bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 336: The Novel and Useful Scoring System to Predit Massive Transfusion for Trauma Patients: Traumatic Bleeding Severity Score (TBSS)
Authors: Ogura Takayuki , Nakano Minoru , Nakamura Yoshihiko , Takahashi Eiji , Nakamura Mitsunobu , Miyazaki Dai , Machida Hiroshi , Suzuki Hiroyuki , Fujizuka Kenji , Amemiya Yu , Harasawa Tomofumi 
Published: April 2024

Background: There is no clear criterion to activate massive transfusion (MT) for trauma patients. Several studies showed that Trauma Associated Severe Hemorrhage (TASH) score and Assessment of Blood Consumption (ABC) Score were high accuracy in predicting the necessity of MT for trauma patients. However, some study showed that the accuracy of these scoring systems for elderly patients was not perfect. In japan, since the population is aging and the number of elderly trauma patient increases, these scoring systems are not useful so much. The aim of this study was to create new scoring system and predict the necessity of MT for trauma patients using it.
Methods: In the first analysis, new scoring system was created. We enrolled 119 severe trauma patients admitted to our center between January 2008 and December 2010. MT predictors were found by statistical methods from clinical and laboratory variables in the Primary Survey. Each MT predictor was converted into the simple score based on each odds ratio in multivariate logistic regression analysis. TBSS was defined as the total of each score.
In the second analysis, the accuracy of TBSS was tested. 114 patients admitted between January 2010 and March 2012 were examined. Receiver operating characteristic curve analysis were performed to compare the accuracy between TBSS and conventional scoring systems (TASH Score and ABC Score).
Results: In the first analysis, five preditors of MT were identified: age (> 60 year-old = 6pts), systolic blood pressure (< 110 mmHg = 4pts, < 100 mmHg = 8pts, < 90 mmHg = 12pts), positive focused assessment with sonography for trauma (FAST) ( [the number of regions with positive FAST] × 3pts), severity of pelvic fracture (stable fracture = 3pts, incomplete unstable fracture = 6pts, complete unstable fracture = 9pts), and lactate (> 2.5 mmol/L = 4pts, > 5.0 mmol/L = 8pts, > 7.5 mmol/L = 12pts).
In the second analysis, TBSS excellently predicted MT (area under the curve (AUC) =0.985, p<0.01). The AUC of TBSS was higher than that of TASH Score (AUC=0.887) and ABC Score (AUC=0.809) (both Bonferoni adjusted p<0.05).
Conclusion: TBSS based on the Primary Survey is high accuracy in predicting the necessity of MT. TBSS provide more useful information to predict MT compared with TASH Score and ABC Score.
Abstract 339: Impact of Left Ventricular Dilatation on Characteristics of Ventricular Fibrillation and ICD Shock Success
Authors: Bonnes Judith L , Jaspers Focks Jeroen , Westra Sjoerd W , Brouwer Marc A , Smeets Joep L 
Published: April 2024

Introduction

ICD testing offers a unique setting to study VF characteristics under controlled conditions in humans. Recently, it was observed that myocardial substrate (infarction) affects VF characteristics and shock success in animals. To further study the effect of myocardial pathology on VF, we investigated the association between left ventricular (LV) dilatation and characteristics of induced VF and we determined the impact of dilatation on the success of the first ICD shock.

Methods

Patients who underwent Medtronic ICD implantation with defibrillation testing between 2005-2011 were included. VF frequency characteristics were analyzed using intracardiac recordings of 4 seconds of induced VF before shock delivery (15 joule) and were compared between patients with normal-mildly and moderate-severely dilated LVs. Multivariate linear regression was performed to associate LV dilatation with the respective VF characteristics.

Results

Patients with moderate-severely dilated LVs tended to have a lower first shock success during testing. In addition, the fundamental frequency of VF was lower and the organization index was higher (Table).

The fundamental frequency was independently associated with LV dilatation (β -0.28; p=0.007), amiodarone use (β -0.48; p<0.001) and history of myocardial infarction (MI) (β -0.20; p=0.048).
The organization index was independently associated with LV dilatation (β 0.04; p=0.030) and history of MI (β -0.05; p=0.003).
The median frequency was not associated with any of the tested variables.

Conclusions

Characteristics of induced VF depend on LV dilatation: VF is slower and more regular in dilated LVs. Interestingly, ischemic etiology of cardiac disease and amiodarone also affect VF characteristics. ICD shock success was slightly lower in patients with dilated LVs. To improve future resuscitation strategies, further research is needed to evaluate the interaction between clinical characteristics, VF and shock success.
Abstract 38: Lactate Clearance Is Associated with Improved Survival and Neurological Outcome in Post--Cardiac Arrest
Authors: Donnino Michael W , Salciccioli Justin , Gaieski David F , Abella Benjamin S , Peberdy Mary Ann , Rittenberger Jon C , Callaway Clifton W , Ornato Joseph , Clore John , Giberson Tyler , Cocchi Michael N 
Published: April 2024

Introduction: Previous investigations demonstrated an association between lactate clearance and in-hospital mortality in post-cardiac arrest patients. These findings have yet to be validated in a multicenter study.
Objective: To determine the association between lactate clearance and outcomes in post-cardiac arrest
Methods: Four center prospective observational study conducted from 6/11 to 3/12. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after ROSC. The primary outcome was difference in lactate clearance between survivors/non-survivors, and secondary outcome was the difference in lactate clearance between those with good/poor neurological outcome. We compared baseline lactate between survivors and non-survivors using the students t-test. We used multivariate adjustments (age and downtime) with linear mixed-models to assess the trend in lactate clearance over 24-hrs between survivors/non-survivors and good/bad neurological outcome.
Results: 111 patients were analyzed. The median age was 63 years (IQR: 50 - 75) and 41% were female. 97% received TH and overall survival was 47%. Survivors had lower baseline lactate levels compared to non-survivors (5.1 +/- 3.4 versus 7.7 +/- 4.7; p = 0.004). Patients with good neurologic outcomes had lower baseline levels of lactic acid compare to patients with poor neurologic outcomes (4.6 +/- 2.6 versus 7.4 +/- 4.7; p = 0.009). After multivariate adjustments survivors had better lactate clearance than non-survivors (p < 0.001; Figure) and patients with good neurologic status had better lactate clearance compared those with poor neurologic status (p = 0.01).
Conclusion: Lower initial lactate as well as more efficient lactate clearance over the first 24-hours post-CA is associated with improved in-hospital survival and good neurologic outcome.
Abstract 42: CPR with a Pulse: Confusion Among Healthcare Providers
Authors: Giberson Brandon E , Miller Joseph , Gaieski David , Abella Benjamin , Wira Charles , Cocchi Michael , Donnino Michael 
Published: April 2024

Background: Healthcare providers nationwide are routinely trained in ACLS, a program from the AHA that teaches participants how to manage cardiac arrest events. Recent changes in ACLS teaching have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that clinicians strictly following the AHA ACLS algorithm may be unsure of the appropriate next action when a resuscitation team member detects a pulse following defibrillation, leading the resuscitator to continue compressions for another two minutes and potentially consider additional medications.
Methods: We constructed an internet survey with scenario-based ACLS questions. The survey link was offered to ACLS providers at 4 major medical centers in the U.S. Inclusion criteria consisted of adult staff member of participating institution with ACLS certification.
Results: A total of 347 surveys met all criteria and were analyzed. The majority (51%) of responders were between the ages of 26-32, and 59.6% were female. Among the analyzed cohort, 54.2 % of responders stated they would continue compressions (+/- other therapies) when a team member detects a pulse following defibrillation whereas 45.8% chose to cease CPR. Of those who chose to continue CPR in patients with a pulse, 42% selected CPR only, 10% selected epinephrine or vasopressin along with CPR, 20% provided amiodarone, and 29% provided both epinephrine and amiodarone. When stratified by profession, 60.2 % of physician participants chose to continue chest compressions in the presence of a pulse, while 47.2 % of nurse responders chose to continue chest compressions.
Conclusion: In this investigation we found that confusion exists as to whether or not CPR and cardiac medications should be continued in the presence of a pulse. Educational initiatives to encourage providers to avoid compressions and medications when a palpable pulse is detected may be necessary.
Abstract 5: Prehospital Hypotension Is Associated with Emergent In-Hospital Procedures and Mortality in Trauma Patients
Authors: Idris Ahamed H , Meier Eric , Brasel Karen J , Daya Mohamud , Egan Debra , Kannas Delores , Kerby Jeffrey D , Lin Steve , McCleod Brent , Minei Joseph , Newgard Craig D , Reiff Donald , Trickett John , van Heest Rardi , Wittwer Lynn K , Bulger Eileen , The Resuscitation Outcomes Consortium Investigators  
Published: April 2024

Background: Prehospital vital signs are the basis of many triage and transport guidelines. They serve to activate prehospital and in-hospital trauma systems, and to direct prehospital and in-hospital resuscitation efforts and other interventions.
Objective: The purpose of this study was to determine the relationship of prehospital systolic blood pressure with emergent in-hospital procedures and mortality.
Methods: Included in this secondary analysis of the Resuscitation Outcomes Consortium (ROC) Hypertonic Saline Clinical Trial are patients 15 years or older who were enrolled in the study shock cohort. These patients had traumatic injury and a systolic blood pressure (SBP) ≤70 mm Hg or 71 - 90 mm Hg and a heart rate ≥108 beats/min. Emergent in-hospital procedures are defined as any blood transfusion, thoracotomy, laparotomy, craniotomy, neck exploration, or angiographic control of hemorrhage within 24 hours of emergency department admission or death within 6 hours of admission. We estimated between-group differences for mortality and the likelihood of emergent procedures for lowest SBP categories of <55, 55-64, 65-74, 75-84, and 85-90 (reference) mm Hg using a multiple logistic regression model adjusted for age, sex, Glasgow Coma Scale score, heart rate, penetrating trauma, prehospital advanced airway attempt, and ROC site.
Results: From May 2006 to August 2008, 853 patients were enrolled, 38 were excluded for incomplete data, and 815 form the analyzable cohort. Mean age was 37 years and 78% were male. Mean (±SD) injury severity score was 24±16, 40% required a prehospital advanced airway, 73% required an emergent procedure, and overall mortality was 26%. We observed a significant relationship between lowest prehospital SBP and in-hospital emergent procedures and mortality (Table).
Conclusion: Prehospital hypotension is significantly associated with in-hospital emergent procedures and mortality, especially when SBP is less than 65 mm Hg.
Abstract 52: CPR Quality and Outcomes in Resuscitation of Suspected Drug-Related Cardiac Arrests
Authors: Koller Allison C , Salcido David D , Callaway Clifton W , Menegazzi James J 
Published: April 2024

Introduction: Cardiac arrest resulting from drug overdose (OD) is a significant public health issue and is the cause of many preventable deaths each year. Little is known about actual resuscitation process parameters of ODs and such arrests are often excluded from out-of-hospital cardiac arrest (OHCA) studies. We sought to investigate the characteristics of emergency medical services (EMS)-treated OHCA cases resulting from suspected OD.
Methods: The University of Pittsburgh Institutional Review Board approved this study. Data from EMS-treated non-traumatic OHCAs were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium, a multi-center clinical research consortium with 10 sites across North America. Cases from 2006-2011 were analyzed. Case definition for OD was naloxone administration or drug overdose indicated on the patient care report. Resuscitation parameters including chest compression fraction, compression rate, and compression depth, shock delivery and the administration of resuscitation drugs were collected and compared between OD and non-OD groups. Demographic and outcome variables including age, sex, EMS- or bystander-witnessed status, return of spontaneous circulation and survival to hospital discharge were also compared by OD status. Resuscitation parameters were compared between groups using logistic regression or t-tests with alpha = 0.05.
Results: We identified 180 OD cases and compared them to 2,162 non-OD OHCAs. Both groups were predominantly male (OD: 66%, non-OD: 59%; p = 0.0498). OD OHCAs were on average 20 years younger than non-OD OHCAs (45 vs. 65 years, p < 0.001). OD cases were associated with higher overall CPR fraction than non-OD (66% vs. 63%, p = 0.0158) and survival (19%, vs.11%; OR: 1.82, CI: 1.12 - 2.94, p = 0.015). OD cases were also associated with higher probability of epinephrine (OR: 2.05, CI: 1.33 - 3.15, p < 0.001) and sodium bicarbonate administration (OR: 2.70, CI: 1.98 - 3.68, p < 0.001). Other variables did not differ.
Conclusion: Patients with OD-related OHCA were more likely to receive resuscitation drugs, receive higher CPR fraction, and survive than non-OD OHCAs.
Abstract 59: Treatment at a STEMI Center Is Associated with Favorable Outcomes Following Out-of-Hospital Cardiac Arrest
Authors: Mumma Bryn E , Diercks Deborah B , Danielsen Beate , Holmoes James F 
Published: April 2024

Introduction: The American Heart Association recommends regionalized post-OOHCA care at cardiac resuscitation centers that are closely aligned with ST elevation myocardial infarction (STEMI) centers. However, the effect of STEMI centers on outcomes following OOHCA remains unknown.
Hypothesis: We hypothesize that treatment at a STEMI center is associated with increased survival and neurologic recovery among OOHCA patients.
Methods: We included patients age 18 years or older with OOHCA in the 2010 California Emergency Medical Services Information Systems (CEMSIS) database whose CEMSIS record was linked to an inpatient record from the California Office of Statewide Health Planning and Development (OHSPD) database. The CEMSIS database is a unified EMS data collection system, and the OSHPD database contains patient-level data for all inpatient and emergency department encounters. We linked CEMSIS and OSHPD records using probabilistic linkage. Multiple logistic regression models including age, sex, race, ethnicity, payer category, hospital size, teaching status, and trauma center status were used to evaluate the association between STEMI center treatment and outcomes. A STEMI center was defined as one with 24-7 percutaneous coronary intervention capability. Good neurologic recovery was defined as discharge to home, residential care facility, psychiatric facility, prison/jail, and against medical advice.
Results: We identified 8481 patients with OOHCA in the CEMSIS database; 3620 were linked to OSHPD inpatient records. The majority (74.0%) were treated at STEMI centers. Median age was 73 years (IQR 60-83). Survival to hospital discharge was similar between the two groups (26.3% vs 25.8%; p=0.76), but good neurologic recovery was higher among those treated at STEMI centers (18.2% vs 10.4%; p<0.0001). In the adjusted analysis, treatment at a STEMI center was associated with survival (OR 1.2, 95% CI 1.0-1.5; p=0.047) and good neurologic recovery (OR 2.1, 95% CI 1.6-2.8; p<0.0001).
Conclusions: Treatment at a STEMI center following OOHCA was associated with favorable outcomes recovery. Our data suggest that regionalized post-OOHCA care in accordance with American Heart Association guidelines may improve neurologic recovery following OOHCA.
Abstract 6: Bone Marrow Mesenchymal Stem Cells Improved Survival in Septic Rats Induced by Cecal Ligation and Puncture
Authors: Fujii Satoru , Taniguchi Takumi , Yamamoto Ken 
Published: April 2024

Background: Some studies have suggested that bone marrow mesenchymal stem cells (BMSCs) have beneficial effects on damaged nerves, ischemia/reperfusion injuries and so on. However, their effects on septic shock have never been scrutinized. In this study, we evaluated effects of BMSCs on septic rats
Methods: Forty male Sprague-Dawley rats were randomly assigned to either of the following groups: group C (n=20), no medication following cecal ligation and puncture (CLP); group M (n=20), BMSCs were administered following CLP. BMSCs were collected from right and left femurs of two rats, using a specially designed devise for that purpose and administered to one rat in either group. Rats in both groups were anesthetized with intraperitoneal pentobarbital and then underwent cecal ligation and puncture. The puncture was performed with 18G needle and 2 holes were made to disseminate inflammation. After skin closure, rats in group M were given BMSCs intravenously. All the rats were observed for the following 7 days. Mortality was calculated for the 7-day observation period.
Result: The mortality rates at 7 days in group M and group C were 30 % and 65%, respectively. There was a significant difference in mortality rate between group M and C. (p<0.05)
Conclusions: Bone marrow mesenchymal stem cells improved mortality in septic rats induced by CLP. This result shows us the potential effect of BMSCs to alleviate systematic inflammation that could result in multiple organ failure. Further studies are underway to clarify the underlying mechanism.
Cardiac Imaging: What Can the Future Learn From the Past?
Authors: Brody William 
Published: April 2024

Tremendous strides in the understanding of the etiology of atherosclerosis have been greatly facilitated through the introduction of new methods of imaging of the vascular system. Innovations in imaging using ultrasound, single photon and positron emitting isotopes, x-rays and nuclear magnetic resonance have provided profound insights into the anatomic distribution and enabled the development of new treatment methods including bypass surgery and angioplasty. In addition, imaging tools have helped to identify the role of the various risk factors for the development of atherosclerosis.
Despite the profound reduction in morbidity and mortality of heart disease over the past 50 years, significant obstacles remain to achieve further reductions due to the challenges of sudden cardiac death, restenosis following angioplasty and bypass surgery, as well as heart failure. In the cardiovascular arena, new treatment methods have in many cases followed from the introduction of new tools for imaging the distribution and extent of atherosclerotic narrowing. The challenges for the future will be to identify those technologies with the most promise for increasing the specificity and sensitivity imaging the distribution and progression of atherosclerosis. A brief review of the evolution of diagnostic imaging and its role in understanding and treating heart and vascular disease can help define a roadmap for further advances.
The Epidemic of Cardiovascular Disease in the Developing World: Global Implications
Authors: Gersh Bernard 
Published: April 2024

Recent data highlight that cardiovascular disease accounts for approximately 16.7 million of total global deaths of 57 million. 87% of worldwide cardiovascular deaths occur in the developing countries and at a younger age than the developed world. In contrast, total deaths due to HIV, tuberculosis, and malaria were approximately 5 million. Future projections are a concern in that it is estimated that death rates from stroke and coronary heart disease in the developing countries would be two to threefold greater than in the developed world. The cost of countries dealing with the dual burdens of communicable and degenerative diseases in terms of loss of productivity and the impact upon the public and private sector is enormous and could be catastrophic. It is likely that the pace of the “epidemiologic transition” underlying at the epidemic will vary according to the rapidity of economic development or the lack thereof and the role of genetic vulnerability needs to be determined.
Nonetheless, the combination of a hostile cardiovascular environment as defined by changing diet, tobacco, lack of exercise, an aging society, air pollution, and the psychosocial and economic stresses in the developing worlds in conjunction with limited national resources and possible genetic vulnerability (the thrifty gene) is likely to lead to an explosion of the epidemic in the next 20 years.
The key question is whether population-based strategies based upon community public health programs and high risk clinic-based strategies can stem the tide or even halt the epidemic. It is likely that the epidemic will involve all developing countries in the future, but the time course is unpredictable, and there is a dire need for prospective data since the implications for resource allocation are profound. Not all developing nations are at the same stage of the “epidemiologic transition“ and the shifting of resources from dealing with communicable diseases to cardiovascular disease needs to be based upon actual as opposed to perceived needs.
The low priority of cardiovascular and chronic diseases on the global health agenda is a cause for concern and integrating the treatment and prevention of chronic diseases into health systems dealing with communicable diseases will contribute to the strengthening of weak health systems and overall community health.