bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19167: Depression is an Independent Predictor of Subclinical Inflammation Onset Among Healthy Individuals: A Cohort Study
Authors: Laurinavicius Antonio G , Franco Fabio G , Conceicao Raquel D , Carvalho José Antonio M , Wajngarten Mauricio , Santos Raul D
Published: April 2024

Background:
Depression increases the risk of coronary artery disease (CAD) by about 1.5 times among healthy individuals. The mechanisms underlying this association, however, are still unclear. Although traditional cardiovascular risk factors tend to cluster in depressed patients as a consequence of an unhealthy lifestyle, part of the excess risk remains unexplained. Inflammation has been pointed as a possible mechanistic link between depression and CAD. We intended to assess the role of depression as an independent predictor of subclinical inflammation onset in a cohort study.

Methods:
We studied 4,222 asymptomatic individuals (mean age: 42.1 years; 20.6% female) who underwent two consecutive routine health evaluations between 2007 and 2012. All the participants were submitted to an extensive baseline clinical and laboratory evaluation and completed the Beck Depression Inventory (BDI). A BDI score >10 was adopted to identify individuals with significant depressive symptoms. Subclinical inflammation was characterized by C-Reactive Protein (hs-CRP) levels >3mg/L. Metabolic syndrome was defined according to the ATP-III criteria. We assessed subclinical inflammation incidence at the following evaluation among those with and without baseline depressive symptoms.

Results:
Baseline prevalence of depression (BDI>10) was 15%. Depressive symptoms were significantly more frequent among women (21.7% vs. 13.3%; OR 1.8 CI 1.49-2.20; p<0,001). Mean follow-up was 21.7 months (SD 9.6). Baseline BDI>10 was associated with a significantly higher incidence of subclinical inflammation at the following evaluation (RR 1.67; CI 1.22-2.29; p=0.002). Even after adjustment for age, gender, smoking status, physical activity, metabolic syndrome, fatty liver and overweight, baseline BDI>10 remained an independent predictor of future subclinical inflammation onset (RR 1.49; CI 1.02-2.16; p=0.037).

Conclusion:
Depression is an independent predictor of future subclinical inflammation onset among healthy individuals. Since depression-related inflammation is only partially driven by behavioral cofactors such as smoking status and the metabolic syndrome, it can represent a mechanistic link between depression and CAD.
Abstract 19183: Overexpression of Apom in Liver Stimulates Formation of Larger, Apom/S1P-Enriched Plasma HDL
Authors: Liu Mingxia , Seo Jeongmin , Allegood Jeremy , Bi Xin , Zhu Xuewei , Boudyguina Elena , Gebre Abraham K , Sorci-Thomas Mary , Thomas Mike S , Shelness Gregory S , Spiegel Sarah , Parks John S
Published: April 2024

Apolipoprotein M (ApoM), a lipocalin family member, preferentially associates with plasma HDL and binds plasma sphingosine 1-phosphate (S1P), a critical signaling molecule in immune homeostasis and endothelial barrier function. ApoM overexpression in ABCA1-expressing HEK293 cells stimulates larger nascent HDL particle formation compared to non apoM-expressing cells, but the in vivo role of apoM in HDL metabolism is poorly understood. To test whether hepatic apoM overexpression increases plasma HDL size, we generated liver-specific apoM transgenic (apoM Tg) mice displaying ~5-fold increase in plasma apoM levels compare to wild type (WT) mice. Although plasma HDL cholesterol concentrations were similar to WT mice, apoM Tg mice had larger plasma HDL particles, enriched in apoM, cholesteryl ester, lecithin:cholesterol acyltransferase and S1P. Despite the presence of larger plasma HDL particles in apoM Tg mice, in vivo macrophage reverse cholesterol transport capacity was similar to WT mice. ApoM Tg mice had ~5-fold increase in plasma S1P that was predominantly associated with larger plasma HDL particles. Primary hepatocytes from apoM Tg vs. WT mice generated larger nascent HDL particles, stimulated sphingolipid synthesis, and increased secretion of S1P. Chemical inhibition of ceramide synthase in hepatocytes stimulated S1P synthesis, but not secretion, suggesting that apoM is rate limiting in export of hepatocyte S1P. Our data suggest that liver-specific apoM overexpression: 1) generates large nascent HDLs and large plasma HDL particles that preferentially bind apoM and S1P, and 2) stimulates S1P synthesis for secretion into plasma. The unique apoM/S1P-enriched plasma HDL may serve to deliver S1P to extrahepatic tissues for atheroprotection or other as yet unidentified functions.
Abstract 19205: Most Hospitalized Patients With Elevated Cardiac Troponin Levels Die From Non Cardiac Causes
Authors: French John K , Briffa Thomas , Aliprandi-Costa Bernadette , Carr Bridie , Brieger David
Published: April 2024

Cardiac troponins (Tn) have major prognostic importance as bio-markers in acute coronary syndromes (ACS). However during hospitalizations, Tn levels are often assayed in patients who do not have an acute coronary syndrome. To examine the prognostic implications of elevated Tn levels in patients with and without cardiovascular disease, survival at 12 months among 251,944 patients admitted in the period 2006-8 to public hospitals in NSW, Australia, was linked to measured troponin levels and their ICD-109 diagnostic code. In total 171,253 patients (68%) had a cardiovascular ICD code (CVD100-199) and 80,691 (32%) had a non-CVD code. Troponin positivity was defined as ≥ 1X the upper reference limit (URL) for the troponin T or I assay used at each institution. In total, of troponin positive patients at 12 months, 3,120 (33%) who had a CVD code had died whereas 6,205 (67%) of patients with a non CVD code had died. The hazard ratios for mortality among patients who were ‘troponin positivity’ and had non-CVD codes, adjusted for age and gender, were 2.0 [1.09-2.01] and for CVD codes 100-199 was 2.5 [2.3-2.7]. Among troponin positive patients with non-CVD admission diagnoses, the three most frequent causes of death at 12 months were: 1) diseases of the respiratory system, and 2) neoplasia, and 3) injury, poisoning and or external causes. In conclusion, among a large cohort of patients admitted over a two year period to public hospitals in NSW, Australia, more troponin positive patients with a non-CVD ICD code died at 12 months than those with an CVD code for their admission. Non cardiac disease is a common cause of elevated troponin levels and it has significant adverse prognostic consequences.
Abstract 19211: The Relationship Between Anatomical and Functional Coronary Artery Disease Severity and Transmural Myocardial Blood Flow Distribution
Authors: Danad Ibrahim , Raijmakers Pieter G , Harms Hendrik J , Heymans Martijn W , van Royen Niels , Lammertsma Adriaan A , Lubberink Mark , van Rossum Albert C , Knaapen Paul
Published: April 2024

Objectives:
To determine the impact of lesion severity as assessed by the fractional flow reserve (FFR) on the transmural perfusion gradient (TPG) using H215O positron emission tomography (PET) imaging in patients evaluated for coronary artery disease (CAD).

Background:
Myocardial ischemia occurs principally in the subendocardial layer, whereas conventional myocardial perfusion imaging provides no information on the transmural myocardial blood flow (MBF) distribution.

Methods:
Sixty-six patients evaluated for CAD were prospectively enrolled and underwent H215O PET imaging for quantification of TPG. Subsequently, invasive coronary angiography was performed and FFR obtained in all coronary arteries irrespective of the PET imaging results.

Results:
Thirty (45%) patients were diagnosed with significant CAD (i.e. FFR ≤ 0.80), whereas on a per vessel analysis (n=198), 53 (27%) displayed a positive FFR. Hyperemic MBF decreased significantly from 3.09 ± 1.16 to 1.67 ± 0.57 mL·min-1·g-1 (p < 0.001) in nonischemic and ischemic myocardium, respectively. The TPG decreased during hyperemia as compared with baseline (1.20 ± 0.14 vs. 0.94 ± 0.17, p<0.001), and was lower in arteries with a positive FFR (0.97 ± 0.16 vs. 0.88 ± 0.18, p<0.01). A TPG threshold of 0.94 yielded anc accuracy to detect CAD of 59%, which was inferior to transmural MBF with an optimal cutoff of 2.20 mL·min-1·g-1 and an accuracy of 85% (p < 0.001).

Conclusions:
Cardiac H215O PET imaging is able to detect TPGs and demonstrates a significantly lower hyperemic TPG in ischemic myocardium. However, the diagnostic accuracy of TPG seems to be limited compared to quantitative transmural MBF.
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

A 27 year old Somali female initially presented with renal failure and a creatinine of 10mg/dl. A kidney biopsy showed crystalline nephropathy and she was initiated on hemodialysis. A year later while she was pregnant she had multiple heart failure admissions. Echocardiograms (echo) showed normal ejection fraction (EF). A month after delivery she was admitted again with heart failure. Vital signs were stable with elevated JVP and a pansystolic murmur at the apex. Chest x ray showed pulmonary edema. Echo showed moderately concentric left ventricular hypertrophy (LVH) with an EF of 40% and severe mitral regurgitation (MR). Doppler echo showed restrictive filling pattern. Pulmonary artery pressure (PA) was 99 mm of Hg + right atrial pressure (RA) with dilated vena cava. Repeat echocardiogram post ultrafiltration of just 1 liter of volume reduced PA pressures from 99 mm+RA to about 35 mm Hg+ RA with a simultaneous reduction in MR, demonstrating marked preload dependency of left sided filing pressures. Her myocardium demonstrated an echodense speckled reflection and infiltrative cardiomyopathy was suspected. EKG showed LVH making amyloidosis unlikely diagnosis. Right ventricular
endomyocardial biopsy
showed extensive deposition of calcium oxalate crystals in myocardium. Further tests showed increased
serum oxalate level:
140 μmoles/L (ref. upto 27), increased
urinary oxalic acid
excretion:171 μgm (ref. < 57) and increased
urine glycolate:
101 μg/mg Cr (ref. < 79)
.
Liver biopsy
showed very low
AGT (Alanine glyoxylate aminotransferase)
activity of 3.0 μmol/h/mg protein (Ref. 19.1-47.9) along with negative
AGT immunoreactivity
. These results confirmed diagnosis of

primary hyperoxaluria type 1 (PH1)

. She was started on intense hemodialysis regimen and underwent a deceased donor combined liver-kidney transplantation (CLKT). Repeat echo 6 months later shows normal EF, normal PA pressures, regression of infiltrative process with improvement in diastolic function. This is a rare case of PH1 with cardiac involvement leading to progressive infiltrative restrictive cardiomyopathy and recurrent heart failure. Early recognition of the disease is important because CLKT may achieve long-term survival and regression of cardiomyopathy.
Abstract 19253: Chronic Hypobaric Hypoxia and Chronic Intermittent Hypobaric Hypoxia in Rats Leads to a Mismatch in the ADMA-NO Pathway
Authors: Lueneburg Nicole , Siques Patricia , Brito Julio , Arriaza Karem , Pena Eduardo , Klose Hans
Published: April 2024

Introduction:
Chronic Hypoxia (CH) as well as chronic intermittent hypoxia (CIH) are associated with pathophysiological conditions like acute/chronic mountain sickness and pulmonary hypertension. In the manifestation of these diseases the endothelium and the L-arginine/NO pathway plays a crucial role. Asymmetric dimethylarginine (ADMA) is an endogenous formed NO synthase (NOS) inhibitor and well known as a risk factor for respiratory diseases associated with an endothelial dysfunction in the pulmonary circulation. ADMA is metabolized by dimethylarginine dimethylaminohydrolases (DDAH). In order to have a broader view of the involvement and behavior of ADMA and DDAH under CH as well as CIH our study was aimed to assess the changes in ADMA levels and the underlying molecular mechanisms.

Methods:
Wistar rats were maintained under conditions of CIH (2 days of hypobaric hypoxia followed by 2 days of normoxia (NX) for 30 days (428 torr), CH (30 days, 428 torr) and a control group maintained under NX (n=8 within each group). Systemic blood pressure (SBP) was measured by tail cuff plethysmography. ADMA concentration and DDAH activity were measured in lung tissue by a LC-MS/MS assay. Vascular oxidative stress response was determined by expression of Nox4 and the formation of malondialdehyde.

Results:
Hemodynamic measurements showed an increase in SBP in CH compared to NX (171.9±1.2 mmHg vs 176.7±4.6 mmHg; p=0.037). CH and CIH led to the development of a moderate right ventricular hypertrophy. ADMA concentrations in the lung were increased under hypoxia (P(NX vs CIH)=0.01 (85.3±66.3 nM vs 140.3±46.7 nM); P(NX vs CH)=0.007 (85.3±66.3 nM vs 197.1±56.0 nM) although it was more pronounced in CH (P=0.04). Hypoxia increased oxidative stress in the lung in combination with a reduced DDAH activity, more pronounced in CH. Expression of the endothelial NOS was increased but NO bioavailability was reduced in CH and CIH.

Conclusion:
The increase of ADMA might be one reason for impaired NO bioavailability in CH and CIH, resulting in an endothelial dysfunction. Likewise, oxidative stress seems to be another main cause of the mismatch in the ADMA-NO pathway.
Abstract 19342: High-Sensitivity C-Reactive Protein Effects of Icosapent Ethyl (Eicosapentaenoic Acid Ethyl Ester) With and Without Stable Statin Therapy in Hypertriglyceridemic Patients With Metabolic Syndrome
Authors: Bays Harold , Ballantyne Christie M , Braeckman Rene A , Stirtan William G , Soni Paresh N
Published: April 2024

Introduction:
Elevated high-sensitivity C-reactive protein (hsCRP) is a marker for increased cardiovascular disease (CVD) risk. The metabolic syndrome (MetSyn) is a collection of CVD risk factors and includes high triglyceride (TG) levels as a diagnostic criterion. Statins reduce hsCRP. The combination of eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) has not been shown to consistently lower hsCRP levels. Icosapent ethyl (IPE; formerly AMR101) is a high-purity prescription form of EPA ethyl ester approved to reduce TG levels in patients with severe (>=500 mg/dL) hypertriglyceridemia.

Hypothesis:
We evaluated the relative hsCRP effects of IPE in patients with and without statin therapy among hypertriglyceridemic patients with MetSyn.

Methods:
The MARINE study was a multicenter, placebo-controlled, double-blind, 12-week study of 229 randomized patients with TG >=500 and <=2000 mg/dL. This analysis evaluated the effect of IPE on hsCRP in a subset of patients from the MARINE study with MetSyn.

Results:
The MARINE study included 204 patients from the intent-to-treat population with MetSyn. Compared to placebo, IPE 4 g/day significantly reduced blood levels of TG (35%; p<0.0001), non-high-density lipoprotein cholesterol (19.9%, p<0.0001), apo B (9.1%, p=0.0015), and hsCRP (40%, p=0.0007), without a significant increase in low-density lipoprotein cholesterol. IPE 4 g/day also reduced hsCRP levels by 27.6% (p=0.0385) and 78.0% (p=0.0035) compared to placebo in non-statin-treated (n=48) and statin-treated patients (n=16), respectively.

Conclusion:
Compared to placebo, when administered to hypertriglyceridemic patients with MetSyn, IPE 4 g/day improved lipid levels and reduced hsCRP. Compared to placebo, IPE reduced hsCRP more in stable statin-treated patients than in those not treated with statins.
Abstract 19345: Development and Validation of a New Scoring System for Predicting Wound Healing in Critical Limb Ischemia With Tissue Loss following Endovascular Therapy
Authors: Kobayashi Norihiro , Muramatsu Toshiya , Tsukahara Reiko , Ito Yoshiaki , Ishimori Hiroshi , Hirano Keisuke , Nakano Masatsugu
Published: April 2024

Background:
Wound healing is very important endpoint in critical limb ischemia (CLI) with tissue loss. The aim of this study was to design a scoring system for predicting wound healing in CLI patients who were treated with endovascular therapy (EVT) in consideration of various factors including patient background, intervention outcomes, and also wound characteristics.

Methods:
Between April 2007 and October 2012, 184 patients (217 limbs) were treated with EVT for CLI with tissue loss in our institute. In these limbs, 236 individual wounds existed and were divided into a development group (n=118) and a validation group (n=118). Each variables which seem to be associated with wound healing were analyzed using the univariate Cox proportional hazards model. All variables tested in univariate analysis with p<0.25 were included in multivariate Cox hazards model. The scores for each variables were transformed from regression coefficients and computed in a total score.

Results:
In multivariate Cox proportional hazard analysis, no direct blood flow to the wounds (HR 0.38, 95%CI 0.16-0.93, p=0.034), dependence on hemodialysis (HR 0.46, 95%CI 0.27-0.80, p=0.006), infectious wound (HR 0.54, 95%CI 0.30-0.99, p=0.044), heel wound (HR 0.38, 95%CI 0.16-0.91, p=0.029) and extensive wound extending onto the forefoot or midfoot along the dorsal or plantar surfaces (HR 0.09, 95%CI 0.02-0.39, p=0.001) were adverse predictors of wound healing. Each item’s score ranged from 0 to 4 and the total score ranged from 0 to 10. The area under the receiver operating characteristics curve revealed that there was 90.5% accuracy in the total scores predicting the likelihood of wound healing. In the development group, the wound healing rates at 12 months were 83% in low-risk group (scores≦2), 33% in moderate-risk group (scores 3-5), and 4.0% in high-risk group (scores≧6) (p<0.001). In the validation group, the corresponding wound healing rates were 80%, 49%, and 12%, respectively (p<0.001).

Conclusions:
This new scoring system is useful for the risk stratification of wound healing in patients with CLI.
Abstract 196: Remote Ischemic Pre-Conditioning Improves Microcirculation following Severe Hemorrhagic Shock in a Rat Model
Authors: Hu Xianwen , Xu Jiefeng , Yang Zhengfei , Yang Min , Qian Jie , Cahoon Jena , Sun Shijie , Tang Wanchun
Published: April 2024

Introduction:
The microcirculatory flow is a major determinant of tissue oxygen delivery. A significantly reduced microcirculatory flow has been described during and following hemorrhagic shock. We investigated whether remote ischemic pre-conditioning (RIPC) would improve microcirculation following severe hemorrhagic shock.

Hypothesis:
RIPC improves sublingual microcirculation following hemorrhagic shock.

Methods:
Fourteen male Sprague-Dawley rats were randomized into two groups: 1) Remote ischemic pre-conditioning (RIPC) group, 2) Control group. RIPC was performed by four cycles of 5 mins of limb ischemia followed by reperfusion for 5 mins. Hemorrhagic shock was induced by reduction of total blood volume by 50% over an interval of 1 hour, 30 mins after bleeding, reinfusion was initiated with the shed blood over the ensuing 30 mins. Sublingual microcirculation was measured by a sidestream dark-field imaging device at baseline, 1 hour after bleeding, 30 mins after shock, 30 mins after reinfusion and at hourly intervals thereafter for a total of 120 mins.

Results:
The sublingual microvascular flow index (MFI) and perfused vessel density (PVD) were significantly reduced during hemorrhage (P<0.001) when compared with the baseline values. The MFI and PVD were significantly greater after reinfusion in the RIPC group than that in the Control group (P<0.001)(Table).

Conclusions:
RIPC improved sublingual microcirculation following severe hemorrhagic shock.
Abstract 197: Rapid Pediatric Fluid Resuscitation: A Randomized Controlled Trial Comparing the Efficiency of Two Provider Endorsed Manual Fluid Resuscitation Techniques
Authors: Cole Evan T , Harvey Greg , Urbanski Sara , Foster Gary , Thabane Lehana , Parker Melissa J
Published: April 2024

Introduction:
Manual syringe techniques are commonly used by Health Care Providers (HCPs) to accomplish fluid resuscitation for children in shock.

Objectives:
We sought to determine which of two commonly practiced manual fluid resuscitation techniques, Disconnect-Reconnect (DRT) versus Push-Pull (PPT), yielded a higher rate of fluid administration.

Hypothesis:
We hypothesized that a difference in fluid resuscitation rate would exist between DRT and PPT.

Methods:
A 16 participant randomized crossover trial was conducted at McMaster Children’s Hospital in Hamilton, Canada. Consenting HCPs were oriented to the experimental setup, which involved a non-clinical model of a 15 kg toddler in decompensated septic shock. The model incorporated a 22-gauge catheter, with administered fluid draining into a 1-litre graduated cylinder. Following randomization, subjects completed a brief standardization procedure and then were asked to rapidly administer 900 mL (60 mL/kg) of 0.9% normal saline to the simulated child. Between DRT and PPT, a 30-minute washout period was enforced. All testing was video recorded, with data extracted from trial videos by two blinded outcome assessors. The primary outcome of a difference in total fluid administration rate was analyzed by paired t-test.

Results:
Total fluid administration rate (mL/second) significantly differed between the two techniques, with a mean difference of 0.15 [95% CI 0.05; 0.25] (p=0.005). Mean (sd) fluid administration rates were DRT, 1.77 (0.145) and PPT, 1.62 (0.226). A change in fluid administration rate occurred over the intervention for DRT, F(1,15)=2316.36 (p<0.001) and PPT, F(1,15)=806.04 (p<0.001). Pairwise comparisons indicate that DRT Rate 1, 1.63 (0.143) significantly differed from Rate 2, 1.83 (0.176) and Rate 3, 1.88 (0.180); (p<0.001). PPT Rate 1, 1.62 (0.223) and Rate 2, 1.58 (0.237) did not differ, but Rate 2 significantly differed from Rate 3, 1.67 (0.265); (p=0.003). HCPs encountered technical issues more frequently when performing PPT versus DRT. No catheter dislodgements occurred. HCP self reported fatigue did not differ between DRT and PPT (p=0.755).

Conclusions:
Use of DRT resulted in a faster rate of fluid administration than PPT in a simulated pediatric resuscitation scenario.
Abstract 202: Automated Heart Rate Complexity Calculation: Reference Ranges in Trauma and Cardiology Patients
Authors: Batchinsky Andriy , Belenkiy Slava , Baker William , Liu Nehemiah , Necsoiu Corina , Walker Kerfoot , Salinas Jose , Cancio Leopoldo
Published: April 2024

Objective:
Heart rate complexity (HRC), measured by sample entropy (SampEn), and multiscale entropy (MSE), has been useful for detection of injury severity in off-line analysis of animal and human data. However there are no reported reference ranges for these metrics, especially as relevant to automated analysis of the electrocardiogram (ECG)

Materials and methods:
We developed algorithms for automated R-wave detection and HRC and heart rate variability computation. We used them to analyze a mixed data set of ECGs of various lengths from the US Army Trauma Vitals database (TV, n=71), and the Physionet Holter monitor database (n=30). The TV set was further subdivided into injured patients that received lifesaving interventions (LSI, i.e. intubation, chest tube, transfusion, n=49) or who did not (no LSI, n=22). The Physionet data were separated into these groups: (1) normal sinus rhythm, untreated (n=5); (2) normal sinus rhythm, medicated (n=9); and (3) arrhythmias, medicated (n= 16). Group 3 included patients with intermittent atrial fibrillation or ventricular tachycardia while on anti-arrhythmics. One-way analysis of variance with Tukey’s procedure was performed. Data are means ± SD, unitless unless noted otherwise.

Results:
see table 1

Conclusions:
In agreement with previous off-line manual analysis of ECG, automated HRC analysis showed lower values in more severely injured subjects with LSIs. The reference ranges for HRC and select heart rate variability metrics will be useful for prospective evaluation of patients using automated analysis of the ECG.

Table 1.
Abstract 204: Better Volume-Outcome Relationship in the Trauma Centers, but Not in The Regional Hospitals. A Nation-wide Population Based Research in Taiwan
Authors: Harnod Dorji , Chang Chu-Hui , Chang Ray-E , Harnod Tomor
Published: April 2024

Background:
Survival rates for major trauma patients in different levels of hospitals were analyzed to test for the volume-outcome relationship.

Methods:
From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP 90 was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis one year before trauma admission for calculating Charlson Comorbidity Index. And factors such as age, gender, ICU admission, different hospital levels and the hospital case volumes were adjusted in a logistic regression model for survival analysis.

Results:
There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). After controlling the age, genders, co-morbidity and injury severity, the difference of mortality rates were significant in hospital levels. Compared with the risk in low volume centers, the risk of mortality was 0.65 times in mid-volume trauma centers (P=0.048) and the risk of mortality was 0.43 times in high -volume trauma centers (P=0.014). But in regional hospitals, compared with the risk in low volume hospitals, the risk of mortality was 0.73 times in mid-volume regional hospitals (P=0.253) and the risk of mortality was 0.80 times in high-volume regional hospitals (P=0.354).

Conclusions:
Our results suggest major trauma patients should be sent to the trauma centers. And, based on the better volume-outcome relationship in trauma centers, we should not have too many trauma centers in metropolitan area. Many trauma centers could lead to the possible dilution effect and lower the survival rates. And, based on our results, the volume-outcome relationship is not prominent in regional hospitals.
Abstract 213: Retrieval of Plaque Debris by Aspiration Thrombectomy is the Sign of High Risk for Distal Embolization in Acute Coronary Syndrome Patients
Authors: Matsuo Koshi , Ueda Yasunori
Published: April 2024

Background:
Slow flow or no re-flow phenomenon during coronary intervention is mainly caused by distal embolization of thrombus and plaque debris, and is associated with unfavorable long-term clinical outcomes. However, its high-risk patients are not well understood. Aspiration thrombectomy in the patients with acute coronary syndrome (ACS) often retrieves thrombus but sometimes plaque debris. Therefore, we examined if the ACS patients in whom plaque debris was retrieved by aspiration thrombectomy were high-risk of distal embolization.

Methods:
Consecutive patients with ACS (n=151) who received aspiration thrombectomy and coronary intervention with filter-type distal protection device (Filtrap) were prospectively enrolled. We classified them into two groups according to whether (Group A, n=29) or not (Group B, n=122) the plaque debris was retrieved by aspiration thrombectomy. We compared between the groups the frequency of filter slow flow/ no-reflow phenomenon and the frequency of distal embolization captured by filter device.

Results:
Distal embolization of plaque debris was detected more frequently in Group A than in Group B (90% vs. 30%, P<0.0001). Filter slow flow/ no-reflow phenomenon occurred more frequently in Group A than in Group B (93% vs. 29%, P<0.0001).

Conclusion:
Retrieval of plaque debris by aspiration thrombectomy is the sign of high risk for distal embolization in ACS patients. Distal protection may potentially be useful for those high-risk patients.
Abstract 228: Quality Measurement of Dispatcher-Assisted Cardiopulmonary Resuscitation; A Nationwide Observational Study
Authors: Lee Yu Jin , Lee Seung Chul , Shin Sang Do , Kim Joo Yeong , Lee Eui Jung , Song Kyoung Jun
Published: April 2024

Introduction:
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an effective community intervention program to increase bystander CPR rate after cardiac arrest. The 2010 American Heart Association guidelines recommended a very easy, simplified DA-CPR protocol which is composed of two key questions and hands-only CPR. However, there have been few reports on quality of dispatchers’ performance in DA-CPR when the protocol is implemented. This study aimed to evaluate the quality of dispatchers’ performance in DA-CPR.

Methodology:
All patients with cardiac arrest with presumed cardiac etiology transported by emergency medical service (EMS) were enrolled from Aug.13, to October 8, 2012 in Korea. We used a quality measurement protocol and document which was developed from a medical directors’ workshop of Asian EMS Council in Aug, 2012. Sixteen provinces’ medical directors reviewed cardiac arrest registries, DA-CPR registries, and records of conversation between dispatchers and bystanders, and evaluated according to the developed protocol. Primary end pints such as the detection rate, instruction rate, compliance rate, time intervals from call to each process, and barriers to prevent bystanders from performing CPR were analyzed.

Results:
A total 4,601 of cardiac arrest were analyzed. Of these, 709 cases (15.4%) were detected by primary dispatcher (range 4.4%-34.0%), and 590 cases (12.8%) received bystander CPR instruction. Median time (Q1-Q3) from call to detection and to initiation of bystander CPR was 91 seconds (57-118) and 147 seconds (82-206), respectively. Compliance rate for the protocol (on asking key questions) was 37.0%. The CPR instruction failed in 74 cases due to rejection by bystanders, prolonged death, and communication disruption. The number of aborted bystander CPR after initiation of DA-CPR by bystander was 257, who stopped to receive CPR prior to arrival of ambulances at the field due to request by family, disruption of communication, and other reasons. Finally successful DA-CPR was 233 (5.0%) among 4,601.

Conclusion:
Quality of dispatcher performance on DA-CPR protocol was very poor and a few patients received successful DA-CPR. A continuous quality management program should be applied to improve the quality DA-CPR.
Abstract 229: Outcome of Mild therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest: A Nationwide Retrospective Analysis
Authors: Lee Eui Jung , Shin Sang Do , Song Kyoung Jun , Ro Young Sun , Hong Won Pyo
Published: April 2024

Background:
MTH has been known to be effective in patients with shorckable rhythm but controversial whether it improves outcomes in patients with non-shockable rhythms or not. This study aimed to determine whether MTH was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes by ECG rhythms.

Methods:
We used a nationwide OHCA cohort data from 2008 to 2010. We included OHCA survivors of presumed cardiac etiology with age more than 15 years-old, excluding patients with unknown outcome or alert mental status after prehospital return of spontaneous circulation. MTH group was defined as patients received any method of hypothermia. The primary and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression analysis was used to compare outcome of MTH and non-MTH group in total cohort and propensity-score matched cohort including subgroup analysis by ECG type.

Results:
Among 64,155 OHCA patients, 4,557 with survived to admission were used for analysis (1,599 survived to discharge and 499 discharged with good neurological recovery). Overall, MTH group had better outcome than non-MTH group in survival to discharge (53.6% vs. 33.4%, p<0.001) and good neurological outcome (18.3% vs. 10.3%, p<0.001). In the total cohort, the adjusted ORs of MTH group compared to non-MTH group were 1.81 (95%CI 1.44-2.29) for survival to discharge and 1.37 (95%CI 1.00-1.89) for good neurological outcome. In the propensity score-matched cohort, adjusted ORs of MTH group compared to non-MTH group were 1.83(95%CI 1.33-2.50) for survival to discharge and 1.20 (95%CI 0.76-1.88) for good neurological outcome. In the subgroup analysis, the adjusted ORs of MTH group compared to non-MTH group for survival to discharge were 2.04(95%CI 1.15-3.62) in shockable rhythm and 2.05 (95%CI 1.51-2.79) in non-shockable rhythm. Adjusted ORs of MTH group to non-MTH group for good neurological recovery were 1.86(95% CI 1.07-3.21) in shockable rhythm and 1.13 (95% CI 0.59-2.20) in non-shockable rhythm.

Conclusions:
MTH was associated with improved survival to discharge but not good neurological. In a subgroup of shockable rhythm, MTH was associated with better neurological outcome and survival to discharge.
Abstract 234: Temporal Trends of Resuscitation Characteristics After Out of Hospital Cardiac Arrest: Data From a National Survey of Sudden Cardiac Arrest Survivors
Authors: Mosesso Vince , Derian Leslie B , Sears Samuel F , Carney Bill , Lawless Christine E , Lampert Rachel
Published: April 2024

Introduction:
We have little data from survivors of sudden cardiac arrest (SCA). We sought to learn resuscitation characteristics of those who survived out of hospital cardiac arrest (OHCA) and determine if these changed over recent years.

Methods:
An on-line survey regarding circumstances before and after cardiac arrest was emailed to 591 SCA survivors registered with the Sudden Cardiac Arrest Association (Washington, DC) between 10/2012 and 1/2013. Data were analyzed for temporal trends in resuscitation characteristics among survivors whose cardiac arrest was outside the hospital.

Results:
Overall, 189 (32%) survivors responded; of these, arrest occurred outside the hospital in 169. Mean age of respondents with OHCA was 55+/-12 years (range 18-82); 55% were male, and 94% white. Heart disease was known to be present before the arrest in 37% and was diagnosed in 22% after arrest; no heart disease was found in 41%. Arrest occurred within the last two years in 22%, between two and five years ago in 38%, and greater than five years ago in 63% (range 1 month-17 years). Bystander CPR rates were high and trended higher in more recent years. There were no home uses of AED reported; AED use at public sites did not differ by time period. The frequency of therapeutic hypothermia was higher if arrest occurred within the last five years.

Conclusion:
Among OHCA survivors, treatment with therapeutic hypothermia increased over time among survivors, but rates of bystander CPR and AED use did not. Opportunities for improved initial care of persons with OHCA persist, both prehospital and after hospital arrival.
Abstract 236: A Multi Center Study of Awareness During Resuscitation
Authors: Parnia Sam , Fenwick Peter , Spearpoint Ken , Devos Gabriele , Killingbeck Hayley , McLean Paula , Zafari Maziar , Dickert Neal , Beisteiner Roland , Sterz Fritz , Berger Michael , Warlow Celia , o’Donoghue Siobhan , Lovett Salli , Metcalfe Smith Russell , Pink Sandra , Harris Kayla , Sutton Jenny , Walmsley Harry , Little Paul , Farber Mark
Published: April 2024

Awareness during anesthesia is characterized by auditory perceptions, pain, and dream like states and associated with PTSD. Few studies have examined awareness during cardiac arrest. Although, these two phenomena share similarities, there are also differences. In particular during CA, patients may report visual perceptions (‘seeing’ and recalling events). Furthermore, some experiences are associated with the scientifically imprecise entity of ‘near death experiences’ (NDE).

Methods:
A prospective cohort study at 25 hospitals in the US, UK and Austria to determine the incidence of awareness (i.e. visual or auditory) during CA as well as the characteristics of patients’ recollections was conducted. We further examined the feasibility of testing the accuracy of visual and auditory recollections using standardized tests by pre-installing shelves containing images as well as instructing research staff to provide set auditory cues during CPR where possible. Survivors underwent a structured interview which included questions on visual and auditory impressions as well as the Greyson questionnaire to quantify experiences typically classified as NDE (score >=7)

Results:
2060 cardiac arrest events were recorded with a reported survival of 32% (n=657). 23% (n=152) were interviewed. Information on visual or auditory impressions during CA was available on 89% of interviewed subjects. Of these, 37 % responded that they had experienced visual and/or auditory impressions during their time of unconsciousness and CA. Among those with auditory and/or visual impressions, 70% had a Greyson score >0 and 30% had a Greyson score >=7, consistent with a conventionally defined “NDE”. Two had visual recollections of being able to ‘see’ events, and one accurately described details corresponding with a verifiable period of at least 3-5 minutes of CA. Placement of images corresponded with only 33% of all CA locations. The two patients did not have CA in areas with images.

Conclusions:
Auditory and/or visual experiences during unconsciousness may be a relatively common phenomenon. Even though these experiences may not reflect the conventionally defined NDE and may be different, they may indicate that consciousness may not cease as expected with cessation of heartbeat during CA
Abstract 240: Electrocardiogram Changes Associated With In-Hospital Cardiac Arrests due to Respiratory Failure
Authors: Phan Derek , Do Duc , Hayase Justin , Hu Xiao , Boyle Noel G
Published: April 2024

Introduction:
The estimated incidence of in-hospital cardiac arrests (IHCA) in US is over 200,000 annually. Respiratory related causes contribute to approximately 15% of IHCAs. Many arrests due to respiratory problems may be preventable. Thus it may be beneficial to develop methods that can identify patients at increased risk of developing respiratory related cardiac arrests particularly if clinical signs are undetected or develop rapidly.

Hypothesis:
ECG changes preceding respiratory related cardiac arrests may alert caregivers of an impending cardiac arrest when other clinical signs are not apparent.

Methods:
We reviewed all IHCA cases that occurred between April 2010 and March 2012 at UCLA Medical Center in patients age > 18 years, with ECG data available at least 3 hours prior to and including the IHCA, and further analyzed cases related primarily to respiratory failure as determined by chart review. ECG data was analyzed for ECG changes prior to arrest.

Results:
Respiratory failure was designated as the primary cause in 17/65 (26%) of IHCAs reviewed. Of these, the mechanism of IHCA was pulseless electrical activity (PEA) in 70%, and bradyasystolic arrest in 30%; there were no ventricular tachycardia/ventricular fibrillation (VT/VF) arrests. The causes of respiratory failure included: mucous plug (41.2%), aspiration (35.3%), and pneumonia (23.5%). At least one ECG change preceding the arrest was seen in 88% of cases, and at least two ECG changes preceding the arrest was seen in 47% of cases, with an average of 1.6 ECG changes per case.

Conclusions:
At least one significant ECG change was recorded in approximately 90% of IHCA cases due to respiratory arrest with a median time of approximately 13 minutes prior to the arrest. This may provide an additional alert to physicians and nurses of impending cardiac arrest, and allow for earlier detection and intervention.
Abstract 248: Prolonged Adult Cardiac Arrest With Enhanced Cardiopulmonary Resuscitation and Sodium Nitroprusside: A Case Series
Authors: Schultz Jason C , Caldwell Emily , Sarraf Mohammad , Kolbeck Jim , Yannopoulos Demetris
Published: April 2024

Introduction:
Sudden cardiac death remains the leading cause of death in the United States, and overall survival with good neurological function nationally is about 8%. Prolonged refractory cardiac arrest requires an efficient method to maintain viability to the vital organs until a reversible cause, if present, can be treated. Sodium Nitroprusside Enhanced CPR, or SNPeCPR, is a new form of CPR consisting of active compression-decompression (ACD), impendence threshold device (ITD), abdominal binding, and large doses of sodium nitroprusside. We present here a series of 6 patients in whom these methods were utilized in the setting of cardiac arrest in the cardiac catheterization laboratory.

Methods:
6 patients who suffered cardiac arrest (5 VT/VF and 1 PEA) and were treated for an average time of 32±12 minutes before arrival to the cardiac catheterization laboratory. Utilizing a LUCAS® device in combination with an ITD allowed for prolonged periods of CPR during which time percutaneous coronary intervention was performed to re-establish coronary blood flow. Abdominal binding was performed, and finally, alternating boluses of 2 and 1 mg of sodium nitroprusside for a total of 4 doses were given as treatment for no reflow in the coronary vascular bed throughout the duration of CPR. The etiology of the cardiac arrest was ostial LAD occlusion (4 cases), left main occlusion (1) contrast induced anaphylactic reaction and PEA (1).

Results:
Six patients were successfully treated with SNPeCPR. The mean time of CPR was 58±17 minutes. Hemodynamic measurements during CPR approached pre-arrest physiologic levels (mean±STD SBP/DBP was 88±23/38±12) . 5/6 patients survived to hospital discharge. All survivors had normal neurological function at hospital discharge and 1-month clinic follow up Cerebral Performance Category score of 1. Average LVEF at hospital discharge was 48±18 % . 4/5 survivors were alive at one year follow up.

Conclusions:
Sodium nitroprusside, in combination with mechanical adjuncts to CPR, is a safe and effective method of prolonged resuscitation. Further prospective studies will be required to further assess the efficacy of SNPeCPR in cases of prolonged cardiac arrest.
Abstract 255: Sex Difference of Clinical Outcomes in Patients with Out-of-Hospital Cardiopulmonary Arrest: A Prospective Multicenter Observational Study
Authors: Tamura Tomoyoshi , Ito Noritoshi , Nishiyama Kei , Hayashida Kei , Suzuki Masaru , Mochizuki Toshiaki , Kataoka Atsushi , Yamada Noriaki , Hatada Tsuyoshi , Himeno Hideo , Fujioka Masayuki , Oomura Taku , Toyoda Yukitoshi , Abe Mitsuru , Morooka Takaya , Taniguchi Yuusuke , Hori Shingo ,   J-POP
Published: April 2024

OBJECTIVE:
There is a strong interest in differences in the outcomes between men and women with out-of-hospital cardiopulmonary arrest (OHCA). The aim of this study is to examine the sex differences of clinical outcomes in patients with OHCA.

METHODS:
The Japan-Prediction of neurological Outcomes in patients Post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether regional cerebral oxygen saturation (rSO2) predicts neurological outcomes in OHCA. In this post-hoc analysis, OHCA were collected after excluding patients exposed to extracorporeal cardiopulmonary bypass from the J-POP registry. The primary outcome measure was a return of spontaneous circulation (ROSC) prior to hospital arrival, and secondary outcome measure was a 90-days neurological outcome.

Results:
Between May 2011 and July 2012, 1204 consecutive patients, age 72±15 years, 40.4% of women, were examined. Men were younger than women (70±15 vs. 75±15 years, p<0.001), with higher percentage of witness status (53.7% vs. 43.1%, p<0.001), and with higher percentage of rSO2 more than 40% at hospital arrival (12.1% vs. 7.0%, p<0.01), and tended to have higher percentage of cardiac etiology (57.6% vs. 52.4%, p=0.07). 118 (9.8%) patients achieved ROSC prior to hospital arrival. 90-day survival rate was 6.1% (n=73), and 90-day good neurological outcome rate was 3.5% (n=42). Men had higher chance of ROSC (11.7% vs. 7.0%, p<0.01), and good neurological outcome at 90 days (4.6% vs. 1.8%, p=0.01). Multivariate analysis adjusting for age (less than 75 y/o or not), witnessed, received CPR by bystander and etiology revealed that sex male was chosen as an independent predictor for ROSC prior to arrival (RR 1.59, 95%CIs 1.03-2.45). Mantel-Haenszel test adjusting for cardiac etiology also showed that men had higher rate of good neurological outcome (RR 2.47, 95%CIs 1.16-5.23).

Conclusion:
Our results demonstrate that men had significantly better chance of ROSC regardless of age, received BLS and etiology, and had better neurological prognosis after cardiogenic OHCA. Additional studies are needed to validate these observations for other potential genetic factors.
Abstract 264: Bystander-initiated Cardiopulmonary Resuscitation in an Asian Community: Does the Socioeconomic Status Matter?
Authors: Chiang Wen-Chu , Ko Patrick Chow-In , Chang Anna Marie , Chen Wei-Ting , Huang Yu-Sheng , Chen Shey-Ying , Lee Bin-Chou , Lai Mei-Shu , Ma Matthew Huei-Ming
Published: April 2024

Objectives:
To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian Metropolitan area.

Methods:
We performed a retrospective study in a prospectively collected cohort from an Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. Primary outcome was bystander-initiated CPR, and secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.

Results:
From Jan. 1, 2008 to Dec. 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among them, 617 (17.3%) cases received bystander CPR. Proportions of bystander CPR in low SES vs. high SES areas were 14.5% vs. 19.6% (p<0.01). Odds ratio (OR) of receiving bystander-initiated CPR were 0.72 (95% confidence interval (CI) 0.60-0.88) in low SES areas after adjusted by age, gender, witnessed status, public collapse, and unrecognized OHCA by online dispatcher. Survival to discharge rate was significantly lower in low SES areas vs. high SES areas (4.3% vs. 6.8%; p<0.01). All results above remained consistent in analyses by mean household income.

Conclusions:
Patients who had an OHCA in low SES areas were less likely to receive bystander CPR, as well as worse survival outcomes.