bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 256: Outcome Prediction of Out of Hospital Cardiac Arrest with Environmental Information Using Machine Learning
Authors: Harford Samuel , Darabi Houshang , Heinert Sara , Del Rios Marina ,   Illinois Heart Rescue
Published: November 2020

Background:
The lethality of out-of-hospital cardiac arrest (OHCA) among minority and low income patients in large urban centers has been extensively described. Neighborhood disparities in OHCA survival outcomes cannot be fully explained by clinical variables alone. Machine Learning (ML) is a sub-field of Artificial Intelligence where algorithms can learn and improve themselves by studying high volumes of data and evaluating interactions that affect OHCA. We sought to determine whether incorporating neighborhood variables into a ML model of OHCA can increase its predictive accuracy of survival outcomes.

Methods:
Using OHCA data from the Cardiac Arrest Registry to Enhance Survival (CARES) database, we geocoded Chicago incidents that occurred outside of healthcare facilities and nursing homes from 2014 - 2019 into the 77 Chicago community areas. Neighborhood characteristics (e.g., access to healthcare, educational attainment, crime rates) were assigned to OHCA cases based on community area using publicly available data from the Chicago Health Atlas (CHA). The merged CARES and CHA data were used to train, validate, test, and analyze ML models for OHCA survival outcomes, defined as a binary outcome based on Cerebral Performance Category or CPC (Good = CPC 1 or 2; Poor=CPC 3, 4, or 5). ML models including deep neural networks were developed and compared using average class sensitivity to models developed using only CARES data.

Results:
ML algorithms were tested on 9,595 cases of OHCA. Baseline results using only CARES data on the Embedded Fully Convolutional Network (EFCN) show an average class sensitivity of 84%. Including neighborhood variables from the CHA dataset increased the average class sensitivity of the EFCN model to 86.5-86.9%.

Conclusion:
The use of neighborhood variables in combination with CARES data can predict neurologic outcomes with a higher level of accuracy than using CARES registry data alone. Future studies will use this newly developed model to perform simulation experiments to identify neighborhood level interventions to improve OHCA survival outcomes.
Abstract 262: Consumptive Coagulation in a Porcine Model of Prolonged Out-of-hospital Cardiac Arrest Treated with ECPR
Authors: Hill Joseph E , Harvey Stephen L , VanZalen Jensyn J , Hala Pavel , Gok Emre , Jung Joshua H , Pak Oliva L , Bartlett Robert H , Rojas-Peña Alvaro , Neumar Robert W
Published: November 2020

Background:
Following prolonged cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR), recovery of organ function and survival are potentially impaired due to a “no reflow” phenomenon associated with microvascular thrombosis. This study evaluated the effects of antithrombotic interventions on coagulation parameters in a in a porcine model of out-of-hospital cardiac arrest (OHCA).

Hypothesis:
We hypothesized that anticoagulant therapy (argatroban) during CPR and/or thrombolytic (streptokinase) therapy at onset of ECPR would prevent consumptive coagulopathy after prolonged cardiac arrest.

Methods:
In a blinded and randomized study, 48 swine (40±5kg) were subjected to 8min of ventricular fibrillation cardiac arrest followed by 30min of goal-directed CPR (gdCPR), and 8hr of ECPR (33°C) with heparin anticoagulation during ECPR titrated to ACT values (200-300s). Animals were randomized to one of 4 groups (n=12) with 350mg/kg argatroban (Arg) or placebo (20mL NSS) administered 12min after arrest and 1.5 MU streptokinase (STK) or placebo (50mL NSS) at ECPR initiation: Group 1 (placebo and placebo); Group 2 (Arg and placebo); Group 3 (placebo and STK); and Group 4 (Arg and STK). Blood samples were drawn at baseline and at 8hr of ECPR (or earlier if the experiment ended). Data was analyzed using t-tests and ANOVA (p<0.05 significant).

Results:
Average platelet count and fibrinogen levels significantly decreased between baseline and at the end of ECPR (
p
=<0.0001) without difference between groups (
p
=0.6315 and
p
=0.7692, respectively). D-dimer levels significantly increased across groups from baseline to the end of ECPR (
p
=<0.0001) without difference between groups (
p
=0.1881).

Discussion:
These results indicate that this OHCA model induces consumptive coagulopathy and the effects of antithrombotic therapies did not mitigate it in this porcine model.
Abstract 267: Impact of Regular Comprehensive Simulation Training for Extracorporeal Cardiopulmonary Resuscitation to Improves the Outcome in Patients with Refractory Cardiac Arrest
Authors: Takagi Daisuke , Unoki Takashi , Nakayama Tomoko , Yudai Tamura , Motoko Kametani , Yutaka Konami , Suzuyama Hiroto , Masayuki Inoue , Tetsuo Yufu , Kazuhisa Kodama , Taguchi Eiji , Tadashi Sawamura , Koichi Nakao , Sakamoto Tomohiro
Published: November 2020

Background:
Extracorporeal CPR (E-CPR) has been utilized as a rescue strategy for cardiac arrest (CA) patients unresponsive to conventional CPR. Although the time from cardiac arrest to starting extracorporeal membrane oxygenation (ECMO) is known as a predictor for a good outcome, the opportunities to establish the E-CPR initiation flow are limited.

Objective:
We developed a protocol for the E-CPR simulation program and investigated whether the faster deployment of ECMO improves the neurological outcome and mortality in patients with refractory CA.

Methods:
In this single-center observational study, we enrolled 140 consecutive patients who received E-CPR from January 2012 to May 2020. E-CPR simulation training was carried out twice a year with the participation of doctors and co-medicals using a mock vascular model to practice ECMO cannulation and initiation since October 2017. 86 patients received E-CPR in the pre-simulation period (from January 2012 to September 2017), and 54 received in the post-simulation period (October 2017 to May 2020). We assessed the 30-day survival rate and the rate of the Cerebral Performance Category grades 1 and 2 as favorable neurological prognosis.

Results:
No significant difference in age, the rate of the male sex, witnessed CA, by-stander CPR, shockable rhythm at the initial contact, acute coronary syndrome (ACS) as a cause of CA, and out of hospital CA (OHCA). The collapse to ECMO placement time (CTET) was significantly shorter in the post-simulation group compared to the pre-simulation group (44 min [IQR; 27-74] vs. 32 min [IQR; 15-46]; P<0.01). The rate of 30-day survival and favorable neurological outcome was significantly higher in the Post-simulation group compared to the pre-simulation group (16% vs. 20%; P=0.02, 9% vs. 13%; p=0.03, respectively). Cox regression analysis including data on the age, male sex, OHCA, initial shockable rhythm, ACS, and CTET revealed that CTET was significantly associated with the 30-day mortality (HR for 5 minutes increase, 1.12 [95%CI; 1.07-1.16]; p<0.01).

Conclusion:
A regular comprehensive simulation-based E-CPR training improves the 30-day mortality and the neurological outcome in patients with refractory CA as a result of the shortening of the ECMO deployment.
Abstract 282: In Hospital Outcomes of Cardiac Arrest in Patient with End Stage Renal Disease
Authors: Khan Muhammad , Khan Muhammad U , Munir Muhammad
Published: November 2020

Background:
End stage renal disease (ESRD) is a well-recognized risk factor for development of sudden cardiac arrest(SCA). There is limited data on outcomes after an in-hospital SCA event in ESRD patients.

Methods:
Data were obtained from National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using International Classification of Disease, 9th Revision, Clinical Modification, and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Propensity -matched analysis using logistic regression with SD caliper of 0.2 was used to match patients with and without ESRD. Crude and propensity-matched (PS) cohorts outcomes were calculated.

Results:
A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS matched cohort (70.4% vs. 70.7%, p = 0.45, figure 1) with an overall downward trend over our study years (figure 2).

Conclusion:
In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients
Abstract 291: Return of Spontaneous Circulation Detection in Pseudo-Pulseless Electrical Activity Using Plethysmography
Authors: Guerra Sylvia M , Lindqwister Alexander L , Klein Samuel B , Moodie Karen L , Paradis Norman A
Published: November 2020

Background:
Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. p-PEA may constitute up to 40% of reported cases of cardiac arrest and its physiology is different from ventricular fibrillation or even True-PEA. There have been promising studies showing that pulse oximetry plethysmography (POP) can be used to monitor the quality of cardiopulmonary resuscitation (CPR) and detect return of spontaneous circulation (ROSC) during undifferentiated PEA. However, the utility of POP has not been characterized in p-PEA.

Methods:
Pigs (N = 14) were instrumented with aortic and central venous micro-manometer catheters. A POP device was attached to the left ear at the cauda helicis. Hypoxic p-PEA was induced using a 94% N
2
, 6% O
2
mix. Hemodynamic and POP amplitudes were recorded. Mean amplitudes were then calculated for baseline, untreated p-PEA, CPR (if administered), and during ROSC, which was defined as a positive MAP incline to a stable plateau pressure. POP amplitudes were then analyzed as relative increase ratios of ROSC compared to disease state.

Results:
There were statistically significant increases in relative POP amplitudes in ROSC from the p-PEA disease state (Figure 1). In pigs that required CPR for ROSC, the mean ROSC to CPR POP ratio was 1.204 (P<0.01, 95% CI [1.26 - 3.33]). Pigs that did not require CPR for ROSC had a mean ROSC to pseudo-PEA ratio of 2.17 (p<0.01, 95% CI [1.26 - 3.33]). The mean ratio difference between pigs requiring CPR and those that did not was 0.049.

Conclusions:
These data suggest that measurement of POP may delineate the degree of interventions required to achieve ROSC, and can be used in detection of ROSC. If confirmed clinically, POP may be a promising non-invasive operator-independent method that may improve the management of PEA.
Abstract 299: Effect of Start Position and Compression Depth on Mechanical CPR Hemodynamics in Swine
Authors: Allen Shannon E , Hubert Allison , Nsumbu Dorcas , Ang Samantha , Canty John M , Weil Brian R
Published: November 2020

Introduction:
Mechanical devices offer the ability to provide consistent fixed-depth chest compressions during CPR. Although compression depth is considered a primary determinant of CPR quality, the influence of other device settings has received less attention. Accordingly, we evaluated the combined effect of compression depth and device start position on CPR hemodynamics in a porcine model of cardiac arrest (CA).

Methods:
Swine (n=119) were subjected to 7-10 min of CA following electrical induction of ventricular fibrillation. CPR was subsequently performed manually (target peak aortic pressure: 100 mmHg; n=73) or with a mechanical compression system (LUCAS 3.1, Stryker; n=46). Within the mechanical CPR group, animals received 102 compressions/min using either factory default settings (“QuickFit” automated suction cup start position; compression depth: 2.1”; n=13) or custom settings (manual suction cup start position; compression depth: 1.8”; n=33). Aortic pressure (Ao), coronary perfusion pressure (CPP), and regional cerebral oxygen saturation (rSO
2
; via near infrared spectroscopy) were compared between groups after 1 min of CPR.

Results:
Mechanical CPR with automated suction cup start position and compression depth of 2.1” resulted in significantly higher peak Ao and CPP than mechanical CPR with manual start position and compression depth of 1.8” (
Table
). Compared with manual CPR, only mechanical CPR with automated start position and compression depth of 2.1” led to a higher CPP. However, cerebral rSO
2
values fell from 61±1 % at baseline to 49±1 % during CA (p<0.01) and did not increase during CPR in any group.

Conclusion:
Compared with a manual start position and compression depth of 1.8”, use of the LUCAS “QuickFit” feature and compression depth of 2.1” led to a significantly higher CPP during mechanical CPR. Future studies are necessary to determine if differences persist during prolonged CPR with and without concomitant vasopressor administration.
Abstract 312: The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurological Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Ikeda Takamitsu , Miyazaki Yusuke , Marutani Eizo , Ichinose Fumito
Published: November 2020

Introduction:
The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although most CA survivors are sedated during targeted temperature management, the effects of sedation on post-arrest outcomes remain to be determined.

Hypothesis:
Sedation after CA improves neurological outcomes by modulating cerebral electrical activity and metabolism.

Methods:
Ten to 14 days after implantation of EEG transmitters, adult male C57BL/6J mice were subjected to CA and cardiopulmonary resuscitation (CPR). After return of spontaneous circulation (ROSC), mice received intravenous infusion of propofol, dexmedetomidine (DEX), or normal saline (vehicle) for 2 hours. Body temperature was maintained at 37°C, and was subsequently lowered to 33°C. Cerebral blood flow (CBF) was measured for 4 hours following ROSC. To quantify time-dependent EEG changes, we calculated the sum of the Delta, Theta, and Alpha band power in consecutive 12-hour intervals after ROSC (D
0-12
and D
12-24
, T
0-12
and T
12-24
, and A
0-12
and A
12-24
, respectively). Because the increase in fast EEG activity over time may reflect neurological recovery after CA, we compared the ratios of D
12-24
to D
0-12
, of T
12-24
to T
0-12
, and of A
12-24
to A
0-12
among groups.

Results:
As compared with vehicle-treated mice, propofol- or DEX-treated mice exhibited improved survival rate and neurological function after CA, though no difference was found between propofol- and DEX-treated mice. In the vehicle group, CBF was higher than the baseline after ROSC, while the increase in CBF was attenuated in the propofol and DEX group. The values of A
12-24
/A
0-12
and T
12-24
/T
0-12
were significantly higher in propofol- and DEX-treated mice than in vehicle-treated mice (
P
= 0.017 and
P
= 0.004, respectively, propofol vs vehicle;
P
= 0.038 and
P
= 0.002, respectively, DEX vs vehicle), but there was no significant difference in D
12-24
/D
0-12
among groups. In all post-arrest mice, both A
12-24
/A
0-12
and T
12-24
/T
0-12
were positively correlated with better neurological function at 24 and 48 hours after CA.

Conclusions:
Post-arrest sedation was associated with a reduction in CBF and a greater recovery of fast EEG activity after CA, and improved neurological outcomes and survival in mice.
Abstract 323: Three-dimensional Transesophageal Echocardiography and Speckle Tracking Echocardiography in Infective Aortic Endocarditis: Analysis of Parameters Predictors of Outcome
Authors: Capotosto Lidia , Ciardi Maria , Tanzilli Gaetano , Enrico Mangieri , Miraldi Fabio , Mastroianni Claudio , Vullo Vincenzo , Vitarelli Antonio
Published: November 2020

Purpose:
Due to the high mortality and morbidity of patients with aortic endocarditis, careful monitoring is necessary to recognize an early failure of antibiotic and cardiokinetic therapy and avoid a possible cardiogenic or septic shock. The timing of surgery is crucial for patients in whom medical therapy fails. The aim of our study is to identify potential echocardiographic "markers" of adverse events in patients with aortic regurgitation from infective endocarditis.

Methods:
Seventeen patients with aortic regurgitation (AR) from infective endocarditis were studied by 3-dimensional transesophageal echocardiography (3D-TEE) and transthoracic speckle tracking echocardiography (STE). Fifteen healthy subjects were selected as controls. Vegetation size was assessed by 3D-TEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular (LV) longitudinal strain (LS), radial and circumferential strain were measured by STE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV torsion (LVtor).

Results:
Severe AR had decreased LS compared with control subjects. LVtor decreased significantly in severe AR compared to normals (p<.005) as a result of a predominant decrease in apical rotation. By multivariate analysis, LV-LS (p=0.005), LV-tor (p=0.006) and vegetation size (p=0.009) were predictive of adverse events. ROC curves suggested that thresholds offering an adequate compromise between sensitivity and specificity for adverse events detection were -18.2% for mean global LV-LS (AUC .79), 13mm for vegetation size (AUC .86), and 19.4degrees for LVtor (AUC .81). The combination of vegetation size and LV strain had the highest diagnostic accuracy for identifying adverse outcome, superior to vegetation size (p=.006) or LV strain alone (p=.002).

Conclusions:
The combined assessment of the characteristics of vegetating masses and LV function strain parameters improves the sensitivity of the echocardiographic indices in predicting cardiac morbidity and mortality of aortic regurgitation from infective endocarditis.
Abstract 326: Practice Variation in the Transition from Weight-based to Flat Dosing of Epinephrine During Cardiopulmonary Resuscitation in Pediatric Intensive Care Units
Authors: Kienzle Martha , Morgan Ryan W , Dewan Maya , Tegtmeyer Ken , Srinivasan Vijay , Nadkarni Vinay M , Hebbar Kiran , Sutton Robert M , Wolfe Heather A
Published: November 2020

Introduction:
Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations (0.01 mg/kg with a maximum dose of 1mg), but do not specify the age or weight at which adult (flat) dosing should be provided.

Hypothesis:
We hypothesized that there would be considerable practice variation in the transition from weight-based to flat dosing of epinephrine in pediatric ICUs (PICUs) and that more providers would prioritize weight than age in making this decision.

Methods:
We performed an IRB-exempt, multi-institution, internet-based survey. Recipients were U.S. PICU attending physicians (one per institution) involved in resuscitation system oversight. Proportions across categories were compared using Chi-square testing.

Results:
Of 137 institutions surveyed, 68 (50%) responded. Most responding institutions are children’s hospitals (free-standing or dedicated pediatric hospitals within combined hospitals) (67; 99%) and academic (55; 81%); 41 (60%) have PICU fellowship programs. Thirteen (19%) respondents are PICU medical directors, 16 (24%) are resuscitation committee members and 21 (31%) are PICU attendings with an interest in resuscitation. When choosing between weight-based and flat dosing, a significantly higher proportion of providers consider weight (64/68; 94%) vs. age (23/68; 34%) (p <0.01). Among those using age, there were no significant differences in the proportion of providers transitioning at 12 to <14 years of age (0, 0%), 14 to <16 (4, 17%), 16 to <18 (5, 22%) or ≥18 (6, 26%; p=0.82). Among those prioritizing weight, there was a significant difference between the proportion of providers transitioning at 50 to <60kg (28, 44%), 60 to <80kg (17, 27%), 80 to <100kg (5, 8%) or ≥100kg (8, 13%; p< 0.01). Twenty-nine (43%) institutions use an ideal body weight that is less than the patient’s actual weight when dosing epinephrine in obese patients.

Conclusions:
There is considerable practice variation in the transition from weight-based to flat epinephrine dosing during CPR in PICUs with most institutions using patient weight. Given the potential for large variation in amount of epinephrine delivered to these patients, prospective study is warranted to inform PALS guidelines.
Abstract 330: No Direct Mitochondrial Protection Against Ischemia Reperfusion Injury in Rat Isolated Hearts by P188 Postconditioning
Authors: Eskaf Josephine , Meyer Luise J , Cleveland William J , Li Zhu , Riess Matthias L
Published: November 2020

Introduction:
Myocardial infarction and cardiac arrest lead to ischemia-reperfusion (IR) injury in the heart. Timely reperfusion through percutaneous coronary intervention and cardiopulmonary resuscitation, respectively, reduces ischemia but also exacerbates myocardial injury. Maintaining mitochondrial function is crucial in maintaining cardiomyocyte function in IR injury. Poloxamer 188 (P188) is a triblock copolymer that has shown protective effects in in-vitro, ex-vivo and in-vivo myocardial IR models. P188 is thought to improve cellular and mitochondrial function during IR by stabilizing membranes.

Hypothesis:
P188 postconditioning has direct protective effects on mitochondrial function as assessed by ATP synthesis, oxygen consumption and calcium retention capacity (CRC).

Methods:
After approval by the local authorities, hearts of 42 adult male Sprague-Dawley rats were isolated and perfused ex-vivo with oxygenated Krebs Buffer (KB) for 20 min before 30 min of no-flow ischemia. Hearts were reperfused for 10 min with KB. Cardiac mitochondria were isolated with 1 mM P188 vs 1 mM polyethylene glycol (PEG) vs vehicle by differential centrifugation. Mitochondrial function was assessed for complex I and II substrates of the respiratory chain. Statistics: Kruskal-Wallis with Dunn’s posthoc testing; alpha=0.05.

Results:
Mitochondrial function decreased significantly after ischemia and showed improvement with reperfusion. P188 did not result in significant improvements in mitochondrial ATP synthesis, oxygen consumption and CRC function after IR, and neither did PEG.

Conclusions:
P188 does not have a direct protective effect on mitochondria in this model. This might be owed to the fact that no additional damage could be observed after reperfusion which is the type of injury targeted by P188 post-conditioning.
Abstract 334: Evaluating Sedation Regimens and Time to Awakening in Post Cardiac Arrest Patients
Authors: Levito Marissa , McGinnis Cory , Groetzinger Lara , Durkin Joseph , Elmer Jonathan
Published: November 2020

Introduction:
Guidelines for post-arrest care recommend use of short acting sedation, but there is currently significant practice variation. We tested whether benzodiazepine use was associated with delayed awakening in this population.

Methods:
We performed a retrospective cohort study at a large academic medical center including comatose patients hospitalized after resuscitation from in- or out-of-hospital cardiac arrest from January 2010 to September 2019. We excluded patients with cardiac arrest secondary to primary neurological event or trauma, those with severe cerebral edema on initial head imaging, those who were awake post-arrest and those with severe shock for whom benzodiazepines might have been chosen for hemodynamic reasons. We extracted all medication information from the electronic medical record and standard clinical and outcome information from a prospective registry maintained at our center. We considered patients to be exposed to benzodiazepines if they received
>
10mg midazolam equivalents in the first 72 hours after cardiac arrest and censored cumulative mediation data at awakening for those who awakened before 72 hours. Our primary outcome of interest was days from arrest to awakening, which we defined as following verbal commands. We compared median time to awakening across sedation groups, then performed Cox regression to test the independent association of benzodiazepine exposure with time to awakening after adjusting for age, sex, weight, presenting rhythm, arrest location, initial serum creatinine, initial shock severity, initial neurological examination and presence of epileptiform.

Results:
Overall, 2,778 patients presented during the study period of which 621 met inclusion criteria for analysis and 209/621 (34%) awakened after a median of 4 [IQR 3 - 7] days. Patients who received benzodiazepines for sedation awakened significantly later than those who did not (5 days vs. 3 days, P=0.004). In adjusted regression, benzodiazepine exposure was independently associated with delayed awakening (adjusted hazard ratio 0.64 (95% CI 0.44 - 0.94)).

Conclusion:
Benzodiazepine exposure is associated with delayed awakening in comatose survivors of cardiac arrest.
Abstract 335: The Impact of Early Coronary Angiography on Outcomes in Out-of-hospital Cardiac Arrest: The Singapore Experience
Authors: Lim Shir Lynn , Lau Yee How , Chan Mark , Chua Terrance , Tan Huay Cheem , Foo David , Lim Patrick , Liew Boon Wah , Yeo Khung Keong , Ong Marcus ,   Singapore PAROS Investigators
Published: November 2020

Background and Aim:
The benefit of early coronary angiography (CAG) and revascularization in resuscitated out-of-hospital cardiac arrest (OHCA) is unclear. We evaluated the association between early CAG and clinical outcomes in these patients.

Methods:
Data on all resuscitated adult OHCA cases of cardiac etiology between 2011-2015 were extracted from the prospective Singapore Pan-Asian Resuscitation Outcomes Study and linked with data from the national database of cardiac procedures. The 30-day survival and neurological outcomes (good outcome defined as Cerebral Performance Category [CPC] 1 or 2) were compared between patients undergoing early CAG (within 1-calender day) and patients not undergoing early CAG. Inverse probability weighted estimator was used to adjust for propensity to perform early CAG and PCI.

Results:
Of 976 consecutive patients who survived to admission (mean age 64±13, 73.7% males), 401 (41.1%) patients underwent CAG and obstructive coronary artery disease (CAD) was present in 352 (87.8%), of whom 284 (70.8%) underwent revascularization. Patients who underwent early CAG (n=337[34.5%]) were significantly different compared to those who underwent delayed or no CAG (n=639[65.5%]) (Table 1). Early CAG and PCI patients had improved survival and better neurological outcomes (adjusted odds ratio [AOR] 3.806 [95% CI 1.675 - 8.648] and AOR 3.075 [95% CI 1.119 - 8.451]), compared to those without. The odds of survival decreased with epinephrine administration (AOR 0.357 [95% CI 0.199 - 0.640]), but increased with an initial shockable rhythm (AOR 6.587 [95% CI 3.659 - 11.861]). The rates of bleeding (2% vs 0%, p=0.300) and stroke (1.6% vs 1.9%, p=0.880) were not increased with early intervention.

Conclusion:
Early CAG and PCI after OHCA were associated with improved clinical outcomes after OHCA without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.
Abstract 345: Resuscitation Quality in the Intensive Care Unit- A Retrospective, Observational Study
Authors: Roessler Lara L , Holmberg Mathias J , Pawar Rahul , Lassen Annmarie T , Moskowitz Ari
Published: November 2020

Background:
Adherence to quality metrics during in-hospital cardiac arrest (IHCA) have been associated with improved outcomes, however, quality metric adherence in the intensive care unit (ICU) has not been well described. In this study, we assessed trends in adherence to time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of endotracheal airway device placement during IHCA in the ICU and identified potential predictors of adherence failure.

Methods:
This was an observational study using the
Get With The Guidelines® - Resuscitation
registry, a United-States based IHCA registry. Adult patients (>18 years) with an index cardiac arrest in adult ICUs between 2006 and 2018 in the US were included. Generalized estimation equations were used for the analyses.

Results:
We included 75668 patients. From 2006-2018, adherence to time to epinephrine ≤ 5 min increased from 93% (95%CI, 93%-94%) to 98% (95%CI, 97%-98%), time to defibrillation ≤ 2 min went from 71% (95%CI, 68%-75%) to 74% (95% CI, 71%-77%) and confirmation of airway device placement increased from 93% (95%CI, 91%-94%) to 97% (95% CI, 96%-98%). Significant predictors of defibrillation >2 min included a non-cardiac (RR, 1.35; 95%CI, 1.25-1.46) and traumatic (RR, 1.67; 95%CI, 1.34-2.09) illness category, a prior history of renal insufficiency (RR, 1.13; 95%CI, 1.06-1.22), no myocardial infarction (RR, 1.09; 95%CI, 1.00-1.19), no metabolic abnormality (RR, 1.10; 95%CI, 1.01-1.20), events occurring at nighttime (RR, 1.08; 95%CI, 1.01-1.14), an initial PVT as opposed to VF rhythm (RR, 1.10; 95%CI, 1.03-1.16), no arterial line in place at time of event (RR, 1.20; 95%CI, 1.09-1.32), and events occurring at a small hospital (RR, 1.17; 95%CI, 1.02-1.34).

Conclusions:
Overall, quality metric adherence was high in the ICU, with the exception of time to defibrillation ≤ 2 min. Predictors associated with defibrillation >2 min, included a non-cardiac and traumatic illness category and nighttime arrests.
Abstract 352: Development of a Novel Tool for Data Abstraction From 911 Calls for Out-of-hospital Cardiac Arrest
Authors: Hunt Nathanial , Dowker Stephen , Trumpower Brad , O'Leary Michael , Kamdar Neil , Smith Graham , Sams Woodrow , Coulter-thompson Emilee , Bloom Randy , Polydoras Cindy , Irwin Kevin , Swor Robert , Abir Mahshid , Domeier Robert , Friedman Charles , Neumar Robert W , Nallamothu Brahmajee K
Published: November 2020

Introduction:
For out-of-hospital cardiac arrests (OHCAs) unwitnessed by emergency responders, contact with the 911 system provides the earliest point for consistent data collection. Building upon previous tools, we developed a 911 call data abstraction instrument and tested it to see if it reliably tracked key metrics from 911 calls for dispatch assisted CPR in order to guide quality initiatives for OHCA.

Methods:
Data abstractors applied this tool to a random sample of 23 emergency medical services (EMS)-confirmed, second-party, non-traumatic, non-overdose adult OHCAs occurring prior to first responder arrival from November 2017 to November 2019 in Washtenaw County, Michigan. For each call, data elements were collected by 2 independent reviewers. We focused on key variables: 1) whether the arrest was recognized by dispatch in eligible cases (n=23), 2) whether instructed compressions were provided in eligible cases (n=23), and 3) the 911-time-to-first-instructed-compression (n=11). To evaluate interrater reliability, we calculated kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables.

Results:
We included 23 calls with an average patient age of 64.2 (SD: 10.9) lasting an average of ~5 mins. Overall, 16 patients were men and 7 were women. Thirteen calls originated from private residences, 9 from a public place, and 1 could not be identified. We found that OHCA was recognized by dispatch in 18 of the 23 calls (78%). Reviewers reported instructed compressions occurred in 14 of 23 calls (61%). The median 911-time-to-first-instructed-compression of calls where consistent measurement was possible (n=11) was 197.5 seconds (IQR: 2:30.0-4:44.0). Among calls, kappa statistics for recognition of cardiac arrest and provision of instruction compressions was 1.00 (n=23) and 0.91 (n=23), respectively, while the ICC for time-to-first instructed compression was >0.99 (n=11).

Conclusions:
Reviewing 911 calls with this tool was capable of collecting reliable information from independent reviewers on key events including critically important times. Collection of these data is a critical first step for evaluating system performance to improve survival from OHCA.
Abstract 353: Resuscitation Science Training Programs: A Review
Authors: Leung K.H. Benjamin , Jefkins Tiffany , Gustafson Dakota , Moore Julie E
Published: November 2020

Introduction:
While training in the practice of resuscitation is standardized by AHA guidelines and ACLS protocols, training in resuscitation science research has generally relied on mentorship by current researchers. Formal research-focused training programs in resuscitation science exist but the nature of such programs is not well known. We sought to determine the current state of graduate or professional-level research-focused programs in adult resuscitation science using scoping review methodology.

Methods:
We conducted an online web search for the phrases “resuscitation science education”, “resuscitation science training”, “resuscitation medicine education”, and “resuscitation medicine training” in May 2020. Entries were screened for relevance by their title and web text by two independent researchers. Entries were excluded if they did not contain a sizable research foundation or major project component for students. After the screening process, entries were analyzed descriptively and thematically categorized by aspects of program delivery.

Results:
We identified 16 programs that satisfied all inclusion criteria, consisting of 9 instructional programs and 7 research fellowships. Instructional programs were divided between stand-alone programs (4) or electives/add-ons within existing degrees (5). These programs were highly varied in their research requirements with some requiring minimal academic output. Electives/add-ons within existing degrees were generally shorter in length with most averaging only 4 weeks to completion. Two programs offered programs discussing pre-hospital, in-hospital, and post-hospital considerations for patients/caregivers and/or clinicians. Only one stand-alone program was degree-granting. Research fellowships generally varied between 1-2 years. The vast majority of all programs were limited to those with a clinical background, with emphasis on physicians specializing in emergency medicine.

Conclusion:
There is a relative lack of standardized research-focused training programs within resuscitation science. Moreover, existing programs tend to be constrained to those with a clinical background, presenting a barrier of entry for non-clinicians.
Abstract 357: Will a College Student Perform Conventional Cardiopulmonary Resuscitation on a Stranger?
Authors: Short Trevor , Baird Trey , Dluzynski Daniela , Vanscoy Rachel , Panchal Ashish R
Published: November 2020

Background:
For many years, significant effort has been placed on training students in CPR earlyto develop a generation of bystanders willing to act during a cardiac arrest event. This traininghas focused on chest compression only CPR (CCO-CPR) to increase provision and decreasebarriers. More recently, with the increase in opioid overdoses, there is a need for CPR withrescue breathing. It is unclear whether college students are willing to provide compressionswith rescue breaths (conventional CPR). The objective of this study is to evaluate the intentionof college students to perform conventional CPR and determine the characteristics associatedwith CPR performance.

Methods:
A two-page survey was administered to Ohio State University undergraduatestudents in pre-health and non-health related career paths from Jan 2018-Dec 2019.Respondents’ demographic data were collected including age, sex, CPR training, family risk ofcardiac arrest and the student’s career path. Respondents were asked their attitudes concerningperforming CPR (conventional or hands-only CPR) on strangers. Inclusion criteria were age >17and missing < 10% of survey data. Descriptive statistics were calculated and a multivariablelogistic regression model (OR, 95% CI) was constructed to assess the association between thelikelihood of performing CPR on a stranger and demographic characteristics.

Results:
Surveys were received from 883 students (response rate 74%). The student populationhad a high rate of CPR training with 57% (482) with either CCO-CPR or conventional CPRtraining. A large number of students were also studying to be in a healthcare related field (529,60%). Overall, college students reported that they would perform CCO-CPR more thanconventional CPR on a stranger (78% vs 56%, respectively). Odds of performing conventionalCPR on a stranger was elevated in college students trained in CPR (5.16, 3.82-6.99), studying in ahealthcare related field (1.78, 1.31-2.43), and with a family member at risk for cardiac arrest(1.49, 1.07-2.07).

Conclusion:
College students are willing to perform conventional CPR on strangers and thelikelihood of provision increases with CPR training, healthcare field of study, or having at riskfamily members.
Abstract 358: Out-of-hospital Cardiac Arrest and Community First Response: Building Evidence for Policy and Practice
Authors: Heffernan Eithne , Murphy Andrew , O'Donnell Cathal , Egan Jacqueline , Masterson Siobhán
Published: November 2020

Introduction:
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality globally. Community First Response (CFR) is an important component of OHCA management in many countries. It entails the mobilisation of volunteers by the Emergency Medical Services to respond to OHCAs in their locality. These volunteers include lay-people and professionals (e.g. nurses, physicians). CFR can increase rates of cardiopulmonary resuscitation or defibrillation performed prior to the Emergency Medical Services’ arrival, though its impact on survival and cognitive function requires further study. This research aimed to improve our understanding of CFR, including volunteers’ motives and activities, the association between volunteer location and social fragmentation/deprivation, and the outcomes that should be measured for this intervention.

Methods:
This mixed-methods project comprises several key stages: systematic review of the CFR literature, interviews with CFR experts from a range of countries (e.g. USA, Canada, UK, Australia, Singapore), a survey of volunteers, and an analysis of Irish ambulance service records.

Results:
Various factors affect volunteer motivation, such as personality, family history, legislation, and psychological support. Volunteers undertake many activities in addition to responding to OHCAs, including responding to other emergencies (e.g. stroke), raising awareness of OHCA, providing CPR training, and supporting patients’ relatives. Barriers to responding include problems with technology and recruitment. Volunteer location in Ireland does not appear to be influenced by social fragmentation/deprivation. Outcomes that are measured for CFR include response times and survival. Other potentially important outcomes can prove difficult to measure, particularly the benefits for patients’ relatives and communities.

Conclusions:
This project has implications for CFR research and practice, especially recruiting and supporting volunteers and measuring outcomes. Improving these processes could help to optimise and build evidence for this intervention. Funding has been obtained to extend this project so that the impact of the coronavirus disease 2019 (COVID-19) pandemic on the CFR evidence base can be examined.
Abstract 359: Systemic Administration of Allogeneic Mesenchymal Stem Cells Attenuates Post-Resuscitation Left Ventricular Dysfunction in a Porcine Model of Cardiac Arrest
Authors: Nsumbu Dorcas , Kosmerl Kristen , Ashbery Drew , Allen Shannon , Canty John M , Weil Brian R
Published: November 2020

Introduction:
Advances in CPR have increased the likelihood of achieving ROSC after cardiac arrest (CA), but >50% of initially resuscitated patients die before hospital discharge. Evidence that a systemic inflammatory response exacerbates post-ROSC injury supports investigation of anti-inflammatory therapies in this setting. Accordingly, we tested the efficacy of allogeneic mesenchymal stem cell (MSC) administration early after ROSC in a porcine model of CA.

Methods:
Swine (n=33) were subjected to 10 min CA followed by mechanical CPR with defibrillation and intravenous epinephrine (EPI; 0.015 mg/kg). Animals that achieved ROSC (n=19) were blindly randomized to intraventricular saline (n=9) or allogeneic bone marrow-derived MSCs (55±2 x 10
6
; n=10) 30 min post-ROSC. Intravenous EPI was given during the post-ROSC period as needed to maintain MAP ≥60 mmHg. Left ventricular (LV) function and plasma cardiac troponin I (cTnI) were assessed for 4 hr post-ROSC, at which time heart tissue was collected to assess myocardial inflammation (RT-PCR).

Results:
Compared with saline-treated controls, MSC-treated animals exhibited improved post-ROSC LV wall thickening (
A
) and lower cTnI levels, indicative of reduced myocardial injury. By design, both groups had a similar post-ROSC MAP and cardiac output, but the saline group required significantly more EPI (
B
). Although a similar degree of monocyte infiltration (CCR2) and macrophage expansion (CD68) was observed in both groups, MSCs increased expression of the anti-inflammatory marker Arginase1 (
C
) and tended to attenuate the post-ROSC rise in circulating IL-6 (
D
).

Conclusion:
Early post-ROSC delivery of allogeneic MSCs attenuates LV dysfunction and reduces the need for pharmacologic hemodynamic support after CA in swine. These results indicate that systemic MSC administration may be an effective immunomodulatory strategy to reduce post-resuscitation injury, particularly if protective effects extend to the brain.
Abstract 361: The Augmentation of Oxygen-sensitive Generation of Oxygen Radicals in Mitochondria and the Attenuation of Hyperoxia-induced Oxidative Stress After Cardiac Arrest
Authors: Shinozaki Koichiro , Okuma Yu , Aoki Tomoaki , Nishikimi Mitsuaki , Hayashida Kei , Miyara Santiago J , Becker Lance B
Published: November 2020

Introduction:
Hyperoxia can induce oxidative stress resulting in organ injuries after cardiac arrest (CA). Mitochondrial reactive oxygen species (ROS) are key to understanding its mechanism, however the augmentation of oxygen-sensitive ROS generation caused by CA (
Fig 1
) has not been well described.

Methods:
Rats were assigned into: 1) sham with normoxia, 30% O2; 2) sham with hyperoxia, 100% O2; 3) CA with normoxia; and 4) CA with hyperoxia (n=15 for each group). CA was induced by 10-minute asphyxia and CPR was delivered. Neurological deficit score (NDS), histological lung injury score (LIS), survival time were obtained from the CA groups. Carbonyl protein as an oxidative stress indicator was measured at 2 hrs after resuscitation. H2O2 generation from isolated mitochondria were measured
ex vivo
at a normoxic and hyperoxic condition set up with nitrogen and air saturated medium.

Results:
Between the CA groups, the normoxia group had a higher 48hr-survival rate (77%), lower NDS (359±140), and lower LIS (4.3±2.9) compared to those (28%, 452±85, 14±2, respectively) of the hyperoxia group (p<0.01, p<0.05, and p<0.01, respectively). In the brain, lung, and kidney, CA augmented the hyperoxia-induced increase in carbonyl protein (absolute change: sham brain, 0.18 nmol/mg protein vs. CA brain, 0.61 nmol/mg protein; sham lung, 0.29 nmol/mg protein vs. CA lung, 0.72 nmol/mg protein; sham kidney, 0.04 nmol/mg protein vs. CA kidney, 0.55 nmol/mg protein, respectively). In the brain and kidney isolated mitochondria, CA augmented the hyperoxia-induced increase in H2O2 (absolute change: sham brain, 18 pmol/mg protein vs. CA brain, 60 pmol/mg protein; sham kidney, 16 pmol/mg protein vs. CA kidney, 45 pmol/mg protein, respectively).

Conclusions:
The normoxic therapy may attenuate organ damage and improve survival of CA. The reduction of augmented mitochondrial ROS generation, which is oxygen-sensitive, would be an important mechanism and therapeutic target of post-CA care.
Abstract 362: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury
Authors: Spaite Daniel W , Hu Chengcheng , Bobrow Bentley J , Barnhart Bruce J , Gaither Joshua B , Chikani Vatsal , Mullins Terry , Bradley Gail , Denninghoff Kurt R , Rice Amber D , Keim Samuel M
Published: November 2020

Introduction:
The Prehospital TBI Guidelines (PTGs) are intended for both isolated and multisystem TBI (ITBI/MTBI). However, uncontrolled hemorrhage and potential detrimental effects of fluid resuscitation in MTBI may lead to differential effectiveness compared to ITBI.

Methods:
Preplanned subgroup analysis of PTG effectiveness in ITBI and MTBI from EPIC (before/after system study; 133 agencies, >11,000 trained; NIH R01NS071049). Interventions: Prevention/treatment of hypoxia, hypotension, hyperventilation. Inclusion: Barell Matrix 1; 1/07-6/15. Severity subgroups [Head Region Severity Score (HRSS; AIS equivalent)]: Moderate = 1-2; Severe = 3-4; Critical = 5-6. Definitions: ITBI: TBI with no other RSS ≥3 injury. MTBI: TBI plus non-head region RSS ≥3 injuries. Pre (P1) and post-implementation (P3) cohorts were compared using logistic regression.

Results:
Cases: 21,852; median age 45 (IQR 24, 66); 67% male. ITBI: 16,663 (76.3%); P1 = 11,602, P3 = 5061. MTBI: 5189 (23.7%); P1 = 3626, P3 = 1563]. Hypotension occurred much more frequently in MTBI (15.8%) than ITBI (4.5%; OR = 3.9 (3.5, 4.4); p<0.0001) and, after PTG implementation, MTBI patients were much more likely to receive a fluid bolus (10.7%; 167/1563) than ITBI (5.3%; 267/5061; p<0.0001). There was highly significant improvement in aOR for survival in severe (HRSS 3-4) ITBI and MTBI (Fig 1). Furthermore, the severe ITBI and MTBI patients who were intubated or who received any positive pressure ventilation (PPV; basic or advanced) also improved dramatically (Fig 2).

Conclusions:
PTG implementation was independently associated with improved odds of survival in severe ITBI and MTBI. Despite a rate of hypotension 4 times higher in MTBI, survival improvement was at least as strong as for ITBI. Since the MTBI cohort was much more likely to receive fluid resuscitation, these findings support the PTG recommendation for aggressive treatment of hypotension in TBI even in patients with potential ongoing hemorrhage.