bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10618: A Head up CPR Based Care Bundle Improves the Likelihood of Survival to Hospital Discharge After Out of Hospital Cardiac Arrest
Authors: Moore Johanna C , Labarere José , Lick Charles , Duval Sue , Holley Joe , Scheppke Kenneth , Jacobs Michael , Salverda Bayert , Rojas-Salvador Carolina , Nystrom Paul , Quinn Ryan , Adams Paul , Debaty Guillaume P , Hutchison Mack , Mason Charles , Martinez Eduardo , Mason Steven , Clift Armando , Antevy Peter , Grizzard Eric , Garay Sebastian , Lurie Keith G , Pepe Paul E
Published: December 2021

Introduction:
Survival rates after out-of-hospital cardiac arrest (OHCA) remain poor with widespread use of conventional (C) CPR. Based on pre-clinical studies showing improved cerebral flow and neurologically-intact survival, a FDA approved automated Head Up Positioning (AHUP) device for CPR was developed for use with an impedance threshold device (ITD), and manual and/or automated suction cup-based CPR. A prospective observational IRB approved registry was created to track use and clinical outcomes with this AHUP device based bundle.

Hypothesis:
Faster time to use of an AHUP CPR bundle improves survival to hospital discharge after OHCA versus historical controls treated with C-CPR.

Methods:
Registry patients from sites routinely recording time from 911 call to AHUP device placement (T
911
) were included. C-CPR controls were from 3 prior randomized prospective CPR trials: 1) Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) Study, 2) Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study (ROC-ALPS), 3) The ResQTrial. Propensity score analysis was performed using logistic regression for baseline characteristics including age, sex, witnessed arrest, bystander CPR, shockable rhythm, and time to first responder CPR. Each AHUP patient was matched with up to 4 C-CPR patients.

Results:
Of 11 U.S. sites reporting AHUP CPR outcomes, 6 had time from 911 call to AHUP device placement recorded (n = 227). The model yielded a c-statistic of 0.76. Stratified by T
911
, the odds of survival with AHUP CPR were significantly higher than with C-CPR between T
911
< 7 minutes (OR 4.57, 95% CI 1.3-16.0) and T
911
< 15 minutes (OR 2.01, 95% CI 1.1-3.8). There was a time dependent effect of AHUP device placement on survival (See Figure).

Conclusions:
More rapid initiation of an AHUP CPR bundle resulted in improved survival to hospital discharge versus historical controls treated with C-CPR in OHCA.
Abstract 10847: Circadian Variation of In-Hospital and Out-of-Hospital Sudden Cardiac Arrest
Authors: Tang Yicheng , Tertulien Tarryn , Saba Samir
Published: December 2021

Introduction:
Several studies have reported circadian periodicity of sudden cardiac arrest (SCA), most commonly a nadir in event frequency during overnight hours. It remains unclear to what extent this circadian pattern is influenced by variation in patients’ physical activities. One way to elucidate this is to compare patients with out-of-hospital (OHCA) versus in-hospital (IHCA) cardiac arrests, which has not been previously done. We hypothesize that the circadian pattern of SCA will be preserved in a mixed contemporary cohort of OHCA and IHCA survivors.

Methods:
A total of 1,433 consecutive survivors of SCA in the Pittsburgh area from 2002 to 2012 were included. Patient demographics including clinical histories and details of SCA were collected using records from emergency medical services and rapid response teams. Unwitnessed SCA and those with potential non-cardiac confounders were excluded. The distribution of SCA throughout the day and associated patient characteristics were tested for differences using chi-square test and student’s t-test.

Results:
Of the 1,224 patients analyzed, 706 had IHCA and 518 OHCA. We observed a nadir of SCA in the nighttime hours between 0000 - 0600 in both IHCA and OHCA groups (p<0.001). Patients who arrested in this nighttime window had more co-morbidities (p=0.01) and lower percent of angiographically confirmed acute myocardial infarction (p=0.025). A similar circadian pattern was noted for patients with higher or lower comorbidity burden (p<0.001), although more blunted in sicker patients, as well as for patients whose arrest was due to a shockable rhythm (p<0.001). Correspondingly, the IHCA group had higher co-morbidity burden (p<0.001) and a blunted nighttime nadir compared to the OHCA group (p<0.001). We did not observe a temporal variation by day of week but did see a seasonal pattern with a peak in SCA in the Pittsburgh cold months (p<0.001).

Conclusion:
The typical pattern of nighttime nadir in SCA is seen in both OHCA and IHCA but is more blunted in sicker patients and in the hospital. This suggests a common mechanism that transcends differences between the two settings but may be influenced by non-cardiac comorbidities or environmental factors such as activity level.
Abstract 10861: Determining the Importance of Gender, Race, and Body Shape for Cardiopulmonary Resuscitation Education Using Manikins
Authors: Liblik Kiera , Byun Jin , FARINA JUAN , Lloyd-Kuzik Andrew , Burgos Lucrecia Maria M , Howes Daniel , Baranchuk Adrian M
Published: December 2021

Introduction:
Cardiopulmonary resuscitation (CPR) education plays a critical role in reducing cardiovascular deaths. Thus, it is crucial that trainees engage in practice simulations that accurately replicate a cardiovascular emergency. Recent work has shown that certain demographic groups such as Black Americans and women are less likely to receive efficient CPR, and technique may vary on individuals who have an increased body mass index or who are pregnant. Poor representation of these groups in the manikins used for CPR simulation may play a substantial role in these inequities.

Hypothesis:
There is a deficiency in the diversity of race, gender, and body habitus of manikins used for CPR training in North and South America.

Methods:
Institutions, businesses, and non-governmental organizations which administer CPR certification in North and South America were identified for survey distribution through a collaboration with the Inter-American Society of Cardiology. A survey was administered using the online platform Qualtrics (Provo, USA) consisting of 18 questions about manikin supply, usage, and diversity.

Results and Conclusions:
A total of 52 survey responses were received from North America (n=20; 854 total manikins) and South America (n=32; 1,169 total manikins). Of the total manikins (n=2,023), 318 (16%) were non-white, 114 (6%) were female, 20 (1%) represented a non-lean body habitus, and 18 (1%) were pregnant.

The importance of diverse manikin representation in simulation training is underscored by literature detailing deficiencies in CPR initiation and associated outcomes in individuals who are not lean white males. Yet, the majority of manikins used in North and South America still disproportionally represent this population. It is pertinent that manikins used for CPR training reflect all populations at risk for major adverse cardiovascular events.
Abstract 10907: Association of Intentional Cooling, Achieved Temperature, and Hypothermia Duration with Survival in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation-An Exploratory Analysis of ELSO Registry
Authors: Nakashima Takahiro , Ogata Soshiro , Noguchi Teruo , Nishimura Kunihiro , Sefa Nana , Hsu Cindy H , Haas Nathan L , Belohlavek Jan , Pellegrino Vincent , Tonna Joseph , Haft Jonathan , Neumar Robert W ,   The Extracorporeal Life Support Organization
Published: December 2021

Background:
The efficacy of targeted temperature management remains unclear for patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) due to refractory cardiac arrest.

Methods:
We analyzed the Extracorporeal Life Support Organization registry between 2010 and 2019. Patients 18-79 years old who received ECPR and had a reported temperature were included. First, we compared outcomes between patients who completed intentional cooling (IC) and those who did not complete intentional cooling (NIC). Among those who completed IC, we compared the outcomes between i) actual observed temperature <34°C, 34 - 36°C, and ≥36°C, and ii) hypothermia duration below 36°C for <12 hours, 12 - 48 hours, and >48 hours. The primary outcome was in-hospital death within 90 days. Cox proportional hazard models were conducted with adjustment for covariates.

Results:
Among a total of 8,060 patients who received ECPR, 911 patients who had a record of actual temperature were identified. After multivariable adjustment, there was no significant difference in in-hospital mortality between patients treated with IC and NIC (Hazard ratio [HR] 1.13 [95% CI 0.93 - 1.39], p=0.2252). However, among patients treated with IC, recorded temperature at 34 - 36°C had a significantly lower adjusted HR for in-hospital mortality compared with ≥36°C (HR 0.73 [0.56 - 0.97], p=0.0274). Maintaining a temperature <36°C for 12 - 48 hours had a significantly lower adjusted HR for in-hospital mortality compared with <36°C for <12 hours (HR 0.70 [0.53 - 0.91], p=0.0080).

Conclusion:
In this exploratory analysis, IC was not associated with lower in-hospital mortality in patients treated with ECPR. However, among those treated with IC, achieving a target temperature of 34 - 36°C and maintaining it for 12 - 48 hours were associated with lower in-hospital mortality.
Abstract 10911: Amplitude Spectral Area to Guide Shock and Epinephrine Delivery in a Swine Model of Ventricular Fibrillation and Closed-Chest Resuscitation
Authors: Aiello Salvatore , Mendelson Jenna , Baetiong Alvin , Radhakrishnan Jeejabai , Gazmuri Raul J
Published: December 2021

Introduction:
VF accounts for ~30% of all sudden cardiac arrest episodes. VF signal analysis in the frequency domain - calculating the amplitude spectral area (AMSA) - can inform on the probability that an electrical shock could terminate VF followed by return of spontaneous circulation (ROSC). BLS guidelines require delivery of shocks every 2 min and epinephrine every 4 min. Yet, shocks often do not terminate VF and may injure the myocardium. We have previously reported that guiding the timing of shock delivery based on AMSA reduces myocardial injury and improves outcome. Epinephrine is given to increase the coronary perfusion pressure (CPP) and therefore myocardial blood flow but has detrimental effects on post-resuscitation myocardial function and possibly on neurological outcome.

Hypothesis:
Monitoring AMSA during CPR could be used not only to guide shock delivery but also to avoid administering epinephrine when AMSA predicts a high probability of shock success, reserving epinephrine when AMSA predicts a low probability of shock success and additional CPP increase might be helpful.

Methods:
In a swine model of electrically induced VF and mechanical chest compressions, two resuscitation protocols were compared in 8 pigs each: (1) A guidelines-driven (GD), delivering shocks and epinephrine guided by the current BLS protocol and (2) An AMSA-driven, delivering shocks and epinephrine guided by AMSA (ADSE). VF was untreated for 10 min and pigs that achieved ROSC were monitored for 240 min.

Results:
Compared to GD, ADSE was associated with a shorter time to ROSC (400±80 vs 569±16 sec, p=0.034) and higher survival rate at 240 minutes with borderline statistical significance (7/8 vs 3/8, p=0.059). ADSE required fewer shocks (3±2 vs 5±2, p=0.026) and received fewer doses of epinephrine (median [interquartile range], 1[1-1] vs 2[1.3-3], p=0.038).

Conclusions:
Resuscitation with the ADSE protocol was superior to the GD protocol resulting in a shorter time to ROSC with improved survival requiring fewer shocks and fewer epinephrine doses. The ADSE protocol represents a more tailored approach to resuscitation enabling delivery of resuscitation interventions with higher precision and consequently minimizing their associated adverse effects.
Abstract 10941: Cerebral Consumption of Lactate Increases Neurological Injury After Experimental Cardiac Arrest in Rabbits
Authors: Faucher Estelle , lidouren fanny , Abi Zeid Daou Yara , Ghaleh Bijan , Tissier Renaud , Kohlhauer Matthias
Published: December 2021

Introduction:
Neuronal consumption of lactate is known to be protective after long duration of brain ischaemia. However, its consequences on neurological function after shorter duration of ischemia like after cardiac arrest are unknown.

Hypothesis:
We hypothesized that cerebral lactate consumption is deleterious for neurological outcome, whereas lactate dehydrogenase inhibition by oxamate could improve recovery.

Methods:
Male New-Zealand rabbits were anesthetized and surgically instrumented to assess lactate, glucose and O
2
cerebral consumption by measurement of the arterio-jugular differences. After 10 min of ventricular fibrillation, animals were resuscitated and randomly received a 30-min infusion of either saline (Control, n=6), lactate (Lact, 5 mg/kg/min, n=6) or oxamate (Oxa, 37.5 mg/kg/min, n=6). They were followed during 4 h. Additional animals were submitted to the same procedure without surgical instrumentation to allow recovery and assessment of neurological function during 48 h after cardiac arrest. In both experiments, neuronal death was assessed histologically by fluorojade C staining.

Results:
In Control group, a strong increase of the cerebral consumption of O
2
, glucose and lactate was observed during the 4 hours following resuscitation. In Lact group, lactate consumption was increased as compared to Control, whereas it was almost abolished in Oxa group (17.13±3.59, 32.60±6.24 and 4.04±1.58 mmol/L/min in Control, Lact and Oxa, respectively). Additionally, Oxa group presented a reduced consumption of glucose and O
2
after cardiac arrest as compared to other groups. Interestingly, administration of oxamate was highly neuroprotective whereas lactate administration worsened the neurological outcome after cardiac arrest (38±4, 64±10 and 15±6 % of neurological dysfunction score at 48h in Control, Lact and Oxa, respectively). Oxamate infusion was also associated with a significant reduction in the number of degenerative neurons at 4 h and 48 h of follow-up.

Conclusions:
The cerebral consumption of lactate appeared to be detrimental in rabbits after cardiac arrest. Its inhibition by oxamate is potently neuroprotective.
Abstract 10975: National Study of In-Hospital Cardiac Arrest in the Emergency Department, 2010-2018
Authors: Lu Tsung-Chien , Ko Chia-Hsin , WANG CHIH-HUNG , Fang Cheng-Chung , Huang Chien-Hua , Chen Wen-Jone , Tsai Chu-Lin
Published: December 2021

Introduction:
Little is known about in-hospital cardiac arrest (IHCA) in the U.S. emergency department (ED). This study aimed to describe the incidence and mortality of ED-based IHCA visits and to investigate factors associated with higher incidence and poor outcome of IHCA.

Hypothesis:
We hypothesized that ED-based IHCA contributes to a stable proportion of ED visits and remains a higher mortality rate after the event.

Methods:
Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010 to 2018. Adult ED visits with IHCA were identified using the cardiopulmonary resuscitation code, excluding those with out-of-hospital cardiac arrest. Analysis used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design.

Results:
Over the 9-year study period, there was an estimated 1,114,000 ED visits with IHCA and the proportion of IHCA visits in the entire ED population (1.8 per 1,000 ED visits) appeared stable. The mean age of the IHCA visits was 60 years, and 65% were men. Older age, male sex, arrival by ambulance, and being uninsured independently predicted a higher incidence of ED-based IHCA. About 51% of ED-based IHCA died in the ED, and the trend remained stable. Arrival by ambulance, nighttime or weekend arrival, and being in the non-Northeast location were independently associated with a higher mortality rate after IHCA.

Conclusions:
The high burden of ED visits with IHCA persisted and the outcome remained poor. Some patients were disproportionately affected and certain contextual factors were associated with a poorer outcome.
Abstract 10992: Machine Learning to Predict In-Hospital Cardiac Arrest in Patients Admitted from the Emergency Department with COVID-19 and Suspected Pneumonia
Authors: Lu Tsung-Chien , Chou Eric H , WANG CHIH-HUNG , Mostafavi Amir , Tovar Mario , Garrett John , Bhakta Toral , Tsai Chu-Lin , Ma Matthew H
Published: December 2021

Introduction:
There are only scarce models developed for stratifying the risk of cardiac arrest from COVID-19 patients presenting to the ED with suspected pneumonia. By using the machine learning (ML) approach, we aimed to develop and validate the ML models to predict in-hospital cardiac arrest (IHCA) in patients admitted from the ED.

Hypothesis:
We hypothesized that ML approach can serve as a valuable tool in identifying patients at risk of IHCA in a timely fashion.

Methods:
We included the COVID-19 patients admitted from the EDs of five hospitals in Texas between March and November 2020. All adult (≥ 18 years) patients were included if they had positive RT-PCR for SARS-CoV-2 and also received CXR examination for suspected pneumonia. Patients’ demographic, past medical history, vital signs at ED triage, CXR findings, and laboratory results were retrieved from the EMR system. The primary outcome (IHCA) was identified via a resuscitation code. Patients presented as OHCA or without any blood testing were excluded. Nonrandom splitting strategy based on different location was used to divide the dataset into the training (one urban and two suburban hospitals) and testing cohort (one urban and one suburban hospital) at around 2-to-1 ratio. Three supervised ML models were trained and performances were evaluated and compared with the National Early Warning Score (NEWS) by the area under the receiver operating characteristic curve (AUC).

Results:
We included 1,485 records for analysis. Of them, 190 (12.8%) developed IHCA. Of the constructed ML models, Random Forest outperformed the others with the best AUC result (0.930, 95% CI: 0.896-0.958), followed by Gradient Boosting (0.929, 95% CI: 0.891-0.959) and Extra Trees classifier (0.909, 95% CI: 0.875-0.943). All constructed ML models performed significantly better than by using the NEWS scoring system (AUC: 0.787, 95% CI: 0.725-0.840). The top six important features selected were age, oxygen saturation at triage, and lab data of APTT, lactic acid, and LDH.

Conclusions:
The ML approach showed excellent discriminatory performance to identify IHCA for patients with COVID-19 and suspected pneumonia. It has the potential to save more life or provide end-of-life decision making if successfully implemented in the EMR system.
Abstract 11034: Extracorporeal Life-Support for Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Study
Authors: JEONG DAUN , Chang Hansol , HWANG SUNGYEON , Cha Wonchul , Shin Tae Gun , Shin Sang Do , Choi Jin-Ho
Published: December 2021

Introduction:
Despite promising survival and favorable neurological results in IHCA, the outcomes of ECLS for OHCA are more heterogeneous. The clinical setting for the survival and favorable neurological outcomes of ECLS in OHCA may differ from that in IHCA.

Hypothesis:
This study aimed to determine whether ECLS is associated with improved survival to hospital discharge with favorable neurological outcome compared to conventional cardiopulmonary resuscitation and identify in which OHCA patients the implementation of ECLS would be beneficial.

Methods:
The clinical outcome of OHCA treated by ECLS or CCPR between 2015 and 2020 was retrospectively investigated using KoCARC, a nationwide multicenter OHCA registry of Korea. Differences in baseline clinical characteristics were adjusted by matching propensity for ECLS. Primary outcome was 30-day survival with neurologically favorable status of cerebral performance category of 1 or 2. Restricted mean survival time (RMST) was used to compare outcome between groups.

Result:
Of 12,006 patients (mean age=71, male gender=65%) included, ECLS was performed in 272 patients (2.2%). In unadjusted analysis, the frequency of survival with favorable neurological status was higher in ECLS compared to CCPR (15% versus 7%, RMST 9.4 versus 3.8 days, p<0.001). Subgroup analysis revealed that the benefit of ECLS was evident in high-risk groups including initial non-shockable rhythm or CPR duration≥20 min (p<0.05, all). In analysis of propensity score-matched 271 pairs, there was no difference in the clinical outcome between ECLS and CCPR (15% versus 16%, RMST 9.4 versus 9.0 days, p=0.33), but ECLS was still better than CCPR in initial non-shockable rhythm or CPR duration≥20 min (p<0.05, all).

Conclusions:
In this real-world data analysis, ECLS compared to CCPR did not result in better clinical outcome of OHCA in overall. However, ECLS might be beneficial for high-risk patients such as initial non-shockable rhythm or CPR duration≥20 min.
Abstract 11336: Experience with an Institutional Guideline on Extracorporeal Cardiopulmonary Resuscitation for Refractory in Hospital and Out of Hospital Cardiac Arrest
Authors: Oebo Marie , Lundgren Nils Lars Olof , Delaïre Sarah Maiken , Laugesen Helle , Andreasen Jan J
Published: December 2021

Aim:
To compare survival rates in patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an action card.The primary outcome was survival to discharge, and secondary outcomes were low-flow time and rate of cerebral complications.

Methods:
Retrospective evaluation of 37 patients treated with ECPR for refractory cardiac arrest. Information was obtained through medical records. Patients were categorized into two groups - before (BA) and after (AA) introduction of an action card. The card entailed inclusion and exclusion criteria used to evaluate the benefit of ECPR for any individual patient.

Results:
There were no statistically significant differences in baseline characteristics between the groups.After the introduction of the action card, survival to discharge increased from 6.7 % to 18.2 % suggesting a trend toward improved survival, despite this finding being statistically insignificant (p = 0.629).Low-flow time was reduced from 100 (12-195) minutes to 66 (30-195) minutes and the upper extreme was reduced from 195 to 153 minutes, but this was not statistically significant (p = 0.334).Cerebral factors contributed to significantly fewer deaths in AA compared with BA (p = 0.0022).

Conclusion:
There was no statistically significant improvement in survival rates nor a reduction in low-flow time after the implementation of an action card for the use of ECPR in patients with refractory CA. However, cerebral causes factored in fewer deaths and several patients survived despite meeting potential exclusion criteria outlined in local and international guidelines.
Abstract 11399: Time to Anti-Arrhythmic for Out-of-Hospital Cardiac Arrest
Authors: Huebinger Ryan , Chan Hei Kit , Bobrow Bentley , Chavez Summer , Schulz Kevin , Jarvis Jeffrey L
Published: December 2021

Introduction:
Initial shockable rhythm is the strongest predictor of good outcomes for patients with out-of-hospital cardiac arrest (OHCA). While preclinical models have shown benefit of anti-arrhythmics, clinical trials have shown a very modest impact of anti-arrhythmic drugs, possibly related to real-life delays in drug administration. Little is known regarding the time to administration of anti-arrhythmic drugs or the association of time to drug and outcome. We utilized a national EMS registry to evaluate the time of drug administration and the association with outcomes.

Methods:
We evaluated the 2018 and 2019 NEMSIS dataset, including all non-traumatic, adult 911 EMS encounters for cardiac arrests with initial shockable rhythm. We then calculated the time from 911 call to administration of anti-arrhythmic. We excluded cases with time to administration less than 0 or greater than 120 minutes. Stratified by initial antiarrhythmic (amiodarone and lidocaine), we created a mixed-effect logistic regression model evaluating the association between every 5 minute increase in time to antiarrhythmic and ROSC. We modeled EMS agency as a random intercept and adjusted the analysis for age, sex, race, bystander witnessed arrest, location of arrest and EMS response time. We excluded EMS witnessed arrests and cases with missing ROSC data.

Results:
There were 449,630 adult, non-traumatic cardiac arrests identified with 55,142 patients (12.3%) having an initial shockable rhythm; 17,769 (32.2%) received amiodarone and 2,855 (5.2%) received lidocaine initially. The median time in minutes to initial dose of amiodarone was 20.4 with IQR (16-26.7). The median time in minutes to initial dose of lidocaine administration was 20.2 with IQR (15.7-27.0). Increasing time to initial antiarrhythmic was associated with decreased odds of ROSC for both amiodarone (aOR 0.9; 95% CI 0.9-0.94) and lidocaine (aOR 0.9; 95% CI 0.8-0.96).

Conclusion:
Time to administration of anti-arrhythmic medication varied, but most patients received the first does of anti-arrhythmic drug more than 20 minutes after the initial 911 call. Time to administration of antiarrhythmic was linked to ROSC.
Abstract 11514: Extracorporeal Membrane Oxygenation is a Feasible Life Saving Modality for Adult Patients With Neoplasms- Outcomes and Trends in the Last Two Decades
Authors: Suzuki Yota , Mobli Keyan , Silva Madeline , Cass Samuel , Deanda Abe , Tyler Douglas , Radhakrishnan Ravi
Published: December 2021

Introduction:
Extracorporeal Membrane Oxygenation (ECMO) is utilized in the management of severe respiratory and circulatory failure. Advanced malignancy is a relative contraindication but the indication for ECMO in the oncologic population has not been clearly established due to the wide spectrum of malignant disease and prognoses.

Hypothesis:
ECMO is a feasible treatment modality in selected adult oncologic population.

Method:
The Extracorporeal Life Support Organization (ELSO) database was queried for patients older than 18 years with an International Classification of Diseases (ICD) code of neoplasm over the past two decades (2000-2019). The data were divided into two decades to analyze and compare the trends with background and outcomes.

Results:
One thousand, six hundred, and ninety-seven patients met inclusion criteria from the last decade which is more than 15 times the number from the previous decade (n=110). Compared with the previous decade, ECMO was used more in patients with older age (56 vs 50.5 years old; p<0.001), cardiac and extracorporeal cardiopulmonary resuscitation (ECPR) support type (p = 0.001), higher P/F ratio (79.0 vs 61.8; p=0.001), and lower oxygenation index (23.0 vs 35.6; p< 0.001) in the last decade. Although survival did not show significant improvement overall (38.9% [660 of 1697] vs 33.6% [37 of 110]; p=0.272), survival in pulmonary ECMO has significantly improved in the last decade (41.6% [409 of 983] vs 29.1% [23 of 79]; p=0.030). Diagnosis of hematologic malignancy, ECPR, and hematopoietic stem cell transplant were identified as predictors of poor prognosis (p = 0.025, <0.001, and 0.021 respectively).

Conclusion:
Utilization of ECMO for patients with neoplasms has increased over time mirroring the overall increase of adult ECMO. With careful patient selection, ECMO can be successful in oncologic population.
Abstract 11532: Variation in Coronary Angiography Use in Out-of-Hospital Cardiac Arrest
Authors: Dale Patrick , Khera Rohan , Siobhan Brown , Idris Ahamed , Link Mark S , Mody Purav
Published: December 2021

Introduction:
Current patterns of use of coronary angiography (CAG) among out-of-hospital cardiac arrest (OHCA) patients based on ST segment elevation (STE) on post-resuscitation ECG are not well described.

Methods:
Using data from the Continuous Chest Compressions trial between 2011 and 2016, we identified OHCA patients who survived to hospitalization. We examined rates of CAG across different trial clusters in the overall cohort and among pre-specified subgroups with presumed cardiac etiology of arrest e.g. initial shockable rhythm and STE on presenting ECG.

Results:
Of 26,148 OHCA patients across 49 trial clusters, 5608 survived to hospital admission. The mean age of patients was 64 years, with 65% men and 43% with initial shockable rhythm. Among patients with initial shockable rhythm 44% had STE on initial ECG compared with 18% of patients with initial non-shockable rhythm. Use of CAG was significantly higher in patients presenting with STE compared with no STE on initial ECG irrespective of initial rhythm: 70% vs. 31%, p<0.001 for initial shockable rhythm and 28% vs. 5%, p<0.001 for initial non-shockable rhythm. In the overall cohort, there was significant variation in CAG use across trial clusters ranging from 4% - 41% of patients within a trial cluster receiving CAG (
Figure
). This variation persisted among pre-specified subgroups with the proportion of patients within a trial cluster receiving CAG ranged from 11% - 75% for patients with initial shockable rhythm, 0% to 19% with initial non-shockable rhythm, 16% - 82% with STE, 2% - 28% without STE and 0% - 63% in patients with initial shockable rhythm and no STE on presenting ECG (
Figure
).

Conclusion:
There is a higher use of CAG in STE and shockable cardiac arrest, consistent with presumed cardiac etiology of arrest; however, there is large variation in the use of CAG across sites, even among patients with a presumed cardiac etiology of cardiac arrest suggesting challenges with interpretation of current guidelines.
Abstract 11560: Systematic Deployment of AEDs in BC Schools: A Utility and Cost-Effectiveness Study of In-School and Nearby OHCAs
Authors: Liang Li (Danny) , Leung Benjamin , Chan Timothy , Helmer Jennie , Meckler Garth , Christenson Jim , Grunau Brian
Published: December 2021

Background:
While pediatric out-of-hospital cardiac arrests (OHCAs) are relatively uncommon, they have a much higher number of potential years of life lost per event. School-located public access automated external defibrillators (AED) may be beneficial to school-aged OHCAs, but also other OHCAs within the school and in the surrounding community. We sought to identify the incidence of OHCAs within and nearby schools in British Columbia (BC), to estimate the number that may benefit from school-located AEDs.

Methods:
We used prospectively-collected data from the BC OHCA Registry from 2013 to 2018. We examined the addresses of all OHCAs to determine those occurring in public primary and secondary schools. We geo-plotted all OHCAs to identify the number of OHCAs within walking distance of a school. Assuming an average pedestrian speed for AED retrieval of 1.8 m/second, we calculated the number of school-vicinity OHCAs for which a bystander could retrieve an AED prior to a 6.5 minute emergency medical system response interval, assuming that AEDs would be located on the exterior of a school building.

Results:
There were a total of 401,423 children enrolled at 824 schools annually in the study footprint. Of a total of 12,480 EMS-treated OHCAs (220 aged < 18 years), 20 were in in schools, of which 4 were <18 years of age. Of school located OHCAs, 14 (70%) had initial shockable rhythms, 4 (20%) had an AED applied (of whom 3 survived), and 10 (50%) survived. Of the four school-located pediatric OHCAs, three were witnessed (75%), two had initial shockable rhythms (50%), and two (50%) survived until hospital discharge. A total of 1128/12,480 (9%) OHCAs were within retrieval distance of a school, corresponding to 0.228 per school per year (95% CI 0.201-0.255 year-to-year) , which is above current thresholds for cost-effectiveness.

Conclusion:
Outcomes of school-located OHCAs are encouraging, especially those with AED application. While the incidence of school-located OHCAs is low, a substantial proportion of OHCAs occur within a retrievable distance to a school, and thus accessible external school-located AEDs may improve overall OHCA outcomes of a community.
Abstract 11759: Survival Among Medicare Beneficiaries After Out-of-Hospital Cardiac Arrest Undergoing Interhospital Transfer
Authors: Abbott Ethan , Buckler David , zebrowski alexis , Abella Benjamin , Carr Brendan G
Published: December 2021

Intro:
Among individuals treated for out-of-hospital cardiac arrest (OHCA), there is hospital-level variability in mortality, but the relationship between interhospital transfer (IHT) OHCA volume and survival remain unclear. We sought to examine the association of OHCA volume and survival for individuals undergoing IHT.

Methods:
Utilizing age-eligible Medicare fee-for-service claims, we identified an emergency department treated OHCA cohort using ICD-9/10 diagnosis codes. Hospital OHCA volume was defined as the total number of index (first-treated) OHCA claims during the study period and were binned into quartiles. Each claim was assigned the OHCA volume quartile of the index hospital and the index volume of the receiving hospital. Multiple logistic regression was conducted to assess the association between initial and receiving hospital volume categories and survival to 30 days among IHT patients while controlling for patient-level characteristics (age, sex, race), comorbidity index, urbanicity of index hospital and days to transfer.

Results:
We identified a cohort of 222,018 claims at 4,461 hospitals between 1/2013-12/2015. Median age was 78 years (IQR 71-85); 44% were female; 11% of the cohort was alive at 30 days. IHT occurred in 12,245 cases (5.5%) and 59% of transfers occurred on the day of admission or day 1. Transfers originated from 3411 index hospitals and 1566 receiving hospitals. Median OHCA hospital index volume was 25 [IQR 9, 67]. Adjusted odds of survival at 30 days was significantly lower at index hospitals with lower OHCA volumes compared to the highest volume category (aOR [95%CI] Q2: 0.71 [0.6, 0.83] p<0.001). Additionally, odds of survival at 30 days was significantly lower at low volume receiving hospitals (aOR [95%CI] Q1: 0.73 [0.55, 0.99] p<0.001), and increased for higher OHCA volume receiving hospitals, but these groups did not achieve statistical significance.

Conclusion:
For Medicare beneficiaries who suffer an OHCA and undergo IHT, lower index and receiving hospital OHCA volume was significantly associated with decreased adjusted odds of 30-day survival. Further exploration of hospital characteristics, timing, and transfer patterns is needed to understand differences in benefit for OHCA patients undergoing IHT.
Abstract 11763: The impact of the Australian Warning Signs Campaign on Emergency Medical Service Use for Acute Coronary Syndrome and Unspecified Chest Pain
Authors: Eastwood Kathryn J , Howell Stuart , Nehme Ziad , Finn Judith , Smith Karen L , Cameron Peter , Stub Dion , Bray Janet
Published: December 2021

Background:
Between 2009 and 2013, the National Heart Foundation of Australia ran mass media campaigns to improve Australian’s awareness of Acute Coronary Syndrome (ACS) symptoms and the need to call emergency medical services (EMS). This study examined the impact of this campaign on emergency department (ED) presentations and EMS use in Victoria, Australia.

Methods:
The Victorian Department of Health and Human Services provided data for adult Victorian patients presenting to public hospitals with an ED diagnosis of ACS or unspecified chest pain (U-CP). We modelled changes in the incidence of ED presentations, and the association between the campaign period and 1) EMS arrival and 2) referred to ED by a general practitioner (GP). Models were adjusted for increasing population size, ACS subtype and demographics.

Results:
Between 2003 and 2015, there were 124,632 eligible ED presentations with ACS and 536,148 with U-CP. In ACS patients, the campaign period was associated with an increase in ED presentations (Incidence Rate Ratio: 1.11; 95% CI: 1.07-1.15), a decrease in presentations via a GP (Adjusted Odds Ratio [AOR]: 0.77; 95% CI: 0.70-0.86), and an increase in EMS use (AOR: 1.10; 95%CI: 1.05-1.17). Similar, but smaller associations were seen in U-CP.

Conclusions:
The Warning Signs Campaign was associated with improvements in treatment seeking in ACS patients -including increased EMS use. The increase in ACS ED presentations corresponds with a decrease in out-of-hospital cardiac arrest over this time. Future education need to focus on improving EMS use in ACS patient groups where use remains low.
Abstract 11816: Combined Use of VA-ECMO and IMPELLA (ECPELLA) Reduces Myocardial Damage and Mortality in Lethal Cardiogenic Shock Patients Due to Acute Coronary Syndrome
Authors: Unoki Takashi , Kametani Motoko , Toyofuku Takaaki , Konami Yutaka , Suzuyama Hiroto , Inoue Masayuki , horio eiji , Yufu Tetsuo , Kodama Kazuhisa , Yamamuro Megumi , Taguchi Eiji , Sawamura Tadashi , NAKAO KOICHI , Sakamoto Tomohiro
Published: December 2021

Background:
Short-term mortality of lethal cardiogenic shock (CS) patients due to acute coronary syndrome (ACS) remains to be improved. The veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been applied as the effective lifesaving modality for CS patients. While VA-ECMO maintains end-organ perfusion, it increases the damaged left ventricular (LV) afterload. Combined treatment of VA-ECMO and a micro-axial Impella pump, ECPELLA, simultaneously provides the systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect by ECPELLA can reduce the myocardial damage and the mortality.

Purpose:
This study was to assess whether ECPELLA reduces myocardial damage and improves the mortality of CS patients due to ACS.

Methods:
From January 2012 to May 2021, 66 consecutive patients with lethal CS (SCAI stage-E) due to ACS were enrolled. All patients received VA-ECMO support prior to or after the percutaneous coronary intervention. Among them, 34 patients received ECPELLA and 32 patients received VA-ECMO + IABP. We assessed serum CK-MB levels and the cumulative 30-day mortality.

Results:
There were no significant difference in age, rate of male sex, coronary risk factors, ST elevated ACS, left main trunk (LMT) lesion, and the time from onset to reperfusion between two treatment groups. The ECPELLA group had significantly lower peak CK-MB and lower 30-day all-cause mortality compared to the VA-ECMO + IABP group [Peak CPK level: median (IQR); 295 (92-507) vs.580 (219-1090): p=0.002, the 30-day mortality rate: 50% vs. 76%: p=0.02, respectively]. Multivariate Cox proportional hazard analysis including age, the time form onset to reperfusion, LMT lesion, E-CPR, and ECPELLA revealed that the ECPELLA (HR: 0.30 95% confidence interval:0.13-0.64; p=0.002) was independently associated with the 30-day all-cause mortality.

Conclusion:
Results suggest that the ECPELLA reduces the myocardial damage shown by peak CK-MB and improves the 30-day mortality.
Abstract 11817: The Effect of Time to Treatment With Antiarrhythmic Drugs on Return of Spontaneous Circulation in Shock Refractory Out-of-Hospital Cardiac Arrest: A Secondary Analysis of the ALPS Randomized Controlled Trial
Authors: Rahimi Mahbod , Dorian Paul , Cheskes Sheldon , Lebovic Gerald , Lin Steve
Published: December 2021

Purpose:
The effects of amiodarone and lidocaine on the return of spontaneous circulation (ROSC), relative to time to treatment in out of hospital cardiac arrest (OHCA) patients is unknown. We conducted a post-hoc analysis of the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo (ROC ALPS) randomized trial examining the association of time to treatment with ROSC at emergency department (ED) arrival.

Method:
In the ROC ALPS trial, adults with non-traumatic OHCA with initial VF/pVT after ≥ 1 shock were randomized to receive amiodarone, lidocaine or placebo. We used logistic regression to examine the association of time to treatment (911 call to study drug administration interval) with ROSC at ED arrival.

Results:
Overall, 1112 (36.7%) patients had ROSC at ED arrival. Time to treatment data were available for 2994 (99%) of the patients. The proportion of patients with ROSC at ED arrival decreased as time to drug administration increased, in amiodarone (OR 0.92, 95% CI 0.90-0.94 per min increase), lidocaine (OR 0.95, 95% CI: 0.93-0.96) and placebo (OR 0.95, 95% CI: 0.93-0.96) arms. The odds of ROSC at ED in the amiodarone group (versus placebo) changed in relation to the time of drug administration (OR 0.96, 95% CI: 0.93-0.99). With short times to drug administration, ROSC was higher in amiodarone versus placebo recipients, whereas ROSC was higher with placebo at later times. Comparing lidocaine to placebo, ROSC rate increased at all times (OR 1.29, 95% CI: 1.07-1.59); there was no time to drug administration effect (OR 1.00, 95% CI: 0.97-1.03). Among all patients, survival at hospital discharge was 21.0%, 24.4%, and 23.7% for placebo, amiodarone and lidocaine respectively.

Conclusion:
Amiodarone’s efficacy in restoring ROSC declined with longer duration of arrest, potentially due to its adverse hemodynamic effects. Overall, amiodarone and lidocaine had similar effects on mortality; in this study, ROSC at ED arrival trend did not reflect the overall survival rate
Abstract 12051: Impact of COVID-19 on Barriers to Dispatcher-Assisted Cardiopulmonary Resuscitation in Adult Out-of-Hospital Cardiac Arrests in Singapore
Authors: Toh Cherylyn Hui Xin , Lim Shir Lynn , Muhammad Yazid , Shahidah Nur , Ng Qin Xiang , Ho Andrew , Arulanandam Shalini , Leong Benjamin S , White Alexander , Ong Marcus E
Published: December 2021

Objective:
Reduced rates of bystander cardiopulmonary resuscitation (BCPR) in out-of-hospital cardiac arrest (OHCA) were observed during the Coronavirus Disease-2019 (COVID-19) pandemic in many regions. We investigated the impact of COVID-19 on barriers to Dispatcher-Assisted Cardiopulmonary Resuscitation (DA-CPR) in Singapore.

Methods:
This nationwide retrospective cohort study involved all calls to our national 995 call center for adult (≥ 18 years old) OHCA not witnessed by Emergency Medical Services. We reviewed audio recordings during the pandemic (January-June 2020) and pre-pandemic (January-June 2019) periods to compare the OHCA characteristics, and the types of “barriers” to DA-CPR — the reason why DA-CPR was not performed. Our primary outcome was the presence/absence of barriers to DA-CPR. Multivariable logistics regression was used to estimate the adjusted odds ratio (aOR) for the likelihood of barriers to DA-CPR accounting for patient and event characteristics. The effect of COVID-19 on DA-CPR rates was evaluated using interrupted time series analysis.

Results:
There were 1481 OHCA during the pandemic (median age 73 years, 62.7% male), and 1400 prior to the pandemic (median age 72 years, 63.6% male). Residential OHCA and witnessed OHCA increased during the pandemic (78.9% vs 75.5%, p=0.03 and 56.1% vs 39.9%, p<0.01 respectively), but not BCPR and DA-CPR (64.3% vs 65.6%, p=0.44, and 49.1% vs 48.1%, p=0.57 respectively). There were increased barriers to DA-CPR during the pandemic — ‘patient status changed’ (difficulty with recognition) and ‘caller not with patient’ (witnesses calling family rather than 995) doubled in proportion during COVID-19. ‘afraid to do CPR’ fell to 3.8% during the pandemic, while the fear of COVID-19 transmission made up 0.5% of the barriers. Logistic regression showed that females and OHCAs occurring in home residences were more likely to have barriers to DA-CPR (aOR 1.27 and 2.63 respectively). COVID-19 did not have an impact on the trend of DA-CPR rates (p=0.49).

Conclusion:
COVID-19 did not affect callers’ willingness to perform DA-CPR. Distancing measures led to more residential arrests with an increase in proportion with barriers to DA-CPR, highlighting opportunities for public education and intervention.
Abstract 12132: Diurnal Variation in Citizen Responder and Automated External Defibrillation Coverage of Out-of-Hospital Cardiac Arrest in Denmark According to Area Types
Authors: Christensen Nanna B , Folke Fredrik , Kjoelbye Julie , Jakobsen Louise Kollander , Jørgensen Anne J , Andelius Linn , Gregers Mads Christian Tofte , Ringgren Kristian B , Torp-Petersen Christian , Hansen Carolina M
Published: December 2021

Introduction:
Following the implementation of the Danish AED network and a nationwide citizen responder (CR) program for out-of-hospital cardiac arrest (OHCA), CR and AED coverage for OHCAs according to area types has not been investigated. We aimed to assess AED and CR coverage of historical OHCAs according to area types in daytime (12pm) and nighttime (12am).

Methods:
We included non-EMS witnessed OHCAs from the Danish Cardiac Arrest Registry (2016-2019) and AEDs registered with the Danish AED network (November 2020) available at 12am (n=22,418) and 12pm (n=14,734). Exact locations of CRs who were registered with the national CR program by December 2020 were identified on a normal working day (Wednesday, December 2, 2020) at 12am and 12pm (representing day- and nighttime location). OHCAs, AEDs, and CRs were identified and geocoded using a geographical information system. Urban Atlas was used to categorize areas into subgroups using satellite images; high density residential areas, low density residential areas, public and industrial sites, nature, sport and leisure facilities, transportation (e.g. airport and railway stations), and fast transit roads.

Results:
A total of 10,126 OHCAs (63.0% male, median age 73 years). We mapped 14,119 AEDs (12 pm) and 24,372 CR (12 pm) in Urban Atlas. Most OHCAs in all area types were covered by >= 1 AED. A greater variation was observed in CR coverage when compared to AED coverage, according to area type. Little difference in coverage of both AED and CR according to time of day was observed. (Figure 1)

Conclusion:
The highest CR and AED coverage were observed in high density residential areas, transportation sites, public and industrial areas, and sport and leisure facilities, which is where most OHCAs occurred. These findings indicate a high coverage of citizen responders and AEDs in Denmark.