bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 303: End-Tidal CO2 Reactivity Is Associated with Defibrillation Success
Authors: Husa Ruchika D , Bowers Owen , Sell Rebecca , Scyoc Dorothy , Minokadeh Anush , Davis Daniel 
Published: April 2024

Background: High quality cardiopulmonary resuscitation (CPR) appears to modulate ventricular fibrillation (VF) morphology and increase defibrillation success. However, VF waveform analysis has not proven to be clinically effective in guiding resuscitation. End-tidal CO2 (PetCO2) correlates well with cardiac perfusion during CPR.
Objective: To evaluate PetCO2 as a predictor of defibrillation success.
Methods: This was a prospective, observational study conducted at two urban academic hospitals with a combined total of 500 beds. Data regarding defibrillation attempts, CPR process, and PetCO2 were abstracted from monitor/defibrillators. All arrest victims with primary VF or ventricular tachycardia (VT) for whom CPR and PetCO2 data were available were included in this analysis. Patients with return of spontaneous circulation (ROSC) were compared to those without ROSC with regard to the change in PetCO2, mean and final compression rate and depth, and chest compression fraction (CCF).
Results: A total of 32 patients were included in this analysis; 19 of these (59%) had ROSC. PetCO2 values prior to the final defibrillation attempt were 121% higher than initial PetCO2 values in patients with ROSC versus only 19% higher in patients without ROSC (p<0.01). Patients with and without ROSC were similar with regard to mean compression depth (2.5 vs. 2.7 inches, p=NS), final compression depth (2.7 vs. 2.8 inches, p=NS), mean compression rate (119/min for both, p=NS), final compression rate (121/min vs. 123/min, p=NS), mean CCF (83% vs. 85%, p=NS), and final CCF (83% vs. 91%).
Conclusions: An increase in PetCO2 was associated with ROSC among inpatients with VF/VT arrest. No differences with regard to overall or final CPR process measures were observed. The “PetCO2 responsiveness” to CPR may reflect an underlying physiology that predicts defibrillation success.
Abstract 54: Does Telephone-Assisted Cardiopulmonary Resuscitation Improve the Outcome of Out-of-Hospital Cardiac Arrest?
Authors: Loeb Thomas , Ozguler Annna , Baer Geraldine , Groizard Charles , Baer Michel 
Published: April 2024

Objectives:
In an effort to increase the proportion of victims who receive bystander cardiopulmonary resuscitation (CPR) in case of out-of-hospital cardiac arrest (OHCA), it is now clearly recommended to propose t-CPR. However, very few studies have demonstrated, in real life conditions, the clinical benefits of such recommendations.

The aim of this study was to assess the survival benefit of t-CPR on OHCA, compared with no bystander CPR.

Materials and methods:
This study was conducted over a seven-month period in 2011. It included all incoming calls to an Emergency Medical Service dispatch center in which t-CPR was instructed to non-priorly trained bystanders.

The comparison group was matched on the date of occurrence; we enrolled incoming calls for witnessed OHCA with no bystander-CPR performed before rescuers arrival.
Variables were given as means or percentages. Data were compared using Chi-square tests and Student’s t-test

Results:
The results appear in Table 1.

Conclusion
: This study showed that in OHCA, when bystanders initiated t-CPR, despite 1- a younger age population 2- more advanced life support and 3- higher rates of ROSC prior to hospital arrival, there was no improvement in survival rate after ICU discharge. As t-CPR does not seem sufficient to improve outcome, training citizens in CPR remains a top priority.
Abstract 65: Racial Disparities in Outcomes Following Nonshockable In-Hospital Cardiac Arrest
Authors: Razi Rabia R , Churpek Matthew M , Yuen Trevor C , Peek Monica E , Edelson Dana P ,   Get With the Guidelines®-Resuscitation Investigators
Published: April 2024

Background: Black patients have previously been shown to have worse outcomes from ventricular arrhythmias. This discrepancy was largely explained by individual patient characteristics and racial clustering by hospital. However, the vast majority of in-hospital cardiac arrests are due to pulseless electrical activity (PEA) and asystole and little is known about the relationship between race and outcomes in this patient group.
Methods: We analyzed PEA and asystolic in-hospital cardiac arrests in the Get With The Guidelines-Resuscitation (GWTG-R) database from 2000 to 2009. A generalized estimating equation model was used to estimate the average survival difference between black and white patients in the study population. Multilevel conditional fixed effects logistic regression models were then used to estimate the relationship between race and survival to discharge and ROSC, sequentially controlling for hospital, patient demographics, comorbidities, arrest characteristic, process measures and interventions in place at the time of arrest.
Results: We identified 76,385 eligible index arrests with a presenting rhythm of PEA or asystole, of which 19,236 (25%) were black. Black patients were younger on average (63 vs 71 years, p<0.001) and had more comorbidities than their white counterparts. Survival to discharge was 13% for white patients and 10% for black patients (unadjusted OR 0.83; 95% CI 0.78-0.88). This effect remained nearly constant after controlling for hospital, patient, and event-specific confounders (adjusted OR 0.85; 95% CI 0.79-0.92). Similar results were shown for ROSC (adjusted OR 0.88; 95% CI 0.84-0.92).
Conclusion: Black patients have significantly lower survival rates after in-hospital PEA and asystolic arrests. Hospital, patient demographics, event characteristics, and co-morbidities as measured in the GWTG-R database failed to explain this discrepancy. Furthermore, the consistency between the outcomes differences in ROSC and survival to discharge suggest that there are unmeasured intra-arrest and/or pre-arrest racial differences present. This is in contrast to shockable cardiac arrests in the same database, in which the disparity was greatly reduced after accounting for measured confounders.
Abstract 76: Early Institution of Hypothermic Total Liquid Ventilation After Prolonged Cardiac Arrest Protects Against Kidney Ischemic Alterations
Authors: Tissier Renaud , Giraud Sébastien , Quellard Nathalie , Fernandez Béatrice , Goujon Jean-Michel , Lidouren Fanny , Darbera Lys , Kohlhauer Matthias , Chenoune Mourad , Bruneval Patrick , Ghaleh Bijan , Berdeaux Alain , Hauet Thierry 
Published: April 2024

Introduction: Warm ischemia before organ removal is a major cause of kidney alterations in transplants from non-heart-beating donors. In a rabbit model of cardiac arrest (CA), we showed that rapid cooling using total liquid ventilation (TLV) can improve survival and protect heart and brain after resuscitation.
Hypothesis: We hypothesized that TLV with perfluorocarbons can also limits kidney alterations after CA, with potential applications for controlled organ donation in the Maastricht III category.
Methods: Anesthetized rabbits were submitted to 15 min of untreated ventricular fibrillation. After resuscitation and resumption of spontaneous circulation (ROSC), rabbits underwent Control life support or hypothermia (32-33°C) induced by TLV and maintained with external blankets under mechanical ventilation. Life support was prolonged during 6 h before kidney removal and analysis. Other rabbits were submitted to similar follow-up with no CA (Sham group).
Results: In each group, 8 animals completed the protocol. Despite similar delays before ROSC (∼4 min), epinephrine doses required to maintain blood pressure throughout follow-up were lower in TLV vs Control (361±23 vs 990±179 µg/kg, respectively). This was accompanied by a decrease in creatinine blood levels after CA (12±1 vs 16±2 mg/l), while still altered when compared to Sham values (8±1 mg/l). Importantly, kidney lesions were also attenuated in TLV vs Control (Figure). The nephroprotective effect of TLV was not related to differences in delayed inflammatory or immune renal responses since transcriptions of, e.g., IFN-γ, TNF-α, IL-1β, MCP-1, TLR-2, TLR-4, VEGF, ICAM-1 and E-selectin were similarly altered in TLV and Control vs Sham. An immediate anti-ischemic effect of rapid cooling with TLV might accordingly be involved.
Conclusion: Ultra-fast cooling with TLV limits kidney alterations after prolonged experimental CA.

*, p<0.05 vs Sham; †, p<0.05 vs Control.
Abstract 79: The Predictive Value of NT-pro BNP in Cardiac Arrest Patients Treated with Mild Hypothermia
Authors: Wee Jung Hee , Park Jeong Ho , Youn Chun Song , Park Kyu Nam , Choi Seung Pill 
Published: April 2024

Background
There has not been accurate, independent
biomarker to reliably predict neurological outcome in cardiac arrest survivors.
B-type natriuretic peptide (BNP) has both prognostic and diagnostic value in
heart diseases, and many studies showed NT-pro BNP had more accurate than BNP. We
speculated that NT-pro BNP measured after restoration of spontaneous
circulation (ROSC) may predict patient outcome.
Methods & Results
A retrospective review of comatose
survivors who were treated with mild therapeutic hypothermia after cardiac
arrest due to cardiac origin to two tertiary general hospitals between June
2007 and May 2011 was performed. NT-pro BNP level was checked in 87 patients
immediately after ROSC. 35 (40.0%) had a favorable neurological outcome (cerebral
performance category 1, 2) and 53 (60.9%) showed survival discharge. The mean value of NT-pro BNP was 557.1±1327.9pg/ml and 5,541.7±9,758.9pg/ml in
favorable and unfavorable outcome, respectively (p=0.001). The AUC for
favorable neurological outcome was 0.747, and 0.720 for death. The NT-pro BNP
cutoff value of 362.7pg/ml for a favorable neurological outcome had a
sensitivity of 65% and a specificity of 69%. The cutoff value of 393.8pg/ml for
mortality had a sensitivity of 71% and a specificity of 66%. Adjusted odds
ratios for favorable neurological outcome at 6 months were 0.686 (95% CI
0.205-2.295), 0.267 (0.0765-0.930), 0.060 (0.11-0.328) compared to the lowest
quartile, respectively (p<0.001).
Conclusion
The measurement of NT-pro BNP had valuable
information to predict the neurological outcome for comatose survivors treated
with mild hypothermia after out-of-hospital cardiac arrest of cardiac etiology.
Abstract 85: The Overall Performance Category and Cerebral Performance Category to Assess Neurologically Intact Survival at Discharge from Cardiac Arrest: A Good Estimate of Patients’ Functioning?
Authors: Beesems Stefanie G , Wittebrood Kim M , de Haan Rob J , Koster Rudolph W 
Published: April 2024

Objective- It is known that recovery from neurologic damage takes 6-12 months. However, most studies on out of hospital cardiac arrest (OHCA) use the Overall Performance Category (OPC)/Cerebral Performance Category (CPC) as outcome at discharge from hospital. We studied the neurocognitive functioning and level of independence (LoI) of patients (pts) 6-12 months after OHCA and compared the results with the OPC/CPC at discharge.
Materials and methods- The study population comprises all pts (>18 year) who survived 6-12 months after OHCA from mid-2010 to mid-2011. Pts were interviewed by telephone with questionnaires validated for telephonic application. We used a validated cut-off score. Neurocognitive functioning was measured with the Telephonic Interview Cognitive Status (TICS) and LoI with the Modified Rankin Scale (MRS). If needed, the IQ-code was used as proxy-questionnaire to measure the neurocognitive functioning of the pt. Neurological outcome at discharge was assessed from hospital records estimating OPC/CPC (figure).
Results- Comparison between OPC at discharge and MRS at 6-12 months is shown in the figure. Of all pts, 93% was classified as having a good outcome (OPC 1-2) at discharge. At 6-12 months only 76% had a good outcome (MRS 0-2). Thirty of the 218 (13%) pts seemed to be cognitively impaired (TICS <31) at 6-12 months while they were classified as having a good outcome (CPC 1-2) at discharge.
Conclusion- MRS and other tests 6-12 months after discharge better reflect pts’ functioning at home than OPC/CPC at the moment of discharge. OPC/CPC cannot measure impairments that manifest themselves only in the home environment.
Abstract 89: Does Neighborhood Really Matter? How Location Influences Bystander CPR Rates
Authors: Buick Jason E , Ray Joel G , Kiss Alex , Morrison Laurie J 
Published: April 2024

Introduction: Numerous studies have investigated determinants of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. Socioeconomic status and ethnicity have been linked to who receives bystander CPR, and recent studies have showed geographical differences in CPR rates. Research from other disciplines has suggested that location is a strong determinant of health and health related interventions and outcomes. Therefore, the objective of this study was to determine the role of neighborhoods in bystander CPR rates in a Canadian population.
Hypothesis: We hypothesized that neighborhood factors are associated with bystander CPR rates.
Methods: All treated OHCA within the City of Toronto between April 2006 and March 2010 were included. Geographic Information Systems were used to assign patients to census tracts (CT) based on their pick-up address and linked to neighborhood factors (instability, dependency, deprivation, ethnic diversity, crime rate and density of family physicians). Bivariate and hierarchical logistic modeling was performed to assess which factors were associated with bystander CPR.
Results: A total of 5,139 OHCA were eligible for enrollment and contained the required information for geographic mapping. The bystander CPR rate was 41.1%. The bystander CPR rate varied across census tracts (0 - 92%, IQR: 25.0 - 50.0%), where 10% had a bystander CPR rate lower than 15%. The CTs deprivation and density of family physicians were associated with bystander CPR (see table). After adjusting for individual characteristics, no CT level variables were associated with bystander CPR.
Conclusion: Deprivation and the density of family physicians were associated with higher rates of bystander CPR. However, after adjustment for patient characteristics, neighborhoods were not associated with CPR. Future research should explore the relationship between location and witnessed status and its role in bystander CPR.
Abstract 92: Prehospital Activation of an Emergency Department Cardiac Arrest Response Team Improves ROSC and Hypothermia Utilization
Authors: Deal Nathan , Borak Meredith , Karol Janet , Sharp Willard W , Shah Atman P , Beiser David G 
Published: April 2024

BACKGROUND: The induction of therapeutic hypothermia (TH) in comatose survivors of out-of-hospital cardiac arrest (OOHCA) improves survival and neurologic recovery outcomes. Despite results from high-quality randomized control trials and international consensus statements, TH utilization rates remain low. Pre-hospital activation of specialized care teams improves outcomes at trauma, ST-segment elevation myocardial infarction, and stroke receiving centers. We hypothesized that pre-hospital activation of a cardiac arrest response team would augment Emergency Department resuscitation resources and thus improve TH utilization and outcomes for out-of-hospital cardiac arrest patients.
METHODS: An emergency department cardiac arrest response team (eCART) comprised of a cardiology fellow, pharmacist, respiratory therapist, hospital chaplain, and a therapeutic hypothermia expert (“Dr. COOL”) was created at an urban academic hospital. The eCART team was immediately activated by emergency department staff after receiving EMS radio notification of an arrest transport. We compared outcomes in consecutive adult OOHCA patients during the 8 month period before (PRE) and after (POST) instantiation of the eCART activation system.
RESULTS: Clinical characteristics of patients in the PRE (n = 46) and POST (n = 63) intervention periods were similar. The CART activation system was utilized for 97% of OOCHA cases presenting to the emergency department. Rate or return of spontaneous circulation (ROSC) was significantly higher during the POST vs. PRE period (37% vs. 17%, p < 0.05). Initiation of TH in eligible patients was also significantly higher during the POST vs. PRE period (100% vs. 80%, p < 0.05). No difference in the time from ROSC to TH goal temperature < 34 degrees Celsius (201 min +/- 125 vs. 212 min +/- 81, p >0.05) or cardiac catheterization laboratory utilization (43% vs. 50%, p > 0.05) was noted between POST and PRE periods respectively.
CONCLUSION: Pre-hospital activation of an eCART team is associated with improvements in ROSC rate and tended to increase TH utilization. These results suggest that rapid deployment of a specialized cardiac arrest response team to the emergency department may be an effective strategy for improving OOHCA resuscitation.
Abstract 9240: Activation of PPARγ Converts the Mechanism of Flow-Mediated Dilation in Human Microvessels from H2O2 to NO by a Telomerase Dependent Mechanism
Authors: Beyer Andreas M , Gutterman David D 
Published: April 2024

Reactive oxygen species (ROS) are important modulators of vascular reactivity. Coronary artery disease (CAD) changes the mechanism of human arteriolar flow-mediated dilation (FMD) from NO to hydrogen peroxide (H2O2), a signaling ROS. Increasing evidence shows that mitochondrial ROS (mtROS) production and the longevity of a cell or organism are inversely related. Telomerase activity (TA), prominent in cellular senescence and tissue aging, shows a reciprocal relationship with mtROS production. Rosiglitazone (Rosi) activates peroxisome proliferator-activated receptor γ (PPARγ) resulting in increased telomerase expression. This could mitigate mtROS production, leading to increased NO bioavailability, improved vascular function, and retardation of atherosclerosis. We hypothesized that PPARγ reduces elevated ROS levels in CAD and converts the mechanism of FMD from H2O2 to NO by increasing telomerase activity.
Human adipose arterioles (~200 µm) from discarded pericardial tissue were cannulated for videomicroscopy. Dilation to graded degrees of shear was measured in vessels constricted with endothelin-1. Pharmacological inhibition of TA (BIRBR 1532 10 μM 15-20 h) in vessels from healthy individuals shifted the mechanism of FMD from NO to H2O2 (Panel A+B). In arterioles from patients with CAD, Rosi (10 μM 15-20 h) shifted the mechanism of FMD from H2O2 to NO (Panel C). In vessels from patients with CAD, BIBRB1532 prevented the ability of Rosi to convert the mediator of FMD from NO to H2O2 (D). We conclude that PPARγ signaling increases telomerase activity in the vasculature, which plays a critical and acute role in modulating microvascular function.
Abstract 9595: A Novel Niacin Analog (ARI-3037MO) Induces Favorable Plasma Lipid Changes Without Flush in Single and Multiple Ascending Dose Placebo Controlled Trials in Normal Healthy Volunteers
Authors: Benedict Claude , Neutel Joel , Bachovchin William , Kiritsy Christopher 
Published: April 2024

INTRODUCTION: Despite niacin’s (NA) beneficial effects on lipids, it’s use is limited by side effects, such as flushing, itching, and increases in liver enzymes and blood glucose. These effects, particularly flushing, lead to poor compliance and persistence in clinical use. ARI-3037MO is an orally active, novel, NA analog that produces significant lipid altering effects at least as effective as NA on low density lipoproteins (LDL-C), triglycerides (TG) and high density lipoproteins (HDL-C) in preclinical studies without flushing.
METHODS: To evaluate safety and pharmacokinetics of ARI-3037MO in humans, we conducted a single ascending dose (SAD) trial and a multiple ascending dose (MAD) trial in healthy volunteers. In SAD study, five doses of ARI-3037MO QD were evaluated in 30 subjects (n=6 per dose; 17 males, 13 females). Ten additional subjects received matching placebo. In MAD trial, four doses of ARI-3037MO [(0.5g (n=8), 1g (n=8), 2g (n=9) & 3.5g (n=9)] QD were evaluated in 34 healthy volunteers (24 males, 10 females) for 14 or 28 days (2g QD cohort only). Eight additional subjects received matching placebo. RESULTS: In SAD trial all doses (0.5g - 6g/day) of ARI-3037MO, were well tolerated with no evidence of flushing, itching or other skin changes even at the 6g QD dose. No liver function or glucose abnormalities were observed. There was a reduction in TG (-56.7 +/- 37.0 mg/dl; mean+/- SEM; p < 0.05 ANOVA) and an increase in HDL-C (+ 7.7 +/- 1.6 mg/dl; p < 0.05 ANOVA) in the 6g cohort. In MAD trial, all doses were well tolerated with no evidence of flushing, itching or other skin changes even at the highest dose. No liver function or glucose abnormalities were observed. There was a significant reduction in TGs with 2g dose given for 28 days as well as a trend toward reduction in LDL-C. Following single or multiple dosing, ARI-3037MO was rapidly absorbed and plasma drug levels showed good dose proportionality. CONCLUSION: The absence of any adverse effects (including flush, increases in liver enzymes and blood glucose) at all doses in the SAD and MAD studies, combined with encouraging lipid effects in these short duration trials indicates that ARI-3037MO represents a potential transformational niacin-based therapy for patients with dyslipidemia and metabolic syndrome.
Abstract 9792: Chrontropic Incompetence in Heart Failure and the Relationship of Minute Ventilation and Chronotropic Response During Exercise
Authors: Hopper Donald L , Abraham JoEllyn M , Samara Michael A , Wilkoff Bruce 
Published: April 2024

BACKGROUND: Cardiac pulmonary mismatch is prevalent in heart failure patients that exhibit chronotropic incompetence (CI). Wilkoff’s model provides evaluation of metabolic chronotropic response (MCR) during exercise. In addition to CI we evaluated a new measure of the normalized heart rate to normalized minute ventilation relationship during exercise (HRn/VEn) which,in combination with the MCR slope, may provide discriminating information in regards to identifying those normal subjects and heart failure patients who would most likely benefit from adaptive rate pacing. Normalization allows comparison of subjects and identification of patients with CI regardless of Age, functional capacity, and during submaximal workloads.
METHOD: We studied the resulting MCR slopes and the HRn/VEn slopes in 40 normal subjects (N) (age 37±9) and 40 heart failure patients (HF) implanted with BiV CRT-D devices (age 62±9) during graded exercise testing by using standard cardiopulmonary exercise testing techniques. Exercise tests were performed to peak exercise (as quantified by the respiratory exchange ratio (RER) RER = 1.13±0.09 N and 1.11±0.07 HF) and the end stage heart rate and minute ventilation data was used in the calculations of the MCR slope and HRn/VEn slopes. RESULTS: Mean MCR slopes were 1.0±0.14 (N) and 0.52±0.23 (HF). The mean HRn/VEn slope were 1.34±0.26 (N) and 0.66±0.28 (HF). Details are presented in the table.
DISSCUSION/CONCLUSSION: When CI is present there is also a significant derangement in the heart rate to pulmonary relationship as shown by the HRn/VEn slopes. A MCR slope of 0.7 which is considered to be severely CI corresponds to a decreased HRn/VEn slope of 0.881 (95% confidence interval of the normal relationship). HF CI patients (MCR slopes <0.7) also exhibit low HRn/VEn measures (> 2 standard deviations from the mean of normal group).