bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 194: ST Changes on Continuous Telemetry Monitoring Before In-Hospital Cardiac Arrests
Authors: Do Duc H , Hayase Justin , Kim Sunghan , Hu Xiao , Boyle Noel G 
Published: April 2024

Introduction:
In-hospital cardiac arrests (CA) remain a significant problem in the United States, affecting up to 750,000 patients annually. No more than 30% survive to discharge - this has improved little in the past 25 years, and is unlikely to improve further without major changes in treatment or better identification of at risk patients. Hence, there is significant interest in predicting impending CA to allow for intervention and possibly improve survival. In this retrospective study, we examine the characteristics of ST changes prior to CA to evaluate their utility in predicting CA.
Methods:
We evaluated all “Code Blue” events at UCLA Ronald Reagan Medical Center, a 520 bed tertiary care hospital, from April 2010 to April 2012. Inclusion criteria were: age ≥ 18, actual cardiac arrest, continuous telemetry data available for at least 3 hours immediately prior to CA. Up to 24 hours of telemetry data prior to CA was obtained and analyzed for each case. The arrhythmic mode and likely underlying cause, and presence/absence/duration of ST changes prior to CA were assessed for each case.
Results:
Of 65 cases meeting inclusion criteria, 19(29%) had progressive ST changes leading up to CA. The most likely cause was respiratory failure in 5(26%), multiorgan failure in 7(37%), acute cardiac failure (pulmonary embolism or myocardial infarction) in 5(26%), metabolic acidosis in 1(5%), and hemorrhagic shock in 1(5%). The arrhythmic mode of CA was pulseless electrical activity in 14(73%), bradycardic in 4(21%) and torsade de pointes in 1(5%). ST changes were detectable on telemetry monitoring in 6(32%) more than 60 minutes prior to CA, in an additional 6(32%) between 10 and 60 minutes prior to CA, and only in the last 10 minutes in a further 6(32%).
Conclusions:
ST changes leading up to CA occurred in one third of cases in this small series, mainly in PEA and bradycardic arrests. These were associated with multiple underlying medical conditions that may lead to cardiac hypoperfusion such as multiorgan failure on pressors, severe hypoxia, pulmonary embolism and myocardial infarction. In about two thirds of the cases in which ST changes were detectable, they were evident more than 10 minutes prior to onset of arrest, which may allow sufficient time for rapid intervention to prevent CA.
Abstract 19487: Simvastatin Loaded High-Density Lipoprotein Nanoparticles Reduce Inflammation in Atherosclerotic Plaques by Directly Acting on Plaque Macrophages and Inflammatory Monocytes
Authors: Tang Jun , Duivenvoorden Raphael , Hewing Bernd , Izquierdo-Garcia David , Mieszawska Aneta J , van Rijs Sarian M , Cormode David P , Ozcan Canturk , Kuan Emma L , Martel Catherine , Lobatto Mark E , Stroes Erik S , Randolph Gwendalyn J , Fuster Valentin , Fisher Edward A , Fayad Zahi A , Mulder Willem J 
Published: April 2024

Rationale: Although statins have been shown to have anti-inflammatory pleiotropic effects in experimental studies, the poor plaque targeting of orally administered statins limits their direct anti-inflammatory therapeutic effect. To that end, we have developed a simvastatin loaded high-density lipoprotein nanoparticle ([S]-rHDL), which has an improved plaque bioavailability and therefore exerts a higher therapeutic effect in apolipoprotein E knockout (ApoE KO) mice than orally administered simvastatin. The purpose of the current study is to understand the mechanism of this potent anti-inflammatory effect.
Methods and Results: [S]-rHDL was found to specifically target plaque macrophages by fluorescence microscopy (a). To investigate the targeting efficiency of [S]-rHDL to monocytes/macrophages, we intravenously injected [S]-rHDL in ApoE KO mice (n=3/time point) and analyzed the cells from aortas and blood by flow cytometry. [S]-rHDL was found to target macrophages and monocytes in aortas (b), and to target inflammatory Gr-1hi monocytes more efficiently than anti-inflammatory Gr-1lo monocytes in blood (c). Last, laser capture microdissection was used to isolate plaque macrophages (n=7), and quantitative RT-PCR was used to measure their mRNA level of TNF-α, the hallmark of macrophage inflammation, which was significantly reduced (d). All the above data support our hypothesis that [S]-rHDL acts on inflammatory monocytes and plaque macrophages and thereby exerts a strong anti-inflammatory effect on atherosclerotic plaque.
Conclusion: In ApoE KO mice, [S]-rHDL specifically targets plaque macrophages. [S]-rHDL also locally acts on macrophages in plaque and preferentially targets pro-inflammatory monocytes in blood, which results in a strong anti-inflammatory effect. This nanotherapy may represent a potent addition to the current standard of care for atherosclerosis patients.
Abstract 237: Cerebral and Somatic rSo2 Monitoring During Pediatric Cardiopulmonary Resuscitation
Authors: Abramo Thomas J , Meredith Mark , Locklear Mathew , Estrada Cristina E 
Published: April 2024

Pediatric resuscitation/arrest has no assessment for tissue resuscitative efforts. Patients have inadequate tissue perfusion despite adequate systemic perfusion during resuscitation. Traditional methods for effective resuscitation have inherent flaws and don’t assess tissue resuscitation. Resuscitated patients by global methods, have significant tissue hypoxia. Refinement in goal directed therapy is to detect tissue resuscitation effects. During resuscitation, better endpoints are needed to guide resuscitation and endpoints. Near-infrared spectroscopy (NIRS) permits noninvasive readings of cerebral and somatic rSO2 tissue saturation. NIRS in adult resuscitations is predictor for survival and neurological outcome. A 15% rSO2 means no detectable tissue O2Hgb. A 95% rSO2 is interpreted as increased perfusion with no tissue O2 extraction.
Purpose: Retrospective analysis of Pediatric ED (PED) Resuscitation/CPR cases with cerebral & somatic rSO2 monitoring.
Methods: 1/09- 2/12 PED patients with resuscitation/CPR had noninvasive monitoring with cerebral & somatic rSO2 monitoring. Probes were placed on left & right forehead & right deltoid. Recordings were every 30 seconds. Medical records and autopsy were reviewed.
Results: Twenty nine patients were monitored Age 9 wks -16 yrs with 75% males. All patients expired. Patient’s etiology were Trauma or Medical: Sepsis, SUID, Drowning, Ingestion.
Conclusion: Preliminary data shows unique Cerebral & Somatic rSO2 monitoring in pediatric resuscitation and CPR. As in adult studies, cerebral and somatic rSO2 for our patients showed similar rSO2 of 95% and 15%. Small sample size precludes definitive conclusions. Our observations shows cerebral and somatic rSO2 gives real-time information on tissue oxygenation during pediatric resuscitations. A large validation study using cerebral and somatic rSO2 with global monitoring is warranted.
Abstract 244: Defibrillation Efficacy Is Not Influenced by Duration of Preshock Pause
Authors: Brouwer Tom F , Walker Robert G , Chapman Fred W , Koster Rudolph W 
Published: April 2024

Background
A prior small study reported a strong relationship between pre-shock pause duration (PreSP) and 1st shock defibrillation efficacy during cardiac arrest resuscitation. We examined the relationship between PreSP and defibrillation efficacy across all shocks in a large cohort of out-of-hospital cardiac arrest (OHCA) resuscitations.
Methods
In an observational study of prospectively collected data, we enrolled all patients with cardiac cause OHCA presenting with VT/VF during calendar year 2009 in five EMS systems. Continuous ECG and impedance recordings from all defibrillators used during resuscitation were reviewed to measure PreSP and determine outcome for all shocks. Defibrillation success was defined as removal of VF for at least 5 seconds post-shock.
Results
Of 902 analyzable biphasic shocks to 281 patients, 763 successfully terminated VF (85%). The median (IQR) PreSP did not differ significantly between successful and failed shocks [8 (4,17) vs 7 (5, 15) sec, p=0.34]. No significant differences were found when analyzing just first shocks [9 (4,18) vs 7 (4,15), p=0.33], just AED shocks [20 (17,23) vs 19 (15,21), p=0.31], or just manual shocks [7 (4,15) vs 7 (4,13), p=0.97]. When grouped by PreSP duration in 10-sec increments, there was no significant trend in shock efficacy with increasing pause duration (Figure, p=0.06). In a univariate regression, there was no significant relationship between first-shock PreSP duration and successful VF termination [OR = 1.15 for every 5-second increase (0.91, 1.47)].
Conclusion
Defibrillation success is not associated with pre-shock pause duration.
Abstract 249: Cardiac Arrest in the Emergency Department: A Comparison of Pediatric and Adult Outcomes and Care Processes
Authors: Donoghue Aaron , Abella Benjamin , Merchant Raina , Berg Robert , Nadkarni Vinay 
Published: April 2024

Background: About 10% of in-hospital cardiopulmonary arrest (CPA) events occur in the Emergency Department (ED). Published outcomes from CPA in the ED are discrepant between adults and children, with much worse survival among children. Reasons for these differences are unclear. We hypothesize a greater prevalence of unfavorable cardiorespiratory physiology among pediatric patients, and less optimal processes of care as a result of lower frequency occurrences among children in the ED.

Methods: Retrospective cohort study from the Get With The Guidelines - Resuscitation database. All patients whose CPA event occurred in the ED were included. Univariate comparison between children (age <18 yo) and adults (age > 18 yo) was done for Utstein outcomes (ROSC, 24 hr survival, survival to discharge) as well as patient factors (illness category, pre-existing conditions), event factors (initial rhythm, pulse sequence, total duration), and times to interventions; χ
2
analysis was used for categorical variables, t-testing for continuous variables.

Results: 706/10947 (6.4%) of pediatric CPA events and 18473/189,653 (9.7%) of adult CPA events occurred in the ED. Median age for adults was 65 yr (IQR 52 - 77 yr), 21 months for children (IQR 3 mos - 10 yr). Children had a greater prevalence of respiratory insufficiency (51% vs. 43%, p<0.001), septicemia (10% vs. 7%, p=0.05), and trauma (18% vs. 6%, p<0.001). Shockable initial rhythm was less common in children (17% vs. 31%, p<0.001) and CPR prior to pulselessness was more common (28% vs. 8%, p<0.001). In children, total duration of CPR was longer (28.6 + 1.0 mins vs. 22.9 + 0.3 mins, p<0.001) and time to epinephrine was shorter (2.2 + 0.4 mins vs. 2.8 + 0.1 mins, p=0.03). Times to compressions, airway, and defibrillation did not differ significantly. 24 hour survival was worse among children (26% vs. 33%, p=0.001); ROSC (49% vs. 52%) and survival to discharge (26% vs. 24%) did not differ significantly.
Conclusions: Compared with adults, 24 hour survival is worse among children with CPA in the ED; other outcomes are less discrepant than in previously published studies. Pediatric CPA in the ED more commonly occurs from respiratory insufficiency or shock. Differences in outcomes do not appear related to timing of critical interventions.
Abstract 251: First-Year Medical Students Acquire Contextually Relevant Cardiopulmonary Resuscitation Knowledge When Exposed to an In-Hospital Focused BLS Course Versus a Traditional Healthcare Provider BLS Course: A Prospective, Randomized, Controlled Evaluation
Authors: Duval-Arnould Jordan M , Perretta Julianne , Chime Nnenna , Hollingsworth Merona , Aksamit Deborah , Twilley Ida-Marguerite M , Luksic Mary Ann , Jung Julianna , Nelson-McMillan Kristen , Shilkofski Nicole A , Hunt Elizabeth 
Published: April 2024

INTRODUCTION: The traditional AHA Healthcare Provider BLS course focuses on out-of-hospital cardiac arrests as the contextual environment and does not provide content focused on optimizing quality of BLS for in-hospital cardiac arrests (IHCA).
METHODS: First year medical students participated in a prospective, randomized, controlled evaluation of a traditional AHA Healthcare Provider BLS course “TradBLS” vs. a modified course including objectives focused on managing IHCA, “HospBLS”. The courses were identical in length, taught by the same instructors, and used AHA materials. Students completed a Multiple Choice Question (MCQ) survey evaluating knowledge regarding CPR performance and leadership. This project was approved by our Institutional Ethics Committee as an Educational Quality Assurance evaluation and by the AHA.
RESULTS: 122 students completed an MCQ survey. Both groups had similar previous BLS certification [HospBLS 29/62 (47%) vs. TradBLS: 32/60 (53%) p = 0.469], and lack of advanced training (neither ACLS or PALS) [95% vs. 97% p = 0.675]. The HospBLS group was significantly more likely to identify a set of six maneuvers to improve quality of in-hospital CPR [87% vs. 27%, p<0.001]. The HospBLS group was more likely to identify 2-person bag-mask-ventilation (BMV) as a maneuver to try when unable to move the chest [77% vs. 18%, p<0.001] as well as correct O2 delivery when performing BMV [90% vs. 17%, p< 0.001]. An equivalent number of students in each group reported they could either lead until the code team arrives [52% vs. 58%, p=0.46] or could lead a simulation but not a real life scenario [5% vs. 10%, p = 0.28]. However, the HospBLS group was much more likely to identify themselves as qualified to be a team leader [44% vs. (3%), p<0.001]; and much less likely to indicate they were not qualified to be a team leader” [0% vs. 28%, p<0.001].
CONCLUSIONS: Medical students that took the HospBLS curriculum were more likely to identify maneuvers to optimize quality of CPR for the IHCA, and expressed greater confidence in their ability to be a team leader. This evaluation suggests that knowledge on optimizing CPR for IHCA can be effectively acquired with the same time and resource utilization of the standard AHA Healthcare Provider course and should be further evaluated.
Abstract 278: A Pilot Study Examining the Role of Regional Cerebral Oxygen Saturation Monitoring as a Marker of Return of Spontaneous Circulation in the Shockable and Nonshockable Causes of Cardiac Arrest
Authors: Ahn Anna , Nasir Asad , Dorazi Francis , Malik Hanan , Parnia Sam 
Published: April 2024

Background: To date there has been no reliable “real time” monitoring available to determine the adequacy of oxygen delivery and cerebral perfusion during cardiac arrest. Although, we have previously demonstrated that the mean regional cerebral oxygen saturation (rSO2) measured by cerebral oximetry can be used to determine return of spontaneous circulation in cardiac arrest, the rSO2 level that corresponds with ROSC in the 3 main different subtypes of cardiac arrest (VF/VT, PEA, asystole has not been examined.
Objectives: To investigate the level of rSO2 that corresponds with ROSC in 1) VF/VT, 2) PEA and 3) asystole subtypes of cardiac arrest using a commercially available cerebral oximeter (Equanox, Nonin, USA)
Methods: Cerebral oximetry was applied to 34 in-hospital cardiac arrest patients and continuous data was collected until either ROSC was achieved or CPR was terminated.
Results: Overall 20 patients achieved ROSC, whereas 14 did not. There was a significant overall difference in mean±SD rSO2% in patients who achieved ROSC (49.7 ± 11.3% vs. 33.9 ± 15.0% p=<0.001) compared to those who did not. Examination of the cardiac arrest subtypes revealed that while this difference was observed in the PEA (n=13) 54.6 ± 8.7 vs. 36.8 ± 20.4 (p=<0.05) and asystole (n=16) 46.6 ± 11.4 vs. 27.4 ± 10.8 (p=<0.05) subgroups, there was no difference in rSO2 in patients with and without ROSC in the VF/VT subgroup (n=5) 41.6 ± 18.5 vs. 45.0 ± 11.6 (p=0.8).

Conclusions
: Although cerebral oximetry may be used as a real-time non-invasive marker of ROSC during cardiac arrest, the main difference in rSO2 between patients achieving ROSC and those without ROSC applies to the asystole and PEA sub groups of cardiac arrest, rather than VF/VT. This likely reflects the different dominant physiological disorders between shockable and non-shockable causes of cardiac arrest. Whereas recovery from PEA and asystole is dependent on the adequacy of oxygen delivery, recovery from VF/VT predominantly relates to the timing of defibrillation.
Abstract 284: The Relation Between Serum Procalcitonin and Perfusion Parameters After the Return of Spontaneous Circulation Following Out-of-Hospital Cardiac Arrest
Authors: Sato Koji , Taniguchi Takumi 
Published: April 2024

<Introduction>Procalcitonin (PCT) has been broadly used as an infectious biomarker. However we often found that the patients without infection showed high level of PCT. In past research, PCT has been reported to be a useful biomarker in predicting neurological outcome after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA).
<Hypothesis>Our hypothesis is that the level of PCT in the patients after ROSC following OHCA may relate to time from cardiac arrest and reflect tissue hypoxia. Moreover it may predict outcome. This study was aimed to evaluate relation between the serum level of PCT and perfusion parameters in OHCA patients.
<Methods>Twenty sequential patients who admitted to the ICU after ROSC following OHCA were included. Infectious patients, trauma patients and extracorporeal CPR patients were excluded. This study was a retrospective, single-center analysis, conducted in the ICU of the university hospital. We evaluated the maximum PCT level within 48hr after admission, cardio-pulmonary arrest time, serum lactate level at admission, Glasgow outcome scale at 28 day.
<Results>Twelve of twenty patients were cardiogenic patients. Average ROSC time from OHCA was 27±17 minutes. The maximum PCT was significantly higher in patients who died in the hospital (2.2±2.6 V.S 15.3±17 ng/mL, p=0.01). We defined Glasgow outcome scale 4-5 as favorable outcomes and eight patients showed favorable outcomes. Serum PCT in patients with favorable outcomes was lower than that of unfavorable outcomes, but there was no statistical significance (1.2±2.5 V.S 9.4±13.5 ng/mL). The maximum PCT significantly correlated with serum lactate at admission (r=0.63, p<0.01), and ROSC time from OHCA (r=0.54, p=0.01). <Conclusions>In conclusion, the maximum PCT after cardiac arrest did not predict neurological outcome. But PCT correlated with degree of tissue hypoxia. The serum PCT may reflect ischemia-reperfusion injury.
Abstract 292: Comparison of Pharmacological and Physical Hypothermia in Cerebral and Myocardial Function in a Porcine Model of Cardiac Arrest and Resuscitation
Authors: Weng Yinlun , Sun Shijie , Chen Wei , Wu Xiaobo , Xu Jiefeng , Tang Wanchun 
Published: April 2024

Objective: Non-selective cannabinoid (CB) 1/2 receptor agonist, WIN 55,212-2, has been demonstrated to produce pharmacological hypothermia and improved outcomes of CPR in a rat model. In this study, we compared the effects of pharmacological hypothermia induced by WIN 55,212-2 and physical hypothermia by surface cooling in myocardial and neurological function in a porcine model of CPR.
Hypothesis: Pharmacological hypothermia by WIN 55,212-2 produced the similar or better cerebral and myocardial function as surface cooling.
Methods and results:Ventricular fibrillation (VF) was induced in 14 male domestic pigs weighing between 35 ± 2 kg. CPR was initiated after 7 min of untreated VF. Defibrillation was attempted after 5 min of CPR. If ROSC was not achieved, two mins of CPR was continued and sequenced with defibrillation attempt until ROSC or for a total of 15 mins. At 5 min post resuscitation, animals are randomized to receive intravenous infusion with WIN 55,212-2 at a dose of 1.0 mg/kg/h or surface cooling until blood temperature cooled down to 34 celcius degree and maintained for 4 hrs. When compared to the animals treated with surface cooling, significantly improvement in neurological alertness score (NAS) was observed in the WIN 55,212-2 treated animals at 24 and 48 hrs, but not at 72 hrs (WIN 55,212-2 vs surface cooling: 24 hrs, 93 ± 5 vs 77 ± 12, p<0.01; 48 hrs, 100 ± 0 vs 93 ± 6, p=0.01) (Figure 1A). As to the post resuscitation myocardial function, there was no significant difference in ejection fraction (EF) between these two groups (Figure 1B).
Conclusions: Pharmacological hypothermia induced by WIN 55,212-2 exerted better post resuscitation short-term neurological function than physical hypothermia with the similar post resuscitation myocardial function.
Abstract 296: Determinants of Incidence of Ventricular Fibrillation as First Recorded Rhythm During Out-of-Hospital Cardiac Arrest and Association with Long-Term Neurological Outcomes: Observations from a Large Randomized Clinical Study
Authors: Yannopoulos Demetris , Holcomb Richard , Frascone Ralph J , Mahoney Brian D , Wayne Marvin A , Swor Robert A , Domeier Robert M , Olinger Michael L , Tupper David E , Aufderheide Tom P 
Published: April 2024

Background: We sought to identify the factors that were associated with higher incidence of VF and survival with good neurological function in the ResQ Trial patients that compared standard cardiopulmonary resuscitation (S-CPR) versus active compression decompression CPR with an inspiratory impedance threshold device (ACD+ITD) in patients with out of hospital cardiac arrest (OHCA).
Methods: A retrospective analysis of a randomized multicenter clinical study of 1655 patients with OHCA. 88.3% (106/120) of the patients discharged with good neurological function [Modified Rankin Score (MRS)≤3] had a first recorded rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF). The first rhythm was recorded in 99.4% (1645/1655) of the cases about 9.5 minutes after 911 call, on average 3 minutes after the arrival of EMS on the scene and after CPR was performed for at least 2 minutes.
Results: A total of 32.8% of the patients had VF as presenting rhythm and 42.8% received bystander CPR. Presence of bystander CPR was associated with a higher VF incidence only in the S-CPR group (40.8% versus 23.1% with no bystander, p=0.001) but survival was 7.6% versus 4.6% p=0.09. Presence or absence of bystander CPR let to similar VF incidence and survival in the ACD+ITD group 36.1% versus 33.9% and 9.0% versus 8.9% respectively, p>0.2. After propensity adjustment for witnessed arrest, age <67, gender, public location, bystander CPR lost significance. In the absence of bystander CPR, ACD+ITD significantly increased the incidence of first recorded VF compared to S-CPR from 106/459 (23.1%) to 164/484 (33.9%) [OR 1.71, 95% CI (1.27, 2.30), p<0.001], and in patients with VF, return of spontaneous circulation increased from 65/459 (14.2%) to 104/484 (21.5%) [OR 1.66, 95% CI (1.16, 2.37), p=0.004], leading to an overall doubling of survival with MRS≤3 from 21/455 (4.6%) to 43/482 (8.9%) [OR 2.02, 95% CI (1.15, 3.65), p=0.009]. After propensity adjustment ACD+ITD remained a significant predictor of an MRS≤3, (p= 0.02).
Conclusions: VF was the most important predictor of survival with MRS≤3.
In the absence of bystander CPR, ACD+ITD increased VF incidence as the first recorded rhythm and doubled survival to hospital discharge with MRS≤3 compared to S-CPR.