bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18829: Cardiac Resynchronization Therapy Among Patients With Heart Failure With Reduced Ejection Fraction and Right Bundle Branch Block: A United States Population Based Study
Authors: Mujib Marjan , Mazumder Nabila K , Kolte Dhaval , Khera Sahil , Palaniswamy Chandrasekar , Harikrishnan Prakash , Sule Sachin , Aronow Wilbert S , Frishman William H , Fonarow Gregg C , Ahmed Ali
Published: April 2024

BACKGROUND:
Little is known about the efficacy of cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFREF) and right bundle branch block (RBBB). The objective of this study was to assess utilization of CRT in the United States, selected inpatient outcomes, and associated patient and hospital characteristics.

METHODS:
We screened hospital discharges from the 2002-2010 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. ICD-9-CM diagnosis codes 428.20-428.23 were used to identify primary HFREF and ICD-9-CM code 426.4 was used to identify any RBBB. Patients who underwent CRT were identified using ICD-9-CM procedure codes. Discharge weights were used to measure national estimates. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed.

RESULTS:
Of 13,590 HFREF patients with RBBB, only 1368 (10%) underwent CRT during 2002-2010 in the United States. No CRT was done in 2002. Utilization of CRT among HFREF with RBBB patients increased from 0.4% in 2003 to 20% in 2010 (50 times increase, P for Trend <0.001). Predictors of CRT utilization were younger age, male gender, white race, elective admission, urban-teaching hospital, private insurance status and <2 comorbidities. Compared to patients who did not receive CRT, those with CRT had significant shorter length of stay (4.7 vs. 5.1 days, P<0.001), but higher in-hospital charges (135,099 vs 33,400 USD, P<0.001). Overall, in-hospital mortality rate was 2.5% (335/13,590); however, not a single in-hospital death occurred among those who received CRT.

CONCLUSIONS:
The numbers (and proportions) of CRT among HFREF with RBBB patients in the United States increased steadily increased from 2002 to 2010. CRT recipients had a significant reductions in hospital length of stay and increases in hospital charges. Further studies are needed to estimate the association of CRT and long-term outcomes.
Abstract 19113: Invasive Evaluation of Chest Pain in Patients With Angiographically Normal Coronary Arteries
Authors: Lee Bong-Ki , Yong Andy C , Fearon William F , Lim Hong-Seok , Nguyen Patricia K , Yeung Alan C , Tremmel Jennifer A
Published: April 2024

Background:
More than 20% of patients with angina have no angiographic evidence of coronary artery disease (CAD). Our aim was to investigate alternative etiologies for chest pain in these patients.

Methods:
In patients with angina who were referred for coronary angiography and had no angiographic CAD, endothelial function testing, intravascular ultrasound (IVUS), and physiology measurements were performed.

Results:
A total of 139 patients were enrolled. The average age was 54.0±11.4, with 107 women (77%). Seventy four patients (53.2%) had hypertension, 32 (23.2%) diabetes, 87 (62.6%) dyslipidemia, 10 (7.2%) tobacco use, and 45 (32.4%) a family history of CAD. Endothelial dysfunction (a decrease in luminal diameter of >20% with intracoronary acetylcholine) was present in 61 patients (43.9%). Five patients (3.6%) had fractional flow reserve <0.80. Microcirculatory impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (20.9%). Myocardial bridging (an echolucent halo found on IVUS with systolic arterial compression >10%) was present in 54 patients (43.9%). Thirty eight patients (27.3%) had no coronary explanation for their chest pain, with normal endothelial function and coronary physiologic assessment, and no myocardial bridging. There was no complication.

Conclusion:
Many patients with angina and no angiographic evidence of CAD have occult coronary circulatory abnormalities, while a minority has no coronary etiology to explain their symptoms. A complete invasive assessment of these patients at the time of coronary angiography provides important diagnostic information which may affect treatment.
Abstract 19432: Difference in Outcomes After Repeat Percutaneous Coronary Intervention for Sirolimus-Eluting Stent Restenosis Lesions With or Without Stent Fracture
Authors: Sakamoto Yasunari , Muramatsu Toshiya , Tsukahara Reiko , Ito Yoshiaki , Ishimori Hiroshi , Hirano Keisuke , Nakano Masatsugu , Yamawaki Masahiro , Araki Motoharu
Published: April 2024

Background:
Presence of stent fracture (SF) after sirolimus-eluting stent (SES) implantation has reported to be associated with an increased risk of in-stent restenosis and target lesion revascularization (TLR). Incidence of SF and the relevance to cardiovascular events are previously reported. But little is known about the outcomes after repeat percutaneous coronary intervention (PCI) for SES restenosis lesion with SF. So this study compared the outcomes after repeat PCI for SES restenosis lesion with or without SF.

Method:
From April 2007 to September 2011, total 2020 lesions implanted SES during PCI at our hospital. Total 148 lesions, 7.3% had restenosis (defined as % diameter stenosis >50%) in follow up angiogram. Of the restenosis lesion, 107 lesions went to TLR those consisted of 75 lesions with repeat DES implantation and 32 lesions with balloon angioplasty alone. SF was defined as complete or partial separation of the stent as assessed by plain fluoroscopy and detected in 61 lesions of SES restenosis lesions. Thirty-three SES restenosis lesions with SF (SF group) and 42 SES restenosis lesions without SF (non SF group) were retrospectively evaluated re-restenosis rate during follow up after repeated implantation of DES.

Result:
Baseline characteristics were similar. One-year cumulative incidence of re-restenosis after repeat DES implantation for SF group and non SF group which calculated by Kaplan-Meier method were 68% and 36% (Log-rank test P=0.0332), respectively (figure).

Conclusion:
Restenosis lesions with SF had significantly high incidence of re-restenosis after repeat DES implantation.
Abstract 226: Relation Between Glasgow Coma Scale Motor Score Immediately After ROSC and Neurologic Outcomes in Patients Treated With Hypothermia After Out-of-Hospital Cardiac Arrest: J-PULSE-Hypo Registry
Authors: Kuroda Yasuhiro , Kawakita Kenya , Nagao Ken , Yonemoto Naohiro , Yokoyama Hiroyuki , Nonogi Hiroshi ,   the J-PULSE-Hypo Investigators
Published: April 2024

Background:
The 2010 American Heart Association Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) recommend that comatose adult patients with return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation (VF) cardiac arrest should receive therapeutic hypothermia (Class I). However, it remains unclear whether Glasgow Coma Scale (GCS) immediately after ROSC predicts neurologic outcome in patients treated with hypothermia after out-of-hospital cardiac arrest.

Methods:
We conducted a multicenter retrospective study at 14 institutions to evaluate the effect of therapeutic hypothermia on out-of-hospital cardiac arrest between January 2005 and March 2011 (505 patients). The study committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming rate. In the patients with ROSC at hospital arrivals, the relationship between GCS score at hospital arrivals and neurological outcomes were analyzed. Neurologic outcomes at 90 days after cardiac arrest were examined. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.

Results:
A total of 100 patients were studied. GCS score at hospital arrivals was distributed from 3 to 10. GCS motor scale at hospital arrivals was distributed from M1 (n=64), M2 (n=9), M3 (n=10), M4 (n=15), to M5 (n=2). Time interval between ROSC and hospital arrivals was distributed from 0 to 51 min (median 10 min, IQR: 5 - 17). A favorable outcome at 90 days after cardiac arrest was observed in 89 patients (89 %). All patients with GCS M4 and M5 (n=17) in which examined within 22 min after ROSC predict favorable outcome. Among the patients with GCS M1-3 (n=83) in which examined within 51 min after ROSC, favorable outcome was observed in 87 % (n=72) patients.

Conclusions:
Our results suggest that GCS motor scale at hospital arrivals after ROSC before induction of therapeutic hypothermia predict favorable outcomes.
Abstract 239: Initial Cytokine Levels Are Associated With Outcome After Cardiac Arrest
Authors: Peberdy Mary Ann , Ornato Joseph P , Helm Shirley L , Thacker Leroy R , Callaway Clifton W , Rittenberger Jon C , Cocchi Michael N , Gaieski David F , Abella Benjamin S , Donnino Michael W ,   for the National Post Arrest Rsch Consortium Investigators
Published: April 2024

Background:
The post arrest syndrome is characterized, in part, by a systemic inflammatory state whose molecular mechanisms and association with survival remain poorly understood. A deeper understanding of cytokine activity post arrest may identify an early biomarker for outcomes as well as a potential therapeutic target.

Hypothesis:
Cytokine elevation is associated with survival after cardiac arrest (CA) and ROSC.

Methods:
One hundred eleven consecutive patients (pts) enrolled in the multicenter Characterization of Mitochondrial Injury after Cardiac Arrest (COMICA) study underwent serial serum measurements for IL-6, IL-8, IL-10, and TNFα via a Millipore Multiplex Human Cytokine Panel at Time 0 (T0) defined as upon arrival to the hospital, and 12, 24, 36, and 48 hours post ROSC. We assessed the ability (sensitivity, specificity, and area under the receiver operating curve (ROC)) of these cytokines drawn at T0 to predict survival to hospital discharge. A repeated measures ANOVA was fit with a between subjects factor (Group: Survived, Expired), a within subjects factor (Time: 0, 12, 24, 38, 48) and the interaction between these two factors. Values are presented as mean ± SEM.

Results:
The areas under the ROC [sensitivity, specificity] were: IL-6= .894 [.732, .837]; IL-8= .800 [.851, .696]; IL-10= .738 [.738, .745]; and TNFα= .512 [.975, .143]. The repeated measures ANOVA analysis for IL-6, which had the best predictive value, is shown in the Figure. There was a significant Group x Time interaction (p=0.0022) and post-hoc tests revealed a significant difference in Log(IL6) at T0 (p 6.72 at baseline is approximately 19 times (OR=18.68, 95% CI (6.60, 52.90)) more likely to die before being discharged than a pt with Log(IL6) < 6.72.

Conclusion:
Early IL-6 levels are strongly associated with outcome after CA. Further investigation is needed to determine molecular mechanisms and potential for use as an early marker of outcome in post arrests pts.
Abstract 242: Association Between Charlson Comborbidity Illness Components and Outcome Following Cardiac Arrest
Authors: Rittenberger Jon , Calderon Luis , Doshi Ankur , Dezfulian Cameron , Guyette Francis , Callaway Clifton ,   The Post Cardiac Arrest Service
Published: April 2024

Introduction:
The independent effect of pre-arrest comorbid illness on survival and good neurologic outcome following resuscitation from cardiac arrest has not been defined.

Methods:
Convenience sample of patients treated at a post-cardiac arrest center between 1/1/2005 and 7/22/2009 with Charlson Comborbidity Index (CCI) scores determined. We obtained information and injury severity based on Pittsburgh Cardiac Arrest Category (PCAC) were determined from the medical records. Univariate logistic regression was used to determine the association between individual CCI components and survival and good neurologic outcome (defined as discharge home or to acute facility) were primary outcomes. A multivariate model including PCAC, shockable rhythm, and CCI components found significant in the univariate model was generated. Goodness of fit was evaluated using the Hosmer Lemeshow value.

Results:
Of 348 subjects, the majority (56%) were male, experienced OHCA (54%), with a mean age of 61 (±16) years. VF/VT was the most common rhythm (39%), 32% received coronary angiography, the majority (66%) were comatose, and 56% received hypothermia. VF/VT was associated with survival in the multivariate model whereas PCAC and age was associated with non-survival. VF/VT, cardiac catheterization, and history of myocardial infarction were associated with good outcome in the multivariate model, whereas PCAC was associated with poor outcome. (Table)

Conclusions:
Prior history of diabetes and more severe injury severity associate with worse outcomes whereas factors associated with cardiac etiology arrests (MI, VF/VT, catheterization) are associated with improved outcomes.
Abstract 267: Assessing Public Perceptions of Cardiopulmonary Resuscitation and Bystander Willingness to Act in Out-of-Hospital Cardiac Arrest: A Qualitative Study
Authors: Cheskes Lindsay , Dainty Katie , Beaton Dorcas , Parsons Janet , Morrison Laurie J
Published: April 2024

Background:
Bystander cardiopulmonary resuscitation (CPR) improves the odds of survival from out-of-hospital cardiac arrest (OHCA). Despite this, bystander CPR rates are considerably lower in most Canadian communities compared to their international counterparts. Lay public understanding of OHCA and willingness to perform CPR remains poorly understood within a Canadian context.

Objectives:
1)To explore public knowledge and perceptions of OHCA and CPR. 2)To identify barriers and enablers to engaging community members in performing CPR. 3)To better understand experiences with CPR education.

Methods:
21 semi-structured interviews were conducted with members of the general public. Sampling was purposeful using a maximum variation technique. A range of past CPR training experiences, ethnicities and ages were represented in the sample. Interviews were audio-taped and transcribed verbatim for analysis. An inductive thematic analysis of the data was undertaken and a coding framework developed. Codes were grouped into themes and a concept map was elucidated. Analysis occurred alongside data collection to monitor emerging themes.

Results:
5 themes were identified: 1) knowledge 2) barriers 3) lack of social obligation and responsibility 4) psychological factors and implications and 5) education. Participants frequently wrongly conflated the symptoms of OHCA and those of heart attack; they also overestimated survival rates from OHCA. Many participants articulated the steps of CPR, yet said they would look to others to help first. Concerns about inadequate knowledge/training, causing harm, being watched by others or doing something wrong/missing a step were expressed. Personal safety and concerns about mouth-to-mouth breathing were common. Altruistic values such as a desire to save another person’s life seem to be the primary motivator to providing help. Participants called for simplified education regarding recognition and basic science of OHCA, AEDs and hands-on CPR practice.

Conclusion:
This study illuminates important issues surrounding the performance of bystander CPR. This work informed a larger survey to investigate these phenomena at the national level, with a view towards launching new or tailoring existing community interventions.
Abstract 296: Hypothermic to Ischemic Ratio as a Predictor for Good Neurologic Outcome From Out-of-Hospital Cardiac Arrest Presenting With a Shockable Rhythm
Authors: Sawyer Kelly N , Kurz Michael C , Elswick R K , Camp-Rogers Teresa R ,   Virginia Commonwealth Univ ARCTIC Investigators
Published: April 2024

Objectives:
The Hypothermic to Ischemic Ratio (HI Ratio = total hypothermic time / total ischemic time) has been externally validated as a predictor for survival from out of hospital cardiac arrest (OHCA). We sought to examine its relationship to “good” neurological outcome.

Methods:
Adult, non-traumatic, OHCA patients presenting with a shockable rhythm and surviving to hospital admission between January 2008 and December 2011 were considered for inclusion. Structured data were collected, including all Utstein criteria and relevant time intervals between initiation of therapeutic hypothermia and rewarming. The outcome of interest was “good” or “poor” neurologic status at discharge, defined as cerebral performance category 1-2 and 3-5, respectively. Logistic regression models were used to evaluate the effect of predictor variables on our primary outcome. Odds ratios (OR) with 95% confidence intervals (CI) are reported.

Results:
A total of 128 patients were included. Of those who survived to discharge (n=94), 68.1% had good neurologic outcome. Patients had a mean age of 58.3 years (SD 12.95, 95% CI 56.06, 60.59) and 50.8% were black. The majority of patients were male (71.9%) and had witnessed arrest (89.1%), with 61.7% receiving bystander CPR. In multivariable modeling, younger age (OR 0.92, 95% CI 0.88, 0.96), male gender (OR 3.64, 95% CI 1.30, 11.23), bystander CPR (OR 3.12, 95% CI 1.22, 8.52), and a larger HI Ratio were associated with better neurologic outcome. HI Ratio was the most significant predictor (OR 9.88, 95% CI 4.01, 29.85).

Conclusions:
HI Ratio seems to be a significant predictor for good neurologic outcome after OHCA for patients presenting with a shockable rhythm. Prospective studies should consider HI Ratio as a potential predictor for investigation.
Abstract 307: Selective Brain Perfusion in Addition to Emergency Cardiopulmonary Bypass Resuscitation After Prolonged Asphyxial Cardiac Arrest: Feasibility Studies in a Novel Rodent Model
Authors: Wang Chih-Hsien , Shinozaki Koichiro , Becker Lance B
Published: April 2024

Brief Objectives:
Poor neurological recovery is the major limiting factor in the use of emergency cardiopulmonary bypass (ECPB) in cases of refractory cardiac arrest. To better control cerebral perfusion we developed a novel rodent model of selective brain perfusion (SBP) in addition to ECPB resuscitation. We conducted pilot studies on feasibility of this unique approach Methods

Male:
Sprague-Dawley rats (450-550 gm) were instrumented for ECPB with venous and arterial cannulation. To provide SBP, we additionally cannulated the right common carotid artery (RCCA) and confirmed SBP flow with a Transonic flow probe. First feasibility studies were performed to demonstrate bilateral cerebral flow from unilateral perfusion, and to ascertain tolerability of surgical procedure. To test gross survival effects of SBP in the setting of lethal cardiac arrest, three groups of rats underwent 15 min of asphyxial cardiac arrest followed by resuscitation with 30-min ECPB using 3 different strategies: normothermia with SBP (NT w/ SBP, N=3), hypothermia with SBP (HT w/ SBP, N=3), and hypothermia without SBP (HT w/o SBP, N=3).

After:
ECPB, rats were weaned off ECPB, wounds were closed, and 4-h mechanical ventilation and IV fluids were provided. Rats were then extubated and checked for neurological score (NS: 0-12), development of gross seizures, and the length of time of survival after extubation until death.

Results:
To access feasibility, we injected blue dye into the RCCA and we confirmed that single RCCA perfusion could perfuse the whole brain. Sham studies with rats (3) were conducted with full SBP and ECPR instrumentation for 30-min, then the RCCA was ligated, which confirmed that all rats survived without neurological deficits or limb injury for 3 days. In the pilot survival studies, the longest survival after extubation was observed in HT w/ SBP animal (7.0h±3.0), in contrast to both HT w/o SBP (1.1h±0.4) and HT w/o SBP (2.3h±0.9 ). Similar trends for improved neuro score and fewer seizure were observed for the HT w/ SBP animals.

Conclusion:
Our pilot study showed the feasibility of using brain selective perfusion in a rodent model of highly lethal cardiac arrest. SBP plus hypothermic ECPB trended toward improved survival and neurological outcome and warrants further study.
Abstract 313: Assessment of Arrest Procedures, Hospital Care and Functional Survival of Initial VT/VF Arrest Patients Shocked by a Bystander AED vs Patients Shocked by EMS
Authors: Weisfeldt Myron L , Brown Siobhan , Sanchez Brittany , Aufderheide Tom , Christenson Jim , Daya Mohamud , Gaudio Michelle , Kudenchuk Peter , Marquis Sean , Rea Thomas , Sims Katy , Vaillancourt Christian , Wittwer Lynn , Sopko George , Ornato Joseph , Morrison Laurie ,   ROC Investigators
Published: April 2024

Introduction:
Although one randomized trial and a prospective cohort study suggest that survival to hospital discharge doubles if a bystander uses an AED to defibrillate vs waiting for an EMS provider to defibrillate, there has been no comprehensive comparison of functional survival outcomes or resuscitation treatment differences for these two resuscitation strategies.

METHODS:
Population based data from the ROC Registry (Epistry) provided a comparison of public, witnessed initial VT/VF arrests treated with bystander AED shock (n=77) vs EMS shock (n=328) during 2010. Modified Rankin score (MRS) was determined from the hospital record and MRS <3 at discharge was considered to be good functional survival.

Results:
The two groups were similar in EMS response time, age, and sex. More of the bystander AED vs. EMS shocked patients had bystander CPR (98.7 vs. 62.5%, p<0.001) and fewer received epinephrine (42.9 vs. 72.6%, p<0.001) or amiodarone (9.1 vs. 29.3%, p<0.001). In-hospital care was not different in use of hypothermia (31-32%) but median hospitalization was shorter for bystander AED shocked patients who survived to discharge (10 days vs 13.5 days, ns) Survival to discharge for bystander AED vs. EMS shocked patients was 68% vs. 46% (p=0.001) and survival with MRS < 3 was 53% vs. 33% (p=0.001). The functional survival advantage for bystander AED shocked patients persisted after adjustment for age, sex, bystander CPR and study site: OR of 2.17 (95% CI 1.26, 3.75 p=0.006).

CONCLUSIONS:
Thus AED shock by bystanders for initial VT/VF arrests is associated with greater survival with good to excellent functional recovery and results in less use of medications to achieve stable hemodynamics after arrest.
Abstract 324: Mean Arterial Pressure Achieved During Therapeutic Hypothermia is Not Associated With Neurologically Intact Survival Following Cardiac Arrest
Authors: Hollenbeck Ryan D , Pollock Jeremy S , Giuseffi Jennifer L , Wang Li , Young Michael N , Harrell Frank E , McPherson John A
Published: April 2024

Background:
Therapeutic hypothermia (TH) improves outcomes following cardiac arrest. The optimum hemodynamic goals during TH are unknown. The purpose of this study was to determine if mean arterial pressure (MAP) achieved during TH is associated with neurologically intact survival following cardiac arrest.

Methods:
Retrospective analysis was performed on 188 consecutive comatose survivors of cardiac arrest treated with TH in the cardiovascular intensive care unit of an academic tertiary care hospital. Shock on admission was defined as a systolic blood pressure <90 mmHg or the need for any vasopressor or mechanical support at the time of admission. The cardiovascular portion of the Sequential Organ Failure Assessment (SOFA) score was used to define the achieved MAP for each patient. Multivariable logistic regression was used to examine the effect of achieved MAP during TH on neurologically intact survival to hospital discharged, defined by Cerebral Performance Category.

Results:
Neurologically intact survival was observed in 73/188 (38.8%) patients at hospital discharge, and in 48/162 (29.6%) at a median follow up interval of 3 months. Patients in shock at the time of admission had lower baseline MAP at the initiation of TH (81 versus 87 mmHg; p=0.002), but had similar achieved MAP during TH (80.3 versus 83.7 mmHg; p=0.11). Shock on admission was associated with poor survival (18% versus 52%; p<0.001). Vasopressor use was common (85% of patients) and was not associated with increased mortality. A multivariable analysis including age, time to return of spontaneous circulation, initial rhythm, baseline MAP, and achieved MAP did not demonstrate a relationship between MAP achieved during TH and outcome at hospital discharge (OR 1.28, 95% CI 0.40-4.06; p=0.870) or at follow up (OR 1.09, 95% CI 0.32-3.75; p=0.976).

Conclusions:
We did not demonstrate an association between MAP achieved during TH and neurologically intact survival. Shock at the time of admission was clearly associated with poor outcomes. These data do not support the use of vasopressors to artificially increase MAP in the absence of shock. There is an urgent need for prospective, randomized trials to further define hemodynamic goals during treatment with TH.
Abstract 325: Adverse Events During Therapeutic Hypothermia and Advanced Critical Care After Out-of-Hospital Cardiac Arrest Which Are Associated With Poor Neurological Outcome at Hospital Discharge
Authors: Kim Young-Min , Youn Chun Song , Kim Soo Hyun , Lee Byung Kook , Cho In Soo , Cho Gyu Chong , Jeung Kyung Woon , Oh Sang Hoon , Choi Seung Pill , Shin Jong Hwan , Cha Kyoung-Chul , Yim Hyeon Woo , Park Kyu Nam ,   The Korean Hypothermia Network Investigators
Published: April 2024

Purpose:
The aim of this study was to investigate the association between adverse events (AEs) recorded during therapeutic hypothermia (TH) and advanced critical care after out-of-hospital cardiac arrest (OHCA) and poor neurological outcome in an Asian country where withdrawal of life support by prognostication is not yet permitted.

Methods:
We performed a multicenter retrospective registry-based study of adult OHCA patients treated with TH presenting to 24 hospitals across South Korea during the period from January 2007 to December 2012. The primary outcome was poor neurological outcome, defined as Cerebral Performance Category (CPC) of 3-5, at hospital discharge. AEs and concomitant treatments during cooling, rewarming and advanced critical care period were entered one at a time into the best predictive model for poor neurological outcome for evaluation of association.

Results:
Of a total of 930 OHCA patients entered in the registry, 704 (76%) with a full set of adverse events and covariates for multivariate modeling were included in the analysis. Patients with a poor neurological outcome were 476 [CPC3 = 50 (11%), CPC4 = 214 (45%), CPC5 = 212 (44%)]. Hyperglycemia (46%), hypokalemia (31%) and hypotension (29%) during cooling, and hypotension (22%) during rewarming were common AEs, whereas bleeding were rare (2%). During advanced critical care period, pneumonia (40%), hypoglycemia (23%), myoclonus (22%) and seizure (22%) were common AEs. Sepsis, hypoglycemia, myoclonus, seizure, anticonvulsants and continuous renal replacement therapyduring advanced critical care were associated with poor neurological outcome (Table).

Conclusions:
AEs were common during TH but not associated with poor neurological outcome at hospital discharge. Sepsis, hypoglycemia, myoclonus, seizure, anticonvulsants and continuous renal replacement therapy during advanced critical care period were associated with poor neurological outcome at hospital discharge in our study.
Abstract 339: Combining Urgent Coronary Angiography With Therapeutic Hypothermia Does Not Slow Cooling Times for Comatose Survivors of Cardiac Arrest
Authors: Terman Samuel W , Hume Benjamin D , Menees Daniel S , Silbergleit Robert
Published: April 2024

Introduction:
Selected comatose survivors of out-of-hospital-cardiac arrest (OHCA) meet criteria for both emergent percutaneous coronary intervention (PCI) and induction of mild therapeutic hypothermia (MTH). It is unclear which should be performed first. We hypothesized that urgent catheterization prior to MTH may significantly prolong time to cooling.

Methods:
We conducted a retrospective cohort study, reviewing electronic medical records of all patients treated with MTH in the University of Michigan Emergency Department (ED) for OHCA. We identified whether the endovascular cooling device was inserted in the ED or catheterization lab and assessed time from ED arrival to cooling device insertion, to cooling initiation, and to reaching ≤33.5°C. Neurological outcomes were determined by Cerebral Performance Category (CPC) via chart review. Times were compared via Student’s t-tests.

Results:
Between 7/1/2006 and 9/14/2012, 123 consecutive patients were treated with MTH. Twenty-six (22%) had their device placed in the catheterization lab (14/26 received PCI) while 92 (77%) had theirs placed in the ED. There was no significant difference between catheterization lab v. ED device placement in time from ED arrival to device insertion, arrival to cooling initiation, and arrival to reaching target temperature (see table). Forty-six percent vs 39% of those whose devices were inserted in the catheterization lab vs ED survived past hospital discharge (OR 1.8; 95% CI 0.7-4.4), and 35% vs 39% had favorable 6-month neurological outcomes (OR 1.3; 95% CI 0.5-3.3).

Conclusions:
In our system, initiating cooling in the catheterization lab as opposed to the ED does not significantly delay cooling times. The resources and efficiencies involved in activation of the cath lab team may offset the time taken to perform angiography and potential subsequent PCI. These data support the practice of immediate cardiac catheterization in appropriate comatose survivors of cardiac arrest.
Abstract 80: Lay Bystanders Taught With the 2010 CPR Guidelines Perform Deeper Chest Compressions Than Those Taught With the 2005 Guidelines When Tested Longitudinally, A Multicenter Hospital-Based Study
Authors: Blewer Audrey L , Buckler David G , Beams Owen K , Leary Marion , Riegel Barbara J , Becker Lance B , Groeneveld Peter W , Shea Judy , Putt Mary E , Abella Benjamin S
Published: April 2024

Background:
Survival from cardiac arrest is sensitive to the quality of delivered CPR, including factors such as chest compression depth. In 2010, the American Heart Association (AHA) updated its recommended guidelines to promote deeper chest compressions (> 50-51 mm) and faster rate (>100 per min). It is unknown whether training lay bystanders in hands-only CPR using the 2010 CPR guidelines actually results in deeper compression depth and faster rate when tested longitudinally.

Objectives:
We hypothesized that laypersons taught CPR using the 2010 AHA guidelines will retain psychomotor memory and perform deeper chest compressions at a faster rate than those taught with the 2005 guidelines when tested six months after training.

Methods:
In an ongoing multicenter trial of CPR educational strategies, family members of hospitalized cardiac patients were trained in hands-only CPR using an established video self instructional tool. An initial cohort was taught using the 2005 AHA guidelines, and a separate cohort was taught in a comparable environment and methodology using the 2010 guideline training materials. Subject’s skills and impressions of the training were assessed after initial enrollment. CPR skills were quantified on a CPR-recording manikin and analyzed using statistical software.

Results:
Subject data were collected prospectively from 5/2009 to 4/2013; 312 subjects completed the assessment. Among the subjects, 202 received 2005 guideline training and 110 underwent 2010 training. Mean age were 52±14 years, 240/312 (77%) were spouses/immediate family of the hospitalized patients and 245/312 (79%) were never CPR trained or had not received training in over 10 years. The mean chest compression rate in the 2005 group was 87±25 per min, and in the 2010 group was 87±20 per min (p=ns), while the mean chest compression depth was 34±12 mm in the 2005 group and 44±12 mm in the 2010 cohort (p<0.001).

Conclusions:
Implementation of the 2010 CPR guidelines resulted in a statistically significant increase in lay bystander’s performance of chest compression depth long after initial training. However, mean chest compression rate remained low despite the new guidelines. These findings have important implications for future development of CPR training materials.
Abstract 93: Ecmo as Rescue Strategy for Refractory Cardiac Arrest and Profound Shock
Authors: Gaieski MD David F , Johnson Nicholas J , Hsu Cindy H , Perman Sarah M , Becker Lance B , Grossestreuer Anne V , Leary Marion , Acker Michael
Published: April 2024

Background:
Extracorporeal Membrane Oxygenation (ECMO) has been trialed as a rescue strategy for patients with refractory cardiac arrest unresponsive to conventional cardiopulmonary resuscitation or profound shock unresponsive to vasopressors and inotropes.

Objective:
We sought to describe our institution’s experience with implementation of ECMO for Emergency Department (ED) and inpatient cardiac arrests and cases of profound shock. Main variables were whether a patient was in cardiac arrest or profound shock, location of patient at time of initiation of ECMO, and our primary outcome was survival to hospital discharge.

Methods:
Consecutive patients placed on ECMO for the above indications were enrolled at two urban academic medical centers from July 2007 - February 2012.

Results:
During the study period, 44 patients were included. Average age was 44.6 years, 70% were male, 55% were white, and 77% of patients suffered from cardiac arrest. Among cardiac arrest patients, initial rhythms were ventricular fibrillation or ventricular tachycardia in 45%. Fourteen patients (32%) were cannulated in the ED. The average time from arrest to initiation of ECMO was 46 minutes (range 0.33-3.17 hours). Twenty-four patients (54%) had complications related to ECMO, which were most commonly bleeding and ischemic events. Eleven patients (25%) survived to discharge, of which 9 (20%) were neurologically intact (Glasgow Coma Scale Score of 15) at 6 months.

Conclusion:
In this US case series, ECMO shows promise as a rescue strategy for refractory arrest and profound shock. Further investigations are necessary to refine the technique, patient selection, and ancillary therapeutics.
Abstract 9307: Acute Coronary Syndrome-Like ST-T Changes on Admission Electrocardiogram Predicts In-hospital Death in Patients With Type A Acute Aortic Dissection
Authors: Kosuge Masami , Uchida Keiji , Imoto Kiyotaka , Ebina Toshiaki , Hibi Kiyoshi , Masuda Munetaka , Umemura Satoshi , Kimura Kazuo
Published: April 2024

Background:
In patients with Stanford type A acute aortic dissection (AAD), acute coronary syndrome (ACS)-like ST-T changes such as ST segment elevation (STE) or depression (STD) or negative T wave (Neg T) have been shown to be often observed at presentation. However, the frequency and prognostic impact of such ECG findings remain unclear.

Methods:
We studied the relation admission ECG findings to clinical features at presentation and in-hospital mortality in 258 patients with type A AAD who were admitted within 6 h from symptom onset. Emergency surgery was underwent in 233 patients (90%).

Results:
Patients were divided into the 3 groups according to ECG findings on admission: ACS-like ST-T changes (n=131) [STE (n=11) and STD/Neg T (n=120)]; normal ECG (n=77), and ECG confounders (n=50) [right bundle branch block (n=20) and left ventricular hypertrophy (n=30)]. Age, sex, time to admission, the rate of emergency surgery were similar in the 3 groups. Patients with ACS-like ST-T changes had more frequently had positive troponin (17% vs 3%, 13%), severe hypertension as defined by systolic blood pressure ≥180 mmHg (18% vs 5%, 6%), pericardial effusion (46% vs 9%, 34%), cardiac tamponade (27% vs 3%, 18%), moderate/severe aortic regurgitation (27% vs 7%, 18%), shock (33% vs 3%, 12%) on admission, and in-hospital mortality (14% vs 3%, 6%) as compared with patients who had normal ECG and those who had ECG confounders (p<0.05 for all). In 233 patients undergoing emergency surgery, those with ACS-like ST-T changes had higher prevalences of coronary ostial involvement (14% vs 1%, 2%), concomitant coronary artery bypass surgery (9% vs 1%, 0%) as compared with those with normal ECG and those with ECG confounders (all p<0.05, respectively). On multivariate analysis, ACS-like ST-T changes (odds ratio 3.28, 95%CI 1.02 to 10.1, p=0.038) and no surgically treatment (odds ratio 4.37, 95%CI 1.29 to 14.9, p=0.018) were the independent and significant predictors of in-hospital death.

Conclusions:
Nearly 50% of patients with type A AAD within 6 h from symptom onset showed ACS-like ST-T changes on admission ECG, especially STD/Neg T. ACS-like ST-T changes were associated with more complicated features and independently predicted in-hospital death.
Abstract 9395: Depression and Disease Severity in Patients With Premature Acute Coronary Syndrome: Findings From the PRAXY Study
Authors: Pelletier Roxanne , Thanasoulis George , Lavoie Kim L , Bacon Simon L , Khan Nadia , Pilote Louise ,   GENESIS PRAXY Investigators
Published: April 2024

Background:
Some studies demonstrate that depression is a risk factor for adverse outcomes in patients with acute coronary disease (ACS). However, it remains unclear if this association is confounded by ACS severity. The association between depression and ACS severity in younger patients has not been assessed, and sex differences in this potential relationship are unknown.

Objectives:
To assess whether major depression and depressive symptoms were associated with ACS severity in premature ACS patients; and to assess potential sex differences in these relationships.

Methods:
We enrolled 1023 patients (55 years or less) with ACS from January 2009 to September 2012 through the GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome) study. Patients hospitalized for premature ACS were recruited from 26 centres in Canada, the US, and Switzerland. Main Outcome Measures included left ventricular ejection fraction (LVEF), Killip class, cardiac troponin levels, and Global Registry of Acute Coronary Events (GRACE) score. Univariate and multivariate regressions adjusting for sociodemographic and clinical variables were computed. Interaction terms between sex and major depression/depressive symptoms were added to the models to assess sex differences in the relationship between depression and severity.

Results:
The sample comprised 302 (30%) women and 248 (25%) patients with major depression; the median age was 49 years. Univariate analyses revealed that major depression was associated with a higher probability of normal LVEF (OR=1.70, 95% CI: 1.51-1.97, p=0.03) and lower troponin-I levels (estimate= -4.04, 95% CI: -8.01- -0.06, p=0.05). After adjustment for sociodemographic and clinical characteristics, neither major depression nor depressive symptoms were associated with LVEF, Killip class, Troponin-I levels, or GRACE score. The interaction analyses also revealed no sex differences in these relationships.

Conclusion:
We did not identify any association between major depression or depressive symptoms and ACS severity. The increased risk of mortality and CVD events in depressed patients may be explained by other mechanisms.
Abstract 9413: A Feasibility Study of Non-Invasive Ablation of Ventricular Tachycardia Using High-Intensity Focused Ultrasound
Authors: Lu Fei , Huang Wei , Jia Fengpeng , Benditt David G , Wang Zhibiao , Lei Han , Trohman Richard G
Published: April 2024

Introduction:
Conventional catheter ablation of ventricular tachycardia (VT) is limited in part by its invasiveness and associated complications, particularly when an epicardial approach is needed. This study evaluated the feasibility of targeted ablation of cardiac tissues using high-intensity focused ultrasound (HIFU) as a potential means for non-invasive VT ablation.

Methods & Results:
Ablation of ventricular myocardium was performed in anesthetized closed-chest dogs using a HIFU therapeutic system that is being used clinically for ablation of human solid tumors. The animal was placed onto the HIFU system with its left chest immersed in a tank filled with specially treated water. Ventricular pacing using a quadripolar catheter via the internal carotid artery was performed at a rate slightly higher than intrinsic sinus rate to mimic VT. The myocardium at the tip of the pacing catheter (Figure 1) was targeted for ablation (400 watts for 2-4 s). Ablation end-point was loss of ventricular capture at twice pacing threshold. In 5 separate preparations, pacing could be terminated successfully (Figure 2). No subsequent capture was seen at 5 times baseline pacing threshold but capture could be obtained at different locations using the same pacing catheter. Both transmural and localized lesions could be created in a controlled fashion without evident injury to the skin, lung, or pericardium on postmortem examination.

Conclusion:
This pilot study suggests that HIFU is potentially useful for non-invasive ablation of targeted, localized myocardial tissue; and may be applicable for VT ablation, particularly those of intramyocardial / epicardial origin.
Abstract 9444: Study of Natriuretic Peptides Levels in the Left Ventricular Tissue of Patients With Dilated Cardiomyopathy Using RNA-Seq
Authors: Rosello Lleti Esther , Tarazon Melguizo Estefania , Ortega Gutierrez Ana , Molina Navarro Micaela , Almenar Bonet Luis , Salvador Antonio , Rivera Miguel , Portoles Sanz Manuel
Published: April 2024

Background:
Natriuretic peptides (NPs) levels have been extensively studied in plasma of heart failure (HF) patients. Currently, BNP and proBNP are used for diagnosis and prognosis. Our objective is to evaluate the tissue levels of these peptides and several molecules involved in their processing and biological activity at mRNA level, in the left ventricle of patients with dilated cardiomyopathy (DCM) undergoing heart transplantation.

Methods:
We analyze the mRNA levels of 14 left ventricular samples from patients with nonischemic DCM undergoing heart transplantation and 7 control subjects (CNT), using massive sequencing, RNAseq, (SOLID 5500XL) and RT-qPCR (ViiATM 7 Real-Time PCR System).

Results:
ANP and BNP tissue levels are elevated in DCM compared with CNT group (fold change (FC)=37, p<0.01 and FC=26, p<0.05, respectively). CNP was not detected by RNAseq in the left ventricular samples of patients with DCM or in CNT group. NPs receptors (NPR1, NPR2 and NPR3) show no significant differences in mRNA levels between the two study groups. Finally, regarding the enzymes involved in the cleavage of these peptides we observed that corin is significantly decreased in the DCM group compared to CNT (FC=-2.5, p<0.01), while no significant changes are observed in furin.

Conclusions:
RNA-Seq analysis confirm the presence of ANP in adult ventricular tissue, suggesting that the elevations observed in plasma could be originated in part in the left ventricle. CNP was not detected in cardiac tissue. Changes are specific since there were no modifications in the levels of any of the receptors and only in one of the enzymes involved.
Abstract 95: Cutaneous Complications From Continuous Electroencephalographic Monitoring During Therapeutic Hypothermia After Cardiac Arrest
Authors: Gossip Michelle , Ornato Joseph P , Alderfer Ferne , Roberts Charlotte S , Bazemore Tanya M , Pettyjohn Lynn , Peberdy Mary Ann ,   for the Virginia Commonwealth Univ ARCTIC Investigators
Published: April 2024

Background:
Electroencephalographic (EEG) monitoring, preferably continuous, is a Level I Guideline for patients (pts) treated with therapeutic hypothermia (TH) after cardiac arrest (CA). Skin irritation is a known but infrequent complication of EEG monitoring. TH can decrease cutaneous blood flow which may lead to skin complications at lead placement sites.

Hypothesis:
Prolonged, continuous EEG monitoring in post arrest pts is associated with cutaneous breakdown.

Methods:
Retrospective, before and after cohort of 90 consecutive pts undergoing TH after CA with continuous EEG monitoring. Fifty-nine pts from 1-1-12 to 10-21-12 had forehead and scalp prepped with nuprep and Q-tip rub. Silver/silver chloride electrodes were placed by one of nine trained EEG technicians using conducting paste in a 10-20 system configuration. From 10-22-12 to 3-31-13, 31 consecutive pts had modifications to attempt to prevent skin breakdown found during the before phase with the use of hydrodot electrodes, Z-flow pillows, daily inspection of leads with alteration of placement at any sign of irritation, and standard wound care consultation. Multivariate logistic regression using age, sex, race, diabetes, renal failure, smoker, pressor use, inotrope use, total ischemic time (TIT), and duration of electrode placement was performed to determine clinical factors predictive of skin breakdown.

Results:
See Table. Results are reported as mean [95% CI]. Renal failure was the only clinical variable associated with skin breakdown (p=0.025).

Conclusion:
EEG electrode related skin breakdown is seen frequently after CA in pts treated with TH even after aggressive attempts to decrease its incidence. Post arrest pts undergoing TH with continuous EEGs should be monitored closely for cutaneous complications.
Abstract 10134: Potassium Cardioplegia During CPR for Porcine VF Arrest: A Blinded Randomized Controlled Trial
Authors: Marill Keith A , Salcido David D , Sundermann Matthew L , Koller Allison C , Menegazzi James J
Published: April 2024

Introduction:
Potassium cardioplegia-induced transient asystole may conserve myocardial energy and improve outcome in ventricular fibrillation (VF) cardiac arrest.

Hypothesis:
We hypothesized potassium infusion during VF arrest would lead to an increase in intra-arrest amplitude spectrum area (AMSA) prior to defibrillation, and improved hemodynamic parameters in those animals that attained return of spontaneous circulation (ROSC).

Methods:
Twelve swine were randomized to KCl or placebo in a randomized controlled trial, and 10 were included in an amended protocol. After initiation of monitoring, induction of anesthesia, and instrumentation of the aorta and right atrium, VF was electrically induced. After 4 minutes, 1.5 meq/kg KCl or placebo was infused in blinded fashion in a peripheral ear vein and mechanical chest compressions and ventilations were begun. Initial defibrillation was performed 10 minutes post VF induction, as appropriate. Animals without ROSC received continued resuscitation per Advanced Cardiac Life Support(ACLS) guidelines for 10 more minutes. Animals that achieved ROSC were monitored for 30 more minutes. The primary outcome, change in AMSA from just before study drug infusion to 5 minutes post infusion, was compared using nonparametric statistics.

Results:
Six animals were randomized to KCl and 4 to Placebo. KCl infusion induced approximately 1 minute of transient asystole at the dosage used. The mean change in normalized AMSA was -0.24 in the KCl and 0.21 in the Placebo group, with a median difference of -0.50 (95%CI -0.79 to -0.09), p=0.038, favoring Placebo. Five of 6 (83%) animals in the KCl group and 2 of 4 (50%) in the Placebo group developed an organized, though not necessarily, perfusing rhythm with the difference in proportion 33% (95% CI -33 to 86). One of 6 (17%) animals in the KCl and 2 of 4 (50%) in the Placebo group achieved ROSC with the difference in proportion -33% (95%CI -93 to 33). Hemodynamics were not quantitatively compared post ROSC due to limited survivors. One animal in each group required norepinephrine infusion.

Conclusions:
Potassium as a single agent did not benefit AMSA or ROSC in this porcine model of VF arrest.