bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 299: Trends and Outcomes of In-Patient Pediatric Cardiopulmonary Resuscitation
Authors: Shamszad Pirouz , Marino Bradley S
Published: April 2024

Purpose:
Continual efforts have aimed to improve outcomes in children requiring cardiopulmonary resuscitation (CPR). However, few data have assessed how these efforts have impacted post-CPR survival in children’s hospitals. The purpose of this study was to describe the incidence, outcomes, and risk factors associated with in-patient mortality after pediatric CPR.

Methods:
A multi-institutional, retrospective review of the Pediatric Health Information System (PHIS) database, an administrative database of 42 United States tertiary care children’s hospitals, was performed. All hospitalizations in children <18 years during which CPR was performed from 2004-2012 were included. Mortality was the primary outcome measure. Yearly trend analysis was performed using linear regression. Risk factors assessed for their association with mortality included age, sex, and specific cardiac factors (the presence of congenital heart disease [CHD], concurrent cardiac surgery, and cardiomyopathy [CM]). Factors associated with mortality were assessed by Chi-square analysis and expressed as odds ratio (OR) and 95% confidence interval (CI). A CI not crossing 0 was considered significant.

Results:
There were >4.6 million hospitalizations of which 11,213 (0.2%) involved a CPR event. Overall in-patient mortality after CPR was 50%. Although there was a significant increasing yearly trend in the number of in-patient CPR events (p = 0.003), yearly mortality significantly decreased (p<0.001). Mortality was significantly higher in adolescents (OR 1.5 CI 1.3-1.7) and neonates (OR 1.4 CI 1.3-1.5). Among in-patients, CHD was present in 4,931 hospitalizations (44%), concurrent cardiac surgery in 1,656 (14.8%), and CM in 537 (4.8%). Mortality was lower in hospitalizations involving CHD (OR 0.7, CI 0.6-0.7), CM (OR 0.8, CI 0.7-0.9), and cardiac surgery (OR 0.5, CI 0.4-0.5). Gender was not significantly associated with mortality (p = 0.61).

Conclusions:
CPR in hospitalized children is a rare event associated with high, but improving mortality. Adolescents and neonates are at higher risk for mortality after CPR. Cardiac risk factors in hospitalized children undergoing CPR are associated with lower mortality.
Abstract 3: Early, Single-Dose Post-Burn Estrogen Significantly Decreases Apoptosis at 7 Days and Pro-Inflammatory Cytokines for 45 Days in the Spleen Following Severe Burns
Authors: Warren Victoria , Maass David L , Idris Ahamed H , Pepe Paul E , Gatson Joshua W , Ma Lisha , Zang Qun S , AbdelFattah Kareem , Minei Joseph P , Wolf Steven , Wigginton Jane G
Published: April 2024

Introduction:
In patients with severe burns, remote splenic injury is thought to be a significant contributor to immunosuppression and subsequent morbidity and mortality. We tested estrogen, a potent anti-oxidant, anti-apoptotic, and anti-inflammatory drug as a potential therapy for mitigation of splenic inflammation following severe remote burns.

Methods:
177 male rats were randomized into 3 groups: Group 1 (0.5mg/kg of 17-β estradiol (E2) SQ 15 min after injury), n=84; Group 2 (placebo), n=84; and Group 3 (sham-burn control), n=9. Groups 1 & 2 were given a 3° 40% TBSA dorsal scald burn. Eight burned/treated rats per group were sequentially sacrificed at 0.5, 1, 2, 4, 6, 8, 12, 18, 24 hours and 7 days post-burn, with four rats/treatment sacrificed 45 days post-burn. Spleen tissue was analyzed by ELISA for proinflammatory cytokines (including IL-6, TNF-α, IL-1β). TUNEL staining was performed on the histological specimen.

Results:
Administration of a single, early dose of E2 greatly decreased all measured cytokines for 45 days, as exemplified by IL-1β (see Figure), and decreased apoptosis significantly at the evaluated time point of seven days.

Conclusions:
Early, single-dose estrogen administration following severe remote burns reduces the pro-inflammatory responses in the splenic tissue at all measured time points for 45 days post-burn, and significantly decreases apoptosis in the spleen at seven days. These findings help support consideration of clinical testing of estrogen as a post-burn resuscitation therapy in the future.
Abstract 303: Frequency of Newborn Resuscitation and Stabilization in Three Normal-Risk Delivery Units in Norway
Authors: Skåre Christiane , Nakstad Britt , Kramer-Johansen Jo , ødegaard Silje , Steen Thorbjørn , Niles Dana , Solevåg Anne L , Nadkarni Vinay M , Olasveengen Theresa M
Published: April 2024

Introduction:
Most newborn infants transition from intra- to extrauterine life without interventions; yet neonatal morbidity remains a significant health problem in both resource rich and resource poor health care systems. Although advanced resuscitation of newborn infants with chest compressions, intravenous drugs, and fluids is relatively rare, there are limited data on the frequency of neonatal stabilization and resuscitation measures in normal-risk delivery units.

METHODS:
Prospective, observational study conducted in the delivery units in three hospitals in Norway. All newborn infants assessed for stabilization and/or resuscitation during one month were included. After each incident, data on resuscitation measures and outcome were registered and reviewed by study personnel at every on-call team shift during the study period. Approval was obtained from department heads and institutional review boards.

Results:
1507 babies were live born during the study period, mean weight 3.3 kg and gestational age 39.4 weeks.: 113 (7 %) needed resuscitation interventions beyond drying and stimulation. Suctioning of oropharynx was performed in 77 babies (5 %) and tracheal suctioning in 10 (1%). Positive pressure ventilation (PPV) was provided by a T-piece resuscitator and/or by a self-inflating bag to 58 (4 %) with 39 (3 %) receiving supplementary oxygen. In addition CPAP (but no PPV) was provided to 17 (1 %). One needed chest compressions. Tracheal intubation was accomplished in 4 infants of whom 3 were prematurely born and treated with tracheal surfactant. Intravenous access was established in 8 infants, two received saline infusions and one received epinephrine. After initial resuscitation, 64 (4 %) were admitted to the neonatal intensive care unit and two died. Twenty-one events were handled exclusively by midwifes, 244 by pediatric residents and 39 by attending neonatologists.

CONCLUSION:
Most newborns do not need advanced resuscitation procedures. However, even in low risk deliveries, more than 4 % of newborns required assisted ventilation. Correct assessment of need for ventilatory support and correct execution of positive pressure ventilation needs to be ensured.
Abstract 309: Miniaturized Chest Compressor Improves Cerebral Perfusion Without Increases in Intracranial Pressure During Cardiopulmonary Resuscitation in a Porcine Model
Authors: Xu Jiefeng , Hu Xianwen , Wu Xiaobo , Sun Shijie , Tang Wanchun
Published: April 2024

Introduction:
Previously, we demonstrated that the miniaturized mechanical chest compressor (MCC) improved hemodynamic efficacy and the success of CPR. Currently, we investigated the effects of the same device on cerebral perfusion and intracranial pressure (ICP).

Hypothesis:
Mechanical chest compression with MCC would improve cerebral perfusion without increases in ICP during CPR.

Methods:
Thirteen male domestic pigs weighing 39 ± 3 kg were utilized. Ventricular fibrillation was electrically induced and untreated for 7 mins. The animals were then randomized to receive mechanical chest compression with the MCC (n=7), or the Thumper device (n=6). Defibrillation was attempted after 5 mins of CPR. If resuscitation was not successful, CPR was resumed for 2 mins prior to the next defibrillation until either successful resuscitation or for a total of 15 mins.

Results:
During CPR, significantly greater mean cerebral perfusion pressure was produced by the MCC when compared with the Thumper device. However, there was no significant difference in mean ICP. Interestingly, diastolic ICP was significantly lower in the MCC group, which was closely related to the significantly lower negative intrathoracic pressure in the animals that received the MCC (Table).

Conclusion:
During CPR, mechanical chest compression with MCC significantly improved cerebral perfusion without increases in ICP.
Abstract 310: Early Access to Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm. The Minnesota Resuscitation Consortium Twin Cities Unified Protocol
Authors: Yannopoulos Demetris , Mahoney Brian , Garcia Santiago , Frascone Ralph , Helmer Greg , Lick Charles , Conterato Marc , Baran Kenneth , Roh Steven , Panetta Carmelo , Stark Randall , Haughland Mark , Mooney Michael , Bart Bradley
Published: April 2024

Background:
Cardiac arrest patients that have been successfully resuscitated from shockable rhythms have a high prevalence of thrombotic and/or flow limiting coronary occlusion regardless of the presence of STEMI on the ECG. In 2012 the Minnesota Resuscitation Consortium (MRC) developed an organized approach for the management of all patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL).

Methods:
Eleven metropolitan hospitals with 24/7 PCI capabilities agreed to provide early (within 2 hours of arrival to the emergency department) access to the CCL for all patients that were successfully resuscitated from VF/VT arrest regardless of the presence or absence of STEMI on the surface ECG. Inclusion criteria were: witnessed or un-witnessed, age >18 and <70, cardiac arrest of presumed cardiac etiology, comatose or conscious patients. Patients with PEA or asystole, known DNR/DNI, non-cardiac etiology, significant bleeding of any cause, terminal disease were excluded. Patient outcomes were recorded in the state database Cardiac Arrest Registry to Enhance Survival (CARES).

Results:
A total of 202 patients were resuscitated and met the inclusion criteria in 2012. Of those, 158 (78%) patients were taken to the CCL per the MRC protocol. Forty-two (20.7%) were not taken to the CCL. Of the patients that had early coronary angiography a total of 42% received primary angioplasty and had at least one vessel disease. A total of 113/158 (72%) were discharged alive and of those 106/113 (94%) were discharged neurologically intact with a cerebral performance category score of 1 or 2. All comatose patients received therapeutic hypothermia. Of the patients that did not gain early access to the CCL, 17/42 (40.5%) survived to hospital discharge and of those, 14/17 (82%) had normal neurological function [OR: 3.69; 1.82-7.48, p=0.0003].

Conclusions:
Enabling early access to the catheterization laboratory after cardiac arrest due to a shockable rhythm was associated with 72% survival to hospital discharge and excellent neurological outcomes in a large metropolitan area and real-life clinical practice. Our results support the need for further outcomes based investigation
Abstract 315: Characterization of Out of Hospital Resuscitation Utilizing Blood Transfusion
Authors: Mena-Munoz Jorge , Srivastava Udayan , Martin-Gill Christian , Suffoletto Brian , Guyette Francis
Published: April 2024

Introduction:
While blood transfusion in the hospital setting has been extensively studied, little data exists on out of hospital administration of blood products. We aimed to characterize patients receiving out of hospital blood product transfusion in a critical care transport network that carries blood products.

Methods:
We performed a retrospective review of patients transported by a regional critical care transport service from 1/1/2003 to 6/30/2012 who received blood products during transport. This service carries two units of un-crossmatched Packed Red Blood Cells (pRBCs) on every transport. We describe prehospital factors (vital signs, mechanism of injury, volume and type of blood product transfused) associated with blood transfusion. We further categorized out of hospital transfusions of blood products into three groups based on the volume transfused (lt350 ml, 350-700ml, gt700ml). We compared in-hospital outcomes (mortality, volume and type of subsequent blood transfusion, and need for emergent surgery [lt24 hours]) among these three groups to ascertain the impact of prehospital blood product transfusion.

Results:
We reviewed 1441 transports in which blood products were transfused. Most transfusions were inter-facility transfers (92%, CI 91-93%) and for non-traumatic illness (75%, CI 73-77%). The most common reason for transport was upper gastrointestinal bleeding (20%, 18-22%). A vast majority, 80% (CI 78-82%), of patients required subsequent in-hospital blood transfusion. In hospital 30-day mortality was high, 22% (CI 20-25%), as was need for emergent surgery 27% (CI 25-29%). Mean length of stay was 10.6 days and mean ICU length of stay was 7.2 days. Among those receiving blood products, those transfused with >700ml had higher heart rates (94 vs. 103, p=0.01), whole blood lactate levels (3.5 vs. 6.2, p<0.01), and lower systolic blood pressure (108 vs.122, p<0.01)

Conclusions:
In this sample, the majority of patients receiving blood during critical care transport are during inter-facility transports and for non-traumatic conditions. Gastrointestinal hemorrhage is the most common indication for transfusion and 30-day mortality in this cohort is high.
Abstract 322: Report of Adverse Effects From a U.S. Registry of Patients Undergoing Targeted Temperature Management Following Cardiac Arrest
Authors: Delfin Gail , Grossestreuer Anne V , Gaieski David F , Archer Susan E , Bilson Andi , Abella Benjamin S , Leary Marion
Published: April 2024

Background:
Targeted temperature management (TTM) has been shown to improve outcomes following resuscitation from cardiac arrest. Registry studies from Europe have illustrated an array of potential adverse effects (AEs) from post-arrest cooling, however the broad experience of US hospitals with regard to TTM-associated AEs has not been described.

Objective:
To identify incidence of AEs reported in a multicenter US registry of post-arrest patients treated with TTM.

Methods:
Retrospective chart review of post-arrest patients from 14 US hospitals who were treated with TTM and enrolled into the Penn Alliance for Therapeutic Hypothermia data registry (PATH).

Results:
A total of 675 patients received TTM after cardiac arrest between 1/2005 - 3/2013. Mean age was 59.3±15 yrs, 279/675 (41%) were female and 229/675 (34%) had shockable rhythms. Mean TTM duration was 24.7±9.8 hrs and rewarming duration of 14.3±7.9 hrs. Survival to hospital discharge occurred in 265/666 (40% - data missing in 9 patients); in survivors, 214/265 (81%) manifested Cerebral Performance Category scores of 1 or 2. Data on seizure activity were available for 359/675 patients (53%); 60/359 (17%) manifested seizure/myoclonus clinically or on EEG. AE data associated with the TTM process were available for 316/675 (47%) patients and not documented for 359 (53%). Hyperglycemia (> 144 mg/dL glucose at ≥1 time points during TTM maintenance) was prevalent and reported in 251/316 (79%) patients. Of 316 patients, 157 (50%) described other specific AEs. Shivering was noted in 78/316 (25%) patients, treated most often by meperidine 38/78 (49%) or neuromuscular blockade 34/78 (44%). Fever occurred in 40/316 (13%) patients and dysrhythmias in 19/316 (6%). Three of 19 patients suffered re-arrest during TTM; one re-arrest patient was below target temperature (32-34
o
C). Hypokalemia was reported in 15/316 (5%) and hyperkalemia in 4/316 (1%) patients. Skin breakdown was specified in 15/316 (5%), bleeding in 8/316 (3%) patients- 3 requiring transfusion - and pneumonia in 7/316 (2%).

Conclusions:
In this patient cohort enrolled in a US post-arrest care registry, incidence of AEs is comparable to previous reports. Specifically, bleeding complications were infrequent and comparable to non-US studies.
Abstract 323: Intra-arrest Induction of Preferential Brain Cooling With Mild Systemic Hypothermia Does Not Correlate With Favorable Outcome in a Rabbit Model of Ventricular Fibrillation
Authors: Guan Jun , Diao Mengyuan , Lin Zhaofen , Zhang Zhe , Xiao Yan
Published: April 2024

Introduction:
Recent reports suggested that poor clinical outcomes correlate with rapid cooling in cardiac arrest patients. The possible causes are unclear. We have now compared survival between intra-arrest induction of preferential brain cooling with mild systemic hypothermia and conventional surface cooling animals, and focused on the relationship between hemodynamics and brain temperature (Tb).

Methods:
Untreated VF of 4 min and CPR of 4min were given to 24 rabbits prior to defibrillation. Animals were randomly assigned to (1) preferential brain cooling by a neck cooling collar initiated at beginning of CPR, (2) body surface cooling by ice pads and fan initiated at 30 min after ROSC, (3) spontaneous normothermia control. Core body temperature (Tc) and Tb were monitored by thermoprobes in rectum and brain parenchyma respectively. Mean aortic pressure (MAP), heart rate (HR), LV dp/dt, LV -dp/dt, and PetCO2 were continuously monitored. During 4 hrs of cooling, Tc was maintained between 33.5°C and 34.5°C by turning on/off the cooling regardless Tb. Cooling would also be paused if MAP is below 60 mmHg. Methods for control animals were identical except for cooling.

Results:
Six of 8 animals in each group achieved ROSC and survived to 18±17, 17±18, and 21±23 hrs after ROSC respectively, P=0.921. First time pause of cooling due to low MAP only occurred in all 6 brain cooling animals. At first pause of cooling, Tb and Tc were 34.1±0.8°C and 33.5±0.2°C in body cooling animals, but were 29.2±1.3°C and 35.5±0.9°C in brain cooling animals respectively. MAP and HR in brain cooling animals were significantly lower than those in body cooling and control animals at 30min, and 60 min after ROSC (Table). Linear regression analysis showed that Tb but not Tc was the independent influential factor for MAP after ROSC.

Conclusions:
Early induction of preferential brain cooling does not necessarily improve outcome after ROSC. Hypotension correlates with low Tb and warrants close monitoring and management.
Abstract 327: Impaired Mitochondrial Function Following The Metabolic Phase Of Cardiac Arrest And Resuscitation: Differences In Tissue Vulnerability, Site And Severity Of Dysfunction
Authors: Lampe Joshua W , Selak Mary A , Da Tong , Zhang Wei , Yin Ming , Wang Chih-Hsien , McManus Meagan J , Wallace Douglas C , Becker Lance B
Published: April 2024

Introduction:
Mitochondrial dysfunction may be critical to reperfusion injury following the metabolic phase of prolonged cardiac arrest. However, specific intra-mitochondrial sites of dysfunction remain uncertain and differential tissue vulnerabilities have not been well characterized.

HYPOTHESIS:
The metabolic phase of prolonged cardiac arrest and resuscitation will provoke specific patterns of fixed localized defects in respiratory and phosphorylating activities of mitochondrial function and impact the heart, brain, and kidney differently.

METHODS:
A rodent model of prolonged cardiac arrest was employed with 30 min of untreated axphyxial arrest followed by 60 min of emergency cardiopulmonary bypass (ECPB). Electron transport and energy coupling were analyzed under four experimental conditions: no treatment (NORM), 30 min untreated cardiac arrest (CA30), 30 min arrest plus 60 min ECPB reperfusion (CA30R60) and 90 min arrest (CA90). Measurements of O
2
consumption (states 3 & 4, and respiratory control ratio), NADH oxidase, and partial electron transport reactions (for Complex I+III, II+III, & IV) were performed.

Results:
State 3 O
2
consumption (glutamate/malate) for: (a) the heart at NORM, CA30, CA30R60 and CA90 was 153±28, 90±13, 136±22, and 118±20, respectively (mean±s.d., nanoatoms oxygen/min/mg protein); (b) the kidney was128±32, 82±12, 114±18, and 53±8 respectively; and (c) the brain was 68±5, 57±4, 49±16, and 33±6 respectively. Similar patterns for succinate nourished State 3 O2 consumption and for respiratory control ratios were seen. ETC partial complex measures revealed dysfunction in brain > heart > kidney.

CONCLUSION:
Distinct mitochondrial defects develops after prolonged ischemia and reperfusion that are tissue specific and show unique intra-mitochondrial sites. Respiratory activities of heart > kidney > brain and this is inversely related to the sensitivity of the tissue to ischemia/reperfusion injury. All tissues demonstrate poor respiratory control ratios after 30 min of ischemia. However with 60 min of reperfusion the kidney and brain recover significantly while the brain does not improve. The vulnerability of the brain and heart to ischemia may be linked to mitochondrial pathways and a target for new therapies.
Abstract 328: Critical Role For Intra-mitochondrial NADPH Generation For Survival After Cardiac Arrest: Studies In The Nicotinamide Nucleotide Transhydrogenase Deficit Mouse
Authors: Lampe Joshua W , Da Tong , Selak Mary A , McManus Meagan J , Wallace Douglas C , Becker Lance B
Published: April 2024

INTRODUCTION:
The loss of the mitochondrial nicotinamide nucleotide transhydrogenase (NNT) reduces antioxidant capacity within the mitochondrial compartment, is associated with cardiovascular, endocrine, and inflammatory disease states, but has not been evaluated for a role in reperfusion injury following cardiac arrest. The NNT-/- deficient mutant mouse becomes NADPH depleted during stress and provides an ideal model for studying stress induced antioxidant deficiency during reperfusion after cardiac arrest.

HYPOTHESIS:
Due to oxidant stress during reperfusion of initially successfully resuscitated NNT-/- mice, there will be rapid cardiovascular deterioration mimicking reperfusion injury, and evidence of impaired metabolism and activation of injury cascades.

METHODS:
Using a well described mouse hyperkalemic cardiac arrest model, we induced arrest for 8 min followed by attempted resuscitation in C57BL6N NNT+/+ wild type (N=8) and NNT-/- (N=9) mice. Our primary outcome was survival to 240 min. Tissue and plasma samples were obtained after the 240 minutes or at death. Additional animals were studied at 100 min post arrest to provide time-matched comparisons. Assays were performed for lactate, total antioxidant capacity, circulating Cytochrome c, cleaved caspase-3, and Parkin protein levels.

RESULTS:
All animals were initially resuscitated but significant differences in 240-min survival rate were observed for NNT+/+ (8/8) versus NNT-/- (3/9) mice; p<0.005. Early accelerated death was seen in the NNT-/- mice. Elevations in lactate and circulating Cytochrome c were observed in all animals. However, in the NNT-/- mice total antioxidant capacity was decreased and cleaved caspase-3 and Parkin protein was increased.

Conclusions:
NNT-/- deficiency creates a phenotype of signifcant early death during reperfusion, associated with increased apoptosis, Parkin protein, and decreased antioxidant capacity. This reperfusion accelerated death mimics hemondynamic collapse seen in patients who initially survive cardiac arrest but progress to death. Diminished NADPH generation within the mitochondrial compartment may be one pathway for reperfusion mediated injury and provides a potential new target for therapies after ischemia.
Abstract 333: Simple Conventional Cooling Methods Without Temperature Feedback Regulation Are Not Inferior to Automatic Cooling Device for Improvement of Neurologic Outcome of Cardiac Arrest Patients
Authors: Oh Joo Suk , Oh Sang Hoon , Kyong Yeon Young , Youn Chun Song , Jeung Kyung Woon , Kim Gi Woon , Kim Young-Min , Choi Seung Pill , Park Kyu Nam
Published: April 2024

Objective:
We assessed the hypothesis that therapeutic hypothermia (TH) implemented by only conventional uncontrolled cooling method is not associated with worse neurologic outcome compared to the cooling device equipped with temperature feedback control, regardless of surface or endovascular cooling.

Methods:
We performed a multicenter retrospective registry-based study of adult out of cardiac arrest patients treated with TH presenting to 24 hospitals across South Korea during the period from January 2007 to December 2012. Patients who received TH only by conventional methods such as ice packs, cold fluids, and other convective methods were assigned to one group, and those who received TH by automatic device using body wraps, hydrogel pads and endovascular cooling catheter were assigned to another. Choice of method was based upon device availability of the relevant hospital.

Results:
Of a total of 930 OHCA patients entered in the registry, 851 were included in the analysis, of which 58 underwent only conventional cooling and remaining 793 underwent temperature feedback controlled cooling. More adverse events such as overcooling or rebound hypothermia occurred in the conventional method group, which was significantly associated with poor neurological outcome (cerebral performance category 3-5) at hospital discharge. In multivariate logistic regression analysis, conventional cooling method group was not associated with worse neurologic outcome compared to the automatic cooling device.

Conclusions:
In our study, conventional cooling method without automatic temperature feedback control was not associated with poor neurological outcome at hospital discharge, although it is associated with more adverse events.
Abstract 336: Selective Use of Neuromuscular Blockade in Therapeutic Hypothermia Does Not Delay Time to Target Temperature
Authors: Ryan Avery Kathleen , O’Brien Molly H , Hirning Beth Anne , Szumita Paul M , Pierce Carol D , Chase AnnMarie , Strojwas Stefan , Kyller Michael , Griswold Karen , Seethala Raghu , Massaro Anthony F , Henderson Galen V , Stone Peter , Morrow David A , Scirica Benjamin M
Published: April 2024

Background:
Optimal management of shivering during Therapeutic Hypothermia(TH) is important to quickly achieve target temperature with a goal of improving neurological outcomes. Interventions (pharmacological and non-pharmacological) to manage shivering vary among institutions. We developed a step-wise guideline approach to: 1) prevent and manage shivering during the different phases of TH, 2) avoid delays to achieving target temperature (TT) and 3) reduce the use of neuromuscular blocking agents (NMBA).

Methods:
We report a single center experience examining the differences in time to target temperature, medication use and patient outcomes pre-(Jan2009-June2011) and post-(July2011-April2013) implementation of a TH Prevention and Management of Shivering algorithm.

Results:
A total of 138 patients had TH (62 patients pre vs 76 in the post-guidelines).

Fewer patients post-guideline implementation received any NMBA (55.3% vs 83.9%, p=0.001), with a lower total dose of NMBA (59.4± 58.7 vs 99.8 ± 70.3 mg, p=0.001). In patients who received NMBA, the post group received more bolus only (64.3% vs 5.8%); and less infusion only (9.5% vs 48.1%) or infusion + bolus (26.2% vs 46.1% p <0.001) therapy. As expected, propofol use increased in the post- group (3.1 vs 2.5 mg/kg/hr, p=0.02) as did increased use of fentanyl boluses (n=44 [4.1 ± 3] vs n=17 [2.5 ± 1.4] p=0.03). While more shivering was noted in the post group (43.5% vs 27.4%; p=0.04), there was no significant difference between the groups in the ROSC to TT time or ICU days. Survival and neurological outcomes were similar between the two groups.

Conclusion:
Selective use of NMBA as part of a shivering algorithm does not delay time to TT in TH. The decreased use of NMBA resulted in increased doses of sedation and analgesia without effects on patient survival or neurological outcome. Further research on optimal usage of NMBA in TH is needed.
Abstract 340: Marked Attenuation of Cell Injury by Substrate Availability During Ischemia
Authors: Velmurugan Sathya , Radhakrishnan Jeejabai , Baetiong Alvin , Gazmuri Raúl J
Published: April 2024

Background:
Ischemic injury in cardiomyocytes results in rigor contracture (reduction of length by approximately one third) and reperfusion injury results in hypercontracture (change of morphology from rod-shaped to round forms). Rapid reoxygenation during reperfusion at high oxygen concentrations during limited substrate availability could augment cell injury. We therefore hypothesized that substrate availability during ischemia delays rigor and delayed and gradual reoxygenation reduces hypercontracture. Then, we compared the effects of normocarbic immediate (NIR) and hypercarbic delayed reoxygenation (HDR) following aglycemic anoxia (AA) and normoglycemic anoxia (NA) in isolated adult rat cardiomyocytes.

Methods:
The set-up for creating anoxic environment incorporated (i) a gas blender, (ii) equilibration of ischemic buffer with anoxic gas mixture and perfusing the chamber, and (iii) an acrylic hood, constantly flushed with anoxic gas mixture, to cover the chamber on the stage of the microscope. This set-up resulted in PO2 of 0 mmHg constantly over a period of time. The cells were subjected to 15 min of baseline, 45 min of simulated ischemia and 120 min of simulated reoxygenation (AA-NIR, NA-NIR, AA-HDR, and NA-HDR) with or without glucose as a substrate.

Results:
Substrate availability significantly reduced the occurrence of rigor and hypercontracture (AA vs NA followed by any reoxygenation protocol: p<0.0001, Gehan Breslow survival analysis). Survival from rigor and hypercontracture were not different in AA-NIR and AA-HDR groups while they were significantly higher in NA-NIR compared to NA-HDR group (p<0.0001, Gehan Breslow survival analysis). There was no difference in viability among the groups.

Conclusions:
Substrate availability during ischemia ameliorates ischemia and reperfusion injury while hypercarbic delayed reoxygenation does not appear to be beneficial.
Abstract 341: Vasopressin With Low-Volume Resuscitation is Highly Effective for Resuscitation and Survival From Severe Hemorrhagic Shock
Authors: Gazmuri Raúl J , Whitehouse Kasen , Lima Whittinghill Karla , Baetiong Alvin , Radhakrishnan Jeejabai
Published: April 2024

Background:
We have previously shown in a swine model of controlled bleeding that vasopressin (VP) infusion promotes hemodynamic stabilization. We hypothesized that administering VP with or without modest amounts of normal saline (NS, half the volume of blood removed) could improve survival from severe and protracted hemorrhagic shock.

Methods:
Hemorrhagic shock was induced in 24 pigs by removing blood according to a mono-exponential decay function to 65% or 75% of the animal’s blood volume in 60 or 80 minutes. Pigs were randomized 1:1 to receive an intraosseous infusion of VP at a constant rate of 0.04 U/kg•min-1 from the onset of blood removal until the start of blood reinfusion with NS given at the end of hemorrhage over 30 minutes in half of the pigs.

Results:
Survival analysis by Kaplan-Meier method is shown in Figure comparing the effects of administering VP and NS (VP-NS), VP without NS (VP-noNS), no VP but NS (noVP-NS), and neither VP nor NS (noVP-noNS). The 72-hour survival was significantly different (p=0.009 by Log-rank test), with the highest survival in animals that received both VP and NS (100%) followed by VP-noNS (37.5%), noVP-NS (25%), and noVP-noNS (0%) regardless of shock severity.

Conclusion:
Intraosseous infusion of vasopressin in combination with normal saline was highly effective in securing initial resuscitation and 72-hour survival under conditions of severe hemorrhagic shock.
Abstract 15938: Identification of a Novel Disease Gene for Early Onset Atherosclerosis, Diabetes and Metabolic Syndrome by Whole Exome Sequencing and Linkage Analysis
Authors: Keramati Ali R. , Fathzadeh Mohsen , Singha Rajvir , Choia Murim , Faramarzia Saeed , Manea Shrikant , Kasaeib Mohammad , Bigib Mohammad A. Babaee , Malekzadeh Reza , Hosseinian Adalat , Babaie Masoud , Liftona Richard P. , Mania Arya
Published: April 2024

Ali R. Keramati, 2013 Finalist and Presenting Author
Abstract 9843: Proton Pump Inhibitors inhibit DDAH and processes underlying Idiopathic Pulmonary Fibrosis
Authors: Ghebremariam Yohannes T. , Qingtao Zhou , Ho Lawrence , Rosen Glenn D. , Cooke John P.
Published: April 2024

Yohannes Ghebremariam, 2013 Finalist and Presenting Author
Abstract 14057: P Wave Indices and Atrial Fibrillation: Cross-Cohort Assessments from the Framingham Heart Study and Atherosclerosis Risk in Communities Study
Authors: Magnani Jared W. , Zhu Lei , Lopez Faye , Pencina Michael J. , Soliman Elsayed Z. , Benjamin Emelia J. , Alonso Alvaro
Published: April 2024

Jared W. Magnani, 2013 Finalist and Presenting Author
Abstract 19245: Heart of stone: A mysterious case of diastolic dysfunction
Authors: Sharma Alok , Pritzker Marc , Herzog Charles A. , Goldsmith Steven , Eckman Peter
Published: April 2024

Alok Sharma, 2013 Finalist and Presenting Author
Abstract 18429: Transmembrane protein 88: a Wnt regulatory protein that specifies cardiomyocyte development
Authors: Palpant Nathan J. , Pabon Lil , Rabinowitz Jeremy S. , Hadland Brandon , Stoick-Cooper Cristi , Paige Sharon L. , Bernstein Irwin , Moon Randall T. , Murry Charles E.
Published: April 2024

Nathan J. Palpant, 2013 Finalist and Presenting Author
Abstract 12212: Atherosclerotic Plaque Detection with a Fluorescence/Radionuclide Intravascular Imaging System: Comparison of FDG and 6-NBDG
Authors: Zaman Raiyan T. , Kosuge Hisanori , Pratx Guillem , Carpenter Colin , Xing Lei , McConnell Michael V.
Published: April 2024

Raiyan T. Zaman, 2013 Finalist and Presenting Author
Abstract 13086: Defects in EphA2 Signaling Impair the Migration of Old Human Cardiac Stem Cells
Authors: Goichberg Polina , Kannappan Ramaswamy , Cimini Maria , Leri Annarosa
Published: April 2024

Polina Goichberg, 2013 Finalist and Presenting Author
Abstract 12141: Body Fat Distribution and Incident Cardiovascular Disease in Obese Adults
Authors: Neeland Ian J. , Turer Aslan T. , Ayers Colby R. , Berry Jarett D. , Rohatgi Anand , Das Sandeep R. , Khera Amit , Vega Gloria L. , McGuire Darren K. , Grundy Scott M. , de Lemos James A.
Published: April 2024

Ian J. Neeland, 2013 Finalist and Presenting Author
Abstract 13438: Aortic Valve Adaptation to Aortic Root Dilatation: Insights into the Mechanism of Functional Aortic Regurgitation from Three-Dimensional Cardiac Computed Tomography
Authors: Kim Dae-Hee , Handschumacher Mark D. , Levine Robert A. , Sun Byung Joo , Jang Jeong Yoon , Yang Dong Hyun , Kang Joon-Won , Song Jong-Min , Kang Duk-Hyun , Lim Tae-Hwan , Song Jae-Kwan
Published: April 2024

Dae- Hee Kim, 2013 Finalist and Presenting Author
Abstract XXXXX: Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests
Authors: Matos Renée I. , Watson R. Scott , Nadkarni Vinay M. , Huang Hsin-Hui , Berg Robert A. , Meaney Peter A. , Carroll Christopher L. , Berens Richard J. , Praestgaard Amy , Weissfeld Lisa , Spinella Philip C.
Published: April 2024

Renée I. Matos, 2013 Finalist and Presenting Author
Research Priorities for In-Hospital Cardiac Arrest: An Agenda for the Next Decade
Authors: Chan Paul
Published: April 2024

There are an estimated 200,000 to 300,000 cardiac arrests which occur annually in U.S. hospitals, with relatively low survival rates.  In-hospital cardiac arrest (IHCA) remains a ‘silent epidemic’, and as many patients die of IHCA each year in the U.S. as lung cancer.  Until recently, however, little was known about the epidemiology, processes of care, and outcomes of IHCA. 

In the past decade, a number of key studies have provided important insights.  We now know that certain process of care factors, such as defibrillation time and duration of resuscitations, are tightly linked to patient survival and neurological outcomes.  Several studies have also demonstrated substantial

hospital variation

in processes of care and survival, suggesting that some hospitals are able to excel in the treatment of IHCA.  In fact, survival after IHCA has improved markedly over the past decade (14% in 2000 to 22% in 2009), but these gains have been uneven across sites.    Nonetheless, the factors which distinguish top-performer hospitals in IHCA survival from other hospitals have yet to be defined.

In this lecture, Dr. Chan will review the seminal epidemiological and outcomes studies on IHCA over the past decade.  He will then propose a research agenda for IHCA for the next decade, as well as promote a paradigm shift in the conceptual model of IHCA, investigator collaborations, and research methodologies.
Keys to Early Career Success
Authors: Dracup Kathleen A.
Published: April 2024

Nurse scientists often travel diverse and challenging trajectories during their preparation for a productive career in cardiovascular and stroke nursing. Building on that diversity and using the resources available from the American Heart Association, National Institutes of Health, and other organizations to support an early career is a key component of success. In this lecture, we will consider the importance of good mentorship, the qualities to be looked for in mentors, the elements of a successful productive career, and the lessons to be learned and decisions to be made on the way to achieving work-life balance.
Abstract 72: Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients With Acute Cardiopulmonary Failure: A Single-center Experience
Authors: Sheu Jiunn-Jye , Chua Sarah , Yip Hon-Kan
Published: April 2024

Background:
Conventional therapy against acute pediatric cardiopulmonary failure (APCPF) caused by a variety of disease entities remains unsatisfactory with extremely high morbidity and mortality. For refractory APCPF, extracorporeal membrane oxygenation (ECMO) is one of the last resorts.

Materials and Methods:
In this study, the in-hospital outcomes of pediatric patients with refractory APCPF receiving ECMO support were reviewed.

Results:
Between August 2006 and May 2011, a single-center cohort study was performed in pediatric patients who required ECMO support due to cardiogenic shock or severe hypoxemia. A total of 22 patients with mean age of 7.0 ± 6.3 years received ECMO (male = 11; female = 11). The indications included acute fulminant myocarditis (AFM) (n = 6), congenital diaphragmatic hernia (CDH) (n = 3), acute respiratory distress syndrome (ARDS) (n = 6), enterovirus 71 (n = 3), viral sepsis (n = 2), refractory ventricular fibrillation due to long QT syndrome (n = 1), and pulmonary edema with brain herniation (n = 1). Eighteen patients received veno-arterial (VA) mode ECMO, while another four patients undertook the veno-venous (VV) mode. The duration of ECMO use and hospitalization were 6.1 ± 3.1 and 24.4 ± 19.4 days, respectively. The survival rate in patients with AFM was 100% (n = 6). Successful ECMO weaning with uneventful discharge from hospital was noted in 14 (63.6%) patients, whereas in-hospital mortality despite successful ECMO weaning occurred in 5 patients (22.7%). Failure in ECMO weaning and in-hospital death was noted in 3 patients (13.6%).

Conclusions:
ECMO resuscitation is an effective strategy in the clinical setting of APCPF.

Key words:
Acute cardiopulmonary failure, clinical outcome, extracorporeal membrane oxygenation, pediatrics
Abstract 8: Remote Ischemic Preconditioning Mitigates Myocardial and Neurological Dysfunction via KATP Channel Activation in a Rat Model of Hemorrhagic Shock
Authors: Hu Xianwen , Xu Jiefeng , Yang Zhengfei , Yang Min , Qian Jie , Cahoon Jena , Sun Shijie , Tang Wanchun
Published: April 2024

Introduction:
We investigated whether remote ischemic pre-conditioning (RIPC) would reduce myocardial and cerebral ischemia and reperfusion injuries during and following hemorrhagic shock.

Hypothesis:
RIPC mitigates myocardial and neurological dysfunction as the result of K
ATP
channel activation.

Methods:
Twenty-one male Sprague Dawley rats were randomized into three groups:1) RIPC; 2) RIPC with K
ATP
channel blocker (RIPC+blocker); 3) Control. RIPC was induced by four cycles of 5 mins of limb ischemia followed by reperfusion for 5 mins. Hemorrhagic shock was induced by removing 50% of the estimated total blood volume over an interval of 1 hour, 30 mins after bleeding, the animals were reinfused with shed blood during the ensuing 30 mins. All animals were monitored and observed for an additional 72 hours. Myocardial function was measured by echocardiography at baseline, 1 hour after bleeding, 30 mins after shock, 30 mins after reinfusion and at hourly intervals after reinfusion. The survival and neurological function were evaluated daily for a total of 72 hours.

Results:
At 2 hours after reinfusion, ejection fraction was restored to near-baseline levels and was significantly better than the Control group. Myocardial performance index was significantly decreased than the Control group. In addition, all animals survived for 72 hours in the RIPC group. The duration of survival was significantly longer than the Control group. Neurological deficit score was significantly better in the RIPC group than the control animals. However, pre-treatment of the K
ATP
channel blocker completely abolished the myocardial and cerebral protection effects of RIPC (Table).

Conclusions:
In a rat model of severe hemorrhagic shock, RIPC mitigated myocardial and neurological dysfunction with improved survival by activation of the K
ATP
channel.
Abstract 88: High NT-proBNP in Cardiopulmonary Resuscitated Patients Treated With Mild Therapeutic Hypothermia is Associated With Mortality
Authors: de Waard Monique C , Smit Bob , Spoelstra - de Man Angelique M , Girbes Armand R
Published: April 2024

Introduction:
Despite the apparent appropriateness of mild therapeutic hypothermia (MTH) to limit neurological injury and improve survival in patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA), mortality rates remain high. To date, no accurate and independent biomarker to predict survival in these patients exists. B-type natriuretic peptide (BNP) was found to provide both prognostic and diagnostic value in various cardiovascular diseases. However, the biologically inactive counterpart of BNP, NT-proBNP, was found to be more stable and accurate.

Objective:
Investigate the value of NT-proBNP to predict 28-day mortality in post-CA patients treated with MTH, as well as the influence of MTH on NT-proBNP levels.

Methods and Results:
NT-proBNP levels were measured in post-CA patients who were non-invasively cooled using body wraps (Medi-Therm
®
, Gaymar). Plasma samples were obtained before cooling was started, during 24 hours maintenance and at the end of re-warming. Between 2009 and 2013 327 patients were admitted to the ICU for post-CA MTH treatment. Baseline NT-proBNP values were available for 81 (25%) patients and were subsequently included for the evaluation of NT-proBNP as a prognostic marker. In the 28 days following ICU admission, 38 patients died (47%). Non-survivors had significantly higher baseline NT-proBNP levels (median 1525ng/l, IQR 450-3859 versus median 267ng/l, IQR 99-1766;
P
<0.001) compared to survivors. Adjusted odds ratios for 28-day mortality were 3.3 (95% CI = 0.8, 13.4), 4.4 (95% CI = 1.1, 17.8) and 9.3 (95% CI = 2.2, 40) for increasing quartiles of NT-proBNP as compared to the lowest quartile. A cut-off value of 643ng/l achieved a sensitivity of 67% and a specificity of 66% to predict 28-day mortality. During the different phases of MTH NT-proBNP values decreased or increased. The presence of either pattern in NT-proBNP expression was not associated with outcome.

Conclusions:
High NT-proBNP plasma levels on ICU admission are associated with high mortality in post-CA patients, but are of moderate prognostic value as an independent biomarker. Increases or decreases in patterns of NT-proBNP expression during the separate phases of MTH treatment appear unrelated to 28-day mortality.
Abstract 9321: Selective Inhibition of Inositol Hexakisphosphate Kinases Enhances Mesenchymal Stem Cell Engraftment and Improves Therapeutic Efficacy for Myocardial Infarction
Authors: Zheng Zhang , Gao Xue , Wang Haichang , Cao Feng
Published: April 2024

Rationale:
5-diphosphoinositol pentakisphosphate (IP7), formed by a family of inositol hexakis phosphate kinases (IP6Ks), has been demonstrated to be a physiologic inhibitor of Akt. IP6K inhibition may increase Akt activation in mesenchymal stem cells (MSCs), resulting in enhanced cardiac protective effect after transplantation.

Objective:
To investigate the role of IP6Ks for improving MSCs’ functional survival and cardiac protective effect after transplantation into infarcted mice hearts.

Methods and results:
Bone marrow-derived mesenchymal stem cells (BMMSCs), isolated from dual-reporter firefly luciferase and enhanced green fluorescent protein positive (Fluc
+
-eGFP
+
) transgenic mice, were preconditioned with IP6Ks inhibitor TNP (0.5μmol/L, 1μmol/L, 5μmol/L, and 10μmol/L) for 2 h followed by 6 hours of hypoxia and serum deprivation (H/SD) injury. TNP dose dependently significantly decreased IP7 production with increased Akt phosphorylation. Moreover,TNP at 10μmol/L significantly improved the viability and enhanced the paracrine effect of MSCs after H/SD. Furthermore, MSCs were transplanted into infarcted hearts with or without selective IP6Ks inhibition. Longitudinal
in vivo
bioluminescence imaging (BLI) and immunofluorescent staining revealed that TNP pretreatment enhanced the survival of engrafted MSCs, which promoted the anti-apoptotic and pro-angiogenic efficacy of MSCs
in vivo
. Furthermore, MSCs therapy with IP6Ks inhibition significantly decreased fibrosis and preserved heart function.

Conclusion:
Inhibition of IP6Ks promotes MSCs engraftment and paracrine effect in infarcted hearts at least in part by down-regulating IP7 production and enhancing Akt activation, which might contribute to the preservation of myocardial function after MI.
Abstract 9323: Localized Reentrant Activation in the Left Atrium During Human Atrial Fibrillation: Relationship to Complex Fractionated Atrial Electrograms and Low Voltage Zones
Authors: Ghoraani Behnaz , Dalvi Rupin , Gizurarson Sigfus , Das Moloy , Martin Alexander , Ha Andrew , Suszko Adrian , Krishnan Sridhar , Chauhan Vijay S
Published: April 2024

Introduction:
In humans, the existence of reentrant sources maintaining AF and the underlying electroanatomic substrate has not been well defined. Our objective was to determine the prevalence of localized reentrant activation in the left atrium (LA) during human AF and whether complex fractionated atrial electrograms (CFAEs) or low voltage areas co-localize with these sites.

Methods:
We prospectively studied 32 patients (57±8yrs, 88% persistent AF) undergoing AF catheter ablation. Bipolar EGMs were recorded for 2.5sec during AF using a roving 20-pole circular catheter in the LA. Reentrant activation was defined as sequential temporal activation of bipoles around the circular catheter. Bipolar EGM fractionation index (FI) and bipolar voltage were used to define CFAEs (FI>7) and low voltage areas (<0.1 mV), respectively.

Results:
In 21 (66%) patients, 47 reentrant sites were identified. Few (9%) lasted 2.5sec (CL 183±6ms) (Figure, panel A and C), while the majority (91%) were nonsustained (duration 610±288ms, CL 149±11ms) (Figure, panel B and D). Reentrant sites were most common in the PV antrum (71%) and posterior LA (25%). CFAEs were recorded from 18±12% of LA area and most (92±7%) were not associated with reentrant sites. However, 85% of reentrant sites contained CFAEs (Figure, Panel B and D). Very low voltage (<0.1mV) areas comprised 12±10% of LA area and were present in 23% of reentrant sites.

Conclusions:
In patients with predominantly persistent AF, localized reentrant activation is commonly present, but tends to be transient (<1 second). Although most CFAEs do not co-localize with reentrant sites, the high prevalence of CFAEs and very low voltages within the circuit may indicate slow conduction in diseased myocardium that is necessary for sustaining reentry.