bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4145287: The effects on mortality of statin therapy in patients with heart failure with preserved ejection fraction (HFpEF): An updated systematic review and meta-analysis
Authors: Coan Ana Carolina , Falco Neto Wilson , Katsuyama Eric , Petri Santos Pinheiro Rafael , Prata Alonzo , Fernandes Julia , Scardini Pedro Gabriel , Fukunaga Christian , Andrade Naieli , Gioli-Pereira Luciana
Published: November 2024

BACKGOUND:
Statins have shown benefits in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). However, the effects of statin in patients with heart failure with preserved ejection fraction (HFpEf) remains unclear. Therefore, we aim to perform an updated systematic review and propensity scores (PS) meta-analysis comparing statin with no statin therapy in this population.

METHODS:
We searched in PubMed, Embase, and Cochrane Library databases for studies examining the effect of statin use in patients with HFpEF. The primary outcome was (1) all-cause mortality, with secondary outcomes being (1) cardiovascular (CV) mortality and (3) heart failure (HF) hospitalization. We also performed a subgroup analysis for the primary outcome, comparing studies that used PS and studies that did not adjust the baseline covariates.

RESULTS:
We included in this meta-analysis a total of 17 studies. Our study encompassed 43,911 patients with HPpEF, of whom 19,142 (43.59%) received statin therapy. The mean age was 66.95 years, with a mean follow-up of 3.08 years. In the pooled analysis, statin was significantly associated with reduced all-cause mortality (HR 0.68; 95%CI 0.62-0.76; p<0.01) and HF hospitalization (HR 0.75; 95%CI 0.69-0.81; p<0.01; Fig.1). However, our findings shows no significant change in CV mortality in the statin group (HR 0.84; 95%CI 0.70-1.00; p=0.05; Fig.2A). A subgroup analysis for the primary endpoint reported consistency in the benefits of statin group in patients with HFpEF (HR 0.78; 95%CI 0.74-0.83; p<0.01; Fig.2B) after adjusting the covariates using PS. Moreover, there was a significant difference (p<0.01) between the PS and non-PS results.

CONCLUSION:
In this updated meta-analysis of patients with HFpEF, statin therapy was associated with decreased all-cause mortality and HF hospitalization. Moreover, this finding was confirmed in a subgroup analysis of PS data. However, these benefits do not translate into CV mortality.
Abstract 4145296: Aortic Valve Hemodynamics in Liver Cirrhosis
Authors: Zinoviev Radoslav , Aksoy Olcay
Published: November 2024

Aortic valve stenosis (AS) is often a contraindication to liver transplantation (LT). Despite the widely accepted impact of liver cirrhosis on aortic valve hemodynamics, the change in these parameters with LT or impact of AS on LT outcomes has not been described. Given the rising burden of both AS and liver disease, there is an urgent need to understand this interaction. We identified 674 patients with liver cirrhosis who received LT at UCLA from 1/1/2013 to 12/31/2023 and investigated the change in echocardiographic hemodynamics within a year of the procedure. Patients with severe AS were excluded due to sparsity of these patients in the LT cohort. Aortic valve peak velocity (AV
Vmax
) increased steadily as patients neared transplant and dropped significantly immediately after transplantation (Figure 1A). There was a larger magnitude of change in pre- to post-LT AV
Vmax
in patients with moderate (2.0 vs 1.6 m/s, p < 0.001) as compared to mild AS (1.5 vs 1.4 m/s, p < 0.001) in analysis of variance models. When patients were sorted by ascending pre-operative AV
Vmax
, the magnitude of fall in AV
Vmax
steadily increased (Figure 1B). There was a similar change in mean gradients whereas aortic valve area and dimensionless index remained unchanged after LT. There was a significant decrease in all other echocardiographic parameters associated with volume after LT: biatrial volume and pressure, and biventricular size. There was a 5.5% drop in left ventricular ejection fraction (LVEF) after LT that was statistically significant in confounder-controlled regression models (p<0.001) and negatively correlated with increasing preoperative AV
Vmax
(-6.2%/ms
-1
, p = 0.02). The presence of mild or moderate aortic stenosis was not associated with a change in 30-day or 1-year mortality, need for intraoperative vasopressor or peri-operative blood products. Overall, our findings suggest that markers of volume and aortic transvalvular flow decrease after LT without significant change in aortic valve area. There is a significant post-operative fall in LVEF, the magnitude of which is proportional to pre-operative AV
Vmax
. Mild or moderate pre-operative AS are not associated with worse mortality or need for perioperative support.
Abstract 4145299: Myocarditis leading to cardiogenic shock: COVID-19's Cardiac Crisis
Authors: Abdalla Mahmoud , Anjum Mahnoor , Sepulveda Lidia , Ahmad Aftab
Published: November 2024

Background:
COVID-19 can present with a wide spectrum of clinical manifestations ranging from asymptomatic to life-threatening. It is often thought of as a primarily pulmonary infection and different systemic presentations are sometimes overlooked. We present a case of COVID-19 induced myocarditis leading to hemodynamic instability and end-organ dysfunction.

Case presentation:
A 77-year-old male with a history of CKD, paroxysmal atrial fibrillation, and COPD was transferred to our hospital for a higher level of care due to worsening cardiogenic shock. He was cold and wet (Forrester class IV) with a High Sensitivity troponin of 331 and a BNP level of 21,503. EKG showed atrial fibrillation with RVR but no evidence of acute ischemic changes. A TTE was done which revealed an EF of 30-35% and diffuse hypokinesis with regional variation, a significant reduction from an EF of 50-55% just 4 weeks prior. The patient exhibited end-organ dysfunction, as evidenced by deranged liver function tests and a rise in creatinine from a baseline of 2 to 4.6, indicating congestive hepatopathy and cardiorenal syndrome respectively. The patient’s hemodynamics necessitated milrinone and norepinephrine infusions and efforts to wean them off were unsuccessful due to repeated failed fluid bolus challenges. Considering the patient’s clinical picture, there was a strong suspicion of viral-induced cardiomyopathy, and a COVID-19 infection was confirmed by PCR testing; his last COVID-19 booster dose was in 2021. The patient was promptly started on remdesivir and IV steroids. Unfortunately, the patient's condition continued to deteriorate, and he succumbed to his illness.

Discussion:
A myriad of cardiovascular manifestations have been implicated with COVID-19, including ACS, myocarditis, and heart failure. Although the exact underlying mechanisms for each of these conditions are unclear, a complex interplay between direct viral injury, systemic inflammation, and cytokine storm has been hypothesized. Our case illustrates the quick progression of heart failure into cardiogenic shock requiring pressor support, with subsequent rapid decompensation rendering CMR, cardiac catheterization, and biopsy timely impractical. It serves as a reminder to explore COVID-19 as a potential cause of biventricular failure in individuals with no evident reason and rapid clinical deterioration, particularly as early initiation of antiviral therapy could improve prognoses.
Abstract 4145321: Association of Pulmonary Function Test Between Thrombogenicity in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Authors: Kim Yong-Lee , Kim Hyounwoo , KIM HANGYUL , Kim Hye Ree , Kim Kyehwan , Park Jeong rang , Koh Jin-sin , Hwang Seok-Jae , Hwang Jinyong , Kang Min Gyu
Published: November 2024

Introduction:
Pulmonary dysfunction is a risk factor for increased mortality in patients with acute coronary syndromes (ACS). The purpose of this study was to investigate the association between thrombogenicity and pulmonary function test abnormalities in patients with ACS.

Methods:
We included ACS patients who underwent successful percutaneous coronary intervention (PCI). Pulmonary function was assessed by spirometry based on the forced expiratory volume in one second (FEV
1
%pred) after PCI. Thrombogenicity was evaluated with the thromboelastography and conventional hemostatic measures.

Results:
Among 323 patients, 90 patients (28.8%) had pulmonary dysfunction (moderate or severe spirometric abnormality, FEV
1
%pred <70). Patients with pulmonary dysfunction had higher levels of conventional biomarkers for thrombogenicity (D-dimer, 1.24±1.9 vs. 0.78±1.08 ug/mL, p=0.016, and fibrinogen, 383±124 vs. 331±90 mg/dL, p<0.001, respectively). On thromboelastography, platelet-fibrin clot strength (PFCS) was significantly higher in patients with pulmonary dysfunction (69.2±5.9 vs. 65.4±6.7 mg/dL, p<0.001). High PFCS (≥ 68 mm) was associated with pulmonary dysfunction (OR, 2.30, 95% CI 1.41 – 3.76, p=0.001). All-cause death rate for 3-years was increased in pulmonary dysfunction and high PFCS (23.3% vs. 14.1%, Log-rank test p=0.003, and 27.9% vs. 10.8%; Log-rank test p=0.003, respectively) (Fig. 1).

Conclusions:
This study showed the association between heightened thrombogenicity and pulmonary function test abnormalities and their prognostic implications in ACS patients. This study suggests a pathogenetic mechanism for the poor prognosis of patients with pulmonary dysfunction after PCI.
Abstract Su1202: The utility of post cardiac arrest temperature control protocol according to the severity of hypoxic encephalopathy based on amplitude-integrated electroencephalography findings
Authors: Inoue Ken , Sugiyama Kazuhiro
Published: November 2024

Introduction:
The TTM2 trial showed that active fever prevention below 37.5°C and hypothermia at 33°C had similar outcomes in out-of-hospital post cardiac arrest patients. However, the patients in the trial had mild hypoxic encephalopathy, and the effects of hypothermia may vary with its severity. We previously reported that amplitude-integrated electroencephalography (aEEG) findings after the return of spontaneous circulation can be used to categorize the severity of hypoxic encephalopathy (Crit Care. 2018;22:226). In September 2022, we adopted a new temperature control protocol wherein the target temperature was set based on aEEG findings. This study examined changes in outcomes before and after implementing this new protocol.

Methods:
We assessed out-of-hospital cardiac arrest patients who received post cardiac arrest care in our emergency intensive care unit between March 2021 and February 2024. We divided the patients into two groups: before (B) and after (A) the introduction of the new protocol. We classified the patients into categories 1 (C1) to 4 (C4) based on the severity of hypoxic encephalopathy (Figure 1). All patients in group B were treated with hypothermia at 34°C. In group A, patients in C1 were treated with active fever prevention, and those in C2–C4 received hypothermia at 34°C (Figure 2). Primary outcome was favorable neurological outcomes (cerebral performance categories of 1 or 2) at hospital discharge. Secondary outcome was the duration of mechanical ventilation.

Results:
A total of 160 patients were included. The median age was 62 years and 105 (66%) patients had cardiac etiology. Fifty-five (34%) patients underwent extracorporeal cardiopulmonary resuscitation. The median cardiac arrest time was 29 min. Groups B and A comprised 57 and 103 patients, respectively. C1 category comprised 20 and 28 patients in groups B and A, respectively. The rate of favorable neurological outcomes was 35% in both B and A groups (p=1.00). Regarding C1 patients, the rates were 90% and 86% in B and A groups (p=1.00). Median duration of mechanical ventilation was 5 and 3 days in group B and A, respectively (p=0.11).

Conclusion:
Neurological outcomes before and after introducing the new protocol were similar. Management of patients with mild hypoxic encephalopathy can be simplified with active fever prevention. A temperature control protocol based on the severity of hypoxic encephalopathy using aEEG findings is feasible for emergency physicians.
Abstract Su1205: The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience
Authors: Tajlil Arezou , Abdelradi Amr , Mosleh Wassim , Kattel Sharma , Al Jebaje Zaid , Sharma Umesh
Published: November 2024

Background:
Hypothermia-Induced Targeted Temperature Management (TTM) is a neuroprotective treatment after the return of spontaneous circulation (ROSC) in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, its effectiveness in all patient subpopulations is debated. While short-term survival has been well studied, the impact of TTM on long-term survival is still unknown.

Methods:
In a prospective cohort study, 98 comatose survivors of non-traumatic OHCA were recruited from four tertiary-level hospitals in Buffalo, Western New York and followed up for five years. Patients with active cancer, infection, cardiac pathology or surgery in three-month prior to presentation, were excluded. Cardiac arrest characteristics, demographics, comorbidities, and therapeutic interventions were recorded. According to TTM protocols, a target body temperature of 33°C was reached and maintained for 24 hours using either an intravascular cooling catheter or a surface cooling system. This was followed by gradual controlled rewarming over 12-24 hours to normothermia. Factors associated with the receipt of TTM were determined. The effect of TTM on five-year survival was studied using cox-regression analysis.

Results:
Among comatose patients with mean age of 60.1±14.9 years, 49% received TTM. Females were significantly less likely to receive TTM (35.1% vs 59.3%, p=0.021). In TTM group, the time to ROSC was significantly longer: median [IQR] 14.5 mins (5-19.7) vs 20 mins (12-27), p=0.018. TTM group was more likely to have a history of coronary artery disease (CAD) (12.5% vs 35.4%, p=0.009). Overall, 5-year mortality did not differ significantly between TTM vs. non-TTM: 72.9% vs 66.0%, (HR: 1.134, 95% CI: 0.705-1.826, p=0.603) in univariate and multivariate Cox-regression analysis (Table 1).

Conclusion:
While females are less likely to receive TTM treatment, TTM is more likely to be used in patients with a longer time to ROSC and a history of CAD. The overall five-year survival remains high in both treatment groups in all eligible patients, as well as in shockable and non-shockable rhythm groups studied separately. Larger cohort studies are needed to determine the patients who may benefit most from TTM.
Abstract Su1207: Influence of Duration of Device-based Fever Prevention on Inflammation, Vasopressor Usage, and Oxygen Consumption after Cardiac Arrest - a Substudy of a Randomized Controlled Trial
Authors: Meyer Martin , Beske Rasmus , Molstrom Simon , Grand Johannes , Schneekloth Simon , Obling Laust Emil Roelsgaard , Moller Jacob , Schmidt henrik , Kjaergaard Jesper , Hassager Christian
Published: November 2024

Background:
In the post-resuscitation phase, cardiac arrest patients develop a systemic inflammatory response and fever is likely if not actively treated. The Blood Pressure and Oxygenation Targets after Out-of-hospital Cardiac Arrest (BOX) trial, randomized patients to a total duration of device-based fever prevention for 36 or 72 hours. The trial found no differences in mortality or neurologic outcome. Use of device-based fever prevention for a shorter or longer duration could however result in clinically relevant differences in the magnitude of inflammation, vasopressor usage, and oxygen consumption.

Aim:
To assess the effect of a shorter or longer duration of device-based fever prevention on inflammation, vasopressor usage, and oxygen consumption in the intervention period from 36 to 72 hours.

Methods:
The BOX trail [NCT03141099] randomized comatose resuscitated out-of-hospital cardiac arrest (OHCA) patients to three different treatment targets in the post-resuscitation phase: mean arterial blood pressure target of 63 or 77mmHg; oxygenation targets of 68-75 or 98-105 mmHg; and duration of device-based fever prevention in comatose patients for a total of 36 or 72 hours. Endpoints at 48 and 72 hours: leukocytes; CRP; vasoactive-inotropic score (VIS); systemic oxygen consumption determined by use of Fick’s principle. Analyses were performed both on the total BOX population, and for a sensitivity analysis, selectively on patients still comatose at 72 hours (i.e., not awake or dead) as these had the most exposure to the intervention.

Results:
The total population consists of 789 patients, with 393 and 396 randomized to a total duration of device-based fever prevention for 36 and 72 hours respectively. For the analysis of patients still comatose at 72 hours, 122 and 148 were available for analysis in the 36-hour and 72-hour group respectively. There were no differences between the 36- and 72-hour group for leukocytes, CRP, VIS, or oxygen consumption during the intervention period from 36 until 72 hours, neither for the total population (Figure 1, all p>0.05) or the cohort of patients still comatose at 72 hours (Figure 2, all p>0.05).

Conclusions:
There were no group differences for patients randomized to device-based fever prevention for 36 or 72 hours with respect to the magnitude of inflammation, vasopressor usage, or oxygen consumption. These findings were consistent for the cohort as a whole, and when examining those with most exposure to the intervention.
Abstract Su401: Confidence in performing CPR after training with traditional and female-breasted manikins
Authors: Khosla Shaveta , Gupta Ahana , Ukpaby Chinenye , Schwerin O'Reilly Courtney , Froelich Elizabeth , Sasson Comilla , Kotini-Shah Pavitra
Published: November 2024

Introduction:
Studies have documented that females experiencing an OHCA are significantly less likely to receive cardiopulmonary resuscitation (CPR) than males in public locations. Reasons for this disparity include bystanders fear of being perceived as sexualizing or assaulting females during CPR, concerns about physically injuring females, or low confidence in rendering CPR on females. This pilot study aimed to assess the confidence of CPR trainees who were trained on both traditional and female-breasted manikins.

Methods:
Participants were enrolled at a community bystander CPR training for teachers at an urban public school in 2024. Participants who consented to participate in the study were asked to complete surveys. All participants received a didactic on hands-only CPR, followed by two sets of hands-on practice, first with a traditional manikin, and then with a female-breasted manikin or vice versa.

Results:
Of the 112 participants enrolled in the study, 88.4% were women, and 14% were >50 years of age. The sample was almost all White participants, with high education status (88.4% with a Master’s or college education). The majority (86.6%) had prior CPR training, but most of them reported receiving training more than a year ago. After the two sets of practice (one with traditional manikin, and one with female manikin), 84.7% felt confident to perform CPR on both males and females, while 9.9% felt more confident to perform CPR on female and 5.4% on male. Men and women (84.6% and 84.7%, respectively) felt equally confident in performing CPR on both males and females. Although 28.4% felt either ‘slightly uncomfortable’ or ‘very uncomfortable’ with use of the female manikin, after practicing on a female manikin, 81.6% felt more comfortable with doing CPR on women (11.1% still felt uncomfortable and 7.3% were neutral). When asked which manikin made them feel more confident in performing CPR, 70.9% reported both, while 7.2% said neither, 10% said female manikin and 11.8% selected traditional manikin. 70% of women and 75% of men selected both manikins.

Conclusion:
Training with both types of anatomically accurate manikins is important in improving confidence of community lay responders in performing CPR and reducing community level gender disparities. Future analysis will evaluate change in confidence with each manikin type and assess confidence and knowledge retention 6 months after the training.
Abstract Su403: Iterative Simulation to Optimize Mechanical CPR Device Application
Authors: Lauer Caroline , Wilhelm Kelsey , Leon Elizabeth , Howard Kim , Cook Shane , Schlesinger Shira
Published: November 2024

Mechanical chest compression devices (MCDs) are commonly used for in-hospital and emergency department (ED) cardiac arrest resuscitation. Manufacturer guidelines and educational materials demonstrate that in the prehospital setting, MCDs can be deployed with an interruption in CPR of less than 15 seconds. No similar materials exist for the in-hospital environment, where observational studies have noted median CPR interruptions of up to 40 seconds for MCD deployment. With the integration of extracorporeal CPR (eCPR) into OHCA systems of care, the need to transfer patients with ongoing CPR to MCDs in the ED is growing.

To develop a hospital-specific procedure for receiving a patient in cardiac arrest and deploying the MCD with minimal no-flow time.

We used an iterative participatory design process to develop a procedure for receiving patients in cardiac arrest from Emergency Medical Services (EMS). Tasks included transferring a patient, replacing defibrillator pads, and deploying the hospital MCD with minimal no-flow time. Participants including ED physicians, nurses, and respiratory therapists performed a series of simulations using a high-fidelity manikin, resuscitation equipment, and an MCD. Simulations were followed by focused debriefings, participant-directed modification of the working procedure, and repeat simulation until participants expressed satisfaction with the procedure. Participant roles were shuffled after each round. The primary outcome was the duration of CPR interruption required to deploy the MCD; change in this time over successive iterations was assessed using a Wilcoxon signed-rank test. The final procedure described a sequence of steps and responsibilities that participants deemed efficient and reproducible.

Through seven simulation-debriefing cycles, CPR interruption associated with MCD deployment decreased from 19 to 10 seconds (p = 0.033). The most common failure modes that participants corrected during modifications involved needed equipment that was out of reach, obstructed provider positioning, and poorly defined roles. On subsequent days, two additional groups of on-shift ED providers deployed the MCD in less than 15 seconds following the developed procedure.

Using an iterative design process, we created an MCD deployment procedure that minimized CPR interruptions and was acceptable to hospital staff. This represents an effective, low-cost methodology to design a process for transfer of care during CPR and MCD deployment.
Abstract Su504: The Impact of Locked Cabinets for Automated External Defibrillators (Aeds) on Cardiac Arrest Outcomes: A Scoping Review
Authors: Oonyu Lawrence , Perkins Gavin , Smith Christopher , Vaillancourt Christian , Folke Fredrik , Olasveengen Theresa , Bray Janet
Published: November 2024

Background:
Rapid defibrillation by the public with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest (OHCA) survival. Concerns about theft, vandalism, and misuse of AEDs have led to the implementation of security measures, including the use of locked cabinets to house these devices in public areas.

Aim:
This scoping review aims to systematically explore the existing literature on the impact of locked cabinets for AEDs during emergencies.

Methods:
A search of Medline, Embase, Cochrane, CINAHL and Google Scholar (20 pages) was performed on May 25th 2024. Studies of any design (e.g., experimental, observational, qualitative) that evaluated the impact of locked cabinets on AED accessibility and effectiveness during emergencies. Data were charting was iterative, and after reading included studies the studies were grouped by the outcomes studied.

Results:
We screened 2,096 titles and found 10 relevant studies: 8 observational studies and 2 OHCA simulation studies. Four papers were only published as conference abstract and no studies reported on patient outcomes. Data were reported on varying numbers of AEDS (ranging from 39 to 31,938) which were located inside buildings and public spaces. Overall theft and vandalism rates were very low, with the majority of studies reporting rates of <2%. Although in some studies it was unclear if the AED was stolen, or whether it had been used in an emergency and not returned. The impact of locking AEDs in cabinets was reported in one study, and showed minimal impact on rates of theft and vandalism (0.34% vs. 0.12%, p< 0.01). Two OHCA simulation studies conducted at AED locations showed significantly slower AED retrieval when AEDs were locked away. One survey of first responders reported that 50% (25/50) were injured while accessing an AED, which required breaking glass.

Conclusion:
Rates of theft and vandalism of AEDs located in private and public locations are low overall and in unlocked cabinets. Further research is needed on the impact of locked AEDs on patient outcomes.
Abstract Su507: Occurrence of Fibrillation in Out-of-hospital Cardiac Arrest Patients Presenting in a Non-shockable Rhythm when Treated with an Automated External Defibrillator
Authors: Liu Chenguang , Gao Mengqi , Gehman Stacy , Jorgenson Dawn
Published: November 2024

Background:
Most out-of-hospital cardiac arrest (OHCA) patients who are initially treated with an automated external defibrillator (AED) and present in a non-shockable rhythm never receive a shock. This analysis reports on patients who presented in a non-shockable rhythm when the AED was initially applied and later transitioned into a shockable rhythm.

Methods:
Data from a convenience group of OHCA patients treated with a Philips HeartStart Home, Onsite or FRx AED were included. The AEDs were the first defibrillator on scene either in home, in public access or by a BLS team. Application of any medication during AED use was unlikely. Each patient’s heart rhythms were reviewed by an expert. All patients whose initial rhythm was non-shockable but later received at least one shock were identified and the rhythms were analyzed.

Results:
Out of 876 patients, 322 (36.8%) received at least one shock, of which five patients (1.6%) presented in a non-shockable rhythm and were later shocked. Three patients presented in an organized rhythm. The first patient degraded into Torsade de Pointe as shown in Figure 1; the post-shock rhythm was organized. The second patient received no CPR and A-V pacing was observed in the ECG recording. The pacing stopped when the rhythm transitioned into VF and restarted post shock. The third patient transitioned into VF during chest compressions and the post-shock rhythm was asystole. The remaining two patients presented in asystole and the rhythm evolved to fine VF after receiving chest compressions. After defibrillation, their rhythms returned to asystole.

Conclusions:
For OHCA patients treated with an AED, presenting in a non-shockable rhythm and later transitioning into a shockable rhythm is rare but possible. Lay-responder CPR may play a role in rhythm evolvement. The impact of rhythm changes on survivability of these patients is unknown.
Abstract Su603: Out-of-hospital cardiac arrest presenting with ST-segment elevation myocardial infarction: Real world assessment and treatment
Authors: Halablab Saleem , Kaviyarasu Aarthi , Brothers Taylor , Reis William , Shofer Frances , Abella Benjamin
Published: November 2024

Background:
Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described.

Objectives:
This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice.

Methods:
We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis.

Results:
A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy.

Conclusion:
This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.
Abstract Su702: Association Between In-hospital Cardiac Arrest Incidence and Survival in Older Patients
Authors: Nathani Rohit , Li Qiang , Nguyen Cathy , Koshy Thomas , Hall Hurst , Mentias Amgad , Chan Paul , Girotra Saket
Published: November 2024

Background:
Survival after an in-hospital cardiac arrest (IHCA) varies markedly across hospitals in the U.S. Whether hospitals with IHCA survival also excel in ‘preventing’ IHCA remains unclear.

Methods:
Using 2013-2019 data from the Get-With-The-Guidelines–Resuscitation (GWTG-R) registry linked with Medicare and American Hospital Association data, we identified all patients
>
65 years with IHCA at participating hospitals. Using two-level hierarchical multivariable regression models, we calculated hospital rates of IHCA incidence, adjusted for case-mix index, and risk-standardized survival to discharge (RSSR) for IHCA, adjusted for patient and cardiac arrest variables. We also examined the association of IHCA incidence and RSSR with hospital variables.

Results:
Among >10 million admissions at 335 hospitals during 2013-2019, 77676 patients experienced an IHCA. The median hospital rate of IHCA incidence was 6.9 per 1000 admissions, and the median case-survival rate among those with IHCA was 21.9%. After case-mix adjustment, the median IHCA incidence was 7.9 per 1000 admissions with considerable variation across hospitals: IQR: 5.8-10.3 per 1000 admissions, range 1.2 to 25.4 per 1000 admissions. The median RSSR for IHCA was 22.3%, which varied from 11.5% to 35.7% across hospitals (IQR: 19.5%-24.9%). There was a weak negative correlation between risk-adjusted hospital IHCA incidence and its RSSR (rho = -0.11; p = 0.037) (Figure 1). Adjustment for hospital variables attenuated the negative association between IHCA incidence and RSSR (rho = -0.08; p = 0.13). The nurse-patient ratio was the only modifiable factor significantly associated with lower IHCA incidence (OR = 0.97; p = 0.004) and higher RSSR (OR = 1.05; p <.0001).

Conclusion:
Even after case-mix adjustment, hospital IHCA incidence and survival rates varied markedly. Notably, hospitals with higher survival rates for IHCA did not have a higher incidence. Since case-survival rates for IHCA have plateaued in recent years, our findings highlight that efforts focused on reducing IHCA incidence may yield additional gains in reducing resuscitation deaths in hospitals.
Abstract Su704: Body Mass Index and Outcomes of In-Hospital Cardiac Arrest
Authors: Ikemura Nobuhiro , Abdel Jawad Mohammad , Cho Yoon , Jones Philip , Spertus John , Chan Paul
Published: November 2024

Background:
Although previous studies have reported an association between a patient’s body mass index (BMI) and outcomes for various cardiovascular conditions, the relationship between BMI and survival for in-hospital cardiac arrest (IHCA), a condition for which emergent response is required, has not been fully described.

Aims:
Examine the association between BMI and survival outcomes for IHCA.

Methods:
Within the Get With The Guidelines®-Resuscitation, we identified 56,411 patients with IHCA and available BMI data during 2005-2012 when weight and height data were collected in the registry. BMI was classified as underweight [<18.5 kg/m
2
], normal [18.5 to 24.9 kg/m
2
], overweight [25.0 to 29.9 kg/m
2
], obese [30.0 to 34.9 kg/m
2
], and very obese [≥35.0 kg/m
2
]). Using multivariable hierarchical models with hospital as a random effect, we examined the association between BMI and survival to discharge, stratified by cardiac arrest rhythm type (shockable and non-shockable). As secondary outcomes, we examined rates of sustained return of spontaneous circulation for
>
20 minutes (ROSC) and favorable neurological survival (i.e., survival to discharge without severe neurological disability).

Results:
Among 10,219 patients with a shockable arrest rhythm, 3,964 (38.7%) survived to discharge. After multivariable adjustment, compared with overweight patients, those who were underweight, of normal weight, and very obese had lower survival rates, whereas obese patients had similar survival rates (
Table
). Underweight patients also had a lower rate of ROSC and favorable neurologic survival (
Table
). Among 46,192 patients with a non-shockable arrest rhythm, 7,331 (15.8%) survived to discharge. After multivariable adjustment, all BMI groups had similar rates of survival, ROSC, and favorable neurologic survival, except for underweight patients (
Table
).

Conclusions:
Although the association between BMI and survival outcomes for IHCA varied by initial rhythm, underweight patients consistently had lower survival rates of survival. Very obese patients generally had similar outcomes to other weight groups, underscoring that morbid obesity was not a negative predictor of survival outcomes for IHCA.
Abstract Su903: Prognostic Value of Early Grey-White Ratio in the presence of Hypercapnia after Cardiac Arrest
Authors: Case Nicholas , Coppler Patrick , Faiver Laura , Ratay Cecelia , Steinberg Alexis , Tam Jonathan , Weidman Aaron , Callaway Clifton , Elmer Jonathan
Published: November 2024

Background:
Cerebral edema following cardiac arrest can be quantified by measuring the ratio of grey matter to white matter radiodensity (GWR). Decreased GWR may reflect edema from irrecoverable neuronal cell death or reversible hyperemia driven by hypercapnia. We tested for an interaction between GWR and partial pressure of carbon dioxide (PCO2) predicting outcomes.

Methods:
We identified comatose post-arrest patients treated at our single center between 2010 and 2023 who underwent brain computed tomography (CT) imaging within 24 hours and PCO2 measured within one hour of CT. We extracted demographics, GWR, and PCO2 from our prospective registry and electronic health record. We scaled and centered data, then fit a multivariate logistic model to quantify the interaction between GWR and PCO2 in predicting survival.

Results:
Of 901 included patients, 356 (40%) were female, median [IQR] age was 61 [51-70], and 221 (25%) survived to discharge. CTs were obtained 4.18 [2.8-5.7] hours post-arrest. PCO2 was sampled within 36 median [24-47] minutes of CT. The median PCO2 was 47 [39-59] mmHg. GWR predicted survival (coefficient estimate 1.16, 95% confidence interval [CI], 0.91-1.44, p < 0.001, but PCO2 (-0.11, 95% CI -0.32-0.09, p = 0.29) did not. There was no significant interaction between GWR and PCO2 (0.009, 95% CI -0.24-0.29, p = 0.95).

Conclusion:
There is no evidence of PCO2 modifying the association of early GWR with survival after resuscitation from cardiac arrest.
Abstract Su907: Post-Cardiac Arrest Potassium Abnormalities Associated With Unfavorable Functional Outcome
Authors: Holm Aki , Lascarrou Jean Baptiste , Cariou Alain , Reinikainen Matti , Laitio Timo , Kirkegaard Hans , SOREIDE ELDAR , Taccone Fabio Silvio , Skrifvars Markus
Published: November 2024

Background:
Abnormal potassium levels are common findings in the intensive care unit (ICU) population. We aimed to determine the incidence of dyskalemias at ICU admission and their association with functional outcome in comatose patients resuscitated from cardiac arrest.

Hypothesis:
We hypothesized that both hypokalemia and hyperkalemia are associated with unfavorable functional outcome.

Methods:
Pooled data from four randomized clinical trials in comatose post-cardiac arrest patients admitted to ICU after return of spontaneous circulation (ROSC). Reference potassium levels were defined as between 3 and 4.9 mmol/L, as proposed in the Simplified Acute Physiology Score II. Favorable functional outcome was defined as a Cerebral Performance Category of 1 or 2 at 180 days.

Results:
We included 1133 patients (557 from HYPERION, 346 from TTH48, 120 from COMACARE and 110 from Xe-HYPOTHECA) with a median age of 64 (IQR: 55-72) years and a predominance of males (72%). Overall, 421 (36%) patients had favorable functional outcome. On admission, 221 (19.5%) patients experienced hyperkalemia and 35 (3.1%) patients experienced hypokalemia. More patients in the normokalemia group (364/877, 41.5%) had a favorable functional outcome, as compared to the hypokalemia (11/35, 31.4%) and hyperkalemia (41/221, 18.6%) groups p<0.001). In a mixed-effects logistic regression model including initial rhythm, delay from collapse to ROSC, bystander cardiopulmonary resuscitation, lactate, and urea and with normokalemia as reference group, hyperkalemia was associated with higher odds for unfavorable functional outcome (OR 1.85, 95% CI 1.10-3.12, p=0.02) whereas hypokalemia was not (OR 1.36 95% CI 0.51-3.60, p=0.53).

Conclusions:
One fifth of unconscious cardiac arrest patients experienced dyskalemia on ICU admission. Hyperkalemia was associated with unfavorable functional outcome at 180 days compared to normokalemia, whereas hypokalemia was not an independent predictor of outcome.
Understanding Indo-Canadian Sikh Women’s Challenges after Covid-19
Authors: Morve Roshan K. , Bose Neilesh
Published: November 2024

This paper focuses on Indo-Canadian Sikh women’s issues after Covid-19 and their challenges of diasporic consciousness. It is based on a study conducted with face-to-face interviews in Victoria, Canada, to assess these women’s post-Covid-19 challenges in healthcare and employment and their diasporic dual identity crisis. The research addressed questions like: What are the challenges of Indo-Canadian Sikh women in Canada after Covid-19 and the impact of current political affairs? What are women’s integration challenges (perhaps insecurity, discrimination, etc.)? This research is significant for understanding the difficulties of Indo-Canadian Sikh women as a vulnerable group in terms of diasporic dual consciousness, racial discrimination and post-Covid experiences. Discussions on identity incorporate a diasporic theoretical understanding of the dual identity crisis and elaborate on Canadian multicultural policy from a political perspective.
A bibliographic review of the Chelodesmidae of the Antilles and Bahamas (Diplopoda: Polydesmida)
Authors: SURIEL CARLOS , BUENO-VILLEGAS JULIÁN , MEANS JACKSON C. , BOUZAN RODRIGO SALVADOR
Published: November 2024

Among millipede groups found in the Antilles, the family Chelodesmidae is the most species diverse and well represented in collections. However, to date, there has not been a bibliographic review of the family for the region. Here we compile and review the literature for the Chelodesmidae of the Antilles and the Bahamas, clarify the family’s status for the region, and discuss the central deficits of its taxonomy and the most relevant obstacles for work in the group. The following information is documented for the region: 119 species in 24 genera and 5 tribes. Of the 24 genera, only 8 have been placed in tribes, and 20 are endemic to their respective islands, except for Amphelictogon (Cuba–Hispaniola), Chondrotropis (Hispaniola–Jamaica), Pandirodesmus (Guyana [mainland]–Trinidad and Tobago) and Lepturodesmus (Tobago–Venezuela). Here, Chelodesmidae represents a high species richness when compared to what is known for continental territories, for example in the state of São Paulo, Brazil (64 species) and Venezuela (38 species). Despite its impressive diversity, the Chelodesmidae of the Antilles have yet to be addressed using molecular phylogenetics, and the evolutionary and taxonomic relationships between genera within and outside of the Caribbean are poorly understood.
Post‐traumatic osteoarthritis: The role of accelerated chondrocyte senescence
Authors: Martin James A. , Brown Thomas , Heiner Anneliese , Buckwalter Joseph A.
Published: November 2024

Joint injuries frequently lead to progressive joint degeneration that causes the clinical syndrome of post‐traumatic osteoarthritis. The pathogenesis of osteoarthritis remains poorly understood, but patient age is a significant risk factor for progressive joint degeneration. We have found that articular cartilage chondrocytes show strong evidence of senescence with increasing age, including synthesis of smaller more irregular aggrecans; increased expression of lysosomal beta‐galactosidase and telomere erosion; and decreased proteoglycan synthesis, response to the anabolic cytokine IGF‐I, proliferative capacity, and mitochondrial function. These observations help explain the strong association between age and joint degeneration, but they do not explain how joint injury increases the risk of joint degeneration in younger individuals. We hypothesized that excessive loading of articular surfaces due to acute joint trauma or post‐traumatic joint instability, incongruity or mal‐alignment increases release of reactive oxygen species, and that the increased oxidative stress on chondrocytes accelerates chondrocyte senescence thereby decreasing the ability of the cells to maintain or restore the tissue. To test this hypothesis, we exposed human articular cartilage chondrocytes from young adults to mechanical and oxidative stress. We found that shear stress applied to cartilage explants in a triaxial pressure vessel increased release of reactive oxygen species and oxidative stress induced chondrocyte senescence (as measured by expression of lysosomal beta‐galactosidase, nuclear and mitochondrial DNA damage and decreased mitochondrial function). These observations support the hypothesis that joint injury accelerates chondrocyte senescence and that this acceleration plays a role in the joint degeneration responsible for post‐traumatic osteoarthritis.
Belief in Divine Support and Sense of Mattering: The Image of God as a Moderator?
Authors: Jung Jong Hyun , Upenieks Laura
Published: November 2024

The purpose of this study is to examine how belief in divine support is associated with sense of mattering, and how this association is contingent upon various images of God including authoritative, benevolent, critical, and distant God. Employing OLS regression analyses with data from the 2017 Baylor Religion Survey ( n = 1,375), this study demonstrates that belief in divine support is positively associated with sense of mattering. Yet, a distant God image moderates this association. Specifically, the positive association between belief in divine support and sense of mattering is weaker for individuals who endorse images of God as distant. The findings suggest that while the sense of divine support has beneficial effects on mattering, these psychological benefits are smaller for those who see God as distant. This study contributes to the literature on religion and mattering by underscoring the importance of divine beliefs and their differential effects based on one’s ideas about the nature of God.
The entrepreneurial creative city and its discontents: The politics of art-led urban regeneration in Incheon, South Korea
Authors: Park Se Hoon , Shin HaeRan
Published: November 2024

The increasing occurrence of discontent and conflict regarding making creative cities across the globe has led scholars to pay significant attention to the political dimension of creative-city policies. This study, by exploring the controversy over the Incheon Art Platform, a warehouse-turned art space in Incheon, South Korea, offers a situated understanding of how the city government’s entrepreneurial approach to the creative city was resisted and reinterpreted by local civil society groups. Against the backdrop of enhanced urban entrepreneurialism and the rise of civil activism in Incheon, the arrival of the creative city concept has generated opposing interpretations of the role of art and culture between the city government and civil society groups. Given the state’s expansionist policy toward the cultural sector in the nation, the entrepreneurial version of a creative city was first resisted by local cultural actors along with government-sponsored artists and subsequently sparked an artist-inspired anti-entrepreneurism protest in the city. This paper demonstrated how the creative city became a subject of political struggle within the unique relationship between the state and the cultural sector in South Korea, thereby contributing to enriching global urban knowledge on making and remaking creative cities beyond the Global North.
Subjective and Objective Measurement of Underemployment and Income Among Post-9/11 Veterans
Authors: Morgan Nicole R. , Davenport Katie E. , Balotti Brandon A. , Aronson Keith R. , Perkins Daniel F.
Published: November 2024

Underemployment is an involuntary condition where individuals consider their employment inferior relative to a standard. This study analyzes underemployment among veterans using data from a large longitudinal study and federal occupational data to explore the relationship between subjective perceptions and objective indicators. Veterans reported their occupations, salaries, and subjective underemployment. Each veteran’s occupation was matched with O*NET job zone, education, and occupational median income data. Four groups were identified: neither subjectively nor objectively underemployed, subjectively underemployed only, objectively underemployed only, and both subjectively and objectively underemployed. A one-way analysis of variance (ANOVA) examined salary differences. Most veterans’ occupations required some education, and higher educational attainment correlated with increased underemployment. Two thirds of cases showed agreement between subjective and objective assessments, with underemployed veterans earning significantly less. This study highlights the reliability of self-reports as indicators of objective underemployment and underscores the need for innovative strategies to address veteran underemployment through early detection.