bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 03: High-Dose Intranasal Insulin During CPR Improves Neurological Outcomes in a Rat Model of Cardiac Arrest
Authors: Jinka Tulasi , Chalek Adam D , Wider Joseph M , Maheras Kathleen J , Qvigstad Amanda , Gruley Erin , Raghunayakula Sarita , Liao Jinhui , Ren Xiaodan , Zhang Rui , Sanderson Thomas H , Neumar Robert W
Published: June 2021

Introduction:
Post-cardiac arrest brain injury is a major cause of mortality and morbidity. Insulin has well-established CNS neuroprotecive properties mediated by the AKT survival signaling pathway, and known transnasal transport mechanisms make it possible to rapidly achieve therapeutic brain insulin levels after intranasal delivery.

Hypothesis:
We hypothesize that high-dose intranasal insulin (HD-IN-I) administered during CPR, could improve neurologic outcomes in a rat model of asphyxial cardiac arrest.

Methods:
Male Long Evans rats were subjected to 8-minute asphyxial cardiac arrest then block randomized to HD-IN-I (1.92 U/g brain wet weight) or placebo (PL) given at the onset of CPR by an experimental operator blinded to treatment. Sham operated rats were used as uninjured controls. For the long-term outcome study (n = 14/group), rats with return of spontaneous circulation (ROSC) were maintained at 37.0 ±0.5 °C for 72 hours and neurologic function was assessed on days 7 - 10. For the mechanistic study (n = 6/group), rats with ROSC were euthanized 30 minutes after ROSC and regional brain homogenates were analyzed by western blot for AKT phosporylation.

Results:
HD-IN-I during CPR had no statistically significant effect on ROSC rate (93% (13/14) HD-IN-I vs. 86% (12/14) PL, p > 0.05) or 10-day survival (71% (10/14) HD-INI vs. 43% (6/14) PL, p > 0.05). HD-IN-I had no significant impact on serum glucose concentrations. At 10 days post-ROSC, rats in the HD-IN-I group had significantly improved performance on rotarod (latency to fall 87±27 sec HD-IN-I vs. 41±18 sec PL, p < 0.05), Barnes maze (latency to escape box 27±15 sec HD-IN-I vs. 298±5 sec PL, p < 0.05), and passive avoidance (latency to re-enter shock chamber 300±0 sec HD-IN-I vs. 142±46 sec PL, p < 0.05) testing. Hippocampal phosph-AKT/total AKT ratio increased 2-fold in the placebo group and 5.7-fold in the HD-IN-I group relative to shams (p < 0.05).

Conclusions:
HD-IN-I administered during CPR causes rapid activation of brain AKT survival signaling and improves recovery of neurologic function in a rat cardiac arrest model. Additional studies are warranted to determine dose optimization, therapeutic window and effectiveness in large animal models to advance this novel therapy toward clinical trials.
Abstract 105: Utilization of Therapeutic Hypothermia Post Cardiac Arrest and Outcomes in Teaching vs Nonteaching Hospital: A Retrospective Study of Nationwide Inpatient Sample (NIS) Database
Authors: Jha Anil K , Krishnan Anand M , Wu Fangcheng , Buda Kevin
Published: June 2021

Introduction:
Therapeutic Hypothermia (TH) is a measure to reduce the core body temperature of survivors of cardiac arrest, to further minimize neurological damage caused by severe hypoxia. Clinical trials have shown significant improvement in neurological function among survivors of cardiac arrest received TH.

Methods:
We conducted a retrospective analysis of the Nationwide Inpatient Sample (HCUP-NIS) 2016 database. Patients admitted with a principal diagnosis of cardiac arrest who underwent TH were identified using the ICD-10 codes. A weighted descriptive analysis was performed to generate national estimates. Group of patients admitted to teaching hospitals were compared to those admitted to non-teaching hospitals. Patients were stratified by age, sex, race, demographic and clinical data including Charlson comorbidity index for these two groups and compared for the primary outcome, in-hospital mortality and secondary outcomes of length of stay (LOS) and total hospitalization charges. Analyses were done using STATA statistical software.

Results:
In 2016 total 13780 patients met inclusion criteria out of which half were female. Mean age was 64 years. Admissions to teaching hospital were 9285. Total 670 patients received TH, of which 74% were in teaching hospitals. Group who received therapeutic hypothermia, majority were Caucasians (65%) followed by Hispanics (16%) (p=0.30). Patients who received TH were majority Medicare (58.8% vs 49.5%; p=0.75). Southern hospitals had the most admissions in both groups (45.7% and 31.3%); Northeast region had the least non-teaching hospital admissions (8.5%). Total deaths in TH group were 510, 73% were in teaching hospitals. After adjusting for age, sex, race, income, charlson index, hospital location, and bed-size, there was no statistical significant difference in mortality , LOS and total charges between these two groups (p=0.82, p=0.24 and p=0.67 respectively). Interestingly there was 35% increase in adjusted odds for mortality of cardiac arrest patients in teaching hospitals (p=0.005).

Conclusions:
Among patients admitted with cardiac arrest and undergoing TH there were no significant differences in mortality, LOS or total hospitalization charges between teaching and non-teaching hospitals.
Abstract 11: Early Magnetic Resonance Imaging to Quantify Ischemic Brain Insult Early Following Cardiac Arrest in a Swine Model
Authors: Peckham Miriam , DeHavenon Adam , Alexander Matthew D , Anderson Jeffrey , McNally Scott , McKellar Stephen H , Tonna Joseph , Wong Ka-ho , Steenblik Jacob , Youngquist Scott T
Published: June 2021

Introduction:
Hypoxic ischemic brain injury (HIBI) results from loss of oxygen or perfusion during cardiac arrest and is the most common cause of death/disability in patients surviving to admission. Diagnostic tests are crucial to identify irreversible injury thresholds for neuroprognostication. MRI DTI can detect cellular injury in response to HIBI, but imaging timing and severity of hypoxia vary widely.

Hypothesis:
We hypothesized that a model with fixed periods of ischemia followed by both standardized reperfusion and time to image acquisition would demonstrate a reliable gradient of injury. Such a model would allow neuroprotective strategies to be tested using early imaging biomarkers to quantify effects on cytoarchitecture.

Methods:
Eleven healthy swine (49
+
5 kg) under isoflurane anesthesia underwent control MRI with DTI at b2000/20 directions. Two animals each were then randomized to sham, 10, 15, 20, and one to 30-minutes of arrest. For reperfusion, extracorporeal membrane oxygenation (ECMO) catheters were placed in the distal aorta and right atrium, after which ventricular fibrillation was induced by a bipolar pacing catheter. Following the fixed period of ischemia, animals were reperfused at 2.8-3.5 L/min with unblended oxygenated blood. After 4 minutes they were defibrillated. Over two hours they were weaned from pump and decannulated with epinephrine and fluid boluses for hemodynamic support. Animals were re-imaged within two hours post-resuscitation using the same pre-arrest protocol. Whole brain ADC measurements were performed in the gray and white matter.

Results:
Baseline hemodynamic parameters: BP, Heart Rate, End-Tidal CO2, and SpO2 were similar between animals. When comparing pre- to post-arrest MRI, there was a strong linear correlation between percent gray matter ADC change (r=-0.87, p<0.001) and white matter ADC change (r=-0.79, p<0.001) with ischemia duration.

Conclusion:
MRI DTI changes observed following fixed periods of ischemia with ADC in gray and white matter correlated well with ischemia duration in the first few hours post arrest. These findings support the feasibility of MRI for measuring severity of insult in HIBI and an animal model that might serve as translational endpoint for neuroprotectant strategies.
Abstract 110: Lactate and Hypotension as Predictors of Mortality After In-Hospital Cardiac Arrest
Authors: Issa Mahmoud S , Yankama Tuyen , Patel Het , Ntshinga Lethu , Coker Amin , Grossestreuer Anne V , Donnino Michael , Berg Katherine
Published: June 2021

Background:
In hospital cardiac arrest (IHCA) affects >290,000 people in USA annually. Although there are many differences between IHCA and out of hospital cardiac arrest (OHCA), the bulk of data used to guide management comes from OHCA studies. Prediction of mortality after IHCA could be useful in making decisions around post-arrest care. We hypothesized that elevated lactate and the need for vasopressor support after arrest would predict mortality in an IHCA population.

Methods:
Retrospective single-center observational study of all adult IHCA patients with sustained return of spontaneous circulation (ROSC), lactate within 2 hrs of ROSC, and intubated pre-arrest or within 1 hr after, from 2008 - 2018. Multivariable logistic regression was used to evaluate the association of post-ROSC lactate and need for vasopressors, as well as other covariates, with mortality. Backwards selection was used to determine the most parsimonious model.

Results:
Of 541 patients; 364 met criteria and were included. Overall mortality was 56%. The distributions of initial rhythm, pre-arrest vasopressor and pre-arrest mechanical ventilation were similar between groups. Patients who received vasopressors within 3 hrs of ROSC had higher mortality compared to patients who did not (58% vs. 43%, p-value 0.04). Elevated lactate level was also associated with mortality (44% if < 5 mmol/L, 58% if 5 - 10 mmol/L, and 73% if ≥10 mmol/L, p-value<0.01). Mortality in those with lactate <5 and no vasopressors was 33%, compared to 75% in those with lactate >10 and need for vasopressors (p<0.01). The most parsimonious predictive model included lactate, post-arrest vasopressor, age, arrest location, and pre-arrest diagnosis (AUC 0.68 [95 CI: 0.63-0.74]).

Conclusion:
Post-ROSC lactate and need for vasopressor were useful predictors of mortality, although AUC was lower than what has been reported in OHCA studies. Development of a more discriminating tool would be valuable to clinicians and in IHCA research.
Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest
Authors: Wiberg Sebastian , Holmberg Mathias J , Donnino Michael , Kjaergaard Jesper , Hassager Christian , Witten Lise , BERG Katherine , Moskowitz Ari , Andersen Lars W
Published: June 2021

Background:
While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016.

Methods:
This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups.

Results:
A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group (
p
< 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups.

Conclusions:
For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.
Abstract 116: Acute and Chronic Anti-Arrhythmogenic Effect of Liposome-Encapsulated Hemoglobin (HbV) on the Myocardium Through Improving Myocardial Electrical Remodeling and the Arrhythmogenic Substrate in Hemorrhagic Shock-Induced Heart
Authors: Takase Bonpei , Higashimura Yuko , Hashimoto Kenichi
Published: June 2021

Introduction:
Prolonged blood pressure < 40 mmHg in hemorrhagic shock (HS) causes irreversible heart dysfunction, “Shock Heart Syndrome” (SHS), which is associated with lethal arrhythmias (VT/VF).

Methods:
To investigate whether liposome-encapsulated human hemoglobin (HbV) is comparable to washed red blood cells (wRBCs) for improving arrhythmogenesis in SHS in either acute or chronic phase, optical mapping analysis (OMP), electrophysiological study (EPS) and pathological examinations were performed in Sprague-Dawley rat hearts, being obtained from both acute and chronic phase when each rat survived. The first, they were subjected to acute HS by withdrawing 30% of total blood volume. After HS, rats were immediately resuscitated by transfusing exactly same amount of 5% albumin (5%ALB, n=13), HbV (n=13), or wRBCs (n=13). All rats in chronic phase survived at least several weeks. After excising heart, OMP and EPS were performed in Langendorff-perfused hearts.

Results:
In both acute and chronic phase, OMP showed tendency for abnormal conduction and significantly impaired action potential duration dispersion (APDd) in left ventricle with 5%ALB (25±9 / 24±10 ms, Acute / Chronic phase). In contrast, myocardial conduction and APDd were substantially preserved with HbV (14±3 / 13±5 ms) and wRBCs (14±3 / 15±3 ms) as shown in Figure . Sustained VT/VF was easily provoked by burst pacing stimulus to left ventricle with 5%ALB. No VT/VF was induced with HbV and wRBCs. Pathology showed myocardial structural damage characterized by worse myocardial cell damage and Connexin43 with 5%ALB, whereas it was attenuated with HbV and wRBCs in both acute and chronic phase.

Conclusions:
Ventricular structural remodeling after HS causes VT/VF in the presence of APDd. Transfusion of HbV prevents acutely and chronically VT/VF, similarly to transfusion of wRBCs, by preventing chronic electrical remodeling of APDd and preserving myocardial structures in HS-induced SHS
Abstract 120: Effects of Therapeutic Hypothermia on Blood Parameters in Rats With Acute Hemorrhagic Shock
Authors: Shi Jianru , Dai Wangde , Carreno Juan , Hale Sharon L , Kloner Robert A
Published: June 2021

Background:
Our research group recently observed that therapeutic hypothermia (TH) compared with normothermia improved long-term survival in an experimental model of hemorrhagic shock. The effect of TH on blood counts, blood gases and chemistries during the early phase of recovery from hemorrhagic shock are unknown. Therefore, the purpose of the present study was to examine the effects of TH on blood parameters in the early phase of resuscitation from hemorrhagic shock.

Methods and results:
Sprague Dawley rats (both genders) were randomly assigned to TH (n= 16) or normothermia group (n= 15). Rats were anesthetized with intraperitoneal ketamine and xylazine. After heparinizing, hemorrhagic shock was induced by withdrawing blood to a fixed mean blood pressure (MBP) of 30 mmHg for 30 minutes and then shed blood was reinfused. TH was started 5 minutes after MBP reached 30 mmHg. Core temperature was maintained at ~ 32 °C until blood volume was fully restored, after which the rats were allowed to warm back to normal temperature. In the normothermia group, body temperature was maintained at ~ 37°C. Arterial blood samples were collected 1 hour after resuscitation with shed blood. We found that pO2 (partial pressure of oxygen) was significantly higher in TH group versus the normothermic group. The rats in normothermic group had significantly elevated potassium, chloride and lactate levels and more negative base excess compared to rats that in TH group (Table). The neutrophil was lower in the TH group; the lymphocyte (%) was higher in the TH group. There were no significantly differences in pH, pCO2, sodium, calcium or glucose between the normothermia and TH groups.

Conclusions:
pO2 remained normal and levels of potassium, chloride, lactate and neutrophil were lower in TH group. These results may contribute to the protective effect of TH during hemorrhagic shock.
Abstract 125: Automated External Defibrillator Shock Advisement Performance Among Multiple Human Electrocardiographic Rhythms and Devices
Authors: Szigethy Xavier J , Willson Connor J , Salcido David D , Defilippi Dylan A , Menegazzi James J
Published: June 2021

Background:
Automated external defibrillators (AEDs) perform rhythm analysis in order to facilitate defibrillation. The effectiveness of AEDs is dependent on the accuracy of their rhythm classification, which includes differentiation of shockable rhythms from non-shockable rhythms Independent (i.e. non-industry) evaluation of the performance of AEDs against real-world ECG could lead to improvements in their performance.

Objective:
To evaluate the sensitivity and specificity characteristics of commercial AEDs with respect to quantitative properties of the ECG waveform in several rhythm presentations using real world ECG data.

Methods:
We conducted a prospective simulation study evaluating three commercially available AEDs from Defibtech, Phillips, and Zoll on the determination of ECG rhythm shockability. Performance was evaluated for 181 human ECG recordings (101 ventricular fibrillation-VF, 55 PEA, and 25 asystole) ranging widely in signal characteristics, obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. We used a commercially available digital-to-analog converter (National Instruments USB-6001) to inject the recordings into each AED through a direct lead-wire interface, recording shock advisement decisions in a best-out-of-three approach for each device/rhythm pairing. We calculated the sensitivity and specificity for discriminating VF and non-VF rhythms for each device and overall. VF signal characteristics were calculated, including peak frequency, median amplitude, and peak amplitude, and the VF quantitative waveform measures AMSA and median slope.

Results:
The 101 VF trials featured signals with mean peak frequency 10.02 Hz(IQR 4.80 Hz), mean AMSA 9.13(IQR 7.29), mean median slope 6.72 (IQR 3.66). The sensitivities were: Defibtech 99.0%; Philips 97.0%; Zoll 98.0%. The specificities were: Defibtech 98.7%; Philips 96.2%; Zoll 97.4%. Defibtech recorded 5 discordant advisements and Philips and Zoll recorded eight each. The overall sensitivity was 98.0%, and the specificity 97.4%.

Conclusion:
Evaluated against a wide variety of real-world signal presentations, commercial AEDs demonstrated a high degree of sensitivity and specificity for shockable ECG rhythms.
Abstract 140: Prehospital Protocols for Post-Return of Spontaneous Circulation Care Are Highly Variable
Authors: Benoit Justin L , McMullan Jason T , Spigner Michael F , Menegazzi James J
Published: June 2021

Introduction:
Up to 40% of out-of-hospital cardiac arrest patients will re-arrest in the immediate post-return of spontaneous circulation (post-ROSC) period, and re-arrest is associated with decreased survival. Cardiac arrest guidelines are equivocal regarding what post-ROSC care should be provided in the prehospital setting and when hospital transport should occur. Prehospital protocols must balance the benefit of time-dependent hospital-based care with the risk of early re-arrest. We sought to describe current prehospital protocols for post-ROSC care.

Hypothesis:
Prehospital protocols for post-ROSC care will be variable.

Methods:
A single trained abstractor systematically reviewed a purposive sample of prehospital protocols for adult non-traumatic cardiac arrest from the United States using an a priori standardized data abstraction form. Protocols were either stand-alone or integrated into intra-arrest care. Exclusion criteria were non-911 ground transport agencies and protocols not revised since the 2015 guideline update. All protocols were publically available via the Internet. Data abstraction was conducted in May 2019. The number of protocols that met pre-defined criteria were counted and summarized.

Results:
We identified and reviewed 82 prehospital protocols from 46 states and the District of Columbia. Seven protocols were excluded due to the revision date, leaving 75 protocol included in the study (Table). Six protocols (8%) provide no guidance on prehospital post-ROSC care. ECG acquisition (63/75 [84%]) and transport to specific post-ROSC hospitals (overall 55/75 [73%], but 22/55 [40%] are only if STEMI present) are common but not universal. Only 9 (12%) provide any guidance on when to initiate transport post-ROSC, with 4 (5%) requiring a post-ROSC stabilization period of at least 5 minutes prior to transport.

Conclusion:
Prehospital treatment and transport protocols for post-ROSC care are highly variable across the United States.
Abstract 141: Defibrillation Protocol Update Neurologically Intact Survival for Patients With Out-Of-Hospital Shockable Cardiac Arrest
Authors: Tani Akihiro , Nagao Ken , Tahara Yoshio , Nonogi Hiroshi , Yonemoto Naohiro , Gaieski David , Ito Noritoshi , Yagi Tsukasa , Chiba Nobutaka , Tachibana Eizo , Sato Naoki , Ikeda Takanori
Published: June 2021

Background:
A series of cardiopulmonary resuscitation (CPR) maneuvers of the CoSTR has been updated since first international guidelines was published in 2000. We investigated whether CPR, especially defibrillation protocol, based on the CoSTR update improves neurologically intact survival after shockable out-of-hospital cardiac arrest (OHCA).

Methods:
From the All-Japan Utstein Registry between 2005 and 2015, we enrolled adult patients with witnessed shockable OHCA. Study patients were divided into 3 groups according to each CPR recommendation era (the Guidelines 2000 group in 2005; 3-stacked-shock protocol era, CoSTR 2005 group between 2006 and 2010; 1-shock protocol [1 shock immediately followed by 2 minutes of CPR] era, and the CoSTR 2010 group between 2006 and 2010; simplified dispatcher chest compressions instruction and 1-shock protocol era). Primary endpoint was favorable 30-day neurological outcome after OHCA.

Results:
Of the 73,578 study patients, 5,575 (7.6%) received CPR based on the Guidelines 2000, 32,749 (44.5%) the CoSTR 2005, and 35,255 (47.9%) the CoSTR 2010. Crude frequency of favorable 30-day neurological outcome increased significantly whenever the CPR maneuvers were updated (12.3% in the Guidelines 2000 group vs. 19.3% in the CoSTR 2005 group vs. 23.3% in the CoSTR 2010 group, p<0.001). Multivariable logistic-regression analysis for favorable 30-day neurological outcome showed that adjusted odds ratio (reference, the Guidelines 2000 group) was 1.89 (95% CI, 1.72-2.07) in the CoSTR 2005 group and 2.71 (95% CI, 2.47-2.97) in the CoSTR 2010 group. Other independent predictors were age, sex, collapse-to-CPR interval, call-to-scene interval, witnessed and/or bystander CPR status, and cause of cardiac arrest. On the other hand, some advanced life support maneuvers were not acceptable; adjusted odds ratio of 0.37 (95%CI, 0.35-0.39) in advanced airway management (reference, bug-mask ventilation) and 0.36 (95%CI, 0.33-0.38) in intravenous epinephrine (reference, no epinephrine).

Conclusions:
Defibrillation protocol update based on the CoSTR was the preferable approach to resuscitation for adult patients with witnessed shockable OHCA. However, prehospital epinephrine and advanced airway management were not helpful.
Abstract 148: Installation and Deployment of Automated External Defibrillators in New York State Schools
Authors: Arabadjian Milla , Stepanovic Alexandra , Sherrid Mark
Published: June 2021

Introduction:
AHA recommends that automated external defibrillators (AEDs) be made available in public areas with high likelihood of a sudden cardiac arrest (SCA). Only 18 US states have regulations requiring AEDs in schools and the legislation varies. There is no comprehensive evaluation of the epidemiology of sudden death in schools. School nurses are often the only healthcare providers within a school. New York State (NYS) enrolls almost 3.5 million students with New York City (NYC) being the largest school system in the US; legislation requires AEDs in all public but not in private schools.

Purpose:
Our aims were threefold: to gain epidemiologic data on SCAs in NYS schools, to evaluate the availability and utilization of AEDs, and to identify factors affecting deployment of AEDs.

Methods:
Electronic surveys were sent to school nurse members of the NYS Association of School Nurses and NYC school nurses. We also conducted structured interviews with a representative sample of NYS school nurses.

Results:
Nurses representing 750 public schools and 116 private schools responded, a response rate of 36.4%. There were 71 SCA events, with majority affecting adults on school grounds 41 (58%). AEDs were deployed in 59 (73%). Short term survival occurred in 50 (69%) with 40 (56%) returning to regular activity. While not required to have AEDs available, most private schools had them 69(60%). There were 21 (30%) SCA events in private schools with 8 (11%) occurring in private schools with no AEDs. Of these, 6 (75%) had a negative outcome. Interviews revealed that staff attitude, fear, and training adequacy were factors influencing AED utilization.

Conclusions:
AEDs in schools improve survival outcomes. There has been no comprehensive evaluation of SCA events in US schools and no uniformity in AED legislation among states. While focus is on students, NYS data suggests that attention should also encompass adult SCAs in schools. Comparisons of AED utilization and SCA outcomes in states with and without AED legislation will be of interest, and may have health policy implications.
Abstract 150: AED Transportation System With Smartphone Application Cooperating With Dispatch Center
Authors: Kiguchi Takeyuki , Shimamoto Tomonari , Homma Yosuke , Nishiyama Chika , Kawamura Takashi , Iwami Taku
Published: June 2021

Background:
Although public access automated external defibrillators (AEDs) have been widely installed in Japan, defibrillation by public access AEDs was still rare.

Methods: Study design:
Case series. We developed an AED transportation system with smartphone application cooperating with dispatch center. When a cardiac arrest occurs and lay-person call the emergency service, the dispatcher share information of out-of-hospital cardiac arrest OHCA locations and near-by AEDs via the application with pre-registered volunteers near the victim. This application presents the shortest route to the OHCA scene via nearby AED, and the volunteers bring AED to the OHCA scene. The purpose of this study is to use this system in real settings and to make the task of the system clear. We conducted the experimental study in Owariasahi city, Aichi and Kashiwa city, Chiba. Research period were from January 2017 to March 2019 in Owariasahi city, and from December 2018 to March 2019 in Kashiwa city. We collected the number of registered volunteers, the timeline data of system activation, and the number of responses to occurrence of OHCA by registered volunteers during the study period.

Results:
In Owariasahi city, total of 304 volunteers were registered. 276 suspected OHCAs occurred, 179 cases were eligible excluding the hazardous cases in the scene, and of which 169 cases actually activated the system by the dispatcher. The average time from call to send notification was 3:11 (minutes and seconds) and from call to emergency medical service (EMS) arrival 6:37 (minutes and seconds). The registered volunteer took actions in 94/169 cases (55.6%), transported AEDs in 6 cases, and arrived on the scene in 10 cases. A registered volunteer arrived on the scene earlier than EMS personnel in one case. In Kashiwa city, total of 636 volunteers were registered, and the system was activated in 17 suspected OHCA cases. In one case, a volunteer arrived earlier than EMS and attempted resuscitation.

Conclusions:
This AED transportation system worked well and safe on the actual emergency scene. By increasing the number of registered volunteers, it is expected to increase the number of AED use.
Abstract 160: Interval From Collapse to Reaching Target Temperature Had No Impact for the Neurological Outcome in Post Cardiac Arrest Victims, Retrospective Cohort Study of J-Pulse-Hypo Registry
Authors: Kaneko Tadashi , Kasaoka Shunji , Tahara Yoshio , Nagao Ken , Yonemoto Naohiro , Yokoyama Hiroyuki , Nonogi Hiroshi
Published: June 2021

Introduction:
Currently, the ICEREA study, randomized controlled study of comparison between intravascular and surface cooling for post cardiac arrest syndrome (PCAS), did not show significant advantage of intravascular cooling to improve neurological outcome (Odds ratio 1.41, P = 0.07) (Circulation 2015;132:182-93). However, the study showed that intravascular cooling group showed significant shorter interval to reach 34
0
C (5.5 hr v.s. 8.5 hr, P<0.001). These results indicated the possibility of shorter cooling interval could improve neurological outcome of PCAS cases.

Hypothesis:
Shorter cooling interval could improve neurological outcome in PCAS cases.

Methods:
Inclusion criteria was witnessed, 34
0
C of target temperature (TT), and within 12 hr interval from collapse to reach TT. Three hundred were selected as eligible cases for this study from participants with J-PULSE-Hypo study database. The 300 cases were divided into 4 groups (A: interval from collapse to reach TT within 180 min, B: 181-360 min, C: 363-540 min, D: 541-720 min), and compared the favorable neurological outcome (CPC 1-2) by univariate and multivariate analysis.

Results:
Groups were A: 88 cases, B: 114 cases, C: 74 cases, and D: 24 cases. 477 participants were analyzed. The comparison of each groups for favorable neurological outcome, were not significant difference (A: 46%, B: 62%, C: 61%, and D: 63%, univariate: P = 0.109, multivariate: P = 0.812).

Conclusions:
Shorter cooling interval could not show advantage to improve neurological outcome in PCAS cases.
Abstract 185: The Association Between Sudden Unexpected Death in Infancy and Neighborhood-Level Disadvantages: A Multi-Dimension Evaluation in the City of Chicago
Authors: Nguyen Hai , Del Rios Marina , Pugach Oksana , Nguyen Hoang H
Published: June 2021

Introduction:
The association between sudden unexpected death in infancy (SUDI) and low socio-economic status has been well described in the literature. While the rate of SUDI had declined dramatically following successful campaigns that promoted safe sleeping habits, it has remained stable over the past decade and increasingly been confined to the most socially disadvantaged and vulnerable families. Racial and ethnic disparities persist. Despite extensive research associating the multitude of societal level factors associated with social and economic disadvantage and the increased risk of SUDI, their mechanisms on SUDI remain poorly understood.

Hypothesis:
A novel composite multi-dimensional marker of neighborhood-level disadvantage may be used to evaluate the association between SUDI and neighborhood-level disadvantages in the City of Chicago.

Methods:
Sudden unexpected death in infancy cases were identified from the Cardiac Arrest Registry to Enhance Survival database. The composite neighborhood-level disadvantage index was derived using an explanatory factor analysis of the social economic factors recorded in the 2015 American Community Survey of the 77 community areas of the City of Chicago. We defined 3 levels of disadvantage: high, medium, and low. A geographic information system, was used to map the community areas’ disadvantage level and individual SUDI cases.

Results:
Ninety-one SUDI cases were identified. Non-Hispanic Black (64/91(70%)) and Hispanic (16/91 (18%)) comprised the majority of SUDI cases. Sudden unexpected death in infancy cases were highly concentrated in disadvantaged areas. Eighty-six cases (94.5%) occurred in high and medium disadvantaged areas while 5 cases (5.5%) occurred in the low and no disadvantaged areas (P < 0.0001). Finally, SUDI cases from high and medium disadvantaged areas had a lower hospital admission rate when compared to those from the low and no disadvantaged areas (OR 0.04).

Conclusions:
The study confirms the persistent racial and socio-economic disparities in SUDI in the City of Chicago. The study’s use of a multi-dimensional composite index of neighborhood-level disadvantage and domestic violence would serve as the basis for further analyses and potential social intervention programs.
Abstract 19: Ultra-Fast Cooling Induced by Total Liquid Ventilation Provides Neuroprotection Through a Delay in the Acute Systemic Inflammatory Response After Cardiac Arrest in Rabbits
Authors: Boissady Emilie , Kohlhauer Matthias , Lidouren Fanny , Ghaleh Bijan , Tissier Renaud
Published: June 2021

Introduction:
Ultra-fast cooling with total liquid ventilation (TLV) is potently protective in animal models of cardiac arrest.

Hypothesis:
Here, we hypothesized that this protection involves a mitigation of the acute phase of the inflammatory syndrome after cardiac arrest.

Methods:
Rabbits were anesthetized and submitted to 10 min of ventricular fibrillation. After resuscitation, animals underwent normothermic follow-up (Control, n=6) or ultra-fast cooling by TLV started after resuscitation (TLV, n=6). TLV was used for induction of cooling during 20 min and hypothermia was further maintained during 3 h using external techniques before rewarming. A third group was submitted to a Sham procedure (n=5). Survival and neurological dysfunction were assessed during 3 days.

Results:
TLV improved the clinical neurological recovery as compared to Control group after cardiac arrest. It was corroborated by histological examination showing an attenuation of neuronal degeneration in parasagittal cortex and hippocampus in TLV vs Control groups. After resuscitation, TLV delayed the elevation of interleukin-6 blood levels as compared to Control after cardiac arrest (e.g., 298±63 vs 991±471 pg/ml at 180 min after cardiac arrest in TLV vs Control, respectively). Blood cytometry analyses showed a massive recruitment of neutrophils and leukocytes (including T4, T8 and B-lymphocytes) in both groups. The early lymphocytosis was attenuated in TLV vs Control groups, despite not achieving statistical significance. Blood levels of high-mobility group box 1 increased rapidly and similarly in both groups after cardiac arrest. This suggests that TLV does not mitigate the early release of danger-associated molecular patterns after resuscitation, which is closely related to the immediate cell death after resuscitation. Altogether, these results show an attenuation of the early inflammatory response during hypothermia, suggesting a role of early but not delayed inflammation in the mechanism of ultra-fast cooling after cardiac arrest.

Conclusion:
Beneficial effect of hypothermic TLV could be explained by a delay in immune peripheral cells activation and cytokine release, rather than sustained inhibition of inflammation after cardiac arrest.
Abstract 194: Effects of PEG-20k on Coronary Perfusion Pressure and Post-Resuscitation Myocardial and Cerebral Function in a Rat Model of Cardiac Arrest
Authors: Ge Weiwei , Moore Christine , Zheng Guanghui , Ji Xianfei , He Fenglian , Hu Juntao , Bradley Jennifer , Peberdy Mary Ann A , Ornato Joseph P , Mangino Martin , Tang Wanchun
Published: June 2021

Introduction:
Epinephrine is the primary drug given during cardiopulmonary resuscitation (CPR), when given early, to reverse cardiac arrest (CA) by stimulation of α-adrenergic receptors in vascular smooth muscle. This increases coronary perfusion pressure (CPP) and increases rate of return of spontaneous circulation (ROSC). However, the use of epinephrine is not associated with a significant difference in long-term survival or favorable neurologic outcome when given late after arrest onset. In the present study, we compared the effects of aortic injection of polyethylene glycol-20k (PEG-20k) vs. epinephrine during CPR on CPP and postresuscitation myocardial and cerebral function in a rat model of CA.

Hypothesis:
Aortic injection of PEG-20k during CPR will increase CPP to the same extent as epinephrine without adversely affecting post-resuscitation myocardial and cerebral function.

Methods:
Twenty four male Sprague-Dawley rats weighing between 450-550 g were randomized into four groups: 1) PEG-20k 2) epinephrine 3) saline placebo 4) saline-intra-aorta (IA). Eight minutes of CPR was initiated after 6 minutes of untreated ventricular fibrillation. PEG-20k IA (10% est. total blood volume [1.8ml]), saline IA, saline IV or epinephrine IV (20ug/kg) was given after 4 minutes of CPR by continuous infusion over 3 minutes. CPP was recorded continuously and resuscitation was attempted with 4 Joule defibrillation. Myocardial function was measured at baseline, 2, 4, and 6 hours after ROSC by echocardiography and neurologic deficit scores (NDS) were recorded at 24, 48, and 72 hours after ROSC.

Results:
In both saline groups, CPP did not change. However, aortic injection of PEG-20k increased CPP significantly to the same extent as epinephrine (Fig 1). Post-resuscitation ejection fraction was significantly greater in PEG-20k compared to epinephrine (64
+
1 vs 45
+
3, p<0.05) and NDS was significantly improved in PEG-20k compared to epinephrine (100
+
50 vs 450
+
50, p<0.05).
Abstract 200: Argon Reduces the Vasoconstrictive Effects of Phenylephrine in a Rat Isolated Lung Model
Authors: Hees Josephine E , Cleveland William J , Pille Johannes A , Lotze Felicia P , Salzman Michele M , Balzer Claudius , Riess Matthias L
Published: June 2021

Introduction:
Even with cardiopulmonary resuscitation (CPR), most patients having an out-of-hospital cardiac arrest (CA) either die or endure severe neurological damage. Ventilation with the noble gas Argon (Ar) during CPR improved hemodynamics in a porcine CA model.

Hypothesis:
Ventilation with Ar attenuates vasoconstriction by phenylephrine, an α
1
agonist, in a rat isolated lung model.

Methods:
All procedures were approved by our Institutional Animal Care and Use Committee and performed according to the guidelines of the National Research Council’s Guide for the Humane Care and Use of Laboratory Animals. The lungs of adult male Sprague Dawley rats (250-350 g) were isolated and positive-pressure ventilated with a tidal volume of 10 mL/kg body weight (BW) and a respiration rate of 30 breaths/minute. Both the pulmonary artery and left atrium were cannulated for in- and outflow and the lungs perfused at a constant flow of 40 mL/kg BW with a 4% albumin physiological saline solution (NaCl 119 mM, NaHCO
3
24 mM, Glucose 5.5 mM, CaCl
2
1.6 mM, KCl 4.7 mM, MgSO
4
1.17 mM, NaPO
4
1.18 mM)
.
The mean arterial pressure (MAP) and airway pressure were recorded continuously. The control (C) group (n=6) was ventilated with 65% N
2
, 5% CO
2
, 30% O
2
, the Ar group (n=7) with 65% Ar, 5% CO
2
, 30% O
2
. Baseline (bl) readings for 10 minutes were followed by increasing phenylephrine concentrations from 10
-7
M to 10
-3
M every 5 minutes. Statistics: Student’s t-Test with *p< 0.05.

Results:
When ventilating with Ar, we observed lower MAPs. For the phenylephrine concentrations 10
-5
M C: 1.31 ± 0.02 vs Ar: 1.21 ± 0.03 and 10
-4
C: 1.48 ± 0.02 vs Ar: 1.32 ± 0.05 the differences were significant.

Conclusion:
Ventilation with 65% Ar significantly dilated preconstricted pulmonary vessels in an ex-vivo rat lung model. Pulmonary vasodilation might aid to increased cardiac output during CPR.
Abstract 205: Resuscitation Using eCPR to Predict Survival After In-Hospital Cardiac Arrest (Rescue-IHCA Score) Survival Prediction Model--An Analysis of the American Heart Association Get With the Guidelines--Resuscitation Registry
Authors: Tonna Joseph E , Becker Lance B , Girotra Saket , Selzman Craig , Thiagarajan Ravi R , Presson Angela P , Zhang Chong , Keenan Heather T
Published: June 2021

Background:
To guide extracorporeal cardiopulmonary resuscitation (eCPR) use, a generalizable survival prediction model is needed.

Methods:
We identified patients≥18 years with IHCA who received eCPR (January 2000-December 2017) in the AHA Get With The Guidelines—Resuscitation registry to build a survival model. We categorized admission CPC into ‘good’ (CPC 1) vs other. We singly imputed variables with ≥15% missing (admission CPC [20%], duration of event [15%]). Variables associated with death (p-value ≤0.1) were retained and initial rhythm was forced into the model. We used firth penalized logistic regression to estimate model parameters. To test the imputation effect, we performed a sensitivity analysis excluding CPC. We performed a Kaplan Meier survival analysis stratified by resuscitation duration (0 to ≤15, 15 to ≤30, 30 to ≤60, ≥60 min).

Results:
Of 1,082 patients who underwent eCPR, 963 were included in the model (
Table 1
). Area Under the Receiving Operating Characteristic (AUROC) = 0.81 (95% CI [0.78 to 0.83]). Associations with death included: nighttime eCPR use; non-white race; patients with prior renal insufficiency, preceding hypoperfusion, and congestive heart failure. Initial rhythm was not associated with death. Every 10 minutes of resuscitation was associated with 12% increased odds of death. Shorter resuscitation duration was strongly associated with hospital survival (
Figure 1
). The AUROC was unchanged (0.81 [95% CI 0.78 - 0.84]) after sensitivity analysis excluding CPC.

Conclusions:
In this preliminary registry analysis, survival after eCPR for IHCA was estimated by patient and arrest characteristics. Our findings require validation.
Abstract 206: Neurological Outcomes and the Time From Collapse to the Initiation of Extracorporeal Membrance Oxygenation in Patients With Out-Of-Hospital and In-Hospital Cardiac Arrest
Authors: Unoki Takashi , Takagi Daisuke , Nakayama Tomoko , Tamura Yudai , Yamamuro Megumi , Suzuyama Hiroto , Taguchi Eiji , Katayama Yukihiro , Sawamura Tadashi , maehara junichi , Sakamoto Tomohiro , Nakao Koichi
Published: June 2021

Background:
Encouraging results of extracorporeal cardiopulmonary resuscitation (E-CPR) for patients with refractory cardiac arrest have been shown. However, an optimal timing to switch from conventional CPR to E-CPR are not well established. To determine the optimal timing when E-CPR should be performed, we investigated the relationship between the time from collapse to the initiation of extracorporeal membrane oxygenation (Collapse-to-ECMO time ) and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) treated with E-CPR.

Methods:
A total of 80 consecutive patients (age 64±16 years, male ratio 76%, shockable rhythm 48%, and OHCA 51%) received E-CPR between January 2012 and May 2019. The primary endpoint was survival with good neurological outcomes at hospital discharge (a cerebral performance category of 1 or 2).

Results:
Of the 80 patients included, 8 had good neurological outcomes. The rate of male was significantly higher in the good outcome group compared with the non-good outcome group. There was no significant difference in the age and the rates of initial shockable rhythm and acute coronary syndrome between the two groups. IHCA had the better outcomes compared with OHCA, but the difference does not reach significance [15.4% (6 of 39) vs. 4.9% (2 of 41); P=0.1]. The median Collapse-to-ECMO time was significantly shorter in the good outcome group compared with the non-good outcome group (38.5 min, interquartile range [IQR], 19.3-54.5 vs. 58.5 min, IQR, 35.3-76.0: p = 0.04). The area under the receiver operating curve of the Collapse-to-ECMO time for predicting a good neurological outcome was 0.72, and the optimal cutoff time was 60 min. Stepwise multivariate logistic regression analysis including data on age, sex, shockable rhythm, OHCA, and the Collapse-to-ECMO time under 60 min revealed that a male sex (P=0.03), shockable rhythm (P=0.03) and the Collapse-to-ECMO time under 60 min (P<0.001) were significantly associated with the good outcome.

Conclusions:
The Collapse-to-ECMO time was independently associated with good neurological outcomes. In patients with refractory cardiac arrest, it may be considered to initiate E-CPR within 60 min from collapse regardless of OHCA or IHCA.
Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest
Authors: Unoki Takashi , Takagi Daisuke , Tamura Yudai , Suzuyama Hiroto , Taguchi Eiji , Katayama Yukihiro , Sawamura Tadashi , Maehara Junichi , Sakamoto Tomohiro , Nakao Koichi
Published: June 2021

Background:
Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA.

Methods:
A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods.

Results:
There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period.

Conclusion:
A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.