bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 235: The Glasgow Motor Score Before Induction of Therapeutic Hypothermia Is an Independent Predictor of Good Outcome in Cardiac Arrest
Authors: Youn Chun Song , Kim Gi Woon , Park Kyu Nam
Published: April 2024

Background:
With the recent introduction of therapeutic hypothermia, the application of sedation becomes necessary in cardiac arrest patients. Therefore early prediction of neurologic outcome in these patients is challenging problem. Nevertheless neurologic examination including the Glasgow coma scale should be basis for decision making. So, we investigated the usefulness of the Glasgow motor score before induction of therapeutic hypothermia for outcome prediction in survivors of cardiac arrest treated with therapeutic hypothermia.

Methods:
Between March 2009 and July 2011, patients who successfully resuscitated from cardiac arrest and treated with mild therapeutic hypothermia were included in this study. Data were collected by local post-cardiac arrest care registry. Neurologic outcome was assessed with Cerebral Performance Category (CPC) at hospital discharge and good neurologic outcome was defined CPC score of 1 and 2.

Results:
Total 89 patients were treated with therapeutic hypothermia during study period. Among these patients, 39 were good neurologic outcome and 50 were poor neurologic outcome. The value for prediction of good outcome was as follows: sensitivity 53.8%, specificity 96.0%, PPV 91.3%, NPV 72.7% and AUC 0.749.

Conclusions:
The results of this study show that the Glasgow motor score > 1 before induction of therapeutic hypothermia is an independent predictor of good outcome in patients treated with therapeutic hypothermia. Thus, the patients with the Glasgow motor score > 1 soon after ROSC should be treated aggressively including therapeutic hypothermia.
Abstract 268: Testing ETCO2 as an Indicator of Improved Blood Flow During Prolonged CPR
Authors: Lampe Joshua W , Garcia Josiah D , Yin Tai , Bratinov George , Kaufman Chrisopher L , Becker Lance B
Published: April 2024

Introduction:
There is renewed interest in end-tidal carbon dioxide (ETCO2) as a metric of chest compression (CC) quality. A detailed study of ETCO2 changes and alterations in blood flow and pressures during CPR has not been performed.

Methods:
CPR hemodynamics in three domestic swine (~30 Kg) were studied using standard physiological monitoring. Flow probes were placed on the abdominal aorta, the inferior vena cava (IVC), the right renal artery and vein, the right common carotid and external jugular. Ventricular fibrillation (VF) was electrically induced. Mechanical CC were started after ten minutes of untreated VF. 54 min of CC were delivered at a rate of 100 per minute and at a depth of 1.25 in, which was followed by 6 min of 2 in CC.

Data are presented at the beginning of chest compressions (CC), after 20 minutes of CC at 1.25 inches, after 48 minutes of 1.25 in CC, and after 6 minutes of 2 inch CC. Paired t-tests were used to determine statistical significance.

Results:
CPR effectiveness decayed over time (see table) despite continued CC. After increasing CC depth to 2 inches, minimal changes in blood flow and pressure were observed with the exception of a trend in increased net forward flow in the IVC. ETCO2 was significantly increased after increasing chest compression depth and did not change in accordance with changes in net forward aortic blood flow (
r
=-0.213). ETCO2 correlated most with CC depth (
r
= 0.557), was weakly correlated with IVC flow (
r
= 0.332).

Conclusions:
Blood volume shifts due to prolonged sub-par CC are difficult to repair. After prolonged CC, ETCO2 correlates more with CC depth than with venous return. ETCO2 may not be a reliable metric of CC generated forward flow.
Abstract 274: Primary Reasons Bystanders Do Not Perform CPR When Receiving Dispatcher Instructions
Authors: Murphy Ryan Anne , Dunham Aaron , Tully Jeffrey , Dameff Christian , Panczyk Micah , Wasick Doreen , Spaite Daniel , Bobrow Bentley ,   SHARE Study Group
Published: April 2024

Introduction:
Dispatch-Assisted CPR (DACPR) has been shown to be an effective method of increasing bystander CPR (BCPR) rates and survival from out-of-hospital cardiac arrest (OHCA).

Objective:
No quantitative studies have specifically assessed why bystanders fail to perform CPR when offered pre-arrival CPR instructions from a dispatcher. We identified common reasons bystanders do not perform CPR when 9-1-1 emergency dispatchers offer CPR instructions.

Methods:
Review of suspected OHCA audio recordings from 3 regional 9-1-1 emergency dispatch centers for calls in which dispatchers offered CPR instructions. This study evaluated the subset where callers either verbally refused or were unable to perform CPR. The reasons for refusal or inability to perform CPR were categorized and recorded on a structured data form.

Results:
555 total audio files between 04/11-01/12 were identified based upon dispatch center suspicion of OHCA. Upon review of calls, cases were excluded if: CPR was not indicated (111/555, 20.0%), CPR was already in progress (60/555; 10.8%), bystanders believed the victim to be deceased (59/555, 10.6%), audio was not clear (20/555, 3.6%), caller was not with victim (18/555, 3.2%) or EMS arrived before DACPR could be initiated (13/555, 2.3%). Bystanders performed CPR per dispatch instructions in 30.1% of cases (167/555). In the remaining cases (107/555, 19.3%; study group), BCPR was not performed because bystanders were either unwilling to perform CPR (58/107, 54.2%) or unable to attempt CPR (49/107, 45.8%).

Conclusion:
There are multiple reasons bystanders do not perform CPR, even when dispatcher instructions are offered. In this study, inability to move the arrest victim, fear of causing harm, and panic were the predominant reasons CPR was not initiated. An assertive dispatcher can help overcome these barriers.
Abstract 276: A Genetic Algorithm Prognostic Tool Nested Within a 2500-Patient Registry of Post--Cardiac Arrest Care
Authors: Nielsen Niklas , Seder David , Friberg Hans , Mooney Michael , Rubertsson Sten , Stammet Pascal , Sunde Kjetil , Unger Barbara , Riker Richard R ,   INTCAR Study Group
Published: April 2024

Objectives: Predicting outcome after cardiac arrest (CA) is challenging. With data collected in the International Cardiac Arrest Registry (INTCAR), a novel prediction tool based on genetic algorithm (GA) was developed.

Methods: 2,564 adult, resuscitated, comatose CA patients were included from 35 sites in Europe and USA. Primary outcome was hospital discharge Cerebral Performance Category (CPC) dichotomized into good (GO=CPC1-2) and poor outcomes (PO=CPC 3-5). The GA-based models were constructed using Experlytics® software including all 180 candidate variables from the registry. A decision tree displaying the relation of the information carrying variables was evolved and pruned to a final model and optimized towards accuracy, sensitivity, specificity and Receiver-Operating Characteristic (ROC) value.

Results: Median age was 64 (IQR 54-73) years, 30% were female, the CA was witnessed in 84%, and initial rhythm was VF/VT in 55%, asystole in 23%, PEA in 17%. Time to ROSC was 19 (10-30) min. 37% had a GO at hospital discharge. 35% had coronary disease, 14% insulin dependent diabetes mellitus (IDDM), 8 % non-IDDM and 14% pulmonary disease. The final tree (figure 1) had an accuracy of 85%, a sensitivity of 91% and a specificity of 72%. The area under the ROC curve was 87% (CI 83-90).

Conclusions: A novel tool based on GA predicted outcome comparable to previous models. The GA could visually display the important information carrying variables and their relation. This model requires external validation, but represents a promising tool to better predict outcome and define the relationship between important risk factors

Figure 1. Relation of variables in a decision tree displaying good and poor outcome. ACD, automatic compression decompression, CPC, cerebral performance category, CPR, cardiopulmonary resuscitation, GCS, Glasgow Coma Scale, IDDM, Insulin dependent diabetes mellitus, MRI , magnetic resonance imaging, ROSC, return of spontaneous circulation.
Abstract 280: Association Between Duration of Hyperoxia, Organ Failure and Survival After Cardiac Arrest
Authors: Pullalarevu Raghavesh , Wang Bo , Vaghasia Nishit M , Guyette Frank , Callaway Clifton , Rittenberger Jon , Dezfulian Cameron
Published: April 2024

Background: Prior administrative database studies correlate hyperoxia (based on initial paO2) after cardiac arrest (CA) with increased mortality. These studies did not quantify duration of hyperoxia or incorporate important variables in predicting post-CA survival. We hypothesized hyperoxia duration would not be associated with organ failure or mortality after adjustment for important CA prognostic variables.

Methods: 185 CA survivors receiving >24h mechanical ventilation had oxygen exposure classified hourly based primarily on ABG paO2 or if missing within 2h based on SpO2 as: hypoxic (paO2≤50 or SpO2≤88%), normoxic (paO2 51-150 or SpO2 89-99% or 100% on FiO2≤0.40), moderately hyperoxic (paO2 151-300), severely hyperoxic (paO2>300) and probably hyperoxic (SpO2=100 when Fio2>0.40, no ABG). Univariate regression correlated durations of oxygen exposure to 24h SOFA score and survival to hospital discharge with multivariate regressions incorporating CA type, sex and use of hypothermia (p<0.10 in univariate correlations to outcomes).

Results: Classification based on initial paO2 revealed no significant differences in survival or SOFA (Table 1). Moderate hyperoxia and to a lesser degree combined moderate and severe hyperoxia exposure were associated with SOFA reduction whereas normoxia and hypoxia exposure were associated with higher SOFA, even after multivariate adjustment (Table 2). Severe hyperoxia exposure was associated with reduced survival in univariate but not multivariate analyses.

Conclusions: Exposure to moderate hyperoxia was associated with reduced organ failure whereas severe hyperoxia exposure was not and may correlate with worse survival.
Abstract 286: Feasibility Study for Performing Effective Chest Compressions According to the American Heart Association 2010 Guidelines for CPR and ECC
Authors: Shimizu Yoshitaka , Tanigawa Koichi , Ishikawa Masami , Irifune Masahiro
Published: April 2024

Background:
The American Heart Association 2010 Guidelines for CPR recommend that untrained bystanders provide CPR using chest compression only with an emphasis on “push hard and fast” (a chest compression depth of >5cm at a rate of >100 compressions/minute).

This study aimed to determine the feasibility of performing effective chest compressions according to the 2010 guidelines in comparison with the 2005 guidelines.

Methods:
Fifty-eight sixth-year dentistry students participated in this study. They were divided into 2 groups, g-G2010 and g-G2005. The students were instructed to perform chest compressions according to the 2010 guidelines (g-G2010; compression rate >100 times per minute and >5 cm depth), or the 2005 guidelines (g-G2005; compression rate=100 times per minute and a depth of 4 to 5 cm). Both groups were asked to compress the chest of a manikin (HeartSim 4000, Laerdal Co.) for 5 one-minute sets, with a ten-second break between each set.

Results:
The average numbers of chest compressions were 114 and 105 per minute in g-G2010 and g-G2005, respectively. Both groups maintained compression rates greater than 100 per minute during the 5-minute study period. In g-G2010, chest compressions deeper than 5 cm were achieved only in 58 ± 10 compressions in the first set, and this number decreased to 50 ± 10* compressions in the second set (*p<0.01 vs. the first set). The number of compressions deeper than 4 cm decreased significantly from 108 ± 4 in the first set to 97 ± 7* per minute in the second set (* p<0.05 vs. the first set). In g-G2005, on the other hand, the number of compressions deeper than 4 cm was 97 ± 5 in the first set, and decreased to 92 ± 6 in the second set (n.s.). In the third set, the number of compressions deeper than 4 cm in g-2010 further decreased to 84 ± 7* per minute, which was significantly lower than g-2005, which was 91 ± 6 in the same time set (*p<0.05 vs. g-2005).

Conclusions:
Our study demonstrated that the compression depth in g-G2010 was inadequate in half of the compressions during the first minute of CPR, and its quality degraded further thereafter. These results suggest that the recommended depth of compression in the 2010 guidelines might be difficult for lay rescuers to achieve in compression-only CPR.
Abstract 287: What Is the Optimal Chest Compression Depth During Resuscitation from Out-of-Hospital Cardiac Arrest in Adult Patients?
Authors: Stiell Ian G , Brown Siobhan , Calloway Clifton W , Aufderheide Tom P , Cheskes Sheldon , Vaillancourt Christian , Hostler David , Davis Daniel P , Idris Ahamed , Christenson James , Morrison Laurie , Stouffer John , Free Cliff , Nichol Graham ,   Resuscitation Outcomes Consortium Investigators
Published: April 2024

Introduction:
The 2010 AHA/ILCOR recommendations suggested an increase in CPR compression depth for adults, with a target >50 mm and no upper limit. This target is based upon limited evidence and, hence, we sought to determine the optimal compression depth range for adult patients.

Methods:
We studied emergency medical services treated OOHCA patients from the Resuscitation Outcomes Consortium ROC PRIMED clinical trial and Epistry - Cardiac Arrest database for whom electronic CPR compression depth data were available, from June 2007 to December 2010. We calculated anterior chest wall depression in millimeters for each minute of CPR. We controlled for 10 covariates including compression rate and calculated adjusted odds ratios for survival to hospital discharge, 24-hour survival, and any return of circulation (ROSC). Smoothing splines were used to explore the relationship between average compression depth and outcome for all patients as well as men and women separately.

Results:
We included 9,142 adult patients from 9 U.S. and Canadian cities with these characteristics: mean age 67.5 years; male 64 %; bystander witnessed 44%; bystander CPR 42%; initial rhythms - VF/VT 24%, PEA 20%, asystole 49%, other non-shockable 6%; outcomes - ROSC 31.3%, 1-day survival 22.8%, survival to hospital discharge 7.3%. For all patients, mean compression rate was 108 per minute; mean compression fraction 0.68; mean compression depth 41.9 mm with ranges: <38 mm 37%, 38-51 mm 45%, >51 mm 18%. Adjusted odds ratios for survival to discharge, with depth >51mm as reference, were <38 mm - 0.69 (95% CI 0.53, 0.90) and 39-51 mm - 1.03 (0.81, 1.30). Results were similar for the intermediate outcomes of ROSC and 1-day survival. Covariate-adjusted spline curves revealed that the maximum survival was associated with a depth of 45.8 mm followed by a decline in survival by 50 mm (optimal interval 44-49 mm). We also found no differences in the spline curves between males and females.

Conclusions:
This study found that more than one-third of patients received very low compression depth. The optimal CPR compression depth for survival appears to be 46 mm (44-49) for both males and female adults but falls off after 50 mm. These findings conflict with the 2010 international guideline recommendations.
Abstract 289: Use of Epinephrine During In-Hospital Cardiac Arrest May Not Increase Rate of Survival to Discharge
Authors: Trammell Antoine R , Liao Tze-chun V , Abraham Prasad , Holt Tara , Renelus Benjamin , Sharma Shikha , Zafari Abarmard M
Published: April 2024

Introduction: In a recent large observational resuscitation study the use of epinephrine during out-of-hospital cardiac arrest was associated with survival to hospital admission but not with survival to discharge. Few studies have studied the impact of epinephrine on in-hospital survival outcomes. This study examines in-hospital cardiac arrest survival and the use of epinephrine.

Hypothesis: The use of epinephrine during in-hospital cardiac arrest is associated with increased code survival and survival to discharge.

Methods: This retrospective and observational study includes 286 cases of in-hospital cardiac arrest wherein epinephrine was administered. The outcomes were code survival and survival to discharge. The study period was between June 2010 and October 2011 at an urban, academic medical center. Resuscitation characteristics, including use of epinephrine were compared between code survivors and non-survivors. Charlson comorbidity scores were used to adjust the severity of illness for both groups. Chi-square was used for hypothesis testing. Results were considered significant for p-values < 0.05.

Results: Epinephrine was used in 272 cases of in-hospital cardiac arrest. In 55% (n = 136) of the study cohort, only one dose of epinephrine was administered. There is a significant association between the use of epinephrine and code survival (X2 = 9.87, p = 0.0017). There is a statistically significant association between the use of epinephrine and not surviving to discharge (X2 = 7.69, p = 0.0056). Among persons receiving epinephrine, 13.6% (n = 37 of 272) survived to hospital discharge. There is no significant association between the initial rhythm and code survival (X2 = 75.36, p = 0.34) or survival to discharge (X2 = 4.56, p = 0.47) when epinephrine was administered. The median Charlson score for both groups was 4 (IQR = 2 to 6) and is not significantly different (Ws = 10955, z = 1.24, p = 0.21).

Conclusions: Epinephrine administration during in-hospital cardiac arrest is associated with code survival, but not survival to discharge. Our observations are consistent with the findings reported regarding epinephrine use in out-of-hospital cardiac arrest but warrant larger, randomized studies to confirm our findings
Abstract 308: A Preoxygenation “Bundle” Decreases Desaturation Events and Improves Intubation Success in Air Medical Rapid Sequence Intubation
Authors: Lemieux Justin , Minokadeh Anushirvan , Lanning Jason , Marayag Justin , Davis Daniel
Published: April 2024

Introduction: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and has been associated with increased morbidity and mortality. Preoxygenation with positive-pressure ventilation (PPV) may delay the onset of desaturation. However, PPV may not be used aggressively with emergency RSI due to concern for gastric insufflation precipitating regurgitation and aspiration events.

Objective: To evaluate an aggressive preoxygenation protocol with regard to desaturation events during air medical RSI.

Methods: The RSI protocol used in our air medical program airway training model was modified to employ several interventions designed to optimize preoxygenation prior to initial laryngoscopy. These included: two-person bag-valve-mask (BVM) ventilation, “two-thumbs-up” hand positioning on the mask, correct application of cricoid pressure, aggressive use of nasopharyngeal and oropharyngeal airways, small-volume assisted ventilation prior to administration of RSI medications, and large-volume ventilation following sedation/paralysis but prior to the initial laryngoscopy attempt. This algorithm identified a target SpO2 value of at least 93% based on a previous investigation. Desaturation events [decrease in SpO2 to <90% or a continued decrease by at least 2% if initial SpO2 value was <90%] were identified using physiologic data exported from hand held oximeter-capnometer devices. The incidence of desaturation events was established over a 2-year period prior to and the subsequent 2-year period following implementation of these algorithm changes.

Results: A total of 155 RSI procedures were evaluated over the study period. Desaturation events decreased from 58% in the two years prior to the algorithm changes to 28% in the first year and 14% in the second year following implementation (chi-square test for trend p<0.01). In addition, the intubation success rate increased from 94% to 97% following implementation of the protocol. There were no reports of major aspiration events during the study period.

Conclusions: An aggressive preoxygenation protocol dramatically reduced the incidence of desaturation events and increased intubation success during air medical RSI without increasing aspiration events.
Abstract 314: Outcomes of Patients with Cardiac Arrest Treated with Therapeutic Hypothermia: Insights on Etiology and Initial Rhythm
Authors: Kalish Brian T , Avery Kathleen R , Pierce Carol D , Chase Annmarie , Fine Robert , Forni Alison , Griswold Karen M , Henderson Galen V , Hirning Beth Anne , Hou Peter C , Michael Kyller G , Massaro Anthony F , Morrow David A , Seethala Raghu R , Stone Peter H , Strojwas Stefan , Szumita Paul M , Scirica Benjamin M
Published: April 2024

Background:

Therapeutic hypothermia (TH) improves neurological outcomes and reduces mortality in patients successfully resuscitated after VT/VF cardiac arrest (CA). Outcomes according to the clinical scenarios leading to the CA and initial rhythm, though, vary significantly.

Methods:

We report a single center experience that recommended TH for all patients who were comatose after CA, regardless of etiology or initial rhythm. Patients were categorized according to clinical scenario surrounding CA and initial rhythm. Good neurologic recovery was defined as a cerebral performance category of 1/2 (no deficit to moderate disability). All outcomes were assessed at discharge.

Results

A total of 135 patients with CA received TH of whom 79 cases (58%) had cardiac etiology (27 [20%] were STEMI and 52 [39%] other cardiac etiologies) and 56 (42%) non-cardiac. Patients with a cardiac cause of CA were more likely to survive until discharge than non-cardiac (51% vs. 23%, p=0.002) and have better neurologic recovery (41% vs. 8%, p<0.001). VT/VF was the most common initial rhythm (50%), followed by PEA (30%), asystole (19%), and bradycardia (2%). Patients presenting with VT/VF were most likely to survive at discharge and have better neurologic recovery compared to non-shockable rhythms (p<0.001 for both). (Figure)

Conclusion:

Cardiac etiologies, in particular VT/VF, were the most common cause of CA in patients undergoing TH. PTs with VT/VF had the best survival and neurologic outcomes. Further research into the optimal treatment of CA from non-cardiac etiology or non-shockable rhythms is needed.
Abstract 332: STI Assessment of Left Ventricular Function in Patients With Previous Myocardial Infarction and Recurrent Ventricular Arrhythmias
Authors: Nguyen Bich Lien , Capotosto Lidia , D’Alessandro Gaetana , Gang Eli S , Caranci Fiorella , Barillá Francesco , Siegel Robert J , Vitarelli Antonio
Published: April 2024

Purpose. Our aim was to compare strain parameters of patients with structural heart disease with and without ventricular tachycardia (VT) in order to identify high-risk patients that could have been missed by left ventricular ejection fraction (LVEF) criteria.

Methods. We studied 86 patients (pts) with previous myocardial infarction (age, 59±14 years) scheduled for cardioverter-defibrillator (ICD) implantation. Forty-three pts had documented VT and 43 pts presented with no VT. Left ventricular (LV) function and volumes and score index were determined by two-dimensional echocardiography. Longitudinal LV strain was defined as the average of negative longitudinal strains of 6 segments of the septal and lateral walls in the apical 4-chamber view. Average radial and circumferential strain of 6 mid-LV segments was determined in the mid-short-axis view. Global strain was obtained by averaging the maximum systolic shortening in a 16-segment model. The analysis of strain parameters was performed offline using customized computer software (EchoPAC BT09, GE Ultrasound).

Results. There were no differences in LVEF, LV volumes, QRS and QTc duration between pts with or without VT occurring during follow-up. Multivariate analysis revealed that global (p=0.018) and posterior wall circumferential strain (p=0.007) were strong and independent predictors of the occurrence of arrhythmic events. The area under the curve (AUC) for posterior wall circumferential strain was 0.79 and the optimal cutoff value -6.2% for a sensitivity of 71% and a specificity of 89% in predicting arrhythmic events. AUC for QTc was 0.32 yielding a sensitivity and specificity of, respectively, 49% and 65% to predict arrhythmias and AUC for EF was 0.51 yielding a sensitivity and specificity of, respectively, 56% and 70%.

Conclusions. Circumferential strain was the strongest predictor of spontaneous ventricular arrhythmias among other clinical and echocardiographic variables such as score index and LV function and volumes in patients with previous myocardial infarction scheduled for ICD therapy.
Abstract 335: Outcomes Analysis for Direct Transport to Trauma Centers Versus Transfer After Stabilization at Other Hospitals: Nationwide Population-Based Research in Taiwan
Authors: Harnod Dorji , Ma Mathew Huei-Ming , Chang Chu-Hui
Published: April 2024

Background:
Major trauma remains a major disease with about ten-thousand death annually in Taiwan. Since Trunkey described the concept of “golden hour”, outcomes for trauma patients in different levels of hospitals and the influence of transferring to trauma centers after stabilization in first hospitals become of particular interest.

Methods:
From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis in 2005 for calculating Charlson Comorbidity Index. And factors such as age, gender, preexisting co-morbidities and different hospital levels were adjusted in a logistic regression model for survival analysis.

Results:
There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). After controlling the age, genders, co-morbidity and injury severity, the difference of mortality rates were significant in hospital levels. Compared with the risk in trauma centers, the risk of mortality is 1.58 times in non- trauma centers (P<0.01). In the oldest group (>60 year-old), the risk of mortality is 1.89 times in non-trauma centers (P<0.01). There is no significant difference in the mortality rates between transferred and non-transferred trauma patients. And, the mortality rates is higher in those areas without trauma centers (OR=1.72, P<0.01)

Conclusions:
Our results suggest major trauma patients should be sent to trauma centers for care, especially the elderly patients. And based on the non-significant difference in mortality rates between transferred and non-transferred patients, major trauma patients should be transferred to trauma centers after initial stabilization.
Abstract 341: Estrogen Prevents Sudden Death and Spontaneous Ventricular Fibrillation Associated with Pulmonary Hypertension via Estrogen Receptor Beta Mediated Mechanism
Authors: Umar Soban , Chui Raymond , Hoffman Jonathan , Bapat Aneesh , Karagueuzian Hrayr S , Eghbali Mansoureh
Published: April 2024

Introduction: Previously we showed that right ventricular failure (RVF) secondary to pulmonary hypertension (PH) is associated with spontaneous ventricular fibrillation (VF) and sudden death in rats. We also discovered that estrogen (E2) therapy rescues severe PH and RVF. Estrogen receptor b (ERb) has been shown to play a protective role both in heart and lung. Here we hypothesize that E2 prevents sudden death and abolishes spontaneous VF associated with RVF through ERb.

Methods: Male rats were treated with monocrotaline (MCT 60 mg/kg, s.c.) or PBS (CTRL, n=9). At day 21, MCT rats were left untreated to develop RVF by day 30 (n=9), or treated with E2 (42.5 ug/kg/day, s.c., n=9) with or without ERb antagonist PHTPP (850 ug/kg/day, s.c., n=8) from day 21 to day 30. RV ejection fraction (RVEF) was serially monitord with echocardiography. Direct RV catheterisation was performed terminally to record RV pressure (RVP). At ~day 30, hearts were studied in isolated-perfused Langendorff setting and microelectrode recordings were made. RV-epicardial activation pattern was optically mapped using fluorescent voltage-sensitive dye (RH-237). Trichrome staining was performed to assess cardiac fibrosis. Values are expressed as Mean±SEM.

Results: By day 30, MCT rats developed severe PH (RVP=72±4 vs. 30±2 mmHg in CTRL, p<0.05) and RV failure (RVEF=33±3% vs. 65±1 in CTRL, p<0.05) with moderate RV fibrosis and ∼30% of RVF rats died suddenly. Early after depolarization (EADs) and spontaneous VF were observed in RVF group during normal Tyrode perfusion with wave front dynamics supported by both focal and multiple wavelet patterns. E2 therapy resulted in complete rescue of PH (RVP=38±3 mmHg, p<0.05 vs. RVF; RVEF=60±2%, p<0.05 vs. RVF; no signs of fibrosis) and none of the rats died in E2-groups. No VF was initiated in any of the control or E2 treated rat hearts. In the presence of ERb antagonist PHTPP, E2 could not rescue PH (RVP=60±4 vs. 38±3 in E2; RVEF=42±2 vs. 60±2 % in E2; p<0.05 vs. E2); moderate RV fibrosis was present and spontaneous EADs and VF were observed in all the hearts similar to RVF group.

Conclusions: In conclusion, E2-therapy rescues PH-induced RVF and prevents VF by reversing PH-induced RV-dysfunction and fibrosis most likely through ERb-mediated mechanism.
Abstract 4: Small-Volume 7.5% NaCl Adenocaine/Mg2+ Preserves Cardiac Function During Hypotensive Resuscitation in the Pig Following Severe Hemorrhagic Shock
Authors: Granfeldt Asger , Letson Hayley L , Hyldebrandt Janus A , Wang Edward R , Salcedo Pablo A , Nielsen Torben K , Tønnesen Else , Vinten-Johansen Jakob , Dobson Geoffrey P
Published: April 2024

Background: Cardiac rescue is critical for successful resuscitation. Previously, we reported that ~1 ml/kg 7.5% NaCl with Adenocaine (adenosine and lidocaine) and Mg2+ (ALM) successfully resuscitated rats following severe hemorrhagic shock, and that in pigs ALM significantly reduced the volume of Ringers acetate required to raise MAP to a target of 50 mmHg following 74% blood loss. The present study examines the effect of small volume 7.5% NaCl ALM on cardiac function during 60 min hypotensive resuscitation following 90 min shock in the porcine model.

Methods: Pigs (35-40kg) were subjected to pressure-controlled hemorrhage at a mean arterial pressure (MAP) of 35-40mmHg for 90 min (~75% blood loss). Pigs were randomly assigned to receive either 4 ml/kg 7.5% NaCl ALM (ALM n=8) or 4 ml/kg 7.5% NaCl (Control n=8). Cardiac output (CO), stroke volume, left-ventricular pressures and hemodynamics were collected continuously. Significance *p<0.05.

Results: MAP, end-systolic pressure and CO were significantly higher in the ALM pigs at the end of hypotensive resuscitation (Table). The higher CO was due to a higher stroke volume (SV) maintained at a significantly lower heart rate (HR). Paradoxically dP/dtmax tended to be higher in the Control group during the first 45min of hypotensive resuscitation (p=0.066) with no difference at 60min. Systolic ejection times were significantly increased in the ALM group and inversely related to HR. There was no difference in LV end-diastolic pressure between the two groups indicating that preload was similar during hypotensive resuscitation. LV blood flow at 30min resuscitation was comparable in the two groups (Control: 2.86±0.6 vs. ALM: 4.1±1.4 ml/min/g; p=0.7)

Conclusion: Superior cardiac rescue was achieved in ALM by a higher SV and CO, lower HR and longer ejection times vs Controls. Longer isovolumic contraction and ejection times may be due to suppression of SA nodal activity or rebalancing of sympathetic/parasympathetic control.
Abstract 11740: Identification of a Mechanism vy Which Common Blood Pressure Genetic Variant in the Nppa Gene Regulates Anp Levels
Authors: Arora Pankaj , Wu Connie , Khan Abigail May , Bloch Donald , Davis-Dusenbery Brandi , Ghorbani Anahita , Spagnolli Ester , Martinez Andrew , Ryan Allicia , Tanish Laurel T , Kim Samuel , Miller Karen Klahr , Hata Akiko , del Monte Federica , Holmes Tara Minaker , Buys Emmanuel , Bloch Kenneth D , Wang Thomas J , Newton-Cheh Christopher
Published: April 2024

Pankaj Arora, 2012 Finalist and Presenting Author
Abstract 13292: Comprehensive Cardiac Rehabilitation versus Treatment as Usual For Implantable Cardioverter Defibrillator Recipients Improves Exercise Capacity, General Health and Mental Health - Mixed Methods Approach Embedding Data from a Randomised Clinical Trial with Qualitative Data
Authors: Berg Selina K , Pedersen Preben U , Zwisler Ann-Dorthe , Winkel Per , Gluud Christian , Pedersen Birthe , Svendsen Jesper Hastrup
Published: April 2024

Selina K Berg, 2012 Finalist and Presenting Author
Reprogramming Approaches for Cardiovascular Disease
Authors: Srivastava Deepak
Published: April 2024

Heart disease is a leading cause of death in adults and children. We, and others, have described complex signaling, transcriptional and translational networks that guide early differentiation of cardiac progenitors and later morphogenetic events during cardiogenesis. We found that networks of transcription factors and miRNAs function through intersecting positive and negative feedback loops to reinforce differentiation and proliferation decisions. For example, we found the human mutations in the transcription factor GATA4 disrupt cardiogenesis, in part by affecting GATA4's interaction with TBX5. Many of the developmental cues have been leveraged to control differentiation of pluripotent stem cells into cardiac, endothelial and smooth muscle cells that may be useful for regenerative purposes. We have used similar approaches to direct differentiation of disease-specific human induced pluripotent stem cells in order to model human heart disease. Recently, we utilized a combination of major cardiac regulatory factors, Gata4/Mef2c/Tbx5, to induce direct reprogramming of cardiac fibroblasts into cardiomyocyte-like cells with global gene expression and electrical activity similar to cardiomyocytes. The reprogramming was a stable event at the epigenetic level. We have now used genetic lineage-tracing techniques to demonstrate that resident cardiac fibroblasts can be reprogrammed into induced cardiomyocytes in vivo using a gene therapy approach. The in vivo efficiency of reprogramming into cells that are more fully reprogrammed into beating cardiomyocytes was greater than in vitro and resulted in improved cardiac function after injury. Knowledge regarding the early steps of cardiac differentiation in vivo has led to effective strategies to generate necessary cardiac cell types for disease-modeling and regenerative approaches, and promise to lead to new strategies for human heart disease.
Abstract 69: A Time Series Analysis of Cardiac Arrest Incidence in Denver, Colorado
Authors: Sasson Comilla , Nassel Ariann , Colwell Chris , McVaney Kevin , Johnston Bill , McNally Bryan F , Haukoos Jason
Published: April 2024

Background: Out-of-hospital cardiac arrest (OHCA) is estimated to cause 250,000 deaths annually in the U.S. Previous research has shown seasonal variation in cardiac arrest incidence. However, little is known about how cardiac arrest varies in Denver, CO across time.

Objectives: To analyze cardiac arrest incidence in Denver for 2009-2012 to assess for trends in incidence, seasonal variation and predict future cardiac arrest incidence.

Methods: Design: Secondary analysis of the Denver, Colorado component of the Cardiac Arrest Registry to Enhance Survival (CARES) dataset. Setting: Large urban metropolitan community with a two-tiered EMS system. The catchment area for this community is approximately 150 square miles with an approximate residential census of 600,000 people and includes 10 adult acute-care receiving hospitals. Population: Consecutive arrests from January 15, 2009 through March 31, 2012 entered by Denver Health Paramedic Division staff into the CARES dataset. Data Analysis: Arrests were grouped by month using Stata. R software was used to estimate the trend, seasonality and random error associated with events. An ARIMA model was used to fit the data and predict future OHCA incidence for the subsequent 24 months.

Results: There were a total of 2,270 cardiac arrests patients during the 39 months. Overall, there appears to be a decreasing trend in the incidence of cardiac arrest in Denver (Figure 1). There does also appear to be seasonality in cardiac arrest events. The maximum number of arrests occurred in October 2010 (97). An ARIMA Model (0,2,2) was used to predict future cardiac arrest occurrence over the next 24 months.

Conclusion: It is possible that wide-scale cardiac arrest and prevention efforts have contributed to the decreasing trend in OHCA incidence. Future research will need to examine what factors (e.g., season, temperature, etc.) may be contributing to the observed seasonal variation pattern.
Abstract 81: Feasibility of Using Hospital Personnel to Create a Sustainable CPR Training Program for Family Members of Hospitalized Patients
Authors: Blewer Audrey L , Le Jeffrey , Buckler David , Leary Marion , Riegel Barbara , Bobrow Bentley J , Abella Benjamin S
Published: April 2024

Background:
Bystander CPR rates for cardiac arrest are low in many communities. This is especially the case in the home environment, where fewer potential rescuers are present than in public areas, and CPR training may be lacking. While recent studies have evaluated using the hospital as a unique “point of capture” for family member CPR training using paid research staff, there is a crucial need to develop a low cost, sustainable, CPR education program for patient families.

Objectives:
We sought to evaluate the feasibility of using hospital personnel (nurses and volunteers) to implement our CPR Anytime Hospital-Initiated Training Program (CHIP) using an established video self-instruction (VSI) kit for family members of hospitalized adult patients with coronary disease or significant cardiovascular risk factors.

Methods:
In an ongoing multicenter trial of CPR educational strategies, hospital personnel were sought to implement the CHIP program. After training, hospital personnel and family member impressions on training were assessed using mixed quantitative and qualitative survey instruments. Survey responses were analyzed for statistical significance.

Results:
From 02/2012 to 05/2012, hospital personnel from 4 institutions trained 120 family members in CPR; 86/120 (72%) of the family members were never CPR trained or had not received training in over 10 years. When queried about the program, 119/120 (99%) of the trainees indicated that they felt comfortable learning CPR skills in the hospital environment, and 97/120 (81%) of trainees felt confident using their new skills in a real-life situation. Of 21 hospital personnel (11 nurses, 10 volunteers), 94% felt confident conducting the program. Nurses more frequently indicated that the family members were receptive to participating in the program (Likert scale (1-5) mean score 4.22 + 0.83, 3.77 + 1.39, p=ns). Overall, 94% of the personnel felt that the service was beneficial to families and patients.

Conclusions:
The hospital setting offers a unique “point of capture” to provide CPR instruction to an important, undertrained population. This work suggests that implementation of VSI training programs using hospital personnel is feasible and may confer broader dissemination of life-saving skills.
Abstract 8947: Preoperative Anemia is an Independent Predictor of Postoperative Mortality and Adverse Cardiac Events in Elderly Patients Undergoing Elective Vascular Operations
Authors: Gupta Prateek K , Gupta Himani , Sundaram Abhishek , MacTaggart Jason N , Johanning Jason M , Fang Xiang , Forse R. Armour , Balters Marcus , Longo G. Matthew , Sugimoto Jeffrey T , Lynch Thomas G , Pipinos Iraklis I
Published: April 2024

Background:
Preoperative anemia is associated with adverse outcomes after cardiac surgery, but its association with postoperative outcomes after open and endovascular procedures is not well established. Elderly patients have a decreased tolerance to anemia and are at high risk for complications after vascular procedures. The objective of this study was to assess the impact of preoperative anemia (hematocrit<39%) on postoperative 30-day mortality and adverse cardiac events in patients ≥65 years of age undergoing elective vascular procedures.

Methods and Results:
Patients (n=31,857) were identified from the American College of Surgeons' 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective, multicenter (>250) database maintained across the United States. The primary and secondary outcomes of interest were 30-day mortality and a composite end point of death or cardiac event (cardiac arrest or myocardial infarction), respectively. Forty-seven percent of the study population was anemic. Anemic patients had a postoperative mortality and cardiac event rate of 2.4% and 2.3% in contrast to the 1.2% and 1.2%, respectively, in patients with hematocrit within the normal range (p<0.0001). On multivariate analysis, we found a 4.2% (95% confidence interval, 1.9%-6.5%) increase in the adjusted risk of 30-day postoperative mortality for every percentage point of hematocrit decrease from the normal range.

Conclusions:
The presence and degree of preoperative anemia are independently associated with 30-day death and adverse cardiac events in patients ≥ 65 years undergoing elective open and endovascular procedures. Identification and treatment of anemia should be an important component of preoperative care for patients undergoing vascular operations.
Abstract 8993: Protective Effects of Glucagon-like Peptide-1 on Cardiac Microvessels Injury via cAMP/PKA/Rho Dependent Pathway in Diabetic Rats
Authors: Wang Dongjuan , Luo Peng , Wang Haichang , Liu Nan , Cao Feng
Published: April 2024

Introduction:
Impaired cardiac microvascular function contributes greatly to diabetes cardiovascular disease. Glucagon-like peptide-1 (GLP-1) was found to have multiple cardioprotective effects besides its glucose lowering properties.
Hypothesis:
To investigate the protective effects of GLP-1 on cardiac microvessels injury and the underlying mechanism in diabetic rats.

Methods:
STZ-induced diabetic rats were randomized to 12 weeks of treatment with vehicle, LAF237 or Exenatide. Cardiac function and energetics was examined by echocardiography and
18
F-FDG PET respectively. Lanthanum nitrate perfusion was applied to assess cardiac microvascular barrier function. Cardiac microvascular endothelial cells (CMECs) were cultured in medium alone or medium containing high glucose, GLP-1, high glucose plus GLP-1. Lucigenin-enhanced chemiluminescence assay and DHE staining were used to assess ROS production. The expression of Rho, ROCK, p47
phox
and gp91
phox
was examined by Western blot.

Results:
LAF237 or Exetinade treatment improved cardiac function and energetics as well as microvascular barrier function significantly compared with vehicle groups. Compared with vehicle groups, ROS production was markedly decreased in GLP-1 groups. There were also significant reductions in p47
phox
and gp91
phox
expression. The cAMP/PKA activity was increased and the Rho expression was decreased in high glucose-induced CMECs after treatment with GLP-1, which reproduced the same effects as PKA inhibitor.

Conclusions:
GLP-1 could protect the cardiac microvessels against oxidative stress injury and the resultant microvascular barrier dysfunction in diabetic rats, which contribute to the improvement of cardiac function. The protective effects of GLP-1 are dependent on downstream inhibition of Rho, which is through cAMP/PKA pathway, resulting in subsequent decreased production of NADPH oxidase.
Abstract 9031: Visual Assessment of Brain MRI Detects Injury in Heart Failure
Authors: Pan Alan , Kumar Rajesh , Macey Paul M , Fonarow Gregg C , Harper Ronald M , Woo Mary A
Published: April 2024

Introduction:
Heart failure (HF) patients exhibit impairments in memory and executive function that contribute to HF mortality. Structural brain changes have been reported in areas which control these functions (mammillary bodies, hippocampi, and frontal cortex) using complex magnetic resonance imaging (MRI) quantitative analysis procedures. However, these quantitative MRI procedures are time-consuming to carry out and are not part of standard clinical assessment. It is unknown whether standard visual examination of MR images can detect changes in brain structures controlling memory and executive function in HF.

Hypothesis:
Heart failure patients would show more mammillary body, hippocampal, and frontal cortical atrophy versus control subjects.

Methods:
We visually assessed whole brain regions in 17 HF (mean age ± SD, 54.4 ± 8.1 years; LVEF, 0.28 ± 0.07) and 50 control subjects (age, 50.6 ± 7.0 years) using high-resolution T1-, T2-, and proton density-weighted images acquired from a 3.0 Tesla MRI scanner. Standardized visual scores were assigned to the mammillary bodies and frontal cortex for global atrophy and to the hippocampi for global and regional atrophy and scores were compared between HF and control groups.

Results
and
Conclusions:
Significant global changes emerged in the right mammillary body (1.18±1.13 vs. 0.52±0.74; p=0.024), right hippocampus (1.53±0.94 vs. 0.80±0.86; p=0.005), and left frontal cortex (1.76±1.03 vs. 1.24±0.77; p=0.034) in HF compared to controls. Global changes in the left mammillary body, left hippocampus, and right frontal cortex, and regional differences in bilateral hippocampi did not emerge. In conclusion, visual examination of MR images can detect brain damage in areas controlling memory and executive function in HF patients and may allow for increased opportunity to evaluate the progression of injury to these brain structures and to more easily identify and evaluate potential treatments for this damage in HF patients.
Abstract 9048: Once-Daily Esomeprazole 20mg Prevents Recurrence of Peptic Ulcer in East Asian Low-Dose Aspirin Users at Gastrointestinal Risk: the LAVENDER Study
Authors: Goto Shinya , Okada Yasushi , Choi Myung-Gyu , Lin Jaw-Town , Kinoshita Yoshikazu , Miwa Hiroto , Chiang Chern-En , Sugano Kentaro
Published: April 2024

Objectives:
Gastroprotective therapy is recommended for cardiovascular (CV) patients (pts) taking low-dose aspirin (LDA) and at increased gastrointestinal risk, eg history of peptic ulcer. This study assessed the potential effects of esomeprazole (ESO) in prevention of recurrent peptic (gastric and/or duodenal) ulcer in East Asian pts taking LDA for CV protection.

Methods:
Pts aged >=20y with history of endoscopically confirmed peptic ulcer and taking LDA (81-324mg/d) for CV protection were enrolled (
NCT01069939
). Pts with serious heart failure/unstable hypertension/history of acute coronary syndromes were excluded. Eligible pts were randomized to ESO 20mg/d or placebo (PBO) for a maximum of 72 wks. All pts received concomitant mucosal protection (gefarnate 100mg/d). Primary end point was time to ulcer recurrence, analyzed by the Kaplan-Meier method. Findings are presented up to wk 60, as per a planned event-driven analysis.

Results:
A total of 427 pts (mean age 67y; 79% men) comprised the full analysis set (ESO, n=213; PBO, n=214). There was a statistically significant difference in the time to ulcer recurrence between ESO and PBO (hazard ratio, 0.14; 96.65% CI: 0.04-0.42; p<.001). Estimated ulcer-free rate up to wk 60 was 96.0% and 75.8%, respectively. Sub-analysis showed superior ulcer-free rates for ESO vs PBO regardless of LDA dose (81mg, 100mg, and >100mg) and reason for LDA treatment (primary vs secondary prevention). Treatment with ESO was well tolerated. The rate of serious cardiac-related adverse events with ESO was similar to PBO (1.4% and 1.9% of pts, respectively). No deaths were reported.

Conclusions:
Daily ESO 20mg is efficacious and well tolerated for reducing the recurrence of peptic ulcer in East Asian pts who have a history of ulcers and are taking LDA for cardioprotection. Supported by AstraZeneca K.K., Osaka, Japan. Medical writing support from
in
Science Communications was funded by AstraZeneca.