses in a general ward were trained, being assigned to 6 groups. In 3 months after training, the medical students retained the core skills of chest compression, which included the correct rate and adequate depth of chest compressions, delivering 30 compressions and 2 ventilations, and resuming chest compressions after shocks, whereas checking breathing, 2 ventilations with bag-valve-mask, or checking carotid pulse was done in only 33% of all groups. The airway management and drug use in the secondary ACLS survey and the effective communication and team dynamics were done in 30%-50% of all groups. The registered nurses also retained the core skills of chest compression and drug use in 3 months after training. Especially, effective communication and team dynamics were well-retained in all groups. In 9 months after training the registered nurses also retained, whereas both opening airway and first 2 ventilations were done in 50% of all groups. Checking carotid pulse or checking breathing was little done for at least 5 seconds but no more than 10 seconds.

CONCLUSIONS: Through BLS and ACLS training, the registered nurses have well retained resuscitation skills, but they also have well demonstrated effective communication and team dynamics for longer period than medical students. Medical students are required short interval of retraining ACLS skills with team dynamics, similarly healthcare providers without performing resuscitation as daily work may be. In addition to this, it should be important to apply effectively different way to teach ACLS skills, such as e-learning or self-training.
Abstract 272: Ventilation with i-gel Supraglottic Airway Compared with Mouth-to--Pocket Mask Ventilation Reduces Interruptions in Chest Compressions During Single-Rescuer Lifeguard CPR: A Randomized Simulation Study
Authors: Løfgren Bo , Adelborg Kasper , Mortensen Martin B , Nielsen Lars Henrik , Dalgas Christian , Al-Mashhadi Rozh Husain
Published: April 2024

Introduction:
Minimizing interruptions in chest compression during cardiopulmonary resuscitation (CPR) is a crucial determinant for the outcome following cardiac arrest. The International Life Saving Federation recommends lifeguards to perform CPR using mouth-to-pocket-mask ventilation (MPV). An alternative ventilation method is supraglottic airway ventilation (SAV), however the possible benefit of SAV among lifeguards is currently unknown. The aim of this study was to compare the effect of SAV and MPV on CPR quality.

Materials and methods:
Surf lifeguards in active service were invited to participate. MPV (Pocket Mask™, Laerdal, Stavanger, Norway) is a mandatory part of surf lifeguard training. All participants were trained in using a supraglottic airway (i-gel, Intersurgical®, Workingham, UK). Subsequently, each surf lifeguard was randomized to perform single rescuer CPR using either SAV or MPV separated by five minutes of rest. Data were obtained from a resuscitation manikin (Ambu® Cardiac Care Trainer System, Ambu, Ballerup, Denmark) and video recordings.

Results:
In total, 25 surf lifeguards were included (9 female, 16, male, mean age 25.2 years). All were employed as seasonal lifeguards and none of the participants were healthcare professionals. Interruptions in chest compressions were significantly reduced by SAV (mean+/-SD: 4.8+/-1.0 sec) when compared to MPV (7.8+/-1.3 sec, p<0.001). No significant difference in chest compression depth and rate were observed between groups. Time to first ventilation attempt was 1.9+/-3.0 sec faster when using MPV compared to SAV (p=0.003). No difference in effective ventilations (visible chest rise) were observed when comparing SAV (94.1%) to MPV (95.0%, p=0.96). Tidal volumes were significantly lower following MPV (0.48+/-0.19 L) compared to SAV (0.58+/-0.10 L, p=0.04).

Conclusion:
SAV significantly reduces interruptions in chest compressions during lifeguard CPR and is superior in delivering the recommended tidal volume compared to MPV. Our results suggest that CPR quality is improved using SAV compared to MPV among lifeguards.
Abstract 275: The Effect of Cardiopulmonary Resuscitation Using a 30:2 Compression-Ventilation Ratio, Inclusive of 1-Shock Protocol, by Emergency Medical Services Responders
Authors: Nagao Ken , Tachibana Eizo , Nishikawa Kei , Yagi Tsukasa , Yonemoto Naohiro , Takayama Morimasa , Nonogi Hiroshi , Shirai Shinichi , Kimura Takeshi ,   JCS-ReSS Group
Published: April 2024

BACKGROUND

Cardiopulmonary Resuscitation (CPR) using a 30:2 compression-ventilation ratio was designed to increase the number of compressions, reduce the likelihood of hyperventilation, minimize interruptions in chest compressions for ventilation, and simplify instruction for teaching and skills retention. It is unclear whether a 30:2 ratio, inclusive of a 1-shock followed immediately by 2 minutes of CPR using a 30:2 ratio (1-shock protocol) improves survival in patients with out-of-hospital cardiac arrest.

METHODS

From the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, 287,176 adult patients with out-of-hospital cardiac arrest were included; 199,701 received EMS-responder CPR using a 30:2 ratio and/or 1-shock protocol based on the 2005 CPR guidelines, and 87,475 received EMS-responder CPR using a 15:2 ratio and/or a 3-shock sequence followed by 1 minute of CPR using a 15:2 ratio (3-shock protocol) based on the 2000 CPR guidelines. The primary endpoint was 30-day favorable neurological outcome after cardiac arrest.

RESULTS

Among all study patients and the subgroups of patients who were classified in layperson CPR status, the 30:2 group had significantly higher frequency of favorable neurological outcome than the 15:2 group. The adjusted odds ratio for favorable neurological outcome after the 30:2 group (reference; the 15:2 group) was 1.97 (95% CI, 1.82 to 2.14) in the whole cohort, and 2.20 (95% CI, 1.94 to 2.50) in the subgroups of patients receiving layperson CPR and 1.81 (95% CI, 1.63 to 2.02) in patients not receiving layperson CPR. In the subanalysis, 4 subsets based on the quartiles of collapse to return of spontaneous circulation (ROSC) interval, the 30:2 ratio had no neurological benefits in quartile 1 (≤13 minutes) not receiving layperson CPR (adjusted odds ratio, 1.22; 95% CI, 0.94 to 1.60) or in quartile 4 (≥29 minutes) receiving layperson CPR (adjusted odds ratio, 1.84; 95% CI, 0.93 to 3.63).

CONCLUSIONS

EMS-responder CPR using a 30:2 ratio and/or 1-shock protocol improved neurologically intact survival in adults with out-of-hospital cardiac arrest. However, a 30:2 ratio was not the optimal ratio for patients having achieved ROSC after bystander-witnessed arrest.
Abstract 285: The Effects of Shengfu Injection on Postresuscitation Myocardial Dysfunction and the Impressions of ?-Opioid Receptor in Myocardium in Cardiac Arrest and Cardiopulmonary Rats
Authors: Shan Yi , Wan Jian , Yang Xingyi , Chen Dechang , Li Wenfang , Lin Zhaofen
Published: April 2024

Objective:
The effects of a Chinese traditional medicine Shenfu injection on postresuscitation myocardial dysfunction and the impressions of kappa-opioid receptor in myocardium were investigated in CA/CPR rats, for better understanding of resuscitation medication clinical applications.

Methods:
60 male SD rats were randomized into Shenfu injection (SF) group (n=30) and Control group (n=30). Asphyxia-induced CA was performed by turning-off the ventilator and clamping the endotracheal tube. CPR with chest compression and mechanical ventilation were started after 7min of asphyxia. Shenfu (20ml/kg·h) or saline (20ml/kg·h) was infused from on set of CPR in each group. The baseline blood gas, dP/dt40, LVDP and -dP/dt
max
were measured. The rat hearts were harvested at 0.5h, 2h, 4h, 6h and 24h post resuscitation (PR). The mRNA and protein impressions of κ-OR in postresuscitation myocardium were measured.

Results:
All animals in SF group were successfully resuscitated. 2 were non-resuscitated, 3 occurred VF during CA/CPR in Control group. The 24h survival rate was no statistics difference between SF and control group(50% vs 75%, P =0.264). The postresuscitation myocardial dysfunctions were progressively reversed in Shengfu group. Secifically, HR and MAP were reversed to baseline after PR6h; dP/dt
40
and -dP/dt
max
were significantly increased at PR24h in Shengfu group, in comparison to Control group (P<0.01). The mRNA and protein impressions of κ-OR in postresuscitation myocardium were with a trend of rise up and fell down in all groups, with the highest κ-OR impressions at PR2h. The κ-OR impressions were significantly decreased in SF group, in comparison to Control group (P<0.05).

Conclusions:
The postresuscitation myocardial dysfunctions were remarkably decreased in Shenfu group in comparison to control group. The mRNA and protein impressions of κ-OR in postresuscitation myocardium were significantly decreased after shenfu infusion.
Abstract 298: Efficacy of Bag-Mask Ventilation for Ventricular Fibrillation Sudden Cardiac Arrest
Authors: Tahara Yoshio , Kimura Kazuo , Morimura Naoto , Oi Yasufumi , Yonemoto Naohiro , Nonogi Hiroshi , Kimura Takeshi , Nagao Ken ,   JCS-ReSS Study Group
Published: April 2024

Background:
If bag-mask ventilation is adequate, an advanced airway is not urgently required. Although rescuers may defer insertion of an advanced airway until the patient fails to respond to initial cardiopulmonary resuscitation (CPR) and defibrillation attempts or has return of spontaneous circulation (ROSC), its effects and optimal timing remain unclear.

Methods:
An observational study was performed in 670,313 patients who had out-of-hospital cardiac arrest (OHCA) in Japan and received CPR between January 1, 2005 and December 31, 2010. Of these patients, 9,720 in whom age was from 18 to 74 years, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander CPR was performed, and initial rhythm was ventricular fibrillation (VF) were studied. The subjects were divided into two groups according to the method used for airway management by emergency medical service (EMS) personnel: 5,358 who used a bag-valve mask (bag-mask ventilation group: BMV group) and 4,362 who used an advanced airway including a supraglottic airway device and endotracheal tube (advanced airway management group: AAM group). The rates of ROSC from the initiation of EMS-CPR to arrival at the hospital were compared. Next, subjects who did not have ROSC within 45 minutes before arrival at the hospital were divided into two groups, the pre-hospital non-ROSC BMV group (N=3,092) and the pre-hospital non-ROSC AAM group (N=3,291), and neurologic outcomes at 30 days were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1 or 2.

Results:
The rate of ROSC from the initiation of EMS-CPR to arrival at the hospital was higher (41% vs. 21%, p<0.01) in the BMV group than in the AAM group. The rate of favorable outcomes was higher (8% vs. 3%, p<0.01) in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group. In particular, the rate of favorable outcomes was higher in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group during the first 20 minutes after the initiation of EMS-CPR.

Conclusions:
In patients with VF sudden cardiac arrest, the use of a bag-valve mask for airway management increases the rates of ROSC and favorable outcomes, particularly during the initial period from EMS-CPR to arrival at the hospital.
Abstract 309: An Electromyographic System for Guiding Tracheal Intubation
Authors: Levert Christopher , Terry Robin , Wagner Sarah , Kosh Michael , Nathan Joanna , Arevalos Christopher , Brewer Alan , Razavi Mehdi
Published: April 2024

Introduction:
When tracheal intubation is necessary outside the hospital setting, inadvertent esophageal intubation may occur due to lower levels of provider experience and less access to equipment that can verify tracheal intubation. Therefore, we created a simple, rapid method for guiding endotracheal tube insertion.

Methods:
We constructed a system that can differentiate between the esophagus (smooth muscle tissue) and the trachea (nonmuscular tissue) based on electromyographic signal-response characteristics. We modified an endotracheal tube by adding 4 electrodes (2 for stimulating tissue with applied voltage and 2 for recording the tissue response) and tested the tube in a warm porcine model. We recorded 9 samples in 3 different locations in both the esophagus and the trachea, for a total of 18 samples. Both the stimulating voltage and the tissue response were recorded. We then used computational tools to analyze the resulting data and to create an integrative algorithm for differentiating between esophageal and tracheal tissue, based on the response signal. We differentiated the tissue types by using 3 integrated methods to measure 1) baseline frequency components to determine the average magnitude of contraction of the esophageal muscle tissue; 2) the rate of rectification of the response signal after the stimulation period; and 3) the difference between the average response voltages before and directly after stimulation.

Results:
The average magnitude of contraction was 24.3±13.7 V for esophageal tissue and 6.7±2.7 V for tracheal tissue (
P
=0.013). The average rate of rectification of the response signal was 22.7±15.6 mV/sec for esophageal tissue and -0.177±8.35 mV/sec for tracheal tissue (
P
=0.021). The difference between the average response voltages before and after stimulation was 2.89±1.84 mV for esophageal tissue and 0.834±0.930 mV for tracheal tissue (
P
=0.023). By integrating these 3 methods, our algorithm had a sensitivity of 87.5% and specificity of 100%.

Conclusion:
With our system, rapid differentiation of the endotracheal-tube tip location provides real-time feedback information that may facilitate tube insertion into the trachea.
Abstract 316: Therapeutic Hypothermia for Comatose Survivors After Out-of-Hospital Nonshockable Cardiac Arrest
Authors: Soga Taketomo , Nagao Ken , Nonogi Hiroshi , Yokoyama Hiroyuki , Yonemoto Naohiro , Nishikawa Kei , Hirose Harumi , Yagi Tukasa , Kasai Asuka
Published: April 2024

Background

Clinical evidence strongly supports therapeutic hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital shockable cardiac arrest (VF or pulseless VT), but there are insufficient data that therapeutic hypothermia had neurological benefit for those after non-shockable cardiac arrest (PEA or asystole).

Methods

We conducted a multicenter registry of therapeutic hypothermia (J-PULSE-HYPO study) for unconscious adult patients with ROSC after out-of-hospital cardiac arrest due to cardiac etiology from 14 institutions. At the same periods, All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest was established by the Fire and Disaster Management Agency. From the data of the two registries, we extracted the eligible patients with ROSC after bystander-witnessed non-shockable cardiac arrest; the intervention group consisting of patients who treated with post-ROSC cooling (32-34°C for 12-72 hours), and the control group consisting of patients who met the inclusion criteria of the J-PULSE-HYPO study and matched with the baseline characteristics of the intervention group. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest.

Results

Between 2005 and 2009, 65 of the 452 comatose adult patients treated with post-ROSC cooling were eligible as the intervention group. In the intervention group, the time interval from collapse to ROSC ranged from 5 to 50 minutes, with a mean (± SD) of 27.2 ±11.1 minutes, a median of 27 minutes, and 25th and 75th percentile values of 19.75 and 33.25 minutes, respectively. Of the 4,037 patients with ROSC after bystander-witnessed non-shockable cardiac arrest due to cardiac etiology, 634 were matched as control group. Frequency of a 30-day favorable neurological outcome was a significantly higher in the intervention group than in the control group (37% vs.18%, p=0.0004). The adjusted odds ratio for favorable neurological outcome after the intervention group was 2.9 (95% CI, 1.5 to 5.6).

Conclusions

Therapeutic hypothermia improved neurological outcome for unconscious adult patients with ROSC after out-of-hospital non-shockable cardiac arrest.>
Abstract 321: Factors Associated with Readmission Within 48 Hours to a Cardiac Critical Care Unit
Authors: Williamson Grace , Neal Richard , Mohseni-Bod Hadi , Parshuram Christopher , Kotsakis Afrothite
Published: April 2024

Introduction:
Readmission to the cardiac Critical Care Unit (CCCU) is associated with increased morbidity and mortality and is increasingly used as a measure of quality of care. We have previously shown that introduction of a Medical Emergency Team (MET) following CCCU discharges did not affect rates of readmission within 48 hours in our institution and most readmissions were within 8 hours. The objectives of this study were to identify factors which increase the risk of readmission to CCCU within 48 hours of discharge and to identify the consequences of readmission.

Methods:
A retrospective review was performed. We included discharges from a cardiac Critical Care Unit (CCCU) at a quaternary academic health science centre in the 25 months ending January 2009. We defined index admission as that preceding readmission, and abstracted demographic information, admission details and physiologic parameters preceding discharge from an electronic patient record. Data were represented as means and compared using t-test and linear regression.

Results:
There were 1266 discharges, with 54 (4.3%) children readmitted within 48 hours. Children readmitted were of similar age (2.67 v 2.95 yr, p=0.99), and had not been admitted more frequently in the previous 2 years (0.81 v 0.52 admissions, p=0.21). Length of index admission was not significantly different (160 v 138 hr, p=0.84), however discharge oxygen saturation was lower (90 v 93%, p=0.03) and Bedside PEWS score was higher (4.5 v 3.2, p=0.004) for those children readmitted within 48 hours. Discharge PELOD scores were similar (p=0.63). The PIM2 score at readmission was not significantly different (-4.12 v -4.31, p=0.11) and there was a trend suggesting greater length of CCCU stay (257 v 137 hr, p=0.05) for readmission. Five children (9%) who were readmitted died.

Conclusions:
The rate of readmissions within 48 hrs over this period was higher than previously reported for our institution (4.3% v 2.4%). Factors associated with increased risk of readmission were lower discharge oxygen saturation and a higher composite physiological score (Bedside PEWS). Children had not spent longer in the unit. Children readmitted had a slightly longer stay during their readmission, and 9% of these children subsequently died.
Abstract 323: G-Protein Coupled Estrogen Receptor 1 Activation Protects the Heart Against Ischemia/Reperfusion Injury by Inhibiting the mPTP Opening via PKC/ERK/GSK-3? Pathway
Authors: Chrisostome Bopassa , Lu Rong , Singh Harpreet , Olde Bjorn , Krust Andree , Leeb-Lundberg Fredrik , Toro Ligia , Stefani Enrico
Published: April 2024

Estrogen effect can be mediated by three receptors: Classical estrogen receptors: alpha (ERα) and beta (ERβ), and recently identified G protein-coupled estrogen receptor1 (GPER1). We investigated the role of ERα, ERβ and GPER1 in mediating rapid estrogen-induced cardioprotection in male mice hearts subjected to ischemia/reperfusion using wild type (WT) and gene specific knockout animals. Isolated hearts from wild type (WT: C57BL/6NCrL), ERα
-/-
, ERβ
-/-
and GPER1
-/-
were perfused using Langendorff apparatus with Krebs Henseleit buffer (control) or with the addition of estrogen (40 nM). Hearts were subjected to 18 min global ischemia followed by 60 min reperfusion. Cardiac function was recorded during the entire experiment and myocardial infarct size measured by TTC staining at the end of the reperfusion. Mitochondria calcium retention capacity (CRC) required to induce the mitochondrial permeability transition pore (mPTP) opening was assessed after 10 min reperfusion. Protein levels were measured by Western Blot in whole heart lysates after 5 min treatment just before ischemia, and after 10 min reperfusion. LY294002, U0126 and Chelerythrin-Cl were used as inhibitor of PI-3K/Akt, MAPK/ERK and PKC translocation, respectively. In WT, ERα
-/-
and ERβ
-/-
, estrogen treatment significantly improved cardiac functional recovery, reduced infarct size and improved mitochondrial CRC. However, estrogen effects were completely absent in GPER1
-/-
. Estrogen treatment during 5 min before ischemia induced up-regulation of Akt, GSK-3β, and ERK
1/2
phosphorylation in WT mouse as compared with control but not in GPER1
-/-
. However, after 10 min reperfusion estrogen effect was still oserved on GSK-3β, but not on Akt and ERK
1/2
. Chelerythrin-Cl, and U126, inhibitors of MEK and PKC translocation, respectively abolished estrogen-induced cardioprotection while LY294002, a PI-3K inhibitor, did not prevent estrogen-induced cardioprotection in observed in WT. P<0.05 and n=4-7. Rapid activation of GPER1 induces cardioprotection effect against ischemia/reperfusion injury. Estrogen effects through GPER1 are mediated by phosphorylation of GSK-3β and ERK
1/2
, PKC translocation, and inhibition of the mPTP opening.
Abstract 329: Is Procalcitonin the Prognostic Marker in Septic Shock Patients Caused by Methicillin-Resistant Staphylococcus aureus?
Authors: Taniguchi Takumi , Okajima Masaki
Published: April 2024

Background
: Procalcitonin (PCT) has emerged as the most specific biomarker for bacterial infection. Recently, several investigations showed that PCT not only has diagnostic value as a marker for sepsis, especially among critically ill patients, but also may have prognostic value as well. However, there are few studies whether PCT is the prognostic marker on septic shock patients caused by methicillin-resistant Staphylococcus aureus (MRSA), or not. The present study evaluated the PCT value and the change of PCT value as the prognostic marker on septic shock patients caused by MRSA in intensive care unit (ICU).

Hypothesis
: We hypothesis that the PCT value and the change of PCT value are the prognostic marker on septic shock patients caused by MRSA.

Methods
: Eleven patients (M/F 8/3, mean age 61 years) with septic shock induced by MRSA were measured PCT value at the time of ICU admission and 1, 2, 3 days after ICU admission Primary outcome was the correlation between PCT and severity (mortality and SOFA score), and secondary outcomes were the correlations between PCT and inflammatory responses after ICU admission.

Results
: The PCT level was 1.8 ± 3.3 ng/mL at the time of ICU admission and was 1.5 ± 1.0 ng/mL 3days after ICU admission. There is not significant correlation between PCT level and SOFA scores (r=0.21, p=0.289) at the time of ICU admission. There is not significant correlation between PCT level at the time of ICU admission and mortality (r=0.14, p=0.414), and not correlation between the change of PCT level and mortality (r=0.18, p=0.301). Moreover, PCT did not significantly correlate with WBC counts (r=0.04) and CRP level (r=0.25). The change of PCT level did not significantly correlate with the changes of WBC counts and CRP level.

Conclusion
: The PCT value and the change of PCT value are not the prognostic marker on septic shock patients caused by MRSA.
Abstract 33: Survival from Out-of-Hospital Cardiac Arrest Is Lowest at Night: Findings from the Cardiac Arrest Registry to Enhance Survival (CARES)
Authors: Bagai Akshay , McNally Bryan , Myers Brent , Kim Sunghee , van Diepan Sean , Garvey J Lee , Fosbol Emil L , Monk Lisa , Abella Benjamin S , Granger Christopher B , Jollis James G
Published: April 2024

Background:
Understanding temporal variability in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for pre-hospital resource planning and structuring systems for OHCA care.

Methods:
Using the Cardiac Arrest Registry to Enhance Survival (CARES) database, we studied patients with OHCA of presumed cardiac etiology who were treated by emergency medical services (EMS) from 10/2005 to 12/2010. Measures of pre-hospital care, survival to hospital discharge, and neurologic outcomes were compared between OHCA occurring during daytime (0701-1500h), evening (1501-2300h), and overnight (2301-0700h).

Results:
The frequency of OHCA varied significantly across time blocks with 7503 (40.4%) occurring during daytime, 6883 (37.0%) during evening, and 4202 (22.6%) occurring overnight (p<0.0001). Compared with OHCA patients during daytime or evening, those with OHCA overnight were more likely to be younger, arrest at home, have an unwitnessed arrest, have a non-shockable initial rhythm, and were less likely to receive bystander CPR or AED use (Table). Time from 911 call to EMS arrival was longest at night. Survival to hospital discharge was lowest among overnight OHCA patients. There was no difference in frequency of favorable neurologic outcomes among survivors in the different time blocks. After controlling for differences in patient and arrest characteristics, with daytime as the reference, overnight OHCA was associated with lower survival (OR 0.74, 95% CI 0.63-0.87, p=0.0002), with similar survival for patients with OHCA during evening (OR 0.99, 95% CI 0.88-1.12, p=0.91).

Conclusion:
There is temporal variability in OHCA occurrence with the nadir in frequency occurring at night. OHCA at night is independently associated with lowest survival to hospital discharge. Underlying patient, EMS system, and hospital factors contributing to these observed findings requires further exploration.
Abstract 334: Noninvasive Carbon Dioxide Monitoring During Acute Lung Injury Due to Smoke Inhalation and Burns
Authors: Belenkiy Slava M , Ivey Katherine M , Batchinsky Andriy I , Langer Thomas , Vecchi Vittoria , Salinas Jose , Cancio Leopoldo C
Published: April 2024

Introduction: We evaluated the accuracy of transcutaneous CO
2
(tPCO
2
) and end-tidal CO
2
(ETCO
2
) monitors in a porcine model of Acute Lung Injury (ALI) due to smoke inhalation and burns.

Methods: Anesthetized pigs (n=6) received smoke inhalation injury and 40% total body surface area (TBSA) full-thickness flame burns. They were then transferred to an animal ICU. A SenTec system was used for tPCO
2
measurements, and an Oridion Capnostream for ETCO
2
. PaCO
2
was analyzed with an i-STAT blood analyzer. These measurements were recorded every 6 hrs and as needed. Data are means ±SD, and were analyzed (Bland-Altman and linear regression) both pre- and post-ALI, as well as during hemodynamically stable and unstable (unstable = mean arterial pressure (MAP) < 60 mmHg or receiving i.v.norepinephrine).

Results: See Table. All animals developed ALI (PaO
2
/FiO
2
<300) at 23.5±15.1 hrs. Mean survival time was 46.3 ± 26.3 hrs.

Conclusions: In a porcine model of ALI and under hemodynamically stable conditions, tPCO
2
was an acceptable surrogate for PaCO
2
and was more accurate than ETCO
2
. Overall, tPCO
2
monitoring is a consistent noninvasive substitute for PaCO
2
. Its shortcomings include a slower response time to PaCO
2
changes than ETCO
2
.
Abstract 34: Survival and Neurological Outcome of Out-of-Hospital Cardiac Arrest in Los Angeles County: Preliminary Results After Regionalization of Care
Authors: Bosson Nichole , Eckstein Marc , Sung Gene , Koenig William , Kaji Amy , French William , Shavelle David , Thomas Jay , Gorospe Deidre , Rashi Paula , Tadeo Richard , Niemann Jim
Published: April 2024

Objective: Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). The purpose of this study was to describe recent experience with regionalized care of resuscitated patients in a large metropolitan area and compare it to earlier reported outcomes.

Methods: Los Angeles County established regionalized cardiac care in 2006 with a total of 33 designated STEMI receiving centers (SRC) throughout the county. Since 2010, county-wide protocols mandate transport of all OOHCA patients of presumed cardiac etiology with return of spontaneous circulation (ROSC) in the field to a SRC with an established hypothermia protocol. All SRCs treating ROSC patients report the in-hospital mortality and neurologic outcome of these patients to a single registry maintained by the LA County Emergency Medical Services Agency. We report the preliminary results of the first 8 months after this policy change, with the primary outcome variable of neurologically intact survival at hospital discharge, as defined by a Cerebral Performance Category (CPC) score upon hospital discharge of 1 or 2.

Results: There were 663 patients with field ROSC reported by the SRCs. Of these, 110 (17%) died in the emergency department (DOA), and 66 (10%) were awake and responsive upon hospital arrival, leaving 487 patients included in the study analysis. Of these patients, VF was the initial rhythm in 143 (29%), of whom 36 (25%) survived to hospital discharge (SHD) with a CPC score of 1 or 2. 108 (76%) patients with shockable rhythms received therapeutic hypothermia (TH), of whom 32 (30%) had neurologically intact SHD. In the TH group, the OR for CPC 1 or 2 in patients with an initial shockable rhythm was 3.3 (95%CI 1.1-9.5, p = .04), compared with those who did not received TH. In contrast, the SHD rate in Los Angeles in 2001 for a witnessed arrest with a shockable rhythm was 6%.

Conclusion: These results suggest that regionalization of post-resuscitation care improves the rate of neurologically intact survival from OOHCA.
Abstract 342: Developing an In Vivo Model of Ventricular Refibrillation
Authors: Zamiri Nima , Ramadeen Andrew , Hu Xudong , Farid Talha , Masse Stephane , Dorian Paul , Nanthakumar Kumaraswamy
Published: April 2024

Background

Ventricular refibrillation, defined as re-emergence of VF following successful defibrillation, is as frequent as 79% after out of hospital cardiac arrest, with at least 50% of patients experiencing more than 1 episode of refibrillation. Re-fibrillations are harder to defibrillate and are inversely associated with survival. The mechanism of refibrillation is not known. In order to test hypotheses on preventing or treating refibrillation, a reliable in-vivo refibrillation model is necessary. Pigs have been used as a reliable model to study the efficacy of CPR. Here we present a swine model of ventricular refibrillation following VF.

Methods & Results

Twenty-four Yorkshire pigs were anesthetized. Three Millar catheters were used to measure pressure from abdominal Aorta, RA and LV. An EP catheter was introduced in the RV to induce VF. VF was induced by burst pacing and left untreated for 4 minutes. Then chest compressions were delivered using a pneumatic device at a constant rate of 120/min and manual ventilation was delivered at 6 breaths/min. All animals were defibrillated after 3 min of CPR at 150J, and increasing energy in case of failure. After successful defibrillation, they were observed for a period of 30 min for any occurrence of refibrillation. Refibrillations were treated with defibrillation. The initial VF could not be defibrillated in 3 (12%). Refibrillation occurred in 13 (62%). The mean time to onset of refibrillation was 629 sec after successful defibrillation ranging from 8 to 1600 sec. Mean number of re-fibrillations was 1.14±1.15 (max: 4) with 33.33% (n=7) experiencing more than one episode of refibrillation. Forty-six percent of refibrillations occurred within first 5 min after defibrillation. Overall Survival was 37.5% (n=9). Survival was 38% in re-fibrillation group vs. 44.4% in non-refibrillation group (p=nsS). With regards to initiation, 60% of episodes were preceded by 1 PVC and 20% were preceded by 2 PVCs or more.

Conclusion

We have developed a swine model of ventricular re-fibrillation that resembles reported human data in terms of incidence of re-fibrillation and initiation following VF arrest. This model will serve as a test bed for different pharmacologic and interventional strategies focused on modulating refibrillation.
Abstract 35: A Validation of the Association Between a Quantitative CT Scan Measure of Cerebral Edema and Outcomes Post Cardiac Arrest
Authors: Cristia Cristal , Ho Mai-Lan , Levy Sean , Giberson Tyler , Salciccoli Justin , Cocchi Michael N , Donnino Michael W
Published: April 2024

Introduction: The presence of cerebral edema post cardiac arrest (CA) may indicate widespread neurologic injury. Previous studies have examined the association between a quantitative measure of brain edema on CT scan and outcome. A calculated gray matter to white matter attenuation ratio (GWR) of <1.2 was associated with near 100% non-survivable injury post CA. These findings have yet to be validated in a separate population.

Objective: To validate whether a GWR <1.2 reliably indicates poor survival post arrest. We also sought to determine the inter-relater reliability among reviewers and develop a novel GWR that may be simpler to use in practice.

Methods: We performed a retrospective analysis of post CA patients admitted to a single center from 2008 to 2012. Inclusion criteria were age >18years, non traumatic arrest, and a brain CTscan within 24 hours of ROSC. Three independent physician reviewers measured attenuation in pre-specified areas.

Results: We evaluated 300 patients, of whom 91 met inclusion criteria and 79 had a technically adequate CT for evaluation. Mean age was 64 years (SD +/- 17); 69% were male. In-hospital mortality was 63%. Approximately 59% of patients received therapeutic hypothermia. For the validation measurement, the interclass correlation coefficient was 0.70. Results of GWR <1.2 are shown in Table. Adjusting the cut-off value to <1.1, no survivors were noted by reviewers 2 and 3 (0/19) and 89% did not survive as judged by reviewer 1 (1/8).

Conclusion: A GWR <1.2 on CT imaging within 24 hours post CA was associated with a high degree of mortality and poor neurologic outcome, however this was not invariably true. Similarly, our experimental model did not perform well enough to be used for prognostication. We caution against implementation based on previous investigations until reasons for these disparate findings are elucidated. A threshold <1.1 may be a safer cut-off to identify patients with low chance of neurological survival.
Abstract 37: External Validation of Termination of Resuscitation Guidelines in the Setting of Intra-arrest Cold Saline, Mechanical CPR and Comprehensive Postresuscitation Care
Authors: Diskin Francis J , Kurz Michael C , Camp-Rogers Teresa R , Peberdy Mary Ann , Ornato Joseph P
Published: April 2024

Background: The development of Advanced Life Support (ALS) Termination of Resuscitation (TOR) guidelines for Out-of-Hospital Cardiac Arrest (OOH-CA) seeks to improve the efficiency of scarce pre-hospital resources. However, as pre-hospital treatment for OOH-CA evolves and survival improves, these TOR guidelines must be reevaluated in a contemporary context of EMS providing advanced resuscitation care.

Methods: Retrospective review of all adult (>18 years old), non-traumatic, OOH-CA patients (defined as patients with absence of pulse who received either CPR and/or defibrillation) treated by EMS in Richmond, Virginia, from January 1, 2009 to December 31, 2010. In addition to standard ALS, intra-arrest cold saline, mechanical CPR, and transportation to a comprehensive post-resuscitation center (CPRC) was provided. Survival at 30 days was presumed when death could not be verified from publically reportable sources.

Results: Of the 333 OOH-CA patients enrolled, the majority were male (59%), unwitnessed (52%), received no bystander CPR (67%), presented in a non-shockable initial rhythm (79%), with an average age of 62.5 years. Follow up data was obtained 324 (97.3%) of patients with overall survival of 19%, 15%, and 13% at 7, 14, and 30 days respectively. Of the 77 patients TOR guidelines recommended termination, none survived yielding both 100% specificity (95% CI 100- 92.8%) and positive predictive value (95% CI 100-94.1%). However, TOR guidelines recommended transport of 192 of the 269 patient who died, resulting in a sensitivity of 28.6% (95% CI 34.5-23.4%).

Conclusion: The TOR guidelines continue to have a reliable positive predictive value for death even in the setting of advanced EMS resuscitation methods and access to a CPRC. However, as the potential for survival from OOH-CA improves, the efficiency gained from their use is impacted greatly.
Abstract 47: ECG Changes and Poor Outcomes for In-Hospital Cardiopulmonary Arrest in Patients with Multiple Organ Dysfunction
Authors: Hayase Justin , Do Duc , Kim Sunghan , Hu Xiao , Boyle Noel
Published: April 2024

Background: The likelihood of surviving to discharge after cardiac arrest (CA) is very low for patients with multi-organ dysfunction. However, at time of CA, many patients often undergo resuscitation attempts, which are either unsuccessful or lead to a prolonged, complicated and costly hospital course, ultimately ending in withdrawal of care. In this study, we evaluate the frequency ECG changes occurring prior to CA in patients with multi-organ failure and implications for “code status” discussions.

Methods: We evaluated all “Code Blue” events at UCLA Medical Center, a 520 bed tertiary care hospital, from April 2010 to March 2012, and included all adult CA cases that had significant organ dysfunction in two or more systems with at least 3 hours of continuous telemetry data preceding CA available. We analyzed up to 24 hours of telemetry data prior to CA for any ECG changes from baseline including PR prolongation, QRS widening, ST segment changes, QT prolongation and new onset atrial fibrillation. Charts were reviewed for survival outcomes and code status at time of CA. All cases were adjudicated by a second observer.

Results: There were 30 cases meeting inclusion criteria and included in this study. Of these 15 (50%) were classified as pulseless electrical activity (PEA) arrest, 11 (37%) were bradycardic arrests and 4 (13%) were ventricular tachycardia/ventricular fibrillation arrests. Amongst the PEA group, 13/15 (87%) had any ECG change up to 24 hours prior to CA with QRS widening in 10/15 (67%) and ST segment changes in 6/15 (40%). Amongst the bradycardic group, 8/11 (73%) had any ECG change up to 18.5 hours prior to CA, with QRS widening in 5/11 (45%) and ST segment changes in 4/11 (36%). Survival to discharge was 2/30 (7%) for all patients, with both survivors being discharged to hospice care. At the time of CA, 25/30 (83%) were full code status.

Conclusions: In this limited case series, ECG changes within the 24 hours preceding CA were seen in 77% of patients with multiple organ dysfunction. Survival for this group after CA remains low, with a disproportionately high percentage of patients undergoing extreme life-saving measures despite poor prognosis. These findings may have important implications for discussions regarding the urgency of “code status” with such patients.
Abstract 12746: Hydrogen Inhalation Improves Neurological and Cardiac Outcome in a Rat Model of Cardiac Arrest With Ventricular Fibrillation
Authors: Hayashida Kei , Sano Motoaki , Kamimura Naomi , Yokota Takashi , Suzuki Masaru , Maekawa Yuichiro , Kawamura Akio , Ohta Shigeo , Fukuda Keiichi , Hori Shingo
Published: April 2024

Kei Hayashida, 2012 Finalist and Presenting Author
Abstract 13229: Quantifying Options for Reducing Coronary Heart Disease Mortality by 2020
Authors: Huffman Mark D , Lloyd-Jones Donald M. , Ning Hongyan , Labarthe Darwin R. , Ford Earl S. , Capewell Simon
Published: April 2024

Mark D Huffman, 2012 Finalist and Presenting Author
Abstract 15983: Beta-Aminoisobutyric Acid Increases Browning of White Fat and is Inversely Correlated with Cardiometabolic Risk Factors in Humans
Authors: Roberts Lee D
Published: April 2024

Lee D Roberts, 2012 Finalist and Presenting Author
Abstract 12450: Unusual Treatment of an Unusual Tumor
Authors: Agarwal Shikhar , Kapadia Samir R , Menon Venu
Published: April 2024

Shikhar Agarwal, 2012 Finalist and Presenting Author
Abstract 10887: Love-Making Reveals a Broken Heart: A 46-Year-Old Man with Recurrent Hemoptysis During Sexual Intercourse
Authors: Schimmel Daniel , Lee Daniel C , Maganti Kameswari , Shah Sanjiv J
Published: April 2024

Daniel Schimmel Jr., 2012 Finalist and Presenting Author
Abstract 16912: Cardiac Stem Cell Function is Regulated by Hypoxic and Normoxic Niches within the Myocardium
Authors: Sanada Fumihiro , Junghyun Kim , Sergio Signore , Annarosa Leri
Published: April 2024

Fumihiro Sanada, 2012 Finalist and Presenting Author
Haldane, Hot Dogs and Halitosis: The Anion Nitrite As an Intrinsic Hypoxic Signaling Molecule and New Therapy for Pulmonary Arterial Hypertension
Authors: Gladwin Mark
Published: April 2024

Nitrate and nitrite have traditionally been considered dietary toxins that increase the risk of stomach cancer. In this lecture we discuss how the scientific discovery was made that nitrate and nitrite are in fact natural signaling pathways in the human body.

Nitrite is now considered a biological reservoir of nitric oxide (NO), present in plasma, red cells and organ systems, that is reduced to NO during physiological and pathological hypoxia. Current studies by multiple research groups indicate that dietary and NOS-dependent nitrite formation may contribute to critical physiological functions such as blood pressure control, hypoxic vasodilation, mitochondrial respiration and the cellular resilience to ischemic stress. Recent studies suggest that a number of cellular enzymes regulate nitrite reduction to NO at different oxygen tensions, with organ system specificity. The role of molybdenum containing enzymes and heme-globin superfamily proteins - hemoglobin, myoglobin, neuroglobin, cytoglobin and the plant and drosophila hemoglobins - are the subject of active current study, and recent advances in this area of investigation will be reviewed. Studies of cytochrome C oxidase, neuroglobin and plant hemoglobins have identified a role for heme coordination in the control of nitrite reduction to NO (six-to-five coordinate regulation of nitrite binding and reduction). New pre-clinical and clinical studies suggest that inhaled and oral nitrite may be able to prevent and reverse established pulmonary arterial hypertension and phase II proof of concept trials are currently in progress in the US and Europe. It is proposed that the nitrate - nitrite - NO pathway represents a fundamentally conserved pathway for energetics and signaling in biology.