bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 326: Direct Ventricular Compression Improves Mechanical Synchrony of the Acutely Failing Heart
Authors: Schmitt Benjamin A , Garvin Nicholas J , Budharaju Subbaraju , Reynolds David B , Darner Rebecca J , Prochaska Lawrence J , Anstadt Mark P 
Published: April 2024

Introduction: Mechanical dyssynchrony during acute cardiac failure contributes to ventricular dysfunction. Direct Mechanical Ventricular Actuation (DMVA) provides non-blood-contacting augmentation of systolic and diastolic ventricular function. The purpose of this study was to determine if DMVA can improve mechanical synchrony in the acutely failing heart.
Methods: New Zealand white rabbits (n = 10) were anesthetized, underwent sternotomy, and instrumented for arterial pressures and aortic flow. A 10 MHz transvascular ultrasound probe acquired two-chambered, long-axis transesophageal ventricular images. Heart failure (50% of baseline cardiac output) was modeled using a titrated Esmolol drip. Phenylephrine maintained mean arterial pressure between 60 -70 mm Hg as needed. LV images were analyzed using Siemens speckle tracking software. The LV was divided into six regions which were analyzed for peak strain rate and time to peak strain rate. Average peak systolic and diastolic strain rates were used to assess global myocardial function. Synchrony was determined by analyzing the standard deviation of regional time differences between peak systolic strain rates (dyssynchrony index).
Results: Systolic and diastolic global strain rates were significantly reduced during failure and significantly augmented to near normal during DMVA support. Following a similar relationship, DMVA significantly improved mechanical synchrony during acute heart failure. Recovery strain rates and synchrony were significantly improved vs. failure but did not return to baseline values.
Conclusion: DMVA effectively augments myocardial function in the acutely failing heart. The improvements in pump function are associated with normalization of mechanical synchrony. DMVA’s ability to restore mechanical synchrony during resuscitative ventricular support has favorable implications on cardiac recovery.
Abstract 328: Translating Guidelines into Practice: A Survey Study to Assess Healthcare Provider Attitudes, Preferences and Beliefs Regarding Pediatric Fluid Resuscitation Practices
Authors: Manan Asmaa , Parker Melissa J 
Published: April 2024

Introduction: Children who require fluid resuscitation for the treatment of shock present to tertiary and non-tertiary medical settings. While timely fluid therapy improves survival odds and is accepted as a key component of initial resuscitative care, guidelines are poorly translated into clinical practice.
Objective: To characterize the attitudes, preferences and beliefs of health care providers regarding pediatric fluid resuscitation practices. Hypothesis: Varying attitudes and beliefs concerning pediatric fluid resuscitation performance would exist among providers who frequently resuscitate children. Methods: A single-centre survey study was conducted at McMaster Children’s Hospital from January to May, 2012. The sampling frame (n=111) included nursing staff, physician staff and subspecialty trainees working in Pediatric Emergency Medicine (PEM) or Pediatric Critical Care Medicine (PCCM). A self-administered questionnaire was developed and assessed for face validity prior to distribution. Eligible participants were invited at 0, 2, and 4 weeks to complete a web-based version of the survey. A follow-up survey administration phase utilizing a tablet-based version of the survey was conducted to improve the response rate.
Results: Response rate was 75% (83/111), with 83% identifying themselves as nursing staff and 61% as PCCM providers. Resuscitation experience, frequency of shock management, and years in specialty, were similar between PCCM and PEM responders. Physicians and nurses had differing opinions regarding the most effective method to achieve rapid fluid resuscitation in young children presenting in shock (p<0.001). Disagreement also existed regarding the age and size of patients in whom rapid infuser devices, such as the Level-1 Rapid Infuser, should be used (p<0.001). Providers endorsed a number of potential concerns related to the use of rapid infuser devices in children, and only 14% of physicians and 55% of nursing staff felt that they had received adequate training in the use of such devices (p=0.005).
Conclusions: There is a lack of consensus among health care providers regarding how pediatric fluid resuscitation guidelines should be operationalized, supporting a need for further work to define best practices.
Abstract 51: Prognostic Implication of Initial Coagulopathy in Out-of-Hospital Cardiac Arrest
Authors: Kim Joonghee , Kim Kyuseok , Lee Jae Hyuk , Jo You Hwan , Kim Tae Yun , Rhee Joong Eui , Kang Kyeong Won 
Published: April 2024

Objective: We sought to investigate the prognostic implication of early coagulopathy represented by initial DIC score in out-of-hospital cardiac arrest (OHCA).
Methods: OHCA registry was analyzed to identify patients with ROSC without recent use of anticoagulant between 2008 and 2011. Patients were assessed for prehosptial factors, initial laboratory results and therapeutic hypothermia. Outcome variables were survival discharge, 6-month CPC and survival duration within the first week after ROSC. Logistic regression and Cox-proportional hazards model were used for both univariate and multivariate analysis.
Results: Among 273 eligible patients, initial DIC score was available in 252 (92.3%). Higher DIC score was associated with increased inhospital death (odds ratio [OR], 1.89 per unit; 95% confidence interval [CI], 1.48-2.41) and unfavorable long-term outcome (6-month CPC 3-5; OR, 2.21 per unit; 95% CI, 1.60-3.05). The adjusted ORs for both outcomes were 1.61 (95% CI, 1.17-2.22) and 1.84 (95% CI, 1.26-2.67), respectively. We categorized DIC score in five groups as <3, 3, 4, 5 and >5 and analyzed differential mortality risk using Cox- proportional hazards model. Compared with reference group (DIC score <3), the adjusted HR for early mortality in each remaining group was 1.96 (95% CI, 1.13-3.40), 2.26 (95% CI, 1.27-4.02), 2.77 (95% CI, 1.58-4.85) and 4.29 (95% CI, 2.22-8.30), respectively (p-trend <.001). The area under the receiver operating characteristic of DIC score for prediction of unfavorable long-term outcome was 0.79 (95% CI, 0.69-0.88).
Conclusion: Increased initial DIC score in OHCA was an independent predictor for poor outcomes and early mortality risk.
Uploaded image: Kaplan-Meier plots for cumulative 1-week survival of five DIC score groups; Log-rank test for difference (p <.001, p-trend <.001)
Adventures (and Misadventures) on the Road to Understand (and Reduce) Disparities in Stroke Mortality
Authors: Howard George 
Published: April 2024

Racial and geographic disparities in stroke mortality have existed for over a half-century, and between ages of 45 to 65 are among the largest for any disease. For much of this period, the causes of the disparities have been mysterious; however, investments by NINDS and NHLBI are now providing insights regarding the causes of these disparities.
Diverse and complementary study designs provide information on different aspects of the disparities in stroke. Vital statistics data track temporal patterns in stroke mortality, perhaps the ultimate index of the success in overcoming the disparities. Surveillance studies allow assessment of the contributions of incidence versus case fatality to the disparities in vital statistics mortality data, a distinction critical to effort to reduce the disparities. Finally, cohort studies give insights to the contribution of specific risk factors to disparities in either incidence or case fatality, allowing targeted interventions to be effective.
While deaths from stroke mortality declined by a third over the most recent nine year period, there has been a 35% increase in the black-white disparity and little change in geographic disparities. Surveillance studies suggest that the black-white disparity is primarily attributable to differences in incidence, and also have unmasked Hispanic-white differences in incidence that are not apparent in mortality trends. Longitudinal cohort studies are suggesting multiple targets for intervention such as a multi-dimensional impact of blood pressure on the black-white differences, and indications that diet may be contributing to geographic disparities.
The vital statistics mortality data currently provide a mixed message, with falling stroke mortality for all groups, but a more rapid fall for whites contributing to an increase in the magnitude of racial disparities in stroke. After suffering these disparities over a half-century, information is now emerging to allow us to better understand the underpinnings of the disparities and potentially enter a new era of targeted interventions to reduce these disparities.
Complex Heart Defects of the Neonate: A Personal View
Authors: Norwood William 
Published: April 2024

I believe pediatric cardiologists and congenital heart surgeons must and do work hand-in-glove like no other medical/surgical specialists. Helen Brook Taussig and Alfred Blalock were an early testament to such a notion, albeit I understand Doctor Taussig didn't fully embrace the concept of reparative surgery for tetralogy of Fallot late in her career at Johns Hopkins University.
One evening in the late 1970s I walked through the ICU and there in the corner was a normal looking baby swaddled in a blanket. “Who is this,” I asked. “She's a cardiology patient. She's going to die, nothing can be done.” “Really, what's wrong?” “She has HLHS.” Well, believe it or not, I don't recall knowing anything about HLHS before that night. I quizzed my cardiology colleagues who knew more than I, but not a lot more. I'm not going to say much about HLHS surgery other than it flew in the face of a number of strongly held prejudices at the time and that surgery was necessarily performed in the neonatal period facilitated by DHCA.
Innovation is the life's blood of medicine. In 2008 I was invited to attend rounds at Children's Hospital of Boston and was asked whether I thought our earliest efforts with surgery for HLHS would be possible today. I answered, ''Probably not.'' This somewhat pessimistic view does not reflect a belief that the potential for physician-surgeon collaboration that is so essential to innovation is less now than it was in the era of Taussig and Blalock. Rather, it reflects the realities imposed today by a multi-layered bureaucracy of administrators and regulators who “manage” innovation under the watchful eye of trial lawyers.
Abstract 64: Association Between Blood Pressure Measurements, Vasopressor Use and Outcome in Post--Cardiac Arrest Patients Treated with Therapeutic Hypothermia from 4 Sites (COMICA Study Group)
Authors: Perman Sarah M , Grossestreuer Anne V , Leary Marion , Donnino Michael W , Cocchi Michael N , Peberdy Mary Ann , Ornato Joseph P , Clore John N , Callaway Clifton W , Rittenberger Jon C , Abella Benjamin S , Gaieski David F 
Published: April 2024

Introduction: Specific hemodynamic optimization strategies have not been clearly described nor defined for post-cardiac arrest syndrome (PCAS) patients undergoing therapeutic hypothermia (TH).
Hypothesis: Patients who suffer worse neurologic outcomes will have more significant hemodynamic derangements in the early hours post-arrest than those with good neurologic outcome.
Methods: This is a collaborative study amongst 4 centers with aggressive TH protocols (BID, Penn, Pitt, VCU). It is a secondary analysis from prospectively collected data of out-of-hospital cardiac arrest patients who underwent TH. The primary outcome is neurologic status at hospital discharge measured as cerebral performance category (CPC), dichotomized into “good” (1 or 2) or “poor” (3, 4, or 5). Demographic information, initial rhythm and co-morbid conditions were obtained. Study variables were abstracted at baseline, 12, 24, 36 and 48 hrs. Variables recorded were systolic blood pressure (SBP) at baseline; MAP at each time point; worst, highest and lowest mean arterial pressure (MAP) for each 24 hr interval; vasopressor use.
Results: A total of 111 patients were enrolled. Patients were 61 ± 16.8 years, 59.5% male, with an initial rhythm of VF/VT in 50.5% of cases. The initial SBP for patients with good vs. poor outcome was 150 ± 37 mmHg vs. 128 ± 32 mmHg respectively (p=0.037). Patients in both groups had comparable MAPs at 12 hrs (91 vs. 87, p= 0.34) and at 36 hrs (86 vs. 81, p=0.113); however, the vasopressor use at these time points differed. At 12 hrs, vasopressors were used in 20% of patients with good outcome, versus 43.4% of patients with poor outcome (p=0.017). At 36 hrs, 31.4% of patients with a good outcome were on vasopressors vs. 50.7% with a poor outcome (p=0.06). In the first 24 hrs, subjects with good and poor outcome had equal distributions of their worst MAPs into the “low” (90 mmHg) categories. Conversely, in the second 24 hrs, patients with a poor outcome had a higher proportion of patients where their worst MAP was “low” versus those who had a good outcome (67% vs. 76%, ns).
Conclusions: Patients with poor neurologic outcomes have lower initial SBPs and a higher percentage of vasopressor use during TH versus patients with good neurologic outcomes.
Abstract 66: Association of Initial Neurological Examination with Survival Following Out-of-Hospital Cardiac Arrest
Authors: Rittenberger Jon C , Guyette Francis X , Doshi Ankur A , Clore John , Gaieski David F , Grossestreuer Anne V , Abella Benjamin S , Donnino Michael , Cocci Michael , Peberdy Mary Ann , Ornato Joseph P , Callaway Clifton W , National Post-Arrest Resuscitation Consortium  
Published: April 2024

Introduction: Following resuscitation from out-of-hospital cardiac arrest (OHCA), failure to awaken from coma remains a common cause for withdrawal of care. Prior investigations have demonstrated initial organ system dysfunction is associated with survival and neurologic outcome.
Hypothesis: We hypothesized that initial neurologic examination would be associated with survival following resuscitation from cardiac arrest.
Methods: We conducted a retrospective study of 111 comatose OCHA subjects treated with dedicated post-arrest protocols, including therapeutic hypothermia and hemodynamic optimization. These subjects were prospectively enrolled in a multicenter clinical study examining mitochondrial dysfunction from ischemia-reperfusion injury (COMICA Study Group). Subjects not receiving sedation during the initial examination were eligible for analysis. Neurologic examination was classified using the motor and brainstem subscores of the Full Outline of UnResponsiveness (FOUR). For analysis, subjects were dichotomized as deep coma (FOUR Motor+ Brainstem<4) or not. Survival and good neurologic outcome, defined as a Cerebral Performance Category (CPC) of 1-2 and Modified Rankin Scale (mRS) of 0-3 were compared using chi-squared tests.
Results: Mean age was 61 (SD 17) years, 66 (59%) male, witnessed in 91 (82%), and received bystander CPR in 49 (44%) of cases. The predominant rhythm was VF/VT in 56 (50%) and low flow time was 19 (IQR 9, 28) minutes. The initial neurologic examination was obtained without sedation in 54 (49%) of subjects. Subjects with deep coma on initial examination were less likely to survive (18% vs. 65%; p<0.001), or have a good outcome using CPC (15% vs. 45%; p=0.01) or mRS (15% vs. 45%; p=0.01).
Conclusions: Deep coma on initial neurologic examination is associated with death prior to discharge and poor neurologic outcome. However, depth of coma alone is insufficient to rule out good outcome.
Abstract 70: External Validation of the Hypothermic to Ischemic Ratio as a Predictor of Survival from Out-of-Hospital Cardiac Arrest for Patients Presenting with a Shockable Rhythm
Authors: Sawyer Kelly N , Kurz Michael C , Elswick RK , Zhan Chun , Gaudio Michelle , Morrison Laurie J 
Published: April 2024

Objectives: The Hypothermic to Ischemic Ratio (H/I Ratio = total hypothermic time (THT) / total ischemic time (TIT)) was derived to predict survival after out-of-hospital cardiac arrest (OHCA) and found to be highly significant in multivariable models. We sought to externally validate these findings.
Methods: Adult, non-traumatic, OHCA patients presenting with a shockable rhythm (VF/pVT) and surviving to hospital admission between September 1, 2007, and December 31, 2011, were considered for inclusion. Structured data were abstracted from a population-based dataset (Strategies for Post Arrest Care (SPARC) Network database (Toronto, Canada)). THT was measured from initiation in the ED, through therapeutic hypothermia (TH) and rewarming to at least 36.5°C. TIT was estimated from call to 911 or EMS witnessed collapse to return of spontaneous circulation (ROSC). Patients were excluded for age >90 years, TIT <5 or >90 minutes, cooling initiated >6 hours after ROSC, rewarming time >30 hours, or missing relevant intervals. Stepwise logistic regression was used to fit the most parsimonious model. Results: Overall, 1,170 OHCA patients received TH, average age 65 years (SD 15.4), 71% male, 85% witnessed, and 43% with bystander CPR. A total of 497 VF/pVT patients met our criteria, with 52.5% surviving to discharge. In multivariable modeling (Table), TIT, age, and H/I Ratio were the most significant predictors for survival (Chi-Sq 123.43, p<0.0001, R² = 0.25, area under curve = 0.82).
Conclusions: External validation of the H/I Ratio confirmed it is a significant predictor for survival in OHCA patients presenting with a shockable rhythm. Prospective studies should consider H/I Ratio as a potential predictor for investigation.
Abstract 9: Total Liquid Ventilation Provides a Combined Neuro- and Cardioprotection After a Shockable Cardiac Arrest Occurring After Regional Myocardial Ischemia in Rabbits
Authors: Darbera Lys , Chenoune Mourad , Lidouren Fanny , Kohlhauer Matthias , Adam Clovis , Bruneval Patrick , Carli Pierre , Vivien Benoît , Ricard Jean-Damien , Dubois-Randé Jean-Luc , Ghaleh Bijan , Berdeaux Alain , Tissier Renaud 
Published: April 2024

Introduction: Total liquid ventilation (TLV) with perfluorocarbons has been shown to induce a rapid and protective cooling in animal models of cardiac arrest (CA). In these models, the heart was arrested without underlying myocardial ischemia.
Hypothesis: We assessed whether TLV could provide a combined neuro- and cardioprotection after a CA occurring after previous myocardial ischemia, as commonly observed in the clinical arena.
Methods: Rabbits instrumented with cardiac output (CO) probes were submitted to coronary artery occlusion. Two minutes later, ventricular fibrillation was induced and let untreated during 8 min. Rabbits were subsequently resuscitated and randomly submitted to a normothermic follow-up (Control) or 3 h of hypothermia (32°C) with either TLV or external cold blankets combined to saline infusion (30 ml/kg at 4°C i.v.; Saline group). Coronary artery reperfusion was instituted after 40 min of myocardial ischemia. After awakening, surviving rabbits were followed during 7 days.
Results: Ten rabbits were included and resuscitated in each group. Under cooling, the target tympanic and esophagus temperatures of 32°C were achieved within 5-10 min in TLV vs 30-45 min in Saline group. In the latter group, hypothermia failed to improve subsequent survival, CO or neurological recovery but slightly reduced infarct size vs Control (41±5% vs 54±3% of risk zone, respectively). Conversely, TLV potently reduced infarct size (13±1% of risk zone) and improved CO (e.g., 133±11 vs 84±19 ml/min/kg in survivors at day 1 in TLV vs Control, respectively). As shown in Figure, TLV also improved survival and neurological outcome.
Conclusions: Ultra-fast cooling with TLV induced a potent cardio- and neuroprotection in a rabbit model of CA with underlying myocardial ischemia, whereas conventional hypothermia was less efficient.

Left: Neurological dysfunction score (0%: normal; 100%: death). Right: survival after the cardiac arrest.*, p<0.05 vs Saline and Control
Abstract 90: Systolic and Diastolic Function in Cardiac Arrest Patients During Therapeutic Hypothermia
Authors: Call Shawn L , Milosavljevic Staci L , Gaglianello Nunzio , Widlansky Michael E , Kleczka James F , Choi Byung-il (Bill) W 
Published: April 2024

BACKGROUND: Previous studies and experience have suggested that the LVEF might be depressed in patients (pts) undergoing therapeutic hypothermia (TH) after cardiac arrest. We evaluated LV function by echocardiography (echo) during TH in pts with return of spontaneous circulation(ROSC) after cardiac resuscitation to observe whether TH may preserve cardiac function and contractile reserve compared to the patients without TH.
METHOD: Retrospective chart review on 54 out of 292 pts with ROSC between 2007 and 2010 including echo reports performed prior to, during admission, and follow-up period; excluding 125 pts with no ROSC, and 113 pts with clear non-cardiac cause for arrest, age <18 years, and no echo within 24 hrs of presentation post cardiac arrest.

RESULTS: 32 non-TH patients and 22 TH patients were included in the study after applying the exclusion criteria. The two groups differed by location of arrest, with the non-TH group having 13/32 (41%) and the TH group having 16/22 (73%) out of hospital arrests, (p-value=0.028). 17 (53%) non-TH patients and 7 (31%) TH patients survived to discharge. Systolic function after ROSC in pts undergoing TH (average core temperature: 33.3
o
C) and non-TH were 43 +/- 17% vs. 50 +/- 18% (P:NS), with normal EF (50-55%) in 7 vs. 17 pts (P:NS) and depressed EF (15-49%) in 15 vs. 15 pts (P:NS).Diastolic function in pts with TH and non-TH were normal in 6 vs. 10 pts, mild dysfunction in 3 vs. 6 pts, moderate dysfunction in 5 vs. 4 pts, severe dysfunction in 3 vs. 0 pts, and un-interpretable in 5 vs. 12 pts. (P:NS).Other echo variables i.e.systolic and diastolic dimension and LV mass indices were not statistically different in two groups.

CONCLUSION: There was a trend of reduction in LVEF, but no significant deterioration of LV systolic and diastolic function, suggesting TH may not adversely affect cardiac performance during the procedure. A long term improvement in cardiac function in this population linked to TH warrants further investigation to prove the hypothesis that a reduced LVEF may be related to cardioprotective features associated with decreased demand and consumption of energy in the myocardium during TH following cardiac arrest.