bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 225: Incidence, Timing and Effect of Fever on Outcomes Following Resuscitation from Cardiac Arrest
Authors: Gebhardt Kory , Guyette Francis X , Doshi Ankur , Callaway Clifton , Rittenberger Jon C 
Published: April 2024

Background
Fever after cardiac arrest is associated with poor outcomes. We hypothesized that the association of fever and outcome would differ between patients treated with therapeutic hypothermia (TH) and those not.
Methods
We included 338 comatose patients who survived >48 hours after admission to a single center between 1/1/2005 and 6/30/2010. Fever was defined as T≥ 38.0°C within 48 hours of arrest. Categories of post-cardiac arrest illness severity were defined by neurological examination and sequential organ failure assessment (SOFA) score on presentation: 1) awake, 2) coma (not following commands but intact brainstem responses) + mild cardiopulmonary dysfunction (SOFA cardiac + respiratory score <4), 3) coma + moderate-severe cardiopulmonary dysfunction (SOFA cardiac + respiratory score >=4), and 4) coma without brainstem reflexes. Logistic regression measured association of fever and clinical variables with survival and good outcome (discharge to home or to acute rehabilitation facility).
Results
Mean age was 60 years (SD 16), 212(63%) had out-of-hospital cardiac arrest (OHCA), and 220 (65%) received TH. Ventricular fibrillation/ventricular tachycardia (VF/VT) was the primary rhythm for 133 (40%). Post arrest illness severity was category II in 119 (38%) , category III in 62 (20%), and category IV in 133 (42%). One hundred twenty eight (38%) survived; 75 (22%) with good outcomes. Fever was present in 142 (42%) of patients, with a median onset of 15 hours post-arrest in the non-TH cohort and 36 hours in TH cohort. Survival was associated with VF/VT (OR 2.60, CI 1.56-4.32) and category IV (OR 0.15, CI 0.08-0.27). Good outcome was associated with OHCA (OR 4.08, CI 1.99-8.39) and category IV (OR 0.13, CI 0.06-0.27). Fever was not associated with survival (OR 0.99, CI 0.57;1.70) or good outcome (OR 0.90, CI 0.47; 1.75) overall. Fever was negatively associated with survival in non-TH cohort (OR 0.38, CI 0.17;0.84) but not within the TH cohort (OR 1.48, CI 0.73; 2.97). Fever was not associated with good outcomes in the TH cohort (OR 1.34, CI 0.59; 3.06) or non-TH cohort (OR 0.36, 0.11; 1.13).
Conclusions
Fever is common in both TH and non-TH patients. Onset time is later after TH. Fever is negatively associated with survival in non-TH patients but not in TH patients.
Abstract 236: Administration of Amiodarone During Resuscitation Is Associated with Higher TNF-? Levels in the Early Postarrest Period in the Swine Model of Ischemic Ventricular Fibrillation
Authors: Youngquist Scott T , Niemann James T , Shah Atman P , Thomas Joseph L , Rosborough John P 
Published: April 2024

Introduction: While amiodarone (AMIO) improves ROSC from cardiac arrest due to VF when compared to lidocaine (L), no long-term survival benefit has been demonstrated. Conflicting data exist regarding the effects of AMIO on serum TNF-alpha levels in settings such as cardiopulmonary bypass and CHF. We hypothesized that AMIO administration during resuscitation from VF would result in a TNF-alpha response comparable to L in the early post-arrest period.
Methods: Balloon occlusion of the LAD was used to induce VF in anesthetized, instrumented swine. After 7 min, conventional ACLS was begun. Animals were randomized to either bolus AMIO (5 mg/kg, n=13) or L (1 mg/kg, n=14) for recurrent or refractory VF. Following ROSC, TNF-alpha levels were drawn at 30 and 60 min for analysis.
Results: Groups demonstrated comparable prearrest hemodynamics and resuscitation variables. Prearrest TNF-alpha levels were higher, however, in animals ultimately treated with AMIO (geometric mean of 103.0 vs. 58.8 pg/mL, p=0.01). In the postarrest period, TNF-alpha levels were significantly higher in AMIO than L treated animals at 30 min (2.2 fold higher, 95% CI 1.4-3.4 fold higher, p=0.0016) and at 60 min (2.65 fold higher, 95% CI 1.1-6.3 fold higher, p=0.03). The rate of rise in TNF-alpha among AMIO-treated animals was higher than that in L treated animals by, on average, 1 pg/mL/minute, but this difference in slope was not statistically significant (p=0.4). (Figure)
Conclusion: Higher post arrest TNF-alpha levels in AMIO treated animals may mean that improved rates of ROSC seen with AMIO come at the expense of a heightened pro-inflammatory state in the post-cardiac arrest period.
Abstract 241: Neurocognitive Functioning and Quality of Life After Successful Resuscitation from Cardiac Arrest
Authors: Beesems Stefanie G , Wittebrood Kim M , de Haan Rob J , Koster Rudolph W 
Published: April 2024

Objective Neurocognitive function (NCF) and Quality of Life (QoL) of patients (pts) with an out-of-hospital cardiac arrest (OHCA) may have improved since an increasing number of pts are managed with an AED and Therapeutic Hypothermia (TH) is universally applied. We studied the NCF and QoL of consecutive pts 6-12 months after OHCA and the QoL of their relatives.
Materials and methods The study population comprises all consecutive pts (>18 year) who survived 6-12 months after OHCA from mid-2010 to mid-2011. Pts and relatives were interviewed by telephone. The questionnaires used were validated for telephonic application with a validated cut-off score. The QoL was measured with the SF-12, NCF with the Telephonic Interview Cognitive Status (TICS), level of independence with the Modified Rankin Scale (MRS). If needed, the IQ-code was used as proxy-questionnaire to measure the NCF of the pt. The Caregiver Strain Index (CSI) was used to measure QoL of the relatives. The elderly (≥ 80 years) were compared to an open Dutch population of ≥ 80 years. Treatment effect was calculated with an effect size θ. Effect sizes near 0 are small, >0.8 or <-0.8 are considered as significant and relevant.
Results The proportion of the pts who scored normal on the questionnaires is shown in the table. When TICS and IQ-code are added up, 180 of 220 pts (82%) had a normal NCF. The mean score of elderly on the mental SF-12 was 40.5 and on the physical SF-12 53.2, while the compatible population scored 38.1 (θ =-0.20) and 54.4 (θ =0.15), respectively. Pts with TH scored 54.2 on the mental SF-12, while pts without TH scored 52 (θ=0.26). The mean score on the physical SF-12 of pts with TH was 46.4 and without the need of TH 44.8 (θ=0.16), respectively.
Conclusion QoL, NCF and independency in daily-life 6-12 months after OHCA is normal in the great majority of pts. Mental QoL is better compared to physical QoL. Pts ≥80 years score equal to age comparable persons of the normal population. Outcome after TH is equal to those not needing TH.
Abstract 26: Impact of Total Occlusion of the Coronary Artery and the Amount of Infarct-Related Myocardium in Patients with Refractory Cardiac Arrest due to Acute Coronary Syndrome
Authors: Kagawa Eisuke , Dote Keigo , Kato Masaya , Sasaki Shota , Nakano Yoshinori , Itakura Kiho , Ochiumi Yusuke , Takiguchi Yu , Honda Hideko , Inoue Ichiro , Kawagoe Takuji , Ishihara Masaharu , Kihara Yasuki 
Published: April 2024

Introduction: Acute coronary syndrome (ACS) is a leading cause of sudden cardiac arrest. Percutaneous coronary intervention (PCI) may provide improved outcomes for resuscitated patients; however, prognosis in refractory cardiac arrest patients remains poor. Hypothesis: We assessed the hypothesis that total occlusion of the culprit coronary artery is associated with refractory
cardiac arrest that is unresponsive to conventional cardiopulmonary resuscitation (CPR).
Methods: Adult out-of-hospital cardiac arrest patients who underwent emergency coronary angiography and were diagnosed with ACS were enrolled in this retrospective study. We divided the patients into 2 groups: patients who achieved return of spontaneous circulation by conventional CPR (group 1) and patients with refractory cardiac arrest who were unresponsive to conventional CPR and were treated with extracorporeal CPR (group 2). Data about thrombolysis in myocardial infarction flow grade were collected at initial coronary angiography. P < 0.05 was defined as statistically significant. Results: We enrolled 54 patients (group 1; n = 35), median age of the patients was 61 y (interquartile range 54-72 y), 87% patients were male, 81% patients were witnessed cardiac arrest, 57% patients were received CPR initiated by by-standers, and 67% patients showed shockable initial recorded rhythm. The rate of culprit lesion in the left main trunk was higher in group 2 than in group 1 (3% vs. 21%, P = 0.04), and that in the left circumflex artery was lower in group 2 (20% vs. 0%, P = 0.04). Thrombolysis in myocardial infarction flow grade 3 was observed in 29% of group 1 and 16% of group 2 patients (P = 0.34), and thrombolysis in myocardial infarction flow grade 0 or 1 was observed in 57% of group 1 and 84% of group 2 patients (P = 0.04). Coronary reperfusion therapy by PCI was performed in 81% of the patients, and all of whom achieved return of spontaneous heart-beat.
Conclusions: Total occlusion of the coronary artery and a large amount of infarct related myocardium may be associated with refractory cardiac arrest due to ACS. Coronary reperfusion therapy could achieve higher rate of return of spontaneous heart-beat and may improve outcomes in patients with refractory cardiac arrest.
Abstract 260: Relationship Between the Blood Hemoglobin Level at Hospital Arrival and Post--Cardiac Arrest Neurological Outcome
Authors: Hayashida Kei , Suzuki Masaru , Shiroshita-Takeshita Akiko , Honma Yosuke , Kamura Hiroshi , Hatada Tsuyoshi , Otuka Msafumi , Fujioka Masayuki , Oomura Taku , Murai Akira , Orita Tomohiko , Beppu Satoru , Arimoto Hideki , Nishiyama Kei , Ito Noritoshi , Hori Shingo 
Published: April 2024

OBJECTIVE:
Recent studies have revealed that regional brain oxygen saturation (rSO2) is an excellent predictor for a neurological outcome in OHCA. It also has been suggested that brain tissue oxygenation is crucial for a post cardiac arrest syndrome (PCAS). Hemoglobin (Hb) is an indispensable for oxygen delivery to peripheral tissue. Therefore, it is considered that Hb plays an important role in PCAS. In the present study, we aim to elucidate the relationship between blood Hb level and the neurological outcome in PCAS.
METHODS:
The database of the J-POP registry (multicenter observational study) has prospectively enrolled 764 OHCA patients. Of these, 193 PCAS patients admitted to the wards after ROSC were included in this study. Blood Hb level (median 12.0g/dL, [IQR 10.4-13.8]) and rSO2 (35%, [15-55]) were obtained during resuscitation within 3 min after hospital arrival. The neurological outcome was evaluated by CPC at 30 days, and CPC1 and 2 were defined as favorable neurologic outcome.
RESULTS: Among 193 PCAS patients, 27 showed favorable outcome (14%). There was no significant correlation between rSO2 and Hb level (P=0.43). Univariate analyses revealed that the favorable outcome group was characterized as younger, male, witnessed CA, initial shockable rhythm, higher Hb level, rSO2>35%, and shorter transport interval from the scene to the hospital. Coronary angiography (CAG) and therapeutic hypothermia were also associated with the favorable outcome. The multivariate analysis showed that rSO2>35% (OR 35.0 [7.5-163.4]), Hb (1.48 [1.08-2.01]), CAG (45.8 [7.7-271.1]) were independent predictors for the favorable outcome.
CONCLUSIONS:
A higher blood Hb level was associated with a favorable short-term neurological outcome in patients with PCAS regardless of rSO2.
Abstract 266: Effectiveness of a New Method of Pediatric Advanced Life Support Recertification: PALS on Demand
Authors: Kurosawa Hiroshi , Ikeyama Takanari , Achuff Patricia , Perkel Madeline , Watson Christine , Nadkarni Vinay , Nishisaki Akira 
Published: April 2024

Background: Recent evidence shows poor retention of PALS provider skills. Frequent refresher training, and in-situ simulation are promising interventions. We developed a “PALS on Demand” (PoD) recertification course by deconstructing the training into six 30-min simulation scenario sessions over 6 months. We hypothesized that PoD is as effective as Standard (STD) PALS 1-day recertification delivered with simulation technology (i.e. non-inferiority study).
Method: We randomized PALS certified Pediatric ICU nurses and respiratory therapists to PoD vs STD strategy. Training effectiveness outcome was prospectively defined as self-reported provider confidence and competence (Likert scale: 1 = lowest to 7=highest). We analyzed using a Mixed effect model, adjusting for baseline differences (p<0.05 as significant).
Results: 36 participants were eligible, completed pre-testing baseline and were randomized: PoD (n=19) and STD (n=17). Median age was 32 (IQR:28-40yrs), discipline: nurses:72%, respiratory therapists:28%, with no significant difference between group demographics . 29 had completed data for baseline, training and post-test scenarios(PoD=17/19 vs STD=16/17). In both PoD and STD groups, self-reported confidence (PoD 0.9, 95%CI, 0.5-1.4, p<0.001, and STD 0.6 95%CI,0.2-1.2, p=0.009) and competence improved(PoD 0.9, 95%CI, 0.6-1.3, p<0.001, and STD 0.8 95%CI, 0.5-1.2, p<0.001). After adjusting for baseline demographics, gender and clinical experience, the PoD vs. STD training strategy was not significantly associated with either confidence (p=0.42) or competence (p=0.65) score improvements.
Conclusion: A Simulation-based “PALS-on-Demand” (PoD) approach is feasible. In this non-inferiority study, both PoD and STD simulation-based recertification strategies improved participants’ self-reported confidence and competence equivalently. Further feasibility and objective effectiveness validation of low-dose, high-frequency training is warranted.
Abstract 295: Gas Insufflation in the Stomach During Cardiopulmonary Resuscitation Using Laryngeal Tube Ventilation in Comparison with Bag-Valve-Mask Ventilation
Authors: Yamaga Satoshi , Une Kazunobu , Kyo Michihito , Suzuki Kei , Kobayashi Yasutake , Nakagawa Itsuo , Tanigawa Koichi 
Published: April 2024

Background: Gastric gas insufflation is one of the major complications during cardiopulmonary resuscitation (CPR) using bag-valve-mask ventilation (BVM). Among alternative airways, a laryngeal tube (LT) has an esophageal cuff to avoid not only regurgitation of the gastric content, but also gastric gas insufflation. However, the efficacy of this device for preventing the latter complication during CPR remains unknown.
Objective: We aimed to compare the gastric gas volumes of patients with out-of-hospital cardiac arrest (OHCA) who received CPR with either BVM or LT ventilation in a prehospital setting.
Methods: This was a retrospective analysis using patient data. From January 2010 to December 2011, 148 OHCA patients with either BVM or LT ventilation were enrolled. We used computed tomographic (CT) scans to measure the gastric gas volume. The pulmonary infiltrates on CT were also evaluated as an indication of pulmonary aspiration. A nasogastric tube was not placed in the patients before CT.
Results: The patient background data are shown in the table. Fifty-nine (40%) had BVM ventilation (BVM group) and 89 (60%) had LT ventilation (LT group). The time spent at the scene was longer in the LT group than in the BVM group (p<0.001). The mean gas volumes in the stomach in the BVM and LT groups were 370.7±344.2 and 388.5±418.4 ml, respectively, with no significant difference. No significant differences were observed in the incidence of pulmonary infiltrates on CT between the groups.
Conclusions: We did not find any differences in the gastric gas volume and incidence of pulmonary aspiration between the BVM and LT groups. These data question the effectiveness of LT ventilation for preventing gastric gas insufflation during CPR. Further studies are required to confirm these findings.
Abstract 297: Modulation of Ischemia-Resuscitation Injury by TAT-Mediated PTEN Inhibitors
Authors: Zhu Xiangdong , Shao Zuo-Hui , Li Changqing , Li Jing , Zhong Qiang , Meliton Angelo , Meliton Lucille , Leff Alan R , Vanden Hoek Terry L 
Published: April 2024

Introduction: Recent work shows that mouse cardiac arrest and heart cell ischemia cause PI3K-Akt deactivation, while cardioprotective cooling appears mediated by Akt. To further test the role of PI3K-Akt during ischemic arrest/resuscitation, we developed novel TAT-p85 fusion proteins designed to enter cells rapidly to modulate Akt activation. p85 can both activate Akt via p110 binding, and via feedback deactivate Akt by PTEN binding. We hypothesized that TAT fused p85 lacking the PTEN binding site (TAT-Delta PTEN p85) would enhance p-Akt cardioprotection. Conversely, TAT fused p85 lacking the p110 binding site (TAT-delta p110p85) would decrease p-Akt and abrogate protection.
Methods: A TAT-delta p110 p85 plasmid was constructed by deletion of nucleotides encoding amino acids 478-513. The TAT-delta PTEN p85 plasmid deleted amino acids 1-313. A TAT-GFP plasmid produced fluorescence-tagged TAT protein for measuring cell penetration kinetics. TAT proteins were expressed in E. Coli and purified. Cardiomyocytes were isolated from C57BL6/J mice and exposed to up to 90 min ischemic arrest with 3 h reperfusion (I/R). Cell viability was evaluated by propidium iodide uptake and p-Akt was measured by Western blot. PTEN activity was measured by Malachite green assay using PIP3 as substrate.
Results: Western blot analysis demonstrated that TAT-delta p110 p85 could be transduced into cardiomyocytes within 5 min and levels maintained for more than 2h. TAT-delta p110 p85 blocked H2O2 induced p-Akt at both S473 and T308 sites in a dose-dependent fashion, while PTEN inhibition using TAT-delta PTEN p85 increased p-Akt. During cardiac cell ischemic arrest, p-Akt decreased within 30 min of arrest time. PTEN activity during ischemia increased 2-fold from baseline and was inversely correlated with Akt phosphorylation during I/R. TAT-delta p110 p85 increased cell death from 44.6 +/- 2.7% to 92.5 +/- 3.4%, while TAT-delta PTEN p85 decreased cell death caused by I/R in a concentration-dependent manner from 47.8 +/- 1.4% to 11.9 +/- 5.3%.
Conclusions: We conclude that TAT-delta PTEN p85 with resulting PTEN inhibition may be a promising strategy to mimic and enhance protective cooling by more rapidly reactivating cellular Akt during heart ischemic arrest and resuscitation.
Abstract 300: No Improved Outcome with Vasopressor Drugs or Sodium Nitroprusside in a 10-Minute Untreated VF Cardiac Arrest Model in Swine
Authors: Zuercher Mathias , Na Sang Hoon , Hilwig Ronald W , Ewy Gordon A , Kern Karl B 
Published: April 2024

Background: The use of epinephrine to treat cardiac arrest is increasingly challenged. However, previous investigations have shown minimal favorable outcome without the use of vasopressors or surprisingly positive outcome using sodium-nitroprusside in a modified resuscitation protocol.
Hypothesis: Vasopressor support improves coronary perfusion pressure (CPP) and favorable 24h neurological outcome in prolonged cardiac arrest.
Methods: 35 domestic swine (33.5±5.5 kg) had VF electrically induced and left untreated for 10 minutes. Chest compression only (100/min) advanced life support was given for the first 3 of 7 epochs (2 min each) before ventilation with oxygen was started. Defibrillation attempts were made every 2 minutes. Animals were randomly assigned to one of 5 treatment groups: Placebo, epinephrine (0.045mg/kg), norepinephrine (0.025mg/kg), sodium-nitroprusside (0.0165 mg/kg) plus epinephrine (0.045mg/kg) or sodium-nitroprusside (0.0165 mg/kg). If the rhythm analysis at the beginning of epoch 3 to 7 did not show a perfusing rhythm, the assigned study drug was administered and the protocol continued until ROSC or 25 min, after which the animal was considered non-resuscitated. A swine cerebral performance category (CPC) was determined at 24 hours after onset of cardiac arrest. Data are presented as median and quartiles.
Results: ROSC was achieved in 22 (63%) animals and 12 (34%) survived for 24 hours with a favorable neurological outcome (CPC 1+2) in 10 (29%). There was no significant difference in between drug groups. Of these 10, seven achieved ROSC within the first two epochs before any study drug was administered. In the remaining three a vasopressor drug was administered. CPP (mmHg) was significantly higher in animals with favorable outcome during the first two epochs (Epoch 1: 29 (20/40) vs. 15 (10/19); Epoch 2: 18 (12/25) vs. 7 (3/13); p < 0.05).
Conclusion: Following four minutes of chest compressions and two defibrillation attempts, the administration of epinephrine, norepinephrine, sodium-nitroprusside plus epinephrine or sodium-nitroprusside alone did not influence 24-hour neurological outcome in a swine model of out-of-hospital VF cardiac arrest.
Abstract 311: Early Evaluation Biomarkers-Based of Neurological Prognosis in Hypothermic Post--Cardiac Arrest Patients
Authors: Cacciavillani Luisa , Gasparetto Nicola , Scarpa Daniele , Mion Monica , Brugnaro Luca , Marzari Armando , Zaninotto Martina , Salotti Chiara , Plebani Mario , Iliceto Sabino 
Published: April 2024

Early prognosis of neurological outcome in patients resuscitated from cardiac arrest (CA) is a major medical challenge.
High serum levels of both serum neuron-specific enolase (NSE) and S-100B protein are related with brain damage, but the relationship with neurological outcome at hospital discharge, in hypothermic post CA patients, is uncertain.
The aim of this study was to evaluate the prognostic value and cut-off values of NSE and S-100B protein in predicting neurological outcome in comatose patients after CA treated with therapeutic hypothermia (TH).
Methods: We enrolled consecutive patients, between November 2010 and May 2012. NSE and S-100B values were sampled at admission and every 24 hours since discharge from intensive care unit. According to Cerebral Performance Category (CPC) scale, neurological outcome was dichotomized into good (CPC 1-2) or poor (CPC 3-5).
Results: thirty-one patients (25 males; mean age 60±15years). Twenty patients had a favourable outcome. Median values of serum NSE peak and S-100B peak were 25 ug/L (interquartile range, 20.8 to 43.3 ug/L) and 0.3 ug/L (range, 0.15 to 0.7 ug/L) respectively. High peak values of NSE and S-100B were significantly associated with poor neurological outcome (p=0.015 and p=0.007 respectively). Using a regression tree model we found worst neurological recovery for NSE peak value above 64.7 ug/L or S-100B above 0.65 ug/L (p=0.01 and p=0.007 respectively). Good neurological outcome was associated with NSE peak value less than 40.5 ug/L (p=0.012) especially if S-100B was less than 0.23 ug/L (p=0.031) (figure).
Conclusion: Serum peak concentrations of NSE and S-100B result to be highly predictive of neurological outcome, especially when combined. Moreover, our data demonstrate that a good neurological outcome is associated with NSE peak value minor than 40.5 ug/L especially with S-100B minor than 0.23 ug/L. On this basis, determination of NSE and S-100B peak values may be useful in the early evaluation of prognostic neurological outcome to guide clinical decision making, in hypothermic post CA patients.