bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 276: A Genetic Algorithm Prognostic Tool Nested Within a 2500-Patient Registry of Post--Cardiac Arrest Care
Authors: Nielsen Niklas , Seder David , Friberg Hans , Mooney Michael , Rubertsson Sten , Stammet Pascal , Sunde Kjetil , Unger Barbara , Riker Richard R ,   INTCAR Study Group
Published: April 2024

Objectives: Predicting outcome after cardiac arrest (CA) is challenging. With data collected in the International Cardiac Arrest Registry (INTCAR), a novel prediction tool based on genetic algorithm (GA) was developed.
Methods: 2,564 adult, resuscitated, comatose CA patients were included from 35 sites in Europe and USA. Primary outcome was hospital discharge Cerebral Performance Category (CPC) dichotomized into good (GO=CPC1-2) and poor outcomes (PO=CPC 3-5). The GA-based models were constructed using Experlytics® software including all 180 candidate variables from the registry. A decision tree displaying the relation of the information carrying variables was evolved and pruned to a final model and optimized towards accuracy, sensitivity, specificity and Receiver-Operating Characteristic (ROC) value.
Results: Median age was 64 (IQR 54-73) years, 30% were female, the CA was witnessed in 84%, and initial rhythm was VF/VT in 55%, asystole in 23%, PEA in 17%. Time to ROSC was 19 (10-30) min. 37% had a GO at hospital discharge. 35% had coronary disease, 14% insulin dependent diabetes mellitus (IDDM), 8 % non-IDDM and 14% pulmonary disease. The final tree (figure 1) had an accuracy of 85%, a sensitivity of 91% and a specificity of 72%. The area under the ROC curve was 87% (CI 83-90).
Conclusions: A novel tool based on GA predicted outcome comparable to previous models. The GA could visually display the important information carrying variables and their relation. This model requires external validation, but represents a promising tool to better predict outcome and define the relationship between important risk factors
Figure 1. Relation of variables in a decision tree displaying good and poor outcome. ACD, automatic compression decompression, CPC, cerebral performance category, CPR, cardiopulmonary resuscitation, GCS, Glasgow Coma Scale, IDDM, Insulin dependent diabetes mellitus, MRI , magnetic resonance imaging, ROSC, return of spontaneous circulation.
Abstract 280: Association Between Duration of Hyperoxia, Organ Failure and Survival After Cardiac Arrest
Authors: Pullalarevu Raghavesh , Wang Bo , Vaghasia Nishit M , Guyette Frank , Callaway Clifton , Rittenberger Jon , Dezfulian Cameron 
Published: April 2024

Background: Prior administrative database studies correlate hyperoxia (based on initial paO2) after cardiac arrest (CA) with increased mortality. These studies did not quantify duration of hyperoxia or incorporate important variables in predicting post-CA survival. We hypothesized hyperoxia duration would not be associated with organ failure or mortality after adjustment for important CA prognostic variables.
Methods: 185 CA survivors receiving >24h mechanical ventilation had oxygen exposure classified hourly based primarily on ABG paO2 or if missing within 2h based on SpO2 as: hypoxic (paO2≤50 or SpO2≤88%), normoxic (paO2 51-150 or SpO2 89-99% or 100% on FiO2≤0.40), moderately hyperoxic (paO2 151-300), severely hyperoxic (paO2>300) and probably hyperoxic (SpO2=100 when Fio2>0.40, no ABG). Univariate regression correlated durations of oxygen exposure to 24h SOFA score and survival to hospital discharge with multivariate regressions incorporating CA type, sex and use of hypothermia (p<0.10 in univariate correlations to outcomes).
Results: Classification based on initial paO2 revealed no significant differences in survival or SOFA (Table 1). Moderate hyperoxia and to a lesser degree combined moderate and severe hyperoxia exposure were associated with SOFA reduction whereas normoxia and hypoxia exposure were associated with higher SOFA, even after multivariate adjustment (Table 2). Severe hyperoxia exposure was associated with reduced survival in univariate but not multivariate analyses.
Conclusions: Exposure to moderate hyperoxia was associated with reduced organ failure whereas severe hyperoxia exposure was not and may correlate with worse survival.
Abstract 289: Use of Epinephrine During In-Hospital Cardiac Arrest May Not Increase Rate of Survival to Discharge
Authors: Trammell Antoine R , Liao Tze-chun V , Abraham Prasad , Holt Tara , Renelus Benjamin , Sharma Shikha , Zafari Abarmard M 
Published: April 2024

Introduction: In a recent large observational resuscitation study the use of epinephrine during out-of-hospital cardiac arrest was associated with survival to hospital admission but not with survival to discharge. Few studies have studied the impact of epinephrine on in-hospital survival outcomes. This study examines in-hospital cardiac arrest survival and the use of epinephrine.
Hypothesis: The use of epinephrine during in-hospital cardiac arrest is associated with increased code survival and survival to discharge.
Methods: This retrospective and observational study includes 286 cases of in-hospital cardiac arrest wherein epinephrine was administered. The outcomes were code survival and survival to discharge. The study period was between June 2010 and October 2011 at an urban, academic medical center. Resuscitation characteristics, including use of epinephrine were compared between code survivors and non-survivors. Charlson comorbidity scores were used to adjust the severity of illness for both groups. Chi-square was used for hypothesis testing. Results were considered significant for p-values < 0.05.
Results: Epinephrine was used in 272 cases of in-hospital cardiac arrest. In 55% (n = 136) of the study cohort, only one dose of epinephrine was administered. There is a significant association between the use of epinephrine and code survival (X2 = 9.87, p = 0.0017). There is a statistically significant association between the use of epinephrine and not surviving to discharge (X2 = 7.69, p = 0.0056). Among persons receiving epinephrine, 13.6% (n = 37 of 272) survived to hospital discharge. There is no significant association between the initial rhythm and code survival (X2 = 75.36, p = 0.34) or survival to discharge (X2 = 4.56, p = 0.47) when epinephrine was administered. The median Charlson score for both groups was 4 (IQR = 2 to 6) and is not significantly different (Ws = 10955, z = 1.24, p = 0.21).
Conclusions: Epinephrine administration during in-hospital cardiac arrest is associated with code survival, but not survival to discharge. Our observations are consistent with the findings reported regarding epinephrine use in out-of-hospital cardiac arrest but warrant larger, randomized studies to confirm our findings
Abstract 308: A Preoxygenation “Bundle” Decreases Desaturation Events and Improves Intubation Success in Air Medical Rapid Sequence Intubation
Authors: Lemieux Justin , Minokadeh Anushirvan , Lanning Jason , Marayag Justin , Davis Daniel 
Published: April 2024

Introduction: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and has been associated with increased morbidity and mortality. Preoxygenation with positive-pressure ventilation (PPV) may delay the onset of desaturation. However, PPV may not be used aggressively with emergency RSI due to concern for gastric insufflation precipitating regurgitation and aspiration events.
Objective: To evaluate an aggressive preoxygenation protocol with regard to desaturation events during air medical RSI.
Methods: The RSI protocol used in our air medical program airway training model was modified to employ several interventions designed to optimize preoxygenation prior to initial laryngoscopy. These included: two-person bag-valve-mask (BVM) ventilation, “two-thumbs-up” hand positioning on the mask, correct application of cricoid pressure, aggressive use of nasopharyngeal and oropharyngeal airways, small-volume assisted ventilation prior to administration of RSI medications, and large-volume ventilation following sedation/paralysis but prior to the initial laryngoscopy attempt. This algorithm identified a target SpO2 value of at least 93% based on a previous investigation. Desaturation events [decrease in SpO2 to <90% or a continued decrease by at least 2% if initial SpO2 value was <90%] were identified using physiologic data exported from hand held oximeter-capnometer devices. The incidence of desaturation events was established over a 2-year period prior to and the subsequent 2-year period following implementation of these algorithm changes.
Results: A total of 155 RSI procedures were evaluated over the study period. Desaturation events decreased from 58% in the two years prior to the algorithm changes to 28% in the first year and 14% in the second year following implementation (chi-square test for trend p<0.01). In addition, the intubation success rate increased from 94% to 97% following implementation of the protocol. There were no reports of major aspiration events during the study period.
Conclusions: An aggressive preoxygenation protocol dramatically reduced the incidence of desaturation events and increased intubation success during air medical RSI without increasing aspiration events.
Abstract 314: Outcomes of Patients with Cardiac Arrest Treated with Therapeutic Hypothermia: Insights on Etiology and Initial Rhythm
Authors: Kalish Brian T , Avery Kathleen R , Pierce Carol D , Chase Annmarie , Fine Robert , Forni Alison , Griswold Karen M , Henderson Galen V , Hirning Beth Anne , Hou Peter C , Michael Kyller G , Massaro Anthony F , Morrow David A , Seethala Raghu R , Stone Peter H , Strojwas Stefan , Szumita Paul M , Scirica Benjamin M 
Published: April 2024

Background:
Therapeutic hypothermia (TH) improves neurological outcomes and reduces mortality in patients successfully resuscitated after VT/VF cardiac arrest (CA). Outcomes according to the clinical scenarios leading to the CA and initial rhythm, though, vary significantly.
Methods:
We report a single center experience that recommended TH for all patients who were comatose after CA, regardless of etiology or initial rhythm. Patients were categorized according to clinical scenario surrounding CA and initial rhythm. Good neurologic recovery was defined as a cerebral performance category of 1/2 (no deficit to moderate disability). All outcomes were assessed at discharge.
Results
A total of 135 patients with CA received TH of whom 79 cases (58%) had cardiac etiology (27 [20%] were STEMI and 52 [39%] other cardiac etiologies) and 56 (42%) non-cardiac. Patients with a cardiac cause of CA were more likely to survive until discharge than non-cardiac (51% vs. 23%, p=0.002) and have better neurologic recovery (41% vs. 8%, p<0.001). VT/VF was the most common initial rhythm (50%), followed by PEA (30%), asystole (19%), and bradycardia (2%). Patients presenting with VT/VF were most likely to survive at discharge and have better neurologic recovery compared to non-shockable rhythms (p<0.001 for both). (Figure)
Conclusion:
Cardiac etiologies, in particular VT/VF, were the most common cause of CA in patients undergoing TH. PTs with VT/VF had the best survival and neurologic outcomes. Further research into the optimal treatment of CA from non-cardiac etiology or non-shockable rhythms is needed.
Abstract 332: STI Assessment of Left Ventricular Function in Patients With Previous Myocardial Infarction and Recurrent Ventricular Arrhythmias
Authors: Nguyen Bich Lien , Capotosto Lidia , D’Alessandro Gaetana , Gang Eli S , Caranci Fiorella , Barillá Francesco , Siegel Robert J , Vitarelli Antonio 
Published: April 2024

Purpose. Our aim was to compare strain parameters of patients with structural heart disease with and without ventricular tachycardia (VT) in order to identify high-risk patients that could have been missed by left ventricular ejection fraction (LVEF) criteria.
Methods. We studied 86 patients (pts) with previous myocardial infarction (age, 59±14 years) scheduled for cardioverter-defibrillator (ICD) implantation. Forty-three pts had documented VT and 43 pts presented with no VT. Left ventricular (LV) function and volumes and score index were determined by two-dimensional echocardiography. Longitudinal LV strain was defined as the average of negative longitudinal strains of 6 segments of the septal and lateral walls in the apical 4-chamber view. Average radial and circumferential strain of 6 mid-LV segments was determined in the mid-short-axis view. Global strain was obtained by averaging the maximum systolic shortening in a 16-segment model. The analysis of strain parameters was performed offline using customized computer software (EchoPAC BT09, GE Ultrasound).
Results. There were no differences in LVEF, LV volumes, QRS and QTc duration between pts with or without VT occurring during follow-up. Multivariate analysis revealed that global (p=0.018) and posterior wall circumferential strain (p=0.007) were strong and independent predictors of the occurrence of arrhythmic events. The area under the curve (AUC) for posterior wall circumferential strain was 0.79 and the optimal cutoff value -6.2% for a sensitivity of 71% and a specificity of 89% in predicting arrhythmic events. AUC for QTc was 0.32 yielding a sensitivity and specificity of, respectively, 49% and 65% to predict arrhythmias and AUC for EF was 0.51 yielding a sensitivity and specificity of, respectively, 56% and 70%.
Conclusions. Circumferential strain was the strongest predictor of spontaneous ventricular arrhythmias among other clinical and echocardiographic variables such as score index and LV function and volumes in patients with previous myocardial infarction scheduled for ICD therapy.
Abstract 341: Estrogen Prevents Sudden Death and Spontaneous Ventricular Fibrillation Associated with Pulmonary Hypertension via Estrogen Receptor Beta Mediated Mechanism
Authors: Umar Soban , Chui Raymond , Hoffman Jonathan , Bapat Aneesh , Karagueuzian Hrayr S , Eghbali Mansoureh 
Published: April 2024

Introduction: Previously we showed that right ventricular failure (RVF) secondary to pulmonary hypertension (PH) is associated with spontaneous ventricular fibrillation (VF) and sudden death in rats. We also discovered that estrogen (E2) therapy rescues severe PH and RVF. Estrogen receptor b (ERb) has been shown to play a protective role both in heart and lung. Here we hypothesize that E2 prevents sudden death and abolishes spontaneous VF associated with RVF through ERb.
Methods: Male rats were treated with monocrotaline (MCT 60 mg/kg, s.c.) or PBS (CTRL, n=9). At day 21, MCT rats were left untreated to develop RVF by day 30 (n=9), or treated with E2 (42.5 ug/kg/day, s.c., n=9) with or without ERb antagonist PHTPP (850 ug/kg/day, s.c., n=8) from day 21 to day 30. RV ejection fraction (RVEF) was serially monitord with echocardiography. Direct RV catheterisation was performed terminally to record RV pressure (RVP). At ~day 30, hearts were studied in isolated-perfused Langendorff setting and microelectrode recordings were made. RV-epicardial activation pattern was optically mapped using fluorescent voltage-sensitive dye (RH-237). Trichrome staining was performed to assess cardiac fibrosis. Values are expressed as Mean±SEM.
Results: By day 30, MCT rats developed severe PH (RVP=72±4 vs. 30±2 mmHg in CTRL, p<0.05) and RV failure (RVEF=33±3% vs. 65±1 in CTRL, p<0.05) with moderate RV fibrosis and ∼30% of RVF rats died suddenly. Early after depolarization (EADs) and spontaneous VF were observed in RVF group during normal Tyrode perfusion with wave front dynamics supported by both focal and multiple wavelet patterns. E2 therapy resulted in complete rescue of PH (RVP=38±3 mmHg, p<0.05 vs. RVF; RVEF=60±2%, p<0.05 vs. RVF; no signs of fibrosis) and none of the rats died in E2-groups. No VF was initiated in any of the control or E2 treated rat hearts. In the presence of ERb antagonist PHTPP, E2 could not rescue PH (RVP=60±4 vs. 38±3 in E2; RVEF=42±2 vs. 60±2 % in E2; p<0.05 vs. E2); moderate RV fibrosis was present and spontaneous EADs and VF were observed in all the hearts similar to RVF group.
Conclusions: In conclusion, E2-therapy rescues PH-induced RVF and prevents VF by reversing PH-induced RV-dysfunction and fibrosis most likely through ERb-mediated mechanism.
Abstract 4: Small-Volume 7.5% NaCl Adenocaine/Mg2+ Preserves Cardiac Function During Hypotensive Resuscitation in the Pig Following Severe Hemorrhagic Shock
Authors: Granfeldt Asger , Letson Hayley L , Hyldebrandt Janus A , Wang Edward R , Salcedo Pablo A , Nielsen Torben K , Tønnesen Else , Vinten-Johansen Jakob , Dobson Geoffrey P 
Published: April 2024

Background: Cardiac rescue is critical for successful resuscitation. Previously, we reported that ~1 ml/kg 7.5% NaCl with Adenocaine (adenosine and lidocaine) and Mg2+ (ALM) successfully resuscitated rats following severe hemorrhagic shock, and that in pigs ALM significantly reduced the volume of Ringers acetate required to raise MAP to a target of 50 mmHg following 74% blood loss. The present study examines the effect of small volume 7.5% NaCl ALM on cardiac function during 60 min hypotensive resuscitation following 90 min shock in the porcine model.
Methods: Pigs (35-40kg) were subjected to pressure-controlled hemorrhage at a mean arterial pressure (MAP) of 35-40mmHg for 90 min (~75% blood loss). Pigs were randomly assigned to receive either 4 ml/kg 7.5% NaCl ALM (ALM n=8) or 4 ml/kg 7.5% NaCl (Control n=8). Cardiac output (CO), stroke volume, left-ventricular pressures and hemodynamics were collected continuously. Significance *p<0.05.
Results: MAP, end-systolic pressure and CO were significantly higher in the ALM pigs at the end of hypotensive resuscitation (Table). The higher CO was due to a higher stroke volume (SV) maintained at a significantly lower heart rate (HR). Paradoxically dP/dtmax tended to be higher in the Control group during the first 45min of hypotensive resuscitation (p=0.066) with no difference at 60min. Systolic ejection times were significantly increased in the ALM group and inversely related to HR. There was no difference in LV end-diastolic pressure between the two groups indicating that preload was similar during hypotensive resuscitation. LV blood flow at 30min resuscitation was comparable in the two groups (Control: 2.86±0.6 vs. ALM: 4.1±1.4 ml/min/g; p=0.7)
Conclusion: Superior cardiac rescue was achieved in ALM by a higher SV and CO, lower HR and longer ejection times vs Controls. Longer isovolumic contraction and ejection times may be due to suppression of SA nodal activity or rebalancing of sympathetic/parasympathetic control.
Abstract 69: A Time Series Analysis of Cardiac Arrest Incidence in Denver, Colorado
Authors: Sasson Comilla , Nassel Ariann , Colwell Chris , McVaney Kevin , Johnston Bill , McNally Bryan F , Haukoos Jason 
Published: April 2024

Background: Out-of-hospital cardiac arrest (OHCA) is estimated to cause 250,000 deaths annually in the U.S. Previous research has shown seasonal variation in cardiac arrest incidence. However, little is known about how cardiac arrest varies in Denver, CO across time.
Objectives: To analyze cardiac arrest incidence in Denver for 2009-2012 to assess for trends in incidence, seasonal variation and predict future cardiac arrest incidence.
Methods: Design: Secondary analysis of the Denver, Colorado component of the Cardiac Arrest Registry to Enhance Survival (CARES) dataset. Setting: Large urban metropolitan community with a two-tiered EMS system. The catchment area for this community is approximately 150 square miles with an approximate residential census of 600,000 people and includes 10 adult acute-care receiving hospitals. Population: Consecutive arrests from January 15, 2009 through March 31, 2012 entered by Denver Health Paramedic Division staff into the CARES dataset. Data Analysis: Arrests were grouped by month using Stata. R software was used to estimate the trend, seasonality and random error associated with events. An ARIMA model was used to fit the data and predict future OHCA incidence for the subsequent 24 months.
Results: There were a total of 2,270 cardiac arrests patients during the 39 months. Overall, there appears to be a decreasing trend in the incidence of cardiac arrest in Denver (Figure 1). There does also appear to be seasonality in cardiac arrest events. The maximum number of arrests occurred in October 2010 (97). An ARIMA Model (0,2,2) was used to predict future cardiac arrest occurrence over the next 24 months.
Conclusion: It is possible that wide-scale cardiac arrest and prevention efforts have contributed to the decreasing trend in OHCA incidence. Future research will need to examine what factors (e.g., season, temperature, etc.) may be contributing to the observed seasonal variation pattern.
Abstract 9142: Performance of Synergraft Decellularized Pulmonary Allografts Compared With Standard Cryopreserved Allografts: Results from Multi-Institutional Data
Authors: Bibevski Steven , Wilkinson David A , Ruzmetov Mark , Fortuna Randall , Turrentine Mark , Brown John W , Ohye Richard G 
Published: April 2024

Objectives: Cryopreserved pulmonary allografts frequently demonstrate early valve failure and structural degeneration believed to be related in part to an immune response mounted against HLA specific to the transplanted tissue. SynerGraft processing (CryoLife Inc., Kinnesaw, GA) decellularizes the allograft and therefore reduces its immunogenicity. Previous data comparing standard allograft to SynerGraft has been from single institutions and included limited numbers of patients. The purpose of this project was to assess the durability of the SynerGraft-processed allografts compared with standard cryopreserved allografts using data from multiple institutions.
Methods: A multi-institutional review was performed of all CryoValves implanted between 2001 and 2010. One hundred sixty-three SynerGraft patients and 124 standard allograft controls were evaluated. Demographics, survival, reintervention, and echocardiographic findings were analyzed.
Results: Mean age (months) was 208 ± 198 versus 151 ± 172 (p=N.S.), mean weight (kg) was 45 ± 36 versus 35 ± 33 (p=0.12), and mean valve diameter (mm) was 22.1 ± 5.8 versus 19.5 ± 6.1 (p=<0.05), for SynerGraft and standard allografts, respectively. At a mean echo follow up (months) of 60 ± 34 versus 59 ± 35, mean gradient (mm Hg) was 20.7 ± 15.7 versus 27.3 ± 18.8 mmHg for the (p<0.05). Mean insufficiency grade (0-4) at last follow-up was 1.8 for SynerGraft and 2.3 for standard allograft (p<0.001), and for patients under the age of 24 months was 2.4 for SynerGraft and 3.2 for the standard allograft (p=0.01). By Kaplan-Meier analysis, 8-year freedom from reintervention was 82% for SynerGraft and 60% for the standard allograft (p=0.001). Eight-year freedom from insufficiency was 76% for SynerGraft and 47% for the standard allograft (p<0.001). There was no statistically significant difference in survival.
Conclusions: When compared to standard allografts, SynerGrafts demonstrate superior freedom from significant insufficiency and stenosis at a similar follow up period with lower rates of need for reintervention.