bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 322: Post-cardiac Arrest Care Variations in Michigan Hospitals and Their Impact on Survival
Authors: Song Jaemin , Berger David , Chen Nai-Wei , Paxton James , Miller Joseph , Pribble James , Swor Robert A
Published: November 2020

Introduction:
Targeted temperature management (TTM) is an important component of post cardiac arrest care. Current guidelines recommend deferring prognostic decisions for 72 hours post TTM. Most non survivors have care withdrawn and some hypothesize that early withdrawal of care adversely impacts survival. Our objective is to characterize hospital length of stay (LOS) post cardiac arrest, its relationship to survival and variation by hospitals using a statewide registry.

Methods:
We probabilistically linked out of hospital (OHCA) patients from 2014-2017 in a statewide Cardiac Arrest to Enhance Survival Registry (CARES) and the Michigan Inpatient Database (MIDB). We included resuscitated adult OHCA patients. To assess variation in LOS (arrival-death or discharge), those with > 30 subjects/hospital were included. We abstracted subject demographics, arrest characteristics, in hospital care, and hospital LOS. Our outcome is survival to discharge. We define early death as hospital LOS< 72 hours (LOS<72). We calculated Pearson’s correlation coefficient (r) to characterize the relationship of LOS<72 and patient survival.

Results:
We included 3,644 patients from 38 hospitals. They were predominately male (2160, 59.3%), mean age 62.4, 1716 (47.1%) received TTM, mean LOS was 6.1 days, and 1078 (29.6%) survived to discharge. Median LOS was longer in patients who were survivors (9.0 vs 2.0 days, p<0.001). Median LOS was greater in patients who received TTM (5.0 vs 3.0 days, p< 0.001) and almost half (1813, 49.8%) of all patients had a LOS <72. We observed variation in LOS<72 by hospitals (39.4% to 61.3%, Figure 1), and a negative relationship between LOC<72 and survival (r = -0.36).

Conclusion:
We observed that nearly half of subjects had a LOS<72, and a modest negative correlation of LOS<72 and outcome. These data suggest that further work is needed to clarify whether early hemodynamic collapse or early withdrawal of care explains differences in hospital LOS and survival.
Abstract 327: Asphyxial Cardiac Arrest Induces Dynamic Changes in Dopamine Neurotransmission and Linked Behavioral Deficits
Authors: Braverman Aaron R , Fine David F , Shick Tyler J , Stezoski Jason P , Leak Rehana K , Drabek Tomas , Kochanek Patrick M , Wagner Amy K
Published: November 2020

Introduction:
Cardiac arrest survival has improved with advances in resuscitation care, but survivors face impairments from the resulting hypoxic-ischemic brain injury (HIBI). Given the popular clinical use of DA modulators, despite limited understanding of disturbances in DA neurotransmission after HIBI, we characterized striatal DA signaling and behavioral deficits in a rat model of asphyxial cardiac arrest (ACA).

Hypothesis:
ACA-induced HIBI alters DA neurotransmission linked to behavioral deficits.

Methods:
Adult male Sprague-Dawley rats (n=41) underwent either Sham procedures (n=10) or 5-min no-flow ACA (n=28) insult. Fast-scan cyclic voltammetry (FSCV) and maximal medial forebrain bundle stimulations (60Hz, 10s) were used to characterize presynaptic DA signaling in dorsal striatum (D-Str). FSCV findings were compared with sensorimotor processing [acoustic startle responses (ASR)], open field exploration (total distance & exploratory zone entries), myoclonus, and anhedonia (sucrose preference testing).

Results:
ACA increased maximum evoked overflow
(fig 1)
and several DA release-based kinetic metrics. ACA hindered sensorimotor processing via increased ASR %change, elicited myoclonic responses to auditory stimuli, reduced mobility & exploration, and increased anhedonia. Many behavioral measures correlated with D-Str neurotransmission (
fig 2
).

Conclusions:
ACA causes early hypodopaminergia that evolves to a hyperdopaminergic state by 2 weeks that is associated with behavioral dysfunction. Future work should further characterize striatal pathology post-ACA and identify treatments to resolve altered DA signaling and behavioral deficits.
Abstract 333: A Prospective Study of the Incidence of Intracranial Hemorrhage in Survivors of Out of Hospital Cardiac Arrest
Authors: Gelber Jonathan , Montgomery Martha E , Singh Amandeep
Published: November 2020

Introduction:
Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH.

Aim:
This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC).

Methods:
We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings.

Results:
During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01).

Conclusions:
In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.
Abstract 336: Data-driven Classification of Arrest Location for Emergency Department Cardiac Arrests
Authors: Mikati Nancy , Callaway Clifton W , Coppler Patrick J , Elmer Jonathan
Published: November 2020

Introduction:
Out-of-hospital cardiac arrest (OHCA), in-hospital cardiac arrest (IHCA), and emergency department (ED) cardiac arrests differ in epidemiology, etiology, and outcomes. Resuscitation research is inconsistent in how ED arrests are classified. We used unsupervised learning to compare ED arrests to non-ED OHCA and to non-ED IHCA.

Hypothesis:
Clinical features of ED cardiac arrest patients who achieve return of spontaneous circulation (ROSC) are more similar to IHCA than to OHCA.

Methods:
We performed a retrospective study including all patients resuscitated from cardiac arrest who were treated at a single academic medical center from January 2010 to December 2019. We abstracted clinical information from our prospective registry, including the details of arrest location (ED arrests, OHCA, or IHCA); age; sex; initial arrest rhythm; number of doses of epinephrine, bicarbonate and shocks given during the arrest; duration of arrest; most advanced airway placed intra-arrest; number of rearrests; early post-arrest illness severity (Pittsburgh Cardiac Arrest Category: PCAC); and survival to hospital discharge. We used unsupervised learning (K-prototypes) to identify clusters within the OHCA and IHCA cohorts. We determined the number of subgroups using Scree plots. Finally, we assigned individual ED arrest patients the nearest OHCA or IHCA cluster based on the shortest Gower distance from that patient to the nearest cluster center.

Results:
We included 2,723 patients: 1,709 (63%) OHCA, 642 (23%) IHCA, and 372 (14%) ED arrests. We identified 3 clusters in the OHCA cohort, and 4 clusters in the IHCA cohort. Of the total ED arrest cases, 292 (78%) most closely resembled an IHCA cluster and 80 (22%) most closely resembled an OHCA cluster. The large majority (64%) of ED arrests that were closest to an IHCA cluster survived to hospital discharge; 50% of this subset were awake post-arrest (PCAC I), and 16% were deeply comatose (PCAC IV). In contrast, only 13% of ED arrests that were closest to an OHCA cluster survived to hospital discharge; 65% of this subset were deeply comatose (PCAC IV) and only 5% were awake post arrest (PCAC I).

Conclusion:
Among cardiac arrest patients with ROSC, the large majority of ED arrests resemble IHCA more than OHCA.
Abstract 337: Trends and Outcomes with Early Left Heart Catheterization in Post-Out-of-hospital Cardiac Arrest
Authors: O'Neil Brian J , Mathew Shobi , Dunne Robert B , Miller Joseph B , Klausner Howard , McNally Bryan , Paxton James H , Welch Robert D
Published: November 2020

Background:
Left heart catheterization (LHC) and TTM are proven beneficial after OHCA. Detroit CARES data found a strong, though insignificant, trend for LHC rate and survival (p = 0.1). In 2018, the rate of patients with LHC and good CPC nearly doubled, despite an overall decrease in LHC rate. Therefore, we hypothesize LHC is performed later (after second day of hospitalization) nationwide and a good CPC is likely associated with selection of patients expected to survive.

Methods:
We analyzed the national CARES registry (2013 - 2018) to investigate whether delayed LHC after OHCA was occurring nationally. Included were patients 18 or older, non-skilled care facility patients and surviving to admission. The primary outcome was the CPC dichotomized into good (1 or 2) and poor (3 - 5). A propensity score was derived to predict early LHC that incorporated factors associated with LHC and outcome. A multi-level logistic regression analyses was fit using inverse weighted propensity scores. The primary predictor of interest was early LHC relative to no or late LHC. Also examined were TTM, year of cardiac arrest, and other predictors. Results reported are odds ratios (OR) and the corresponding 95% confidence intervals (95% CI).

Results:
62,195 individual cases were identified; the median age was 61, (IQR-16), 62% male, 32% unwitnessed, 37% bystander CPR, and 35% initial shockable rhythm. 29% had good outcome and 22% received early LHC, 6% late LHC and 72% no LHC. 13% of patients receiving early LHC and 23% with no or late LHC had a good outcome. OR and 95% CI for good outcome were: 2.4 (2.2-2.7) for early LHC, 3.6 (3.3-3.8) for shockable rhythm, 1.9 (1.7-2.0) for public location and 2.0 (1.8-2.2) for witnessed arrest. Over the five-year period, no change in the total LHC occurred and a slight decrease in early LHC, (25%-23%), (Fig 1).

Conclusion:
Early LHC was associated with good outcome (CPC) at hospital discharge. The overall LHC rate is unchanged from 2013-18 with a slight decrease in early LHC.
Abstract 338: Relationship Between Post-arrest Care Cardiac Index and Clinical Outcomes in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial
Authors: Russo Juan J , Boland Paul , Parlow Simon , Unni Rudy , Di Santo Pietro , Bernick Jordan , Osborne Christina , So Derek Y , Hibbert Benjamin M , De Roock Sophie , Fordyce Christopher , Van Diepen Sean , Le May Michel R
Published: November 2020

Introduction:
Comatose survivors of out-of-hospital cardiac arrest (OHCA) have decreased cardiac index (CI) following return of spontaneous circulation. Although reversible, a reduced CI can contribute to cerebral hypoperfusion and impaired neurologic outcomes. We sought to examine the relationship between CI and clinical outcomes following OHCA.

Methods:
CAPITAL-RETURN was a prospective study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management. Between August 2016 and December 2017, comatose survivors of OHCA with an initial shockable rhythm underwent continuous, blinded monitoring of CI using bioimpedance (Cheetah Medical, Portland, OR, USA) for 96 hours after intensive care unit (ICU) admission. In the present study, we examined the association between CI and the composite of death or severe neurologic dysfunction at 6 months (primary outcome) using logistic regression. Severe neurologic dysfunction was defined as a modified Rankin Scale score ≥4. We excluded patients who died or had withdrawal of advanced life support within 72 hours of ICU admission.

Results:
In 53 patients in this analysis (mean age 59±13 years, downtime 24±13 minutes, STEMI 35%), the rate of the primary outcome was 25%. The mean CI was lower in patients with (3.0±0.5 L/min/m
2
) versus without (3.3±0.5 L/min/m
2
) the primary outcome (p=0.018). A higher mean CI during the first 96 hours of ICU admission was associated with lower rates of the primary outcome (OR 0.85 per 0.1L/min/m
2
increase in CI; p=0.025). This association persisted after adjusting for age and downtime (OR 0.78 per 0.1L/min/m2 increase in CI; p=0.014). Cardiac index was similar in patients with versus without the primary outcome at the end of the 96-hour monitoring period (Figure).

Conclusion:
In comatose survivors of OHCA with an initial shockable rhythm, a higher CI during the first 96 hours of ICU admission is associated with lower rates of death or severe neurologic dysfunction.
Abstract 342: Initial Serum Uric Acid and Post Cardiac Arrest Patient Outcomes with Respect to Cardiogenic Causes of Arrest
Authors: Yoon Eun Bee , Chae Minjung K , Lee Sung Eun , Park Eun Jung , Cho Sumin
Published: November 2020

Objective:
Post cardiac arrest patients experience neurologic and systemic ischemic-reperfusion injury. Uric acid (UA) can be a marker of oxidative stress and severity of various cardiogenic diseases, but also has antioxidant capacity with neuroprotective effects. We aimed to evaluate the association between initial UA and neurologic outcomes of survivors of non-cardiogenic and cardiogenic causes of cardiac arrest.

Methods:
This was a retrospective observational study of out of hospital post cardiac arrest patients who had initial UA at admission. Association between UA and cardiogenic cause of arrest was analyzed by linear regression. Then neurologic outcome and UA was assessed with multivariate logistic regression analysis by cardiogenic and non-cardiogenic cause of arrest.

Results:
A total of 126 patients were analyzed. UA was significantly lower in the poor neurologic outcome group than in the good neurologic outcome group [7.9 (1.6) vs. 7.0 (1.8), P<0.01]. Cardiogenic cause of arrest was significantly associated with UA levels [β coefficient 0.87 (0.26-1.49), P=0.01]. In the logistic regression of neurologic outcome and UA by cardiogenic cause of arrest, poor neurologic outcome was not associated with UA in cardiogenic causes of arrest [OR 0.91 (0.62-1.33) P=0.62], but was associated with UA in non-cardiogenic causes of arrest [OR 0.47 (0.23-0.97), P=0.04].

Conclusion:
With respect to neurologic outcome by cardiogenic cause of arrest, lower uric acid was associated with poor neurologic outcomes in non-cardiogenic causes of arrest.
Abstract 343: Effect of Periodic Inspection on Maintenance of the Public Automated External Defibrillators
Authors: Kim Tae Youn , Cha Kyoungchul , Jung Woo Jin , Roh Youngil , Kim So Yeong , Kim Sun Ju , Jung Yoon Kyung , Yoon Sun Hwa , Hwang Sung Oh
Published: November 2020

Introduction and purposes:
Communities need to pay attention to the maintenance of public access defibrillators (PADs) installed in their jurisdictions to ensure that the PADs are always available. The purpose of this study is to assess the maintenance status of the PAD and to investigate the effect of periodic inspections on the maintenance status of the PAD.

Methods:
From 2013 to 2018, PADs installed in Seoul Metropolitan area were eligible. After an 8-hour PAD inspection training, an inspector visited the PAD site once a year to check the defibrillator. The inspector checked the maintenance status of the PAD using the checklist and conducted a questionnaire on PAD management from the PAD manager. At the end of inspection, the inspector gave an instruction on PAD maintenance and usage to the person in charge.

Results:
A total of 18,011 PADs including 3,134 in 2013, 3402 in 2014, 5622 in 2015, 5909 in 2016, 5552 in 2017, and 3615 in 2018 were inspected. During study period, there was a tendency to improve accessibility to PAD including obstacles around the defibrillator (from 9.3% in 2013 to 0.8% in 2018, p trend=0.006) and installation of PAD signs (from 34.3% in 2013 to 99.9% in 2018, p trend=0.007). Maintenance status of PAD was improved in terms of normal operation (from 94.0% in 2013 to 99.7% in 2018, p trend=0.010), normal battery charge status (from 95.6% in 2013 to 99.7% in 2018, p trend=0.037), and availability of valid electrodes (from 97.1% in 2013 to 99.8% in 2018, p trend=0.035). There was no difference in the frequency of actual use to the victims (from 0.7% in 2013 to 1.1% in 2018, p trend=0.803).

Conclusions:
Periodic inspections improve maintenance status of the PAD and its availability.
Abstract 348: Impact of Low and High Partial Pressure of Carbon Dioxide on Neuron Specific Enolase Derived from Serum and Cerebrospinal Fluid in Patients Who Underwent Targeted Temperature Management After Out-of-hospital Cardiac Arrest: A Retrospective Study
Authors: Kang Changshin
Published: November 2020

Aim:
In a previous study, low and high-normal arterial carbon dioxide tension (PaCO
2
) were not associated with serum neuron specific enolase (NSE) in cardiac arrest survivors. We assessed the effect of PaCO
2
on NSE in cerebrospinal fluid (CSF) and serum.

Methods:
This was a retrospective study. PaCO
2
for the first 24 h was analysed in four means, qualitative exposure state (qES), time-weighted average (TWA), median, and minimum-maximum (Min-Max). These subgroups were divided into low (LCO
2
) and high PaCO
2
(HCO
2
) groups defined as PaCO
2
≤35.3 and PaCO
2
>43.5 mmHg, respectively. NSE was measured at 24, 48, and 72 h (sNSE
24,48,72
and cNSE
24,48,72
) from return of spontaneous circulation (ROSC). The primary outcome was the association between PaCO
2
and the NSE measured at 24 h after ROSC.

Results:
Forty-two subjects (male, 33; 78.6%) were included in total cohort. PaCO
2
in TWA subgroup was associated with cNSE
24,48,72
, while PaCO
2
in the other subgroup were only associated with cNSE
24
. PaCO
2
and cNSE in qES subgroup showed good correlation (r= -0.61;
p<
0.01), and in TWA, Median, and Min-Max subgroup showed moderate correlations (r= -0.57, r= -0.48, and r= -0.60;
p<
0.01). Contrastively, sNSE was not associated and correlated with PaCO
2
in all analysis. Poor neurological outcome in LCO
2
was significantly higher than HCO
2
in qES, TWA, and Median subgroups (
p<
0.01,
p<
0.01, and
p=
0.02).

Conclusion:
Association was found between NSE and PaCO
2
using CSF, despite including normocapnic ranges; TWA of PaCO
2
may be most strongly associated with CSF NSE levels. A prospective, multi-centre study is required to confirm our results.
Abstract 349: Target Temperature Management After Return of Spontaneous Circulation Did Not Ameliorate Mid-term (30 to 90-day) Neurological Improvement in Out-of-hospital Cardiac Arrest Patients
Authors: Naito Hiromichi , Yorifuji Takashi , Yumoto Tetsuya , Nojima Tsuyoshi , Fujisaki Noritomo , Yakushiji Hiromasa , Nakao Atsunori
Published: November 2020

Introduction:
Mid/long-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors have not been extensively studied. Targeted temperature management (TTM) after return of spontaneous circulation is one known therapeutic approach to ameliorate short-term neurological improvement of OHCA patients; however, the prognostic significance of TTM in the mid/long-term clinical setting have not been defined.

Hypothesis:
TTM would confer additional improvement of OHCA patients’ mid-term neurological outcomes.

Methods:
Retrospective study using the Japanese Association for Acute Medicine OHCA Registry (Jun 2014 - Dec 2017): a nationwide multicenter registry. Patients who did not survive 30 days after OHCA, those with missing 30-day Cerebral Performance Category (CPC) scores, and those < 18 years old were excluded. Primary endpoint was alteration of neurological function evaluated with 30-day and 90-day CPC. Association between application of TTM (33-36°C) and mid-term CPC alteration was evaluated. Multivariable logistic regression analysis was used for the primary outcome; results are expressed with odds ratio (OR) and 95% confidence interval (CI).

Results:
We included 2,905 in the analysis. Patient characteristics were: age: 67 [57 - 78] years old, male gender: 70.8%, witnessed collapse: 81.4%, dispatcher instruction for CPR: 51.6%, initial shockable rhythm: 67.0%, and estimated cardiac origin: 76.5%. TTM was applied to 1,352/2,905 (46.5%) patients. Thirty-day CPC values in surviving patients were: CPC 1: 1,155/2,905 (39.8%), CPC 2: 321/2,905 (11.1%), CPC 3: 497/2,905 (17.1%), and CPC 4: 932/2,905 (32.1%), respectively. Ninety-day CPC values were: CPC 1: 866/1,868 (46.4%), CPC 2: 154/1,868 (8.2%), CPC 3: 224/1,868 (12.0%), CPC 4: 392/1,868 (20.1%), and CPC 5: 232/1,868 (12.4%), respectively. Of 1,636 patients with 90-day survival, 28 (1.7%) demonstrated improved CPC at 90 days, whereas, 133 (8.1%) showed worsened CPC at 90 days compared with 30-day CPC, respectively. Multivariable logistic regression analysis revealed TTM did not result in favorable mid-term neurological changes (adjusted OR: 1.44, 95% CI: 0.48 - 4.31).

Conclusions:
TTM may not contribute to the beneficial effect on OHCA patients’ mid-term neurological changes.
Abstract 350: Impact on Knowledge Retention on CPR Using a Smartphone App in Teenagers
Authors: Crepaldi Felipe M , Moretti Miguel A , Maya Bárbara G , Magnoni Beatriz G , Costa Giane P , Holsapfel Isabella O , Ferreira João F , Chagas Antonio C
Published: November 2020

Cardiopulmonary arrest occurs more frequently outside the hospital, often in the presence of a teenager. Studies show that knowledge retention of basic procedures in CPR tends to decrease with time.

Hypothesis:
To evaluate the contribution to learning and retention of CPR techniques using a smartphone application (APP) Ressuscita.

Methods:
An application was developed to assist the training of CPR maneuvers. One group of students (gAPP) was trained according to the BLS principles along with the App (which was installed on the smartphones) and the group control (gCT) received the same training, without the APP. Both groups were evaluated at 3 moments, immediately after the first training (T0), 3 months (T3m) and 6 months later (T6m). Theoretical and practical evaluations were performed. After the 3-month, the gCT was received the APP (they were also able to keep the APP). The groups were matched for age and sex. Data were subjected to statistical analysis and treated as mean values and standard deviation. Shapiro-Wilk test, Mann-Whitney test and t test were used.

Results:
93 teenagers were trained, with a mean age of 14 years, 49 in gAPP and 44 in gCT. The graphics show that they were homogeneous and at the end of the training presented the same grade profile in the theoretical and practical evaluation. After 3 months, the gAPP had a better knowledge and retention profile. In the practical evaluation the gAPP demonstrated a smaller reduction in score compared to those with gCT: 0.1
+
0.2 steps vs. 2.1
+
0.3 steps (p <0.001). After six months, the groups returned to the same profile of knowledge and retention. Detailing the practical evaluation, the practical skills were the most improved with the application.

Conclusion:
There was greater retention of knowledge, especially skills, in relation to CPR maneuvers in individuals trained with the app.
Abstract 356: Skill Retention in Medical Students Trained in Cardiac Arrest Care
Authors: Moretti Miguel A , Camboim Adriana O , Ferrandez Caroline A , Etcheverria Isabela C , Costa Iaggo B , Canonaco Juliana S , Mathia Vanessa L , Giraldez Roberto R , Ferreira Joao Fernando M , Chagas Antonio C
Published: November 2020

Background:
Morbidity and mortality reduction in cardiac arrest depends upon early and effective care. Basic life support (BLS) measures encompass a series of procedures to be started outside the hospital usually by trained lay people. Therefore, it is key that lay caregivers retain knowledge and skills late after instruction. However, studies demonstrate loss of cardiopulmonary resuscitation (CPR) skills as early as 30 days after training, pending mostly on the caregiver professional background. In this study, we evaluated medical students’ retention skills at 6 months.

Methods:
Prospective case-control observational study. Medical students underwent a 40-hour BLS training program. CPR skills were evaluated immediately and 6 months after the course based on individual scores before and after training as well as on categorical stratification as excellent, good or poor. Data were compared using F-test, paired t-test and chi-square for categorical variables. A 95% confidence interval was used with a level of significance of 0.05.

Results:
Fifty first-year medical students (54% female) aged between 18 and 24 years were enrolled in the BLS training program. Total number of CPR steps accurately performed decreased after 6 months of training (10.8
vs
. 12.5; p<0.001). Sex and age were not associated with performance. Categorical evaluation was considered excellent in 78% of the students immediately after training but decreased to 40% in 6 months (p<0.01). Hands-on basic skills were mostly lost within the period.

Conclusion:
First-year medical students lost hands-on skills after 6 months of training decreasing the efficacy of CPR measures which might affect outcomes of patients in cardiac arrest.
Abstract 360: Metformin Confers Cardiac and Renal Protection in Sudden Cardiac Arrest
Authors: Rutledge Cody A , Chiba Takuto , Redding Kevin , Sims-lucas Sunder , Elmer Jonathan , Dezfulian Cameron , Kaufman Brett A
Published: November 2020

Introduction:
Sudden cardiac arrest (SCA) affects over 600,000 Americans yearly with substantial mortality. After resuscitation, multiple system organ damage is common. Metformin has previously demonstrated ischemic protection in cardiac and renal tissues. We retrospectively evaluated kidney damage and cardiac function in a cohort of diabetic SCA patients. We also developed a mouse model of SCA that replicates human pathology and pretreated with metformin to evaluate the molecular changes driving these outcomes.

Methods:
We performed a retrospective analysis of patients admitted to a single center from 2010 to 2019 after resuscitation from SCA. We included those with a known diabetes prior to arrest. We extracted home medications from nursing and pharmacy medication reconciliations. Our primary exposure of interest was pre-arrest metformin use (vs no or other medications). We compared first day and maximum serum creatinine (SCr) during hospitalization, as well as cardiac ejection fraction (EF) after arrest. To explore the mechanisms underlying these changes, we developed a mouse model of SCA to compare metformin vs non-treated SCA mice. We evaluated EF and renal endpoints including SCr, BUN, and tubular damage 1-day after SCA. Tissues were collected for molecular and histologic studies.

Results:
We identified 360 diabetic patients of whom 151 (42%) were prescribed metformin at the time of SCA. There were no differences in age, sex, pre-arrest SCr or pre-arrest A1c between metformin and non-metformin treated patients. After SCA, metformin-treated patients had significantly lower initial SCr when compared to non-metformin patients (1.5±0.1 vs 1.7±0.1), 1-day SCr (1.4±0.1 vs 1.7±0.1), max creatinine (1.9±0.1 vs 2.2±0.1 ), and higher EF (49±2 vs 43±2). In the mouse study, pretreatment with metformin group found significantly lower 1-day SCr than non-treated mice (0.40±0.05 vs 1.52±0.22), BUN (64.8±8.2 vs 156.0±39.8), and histologic injury score (0.17±0.71 vs 3.33±0.29), as well as improved 1-day EF (49.6±3.7 vs 38.8±4.5).

Conclusions:
Our data support a renal- and cardio-protective role for metformin after SCA. Future studies will explore biochemical changes driving protection in the mouse with the goal of discovering translatable therapies.
Abstract 366: Association Between Attitudes and Preferences in Cardiopulmonary Resuscitation with Personality Traits in High-risk, Out-patient Healthcare Settings
Authors: Abukhadra Sabine , Jaara Tameen , Preston Caroline , Agarwal Sachin
Published: November 2020

Background:
Little is known about attitudes and preferences towards cardiopulmonary resuscitation (CPR) by outpatient healthcare employees. Investigations assessing the relationship between personality traits and willingness to perform CPR are few.

Methods:
From 10/2018-5/2019, the Columbia University Patient Safety Department partnered with the AHA to conduct training sessions on how to identify an individual in cardiac arrest and perform CPR at eight outpatient medical sites covering all major medical and surgical specialties (~1 million patient visits/year). Sites included did not have code teams and were in varying distances of the Emergency Department (ED). Participants, 80% of employees at each clinic, were surveyed on characteristics and motivation, as they apply to CPR, and completed the Ten-Item Personality Inventory (TIPI).

Results:
Of the 309 participants, 79% (244 of 309) were women and 32% (99 of 309) were Latinx. Before the investigation, 60% (185 of 309) of participants had learned CPR, but only 8.7% (27 of 309) of those individuals had refreshed their knowledge in the past year. About half, 46% (142 of 309), of participants, scored 6 or above (scale 0-7) on the openness personality trait and 77% (238 of 309) scored a 6 or above (scale 0-7) on the conscientiousness trait. More than half, 67% (207 of 309; CI 61-72) of participants claimed that harming others was a major concern in performing CPR at their practice. Participants with high openness scores were significantly less likely to cite their main concern during resuscitation as harm to the victim (p<0.005). When asked of their willingness to perform CPR, 27% (83 of 309; CI 22-33) of participants cited various patient characteristics as deciding factors. Participants with high conscientiousness scores were significantly less likely to view any patient characteristics as critical in the debate to perform CPR (p<0.0001).

Conclusions:
In out-patient healthcare offices, very few employees considered patient characteristics in their willingness to perform CPR; however, the majority are concerned that they will harm a patient by attempting to resuscitate. Future studies should look into the role of different personalities in willingness to perform CPR in a real-life setting.
Abstract 367: Factors That Influence Emergency Responder Treatment Versus Transport Decisions for Out-of-hospital Cardiac Arrest
Authors: Waller Valencia , Fouche Sydney , Entel Kaitlyn , Berri Nasma , Nham Wilson , Armstrong Courtney , Forman Jane , Nallamothu Brahmajee K , Nelson Christopher , Mendel Peter , Abir Mahshid
Published: November 2020

Introduction:
Emergency medical system factors that improve out-of-hospital cardiac arrest (OHCA) survival have not been well elucidated. This study explores factors important to decisions to transport patients before obtaining sustained return of spontaneous circulation (ROSC) in the field throughout the OHCA system of care. Choosing to treat versus transport is a complex decision and reflects various aspects of EMS care that may differ across agencies at different levels of performance.

Methods:
This sequential mixed-methods study used data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) for the years 2014—2017 to identify variation in OHCA outcomes across emergency medical services (EMS) agencies. We then sampled emergency medical stakeholders—dispatch, fire, police, EMS, and receiving emergency departments (EDs)—across nine EMS system sites of varied urbanicity: four high-survival, two intermediate-survival, and three low-survival based on a primary outcome of sustained ROSC with pulse upon ED arrival. To qualitatively explore variations in OHCA survival, we conducted key informant and focus group interviews at each site. Qualitative data were analyzed through combined rapid and rigorous analysis, with a focus on treat versus transport decisions in the Advanced Care link of the “chain of survival” within a broader system of care framework.

Results:
Key factors that weighed into OHCA treatment versus transport decisions pre-ROSC across all sites included: clearly defined roles and protocols, on-scene decision-making authority, distance to the hospital, level of training and expertise, resource availability with regard to personnel and equipment, and payment and reimbursement models.

Conclusions:
Recognizing the critical role of each link in the “chain of survival,” this study identified key factors that impact treat versus transport decisions from the perspective of EMS stakeholders. The next phase of this work will include validating the importance of the identified factors to OHCA survival through a statewide survey of EMS agencies in Michigan. The final product will be a toolkit of best practices to improve survival across U.S. communities.
Abstract 368: Does Filtered Rhythm Technology Lead to Increased Inappropriate Manual Defibrillation?
Authors: To Jimmy , Yang Jenny , Krummen David E , Wardi Gabriel , Sell Rebecca E
Published: November 2020

Introduction:
Defibrillation of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) is an effective treatment for patients with cardiac arrest (CA). Identifying the rhythm during cardiopulmonary resuscitation (CPR) can be difficult with the rhythm obscured by chest compression artifact. “Rhythm” checks are usually recommended, but this interrupts the resuscitation attempt. Filtered rhythm technology such as See-Thru CPR aims to reduce these interruptions by filtering out chest compression artifact, leading to easier visualization of the underlying heart rhythm without stopping CPR.

Hypothesis:
While See-Thru CPR is effective at improving chest compression fraction, inappropriate shocks of non-VF/VT rhythms are still common.

Methods:
This is a retrospective review of an internal database of all cardiac arrests occurring within a two-hospital academic hospital system between July 2012 and September 2019. The local CPR algorithm trains responders to utilize See-Thru CPR to minimize interruptions and increase the chest compression fraction (the average chest compression fraction is > 90%). The database includes all inpatient and emergency room CA and includes patient demographics, cardiac and resuscitation data including CPR parameter data when available, and outcomes. Cardiac arrests with CPR data were reviewed and all defibrillation attempts were identified and analyzed. Pre and post-shock rhythm were identified by reviewing the preceding rhythm strip, and the rhythm following the defibrillation delivery.

Results:
Three hundred thirty-six patients had CA with complete CPR data containing defibrillation attempts. These 336 patients had 1199 defibrillations delivered. Between 1 - 39 shocks were delivered during each event. The majority of defibrillations were delivered correctly for VF/VT (916/1199, 76%), however 23.6% of defibrillations were inappropriate - PEA in 232 attempts (19%) and asystole in 51 (4%). Of these inappropriate shocks, 23 converted to either VF/VT or ROSC, while the rest maintained a non-VF/VT rhythm.

Conclusions:
Defibrillation while using See-Thru CPR for inappropriate shocks is common. Further studies will be needed to show the clinical effects of shocking non-VF/VT rhythms.
Excess 30-Day Heart Failure Readmissions and Mortality in Black Patients Increases With Neighborhood Deprivation
Authors: Patel Shivani A. , Krasnow Maya , Long Kaitlyn , Shirey Theresa , Dickert Neal , Morris Alanna A.
Published: November 2020

Background:

Longstanding racial disparities in heart failure (HF) outcomes exist in the United States, in part, due to social determinants of health. We examined whether neighborhood environment modifies the disparity in 30-day HF readmissions and mortality between Black and White patients in the Southeastern United States.

Methods:

We created a geocoded retrospective cohort of patients hospitalized for acute HF within Emory Healthcare from 2010 to 2018. Quartiles of the Social Deprivation Index characterized neighborhood deprivation at the census tract level. We estimated the relative risk of 30-day readmission and 30-day mortality following an index hospitalization for acute HF. Excess readmissions and mortality were estimated as the absolute risk difference between Black and White patients within each Social Deprivation Index quartile, adjusted for geographic clustering, demographic, clinical, and hospital characteristics.

Results:

The cohort included 30 630 patients, mean age 66 years, 48% female, 53% Black. Compared with White patients, Black patients were more likely to reside in deprived census tracts and have higher comorbidity scores. From 2010 to 2018, 29.4% of Black and 23.0% of White patients experienced either a 30-day HF readmission or 30-day death (
P
<0.001). Excess in composite 30-day HF readmissions and mortality for Black patients ranged from 3.9% (95% CI, 1.5%–6.3%;
P
=0.0002) to 6.8% (95% CI, 4.1%–9.5%;
P
<0.0001) across Social Deprivation Index quartiles. Accounting for traditional risk factors did not eliminate the Black excess in combined 30-day HF readmissions or mortality in any of the neighborhood quartiles.

Conclusions:

Excess 30-day HF readmissions and mortality are present among Black patients in every neighborhood strata and increase with progressive neighborhood socioeconomic deprivation.
Fibroblast Growth Factor 23 and Long-Term Cardiac Function
Authors: Patel Ravi B. , Ning Hongyan , de Boer Ian H. , Kestenbaum Bryan , Lima João A.C. , Mehta Rupal , Allen Norrina B. , Shah Sanjiv J. , Lloyd-Jones Donald M.
Published: November 2020

Background:

Although FGF23 (fibroblast growth factor 23) is associated with heart failure and atrial fibrillation, the mechanisms driving these associations are unclear. Sensitive measures of cardiovascular structure and function may provide mechanistic insight behind the associations of FGF23 with various cardiovascular diseases.

Methods:

In MESA (the Multi-Ethnic Study of Atherosclerosis), we evaluated the associations of baseline serum FGF23 (2000–2002) with measures of left ventricular (LV) and left atrial mechanical function on cardiac magnetic resonance at 10-year follow-up (2010–2012).

Results:

Of 2276 participants with available FGF23 and cardiac magnetic resonance at 10-year follow-up, participants with higher FGF23 levels were more likely White race, taking antihypertensive medications, and had lower kidney function. After covariate adjustment, FGF23 was associated with higher LV mass (β coefficient per 1 SD higher, 1.14 [95% CI, 0.16–2.12],
P
=0.02), worse LV global circumferential strain (β coefficient per 1 SD higher, 0.15 [95% CI, 0.05–0.25],
P
=0.003), worse LV midwall circumferential strain (β coefficient per 1 SD higher, 0.20 [95% CI, 0.08–0.31],
P
=0.001), and lower left atrial total emptying fraction (β coefficient per 1 SD higher, −0.52 [95% CI, −1.02 to −0.02],
P
=0.04). These associations were consistent across racial/ethnic groups and the spectrum of glomerular filtration rates. FGF23 was not associated with the presence of myocardial scar (odds ratio per 1 SD higher, 1.12 [95% CI, 0.86–1.45],
P
=0.42).

Conclusions:

In a multiethnic, community-based cohort, baseline FGF23 levels were independently associated with higher LV mass, lower LV systolic function, and reduced left atrial function over long-term follow-up. These findings provide potential mechanistic insight into associations of FGF23 with incident heart failure and atrial fibrillation.
Biological soil crusts: new genera and species of Cyanobacteria from Brazilian semi-arid regions

Authors: MACHADO DE LIMA NÁTHALI MARIA , BRANCO LUIS H.Z.
Published: November 2020

In the uppermost millimeters of soils is commonly found a thin layer of cryptobiotic organisms, including cyanobacteria, microalgae, lichens, mosses, fungi, bacteria and archaea. These communities are called Biological Soil Crusts (BSCs) or biocrusts and perform important ecological functions, mainly attributed to their capacity of providing soil stability and incorporate nutrients through nitrogen and carbon fixation. Among all the organisms found in the biocrusts, the filamentous cyanobacteria Microcoleus vaginatus and M. steenstrupii are the best studied soil colonizers. The genus Microcoleus is considered complex and has been showing close relation with some species of Phormidium. The poor understanding about these two genera is a limit to the description of the real composition of biocrusts and can generate underestimations in the diversity community and the use of wrong organisms in applied projects (e.g. environmental restoration). This work studied eight cyanobacterial populations from Brazilian BSCs sampled in the Caatinga biome. The populations presented Microcoleus-like and Phormidium-like morphologies, but the phylogenetic analyses based on 16S rRNA gene sequences showed that they represent three new genera and six new species of filamentous cyanobacteria associated to the cryptic genera, they are Pycnacronema caatingensis sp. nov., Pycnacronema edaphica sp. nov., Gracilinea arenicola gen. et sp. nov., Marmoreocelis xerophila gen. et sp. nov., Konicacronema caatinguensis gen. et sp. nov. and Trichocoleus caatingensis sp. nov. The generic name and specific epithets of the new taxa are proposed according to the provisions of the International Code of Nomenclature of algae, fungi, and plants.
Iris zhaoana, a new name for Iris potaninii var. ionantha (I. sect. Pseudoregelia ser. Tigridiae, Iridaceae) from China: evidence from morphological and plastid DNA data

Authors: CRESPO MANUEL B. , ALEXEEVA NINA B. , XIAO YUE E.
Published: November 2020

The new name Iris zhaoana is proposed to replace I. potaninii var. ionantha, which is applied to a dwarf bearded iris described from western China, usually included in I. sect. Psammiris. It is a plant occurring at high elevation and showing roots thick and grey; leaves glaucous-green, blunt to subacute and shortly mucronate at apex; flower solitary, dichromic, bluish-violet, with standards and falls similar in shape and size; falls more richly blotched with deep-violet and with whitish areas; beard of white and blue-white hairs, tipped yellow; fruits globose-ovoid to ellipsoid, shortly acuminate at apex; and seed with a comparatively prominent, large, yellow aril. These features closely relate I. zhaoana to members of I. sect. Pseudoregelia, namely to I. tigridia, with which it has sometimes been confused. Morphological and molecular data are discussed here that support recognition of the Central Asian plant at species rank and its inclusion in I. sect. Pseudoregelia ser. Tigridiae.
A new species and a new record of Peliosanthes (Asparagaceae) from eastern Thailand

Authors: TANAKA NORIYUKI , KALYUZHNY SERGEY S. S.
Published: November 2020

Peliosanthes oksanae is described and illustrated as a new species from eastern Thailand. It is most similar to P. gracilipes known from northern and southwestern Thailand and northwestern Laos, from which it differs mainly by the shorter flowering stem, flowers borne singly or binately in the axils of the bracts and almost free oblong filaments not forming a typical corona. We briefly discuss taxonomic relationships between P. oksanae and two similar species, P. gracilipes and P. caesia. It is notable that especially P. oksanae and P. gracilipes are close in floral characters to Ophiopogon. We also report P. triandra, which was described from southern Cambodia, as new to Thailand. Both P. triandra and P. oksanae occurred in the same habitat.
Typification of two species names in Dendrochilum (Orchidaceae, subgenus Platyclinis)

Authors: NAIVE MARK ARCEBAL K. , SANDERS TREY
Published: November 2020

Dendrochilum Blume (1825: 593), as currently circumscribed, comprises approximately 290 species distributed in Southeast Asia (Pedersen et al. 2019). In the course of updating the genus Dendrochilum website (https://www.dendrochilum.com) and as a start of our revisionary work on the genus, we came across two species names that warrant lectotypification in accordance with the Shenzhen code Art. 9.3, 9.11, 9.12 (Turland et al. 2018). This is accomplished below.
Morphology and molecular phylogeny of Macrobrachium saengphani sp. nov. (Decapoda: Palaemonidae) from Northern Thailand
Authors: SAENGPHAN NUKUL , PANIJPAN BHINYO , SENAPIN SAENGCHAN , SUKSOMNIT AUAREE , PHIWSAIYA KORNSUNEE
Published: November 2020

A small wild prawn of the genus Macrobrachium, found in Chiang Rai Province, Northern Thailand has some morphological features resembling four other closely related species, M. lanchesteri, M. peguense, M. kunjuramani, and M. chainatense. However, it is distinguishable from the above species in terms of distinctive golden colored antennules; number of teeth on the rostrum; number of teeth on the cutting edges of the second pereiopod; and length of carpus relative to that of chela on the second pereiopod. Moreover, DNA analysis places it far apart on the phylogenetic tree from the related species in the genus.
Scribal service people in motion: Culture, power and the politics of mobility in India’s long eighteenth century, c. 1680–1820
Authors: O’Hanlon Rosalind , Venkatkrishnan Anand , Williams Richard David
Published: November 2020

A decade after IESHR’s Special Issue of 2010, ‘Munshis, Pandits and Record-Keepers: Scribal communities and historical change in India’, we return again to the challenges and dilemmas that scribes, bureaucrats, intellectuals and literati of different kinds faced during the early modern centuries. Building on recent advances in our understanding of these key communities, this Special Issue turns the focus to the eighteenth century. We explore the strategies of individuals as they navigated new conditions of service, unexpected opportunities for personal advancement and the complexities of affiliation amid personal networks that extended across boundaries of region, language and religion. We investigate the important role of scribal people in the literary cultures of the eighteenth century, and the new meanings that their participation gave to literary syncretism and hybridity. We return again to questions of intellectual history and the reflections of scribal service people as they sought to find meaning in the collapse of old political formations and the rise of new ones. This Introduction surveys the recent scholarly literature in these connected fields, situates the essays here in the context of this new work, and identifies some of the key questions which remain to be answered in this critical era of transition between the India of ‘early modernity’ and the coming of the colonial world.