bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 243: Pulsatile Versus Nonpulsatile Emergency Cardiopulmonary Bypass: Impact on Early Regional Brain Perfusion After Lethal Cardiac Arrest in Rats
Authors: Boller Manuel , Jung Sung Koo , Yin Tai , Becker Lance 
Published: April 2024

Background: An increasing amount of clinical data suggests that emergency cardiopulmonary bypass (ECPB) is an effective tool for resuscitation from prolonged cardiac arrest. Next to controlling pharmacological components of the reperfusate, ECPB also allows definition of physical characteristics of reperfusion. Pulsatile reperfusion is a intriguing strategy but has not been studied in the setting of ECPB despite its technical feasibility. Thus we aimed at testing the influence of a pulsatile reperfusion component to early brain perfusion after lethal cardiac arrest in a rodent ECPB model.
Methods: After anesthesia and instrumentation, male Sprague-Dawley rats (448±41g) underwent 20 min of untreated asphyxial arrest and were resuscitated with normothermic ECPB with either pulsatile (150 beats/min; 50 mL/min; n=8) or non-pulsatile flow (50 mL/min; n=8). No vasopressors were administered. ROSC was prevented by occluding the right ventricle. At 3 min, FITC-dextran 70 was injected into the bypass circuit. Two minutes later ECPB was stopped, the brain removed and brain slices at defined levels (Bregma -0.3 mm, -1.4 mm, -3.3 mm, -11.3 mm) mounted for fluorescent microscopy and blinded quantification of the area of FITC-stained perfused cerebral microvessels. Perfused areas were quantified for the whole brain, cortex, caudate putamen and hippocampus.
Results: The overall perfused cortical area (41±13%) was significantly higher than the non-cortical area (20±11%), with a trend towards better perfusion with pulsatile bypass in the deeper brain regions (p=0.07). While no differences in mean arterial blood pressure (MAP) between groups were present, perfused areas in putamen (p=0.04) and hippocampus (p=0.03) were significantly higher in animals treated with pulsatile ECPB.
Conclusions: The data suggests that pulsatile ECPB may be of benefit to improve perfusion of deeper brain regions after prolonged cardiac arrest and especially of those areas known to be vulnerable to cerebral hypoxia/ischemia. Additional studies are warranted to further define the role of pulsatile ECPB for resuscitation from lethal cardiac arrest.
Abstract 267: Airway Pressure Is a Valid Surrogate for Intrapleural Pressure During CPR
Authors: Kwon Younghoon , McKnite Scott , Matsuura Timothy , Merriam Andrew , Salverda Bayert , Yannopoulos Demetris 
Published: April 2024

Background:
Using direct measurement of intrapleural pressure (Ppl), we sought to assess true intrathoracic pressure during various interventions of CPR and to explore its relationship with airway pressure (Paw). We hypothesized that Ppl would correlate with Paw and with coronary (CPP) and cerebral (CePP) perfusion pressures.

Methods:
Ppl catheter was inserted into right anterior aspect of pleural cavity. Paw, right atrial (Pra), aortic and intracranial (ICP) pressures were recorded continuously. Proper placements were confirmed in all animals post mortem. Following 4 minutes of untreated ventricular fibrillation in 6 anesthetized female farm pigs (34 ± 2 kg), CPR was performed in the following sequence for 2 minutes per each intervention. Standard CPR (sCPR), Active compression decompression (ACD) CPR, ACD+ inspiratory impedance threshold device (ITD) CPR, ACD + intrathoracic pressure regulator (ITPR) CPR. Data were collected during last 20 seconds of each intervention.

Results:
Highest and lowest mean Paw and Ppl were observed during sCPR and ACD +ITPR CPR respectively. Mean Paw showed modest correlation with mean Ppl. (r2=0.15, p=0.06). After adjusting for variance between the animals, significant correlation was observed (r
2
=0.81, p<0.0001). In contrary, no significant correlation was observed between mean Pra and Ppl. Among intrathoracic pressure variables mean Ppl and Paw (not mean Pra) showed significant inverse correlations with both CPP and CePP. Mean Pra was strongly correlated with ICP. (Table)

Conclusion:
A significant correlation of mean Paw with Ppl provides validity of using Paw as a surrogate measurement to monitor intrathoracic pressure during standard CPR and ACD assisted interventions. Table) Within animal correlation between intrathoracic pressure variables and central perfusion pressures.
Abstract 279: Time to Awakening After Cardiac Arrest: How Long Should We Wait?
Authors: Peberdy Mary Ann , Ornato Joseph P , Donnino Michael , Cocchi Michael N , Rittenberger Jon , Callaway Clifton W , Gaieski David F , Abella Benjamin S , Clore John N ,   for the National Post Arrest Rsch Consortium (NPARC) Investigators
Published: April 2024

Background: Studies performed prior to the use of therapeutic hypothermia (TH) suggest the optimal timeline for prognostication after cardiac arrest (CA) is on day 3 but this may not be generalizable to patients (pts) treated with TH. Current guidelines state that futility should not be declared until greater than day 3 after ROSC in hypothermic pts.
Purpose: To identify the time to awakening in post arrest patients treated with TH.
Methods: Post hoc analysis of a prospective, non-interventional, multi-center trial. Data from 111 consecutive pts from 7-1-11 thru 3-31-12 were analyzed using PASW v20. Results are presented as median [25th, 75th percentiles]. Time to awakening is defined as the number of calendar days from ROSC to purposefully following commands.
Results: Fifty-one of the 111 patients (46%) survived to discharge. Awakening occurred in 39/51 (77%) patients who survived to discharge vs. 1/60 (3%) who awakened and died. Median time to awakening in those who awakened and survived to discharge was 1 [.25, 2] day (range 0-28 days). It took 4.9 days for 90%, and 11.9 days for 95%, of those who awakened to do so. Characteristics of all patients and those who awakened and survived to discharge stratified by time of awakening after ROSC are shown in the Table.
Conclusions: Awakening and good neurological outcome occurs in pts treated with TH who remain comatose on day 3 after CA, irrespective of the first documented rhythm. Most patients who awaken will do so by the end of day 4, but 10% require longer. Our data suggest that it may be necessary to wait >3 days to allow adequate time for awakening after CA in patients treated with TH. Allowing patients adequate time for neurological recovery requires longer hospital stays and additional resources. Further study should prospectively evaluate the timeframe for expected neurological recovery in CA pts treated with TH.
Abstract 301: Does Refibrillation Occur in High-Impedance Patients Who Have Received Shocks Using Biphasic Waveforms with Longer Pulse Durations?
Authors: Di Maio Rebecca , Crawford Paul , Brody David , Howe Andrew , McCanny Paul , Crawford Lauren , Crispino-O’Connell Gloria , Adgey Jennifer 
Published: April 2024

Introduction

The electrical impedance between defibrillator pads has a significant effect on the ability of defibrillators to deliver a therapeutic shock. A variety of technologies are used to deliver the chosen therapeutic shocks safely yet effectively across a wide range of patient impedances.
Defibrillators will not deliver a shock above pre-set impedance. We assessed the hypothesis that devices which have pulse durations over 20ms may predispose the patient to spontaneous re-fibrillation after a successful shock.

Methods

Two defibrillators were tested. Device A (A) limited the current delivered and in high impedance patients would extend the pulse duration as needed to deliver the selected energy while staying below the current limit. Device B (B) would truncate the shock to restrict the pulse duration but operated with higher currents. A high impedance porcine model of ventricular fibrillation (VF) was created. Following pilot work we were unable to demonstrate any relationship between pig mass and impedance. Therefore to create high impedance it was necessary to place resistors in series with the pig between the defibrillator under test and the pads.

Results

From the pilot studies we determined that an impedance of approximately 95ohms resulted in a pulse duration of 20ms when device A delivered a 200J shock. A total of 5 anaesthetised pigs weighing 17-20kg (18.8kg) where used with 168 episodes of VF where impedance was greater than 100 ohms are included in the results. Two energies were tested for A (150 and 200J). B only delivers shocks at a single energy (150J). No re-fibrillation was observed in any patient after any shock.

Conclusions

This study failed to show any evidence of re-fibrillation even at pulse durations longer than 20ms with either device.
Abstract 304: Comparing a Novel Stochastic Integrative Machine Learning Model with AMSA for Predicting Defibrillation Success
Authors: Shandilya Sharad , Ward Kevin , Kurz Michael C , Najarian Kayvan 
Published: April 2024

Introduction
A computational model of defibrillation success, based on physiologic signals, would be highly useful in guiding therapy during cardiac arrest. The Amplitude Spectrum Area (AMSA) measure has been explored in a number of studies as a predictor of countershock success for ventricular fibrillation (VF). We have developed a novel non-linear stochastic method for a unified predictive model of Return Of Spontaneous Circulation (ROSC) and compare this model to AMSA.
Methods
Ninety sample pre-hospital VF Electrocardiogram (ECG) signals including defibrillation were classified as successful (34) or unsuccessful (56) through 10-fold cross validation. A novel integrative model was developed with Machine Learning and features extracted from non-linear stochastic characterization of the ECG signal. This method was subsequently compared with the AMSA method. We replicated the procedure published by AMSA creators and attempted to discern a threshold. The performance of both methods in predicting post-countershock ROSC was measured. Accuracy is calculated as the correctly predicted countershock outcomes divided by all samples in the database. ROC AUC is a measure of predictive model robustness.
Results
The novel integrative model performs real-time, short-term (7.8 second) analysis of the ECGs with prediction Accuracy and Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) of 82.2% and 85%, respectively. Sensitivity was 85.3% and specificity was 80.3%. Using the AMSA methodology, no clear threshold for shock success could be identified for comparison. Employing information-gain based decision stump (or one-rule) for AMSA values yielded 64.6% accuracy and 60.9% ROC AUC. Sensitivity was 44.1% and Specificity was 77.2%.
Conclusion
We report multiple performance metrics for a novel integrative model as well as the previously described, Fourier Transform based, AMSA model for predicting defibrillation success. A stochastic and non-linear basis for signal characterization proves to be more adept in dealing with the known dynamic and non-stationary characteristics/morphology of the VF waveform. It significantly improves performance in analyzing the VF signal to predict countershock success.
Abstract 313: Effects of Therapeutic Hypothermia on Myocardial Oxygen Demand and Coronary Flow Velocity
Authors: Gasparetto Nicola , Cacciavillani Luisa , Scarpa Daniele , Tona Francesco , Perazzolo Marra Martina , Marzari Armando , Iliceto Sabino 
Published: April 2024

Therapeutic hypothermia (TH) has been recently introduced as a therapeutic strategy for brain protection in comatose patients after cardiac arrest (CA). It has been hypothesized that TH could be also useful for myocardial protection thanks to the temporary reduction of myocardial oxygen demand. We aimed to evaluate the effects of mild TH on myocardial oxygen demand and coronary flow velocity (CFV).
Material and methods: We studied 11 comatose patients (9 male, aged 59 ± 12) treated with TH after CA of cardiac origin, and with angiographically normal left descending coronary artery (LAD). Rest CFV in the LAD was detected by transthoracic Doppler echocardiography at TH maintenance phase (32.7 ± 0.8 °C) and after rewarming (36.9 ± 0.5 °C).At same time we evaluated the rate-pressure product as a simple way for the estimation of myocardial oxygen demand.
Results: During TH, CFV was lower than in normothermic condition (11.5± 2.3 vs. 18.4 ± 4.8, p=0.007) as rate-pressure product (6476 ± 1261 vs. 9565 ± 2332, p=0.021). At linear unadjusted regression analysis the relationships between CFV in LAD and rate-pressure product during TH and after rewarming were close (R2=0.598, p=0.0001, figure). Furthermore, TH reduced CFV by 8.8 ± 6.9% for each 1°C reduction in body temperature.
Conclusions: TH reduces rate-pressure product and CFV thus suggesting its potential in reducing myocardial oxygen demand. CFV reduction, induced by hypothermia, parallels that of oxygen demand reduction and is related to the entity of temperature decrease. TH has a potential in protecting myocardium from ischemic damage.
Abstract 319: Prehospital Indication of Reperfusion in STEMI Patients and 1-Month Mortality
Authors: Rosell Fernando , Mellado-Vergel Francisco J , Rivas-Ruiz Francisco ,   Pre-hospital Acute Cardiac Care Group of EPES
Published: April 2024

The indication of reperfusion at first medical contact (RFMC), proceeding directly to Cath-Lab (DCL) or, if not possible, performing pre-hospital thrombolisys on site (PhT), is a key action for STEMI patients. Our objective is to analyse if changes in RFMC are associated with one-month mortality in STEMI patients.
Methods: Retrospective observational study of two periods, P1 (Jan2001-Dec03) and P2 (Jan2005-May2009), from a continuous pre-hospital registry of patients with STEMI. Patients were followed up in-hospital and one month later. Univariate analysis to compare both periods and logistic regression for one-month mortality (from in-hospital admission to one month later).
Results: Total patients included 5522 (2248 P1 and 3274 P2). Univariate analysis (P1 vs P2) found significant differences in (%): age (64.3 vs 63.5, p=0.032), dyslipidemia (33.6 vs 36.7, p=0.02), hypertension (48.4 vs 53.1, p=0.01), history of angina (14.9 vs 11.1, p<0.0001), history of AMI (16.4 vs 13, p=0.001), hypotension (systolic blood pressure<90 mm Hg) (15.2 vs 13.3, p=0.049), Killip>I (19 vs 12.7, p<0.0001), onset-symptoms-call <60 min. (56.5 vs 60.1, p=0.01), PhT (20.8 vs 40.4, p<0.0001), DCL (0 vs 7.1, p<0.0001), in-hospital thrombolysis (46.8 16.4, p<0.0001) primary PCI (4.1 vs 17.5, p<0.0001), rescue PCI (4.3 vs 12, p<0.0001), PCI during hospital admission (16.9 vs 29.8, p<0.0001), RFMC (20.8 vs 47.5, p<0.0001),one-month mortality (18.8 vs 13.8 p<0.0001). The logistic regression in table 1. After adjust for clinical conditions and any PCI treatment preformed, RFMC was associated with less one-month mortality.
Conclusions: There were significant increases of RFMC and percentages of PCI throughout the process in P2. Despite the fact of worst clinical conditions of P1 patients, one-month mortality decreased in P2. RFMC was associated to one-month mortality reduction in STEMI patients.
Abstract 331: Insulin Resistance Is Independently Associated with Sudden Cardiac Death in the Community
Authors: Ahmadi Naser , Teodorescu Carmen , Uy-Evanado Audrey , Reinier Kyndaron , Havmoeller Rasmus , Kowk Dorothy , Huertas-Vazquez Adriana , Chugh Harpriya , Gunson Karen , Jui Jonathan , Chugh Sumeet 
Published: April 2024

Background: Insulin resistance(IR) increases atherogenesis and atherosclerotic plaque instability, but apotential association with sudden cardiac death(SCD) has not been evaluated. We assessed the relationship of triglyceride(TG)/HDL-c ratio, a simple measure of IR, with out-of-hospital SCD.
Methods: From an ongoing large community-based study in the Northwest US, SCD cases(n=529)were compared to 3174 age and gender matched-controls without history of ventricular arrhythmias from a coronary angiography database in the Western US. Medical-diagnoses, procedures, risk-factors and laboratory tests of all-individuals were obtained through medical chart-review prior and unrelated to SCD. Logistic-regression was employed to assess the relation of IR with SCD. IR was defined as TG/HDL-c ratio≥3.8. Left ventricular systolic dysfunction(LVSD) was defined as EF≤35%.
Results: The mean TG/HDL-c ratio was significantly higher in SCD compared to controls (4.24±3.76 vs. 2.71±2.69, p=0.0001). Similarly, IR was more prevalent in SCD vs. controls (39.9% vs. 19.7%, p=0.0001). After adjustment for other clinical conditions and risk factors, the relative risk of SCD conferred by IR was 1.93(95%CI 1.4-2.6) and 1.77(95%CI 1.2-2.6) in subjects with and without diabetes mellitus, respectively (p=0.001). The population risk of SCD attributable to IR was 23%. The risk of SCD increased substantially with the combination of IR with obesity, peripheral vascular disease (PVD) and LVSD (p=0.001). The area under the ROC-curve for prediction of SCD was 0.75 for PVD, 0.76 for IR, 0.80 for LVSD and 0.86 for the combination.
Conclusions: In this population, IR was an independent predictor of SCD. Furthermore, the combination of IR with PVD and LVSD substantially increased the cumulative risk of SCD.
Abstract 333: Sudden Death Expertise Center: A Sudden Cardiac Arrest (SCA) Registry
Authors: Lamhaut Lionel , Bougouin Wulfran , Loeb Thomas , Revaux Francois , Varenne Olivier , Marijon Eloi , Carli Pierre , Jouven Xavier ,   Sudden Death Expertise Ctr Investigators
Published: April 2024

Introduction - Knowledge of the epidemiology of the SCA is scarce, requiring collaboration of Emergency Medical Services and Intensive Care Units. Thus we developed a Sudden Death Expertise Center which first step was to develop a exhaustive register.
Methods - We considered cases from a large ongoing population-based register, conducted in Paris and suburbs (population of 6.6 millions). Using multiple-source and central adjudication, we prospectively enrolled all out-of-hospital cardiac arrests since May 2011. Sources are fire departments (BLS), Mobile intensive care ambulance (ALS) and hospital services (Emergency, Intensive Care, Cardiology). Completeness is ascertained through informatic queries in some hospitals.
Results - Over the first 8 months, we reported 2,214 out-of-hospital cardiac arrests, including 1449 with resuscitation attempted and 1193 with presumed cardiac cause (Figure 1). Among them, mean age was 64.5 years, and they occurred at home in 826 case (72.2%). Initial shockable rhythm was reported in 186 cases (16.2%), and 375 patients (31%) were admitted to hospital. Coronary angiography was performed in 198 patients (53%) and therapeutic hypothermia was applied in 192 patients (51%). Survival at discharge was 3,1% considering all OHCA, and 5,7% for SCA when the resuscitation was attempted. Completeness of the registry was 93%.
Conclusion - This registry allow a better understanding of epidemiology of SCA. The next step is the establishment of a multidisciplinary approach to improve survival, through prevention (education programs), treatments (AED programs), and familial screening.
Abstract 74: Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Sheep Model of Refractory Ischemic Cardiac Arrest
Authors: Stub Dion , Byrne Melissa , Pellegrino Vincent , Kaye David M 
Published: April 2024

Background: Survival after cardiac arrest in the field remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischemic cardiac arrest.
Methods: Twelve sheep were assigned to either ECPR (n = 6) or ‘conventional’ (n = 6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation. CPR was than commenced for 10 minutes in both groups, followed by randomisation to ECPR or CPR for a further 10 minutes. At 23 minutes post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form.
Results: Baseline hemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.8 4+/-2mmHg vs 22.94+/-3mmHg, p=0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p=0.032), which was also associated with significantly increased VF amplitude measures (0.51+/-0.02Mv vs 0.42+/-0.04Mv, p=0.04).
Conclusions: This study indicates that ECPR provides a valuable adjunct to the management of patients with refractory VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.
Abstract 11712: A First Look at Potential Linguistic or Cultural Factors Regarding Bystander CPR Education and Performance in Arab-Americans in Southeastern Michigan
Authors: Shams Ali , Swor Robert 
Published: April 2024

Introduction:
Cultural and community specific barriers were identified as reasons for low bystander CPR/AED rates in minorities. No literature exists that explores this issue in the Arab American population, a large ethnic community in the state.

Methods:
We performed a cross sectional survey of clients receiving services from ACCESS (Arab Community Center for Economic & Social Services), the largest Arabic nonprofit organization in Michigan, during a 3 month period. The survey was presented verbally or in writing in English/Arabic. The questions were regarding demographics, CPR/AED knowledge, barriers to CPR training, and how best to inform and train respondents. A 5 point Likert scale was used and descriptive statistics are presented.

Results:
Of 434 potential respondents, 192(44.3%) completed the survey. Respondents were majority female (58%), adult (mean age 37) and first generation immigrant (73.9%). They were low income (66% < $30K/year) and well educated (65% > H.S. education). They were predominantly Muslims (81%), 23.8% lacked English proficiency, and 42% completed the survey in Arabic.

About a third (30.4%) had prior CPR training. The vast majority (83.8%) support public CPR education and performance, with 63.1% believing they are currently capable of understanding and implementing CPR instructions given over the phone. Perceived barriers to CPR performance are listed in Table 1.
The most common barrier to learning CPR was availability of nearby CPR courses (17.4%). Respondents identified the Internet as their preferred source of information and community centers as their preferred site for CPR training.

Conclusions:
Members of the Arabic community are aware of the importance of bystander CPR/AED and are willing to learn and perform CPR. Language and female chest exposure are two specific issues to address when designing community specific CPR/AED program. Internet and community center based initiative were preferred sites for educational programs.