bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 213: Physiogenomic Response to Prolonged Cardiac Arrest and Resuscitation: Hyporesponders Fail to Upregulate Certain Genes
Authors: Menegazzi James J , Salcido David D , Housler Greggory J , Hollingshead Deborah J , Shi Haiwen , Lyons-Weiler James 
Published: April 2024

Background: In our porcine laboratory studies of prolonged cardiac arrest and resuscitation we have observed that approximately one out of every four animals appears to be hyporesponsive to vasopressor drug therapy during CPR. These hyporesponsive animals fail to generate an increase in coronary perfusion pressure (CPP) sufficient to attain a return of spontaneous circulation (ROSC) and cannot be resuscitated. Some humans unexplainably fail resuscitation despite promising conditions (age, witnessed arrest, bystander CPR, rapid EMS response). We conducted this natural experiment in order to compare the physiogenomic responses of animals that were hyporesponsive, to those that responded as expected to vasopressor therapy. Hypothesis: We hypothesized that we would identify genes that were differentially expressed between the two groups (hyporesponders and normal responders).
Methods: We sedated, anesthetized, and instrumented 14 female swine (mean mass 28.6 kgs). Micro-manometer tipped catheters were placed to measure CPP for determination of response status. Ventricular fibrillation (VF) was induced and untreated for 10 minutes, then CPR was begun. Two minutes later pressors were given (epinephrine 0.1 mg/kg and vasopressin 0.6 U/kg). At minute 15 the first rescue shock was delivered. Twenty-eight minutes after the induction of VF, femoral artery samples were harvested and snap-frozen. Gene expression was assessed on the Affymetrix Porcine Genome Array, and affected pathways were ordered with Pathway Express (with Impact Analysis of p<0.05 considered significant).
Results: We compared 4 hyporesponsive pigs to a sample of 5 normal responders. There were 213 differentially expressed genes affecting 10 pathways shown in the Table (with the apoptosis pathway at p=0.056).
Conclusion: Hyporesponders differentially express genes that affect vasoregulation, myocardial contractility, calcium regulation and 7 other pathways.
Abstract 215: First Shock Success Rates Across Waveforms and Energy Levels in Adult Cardiac Arrest: A Systematic Review and Meta-analysis
Authors: Morrison Laurie J , Henry Rowan , Ku Vivien , Nolan Jerry P , Morley Peter T , Deakin Charles D 
Published: April 2024

Objectives: Current guidelines advise a single biphasic shock followed by chest compressions; however, it is unclear if this applies to all waveforms and energy levels. We conducted a systematic review and meta-analysis of the literature to determine the comparative success rates for single-shock defibrillation across waveforms evaluated in out-of-hospital cardiac arrest patients presenting in Ventricular Fibrillation.
Methods: A comprehensive search strategy was used across Embase, Medline, Cochrane libraries, dissertation abstracts and clinicaltrials.gov, and unpublished data was sought. Two investigators independently reviewed titles, abstracts and full texts in a hierarchical manner for study eligibility with a quadratic kappa score at each level. Two authors abstracted data independently, and the quality of the articles was assessed using the Jadad scale. Outcomes were termination of fibrillation to any rhythm (TOF), return of organized rhythm (ROOR) and return of spontaneous circulation (ROSC).
Results: A total of 3,281 potentially relevant citations were identified and of these 7 RCTs were selected with Kappa values of titles 0.53, abstract 0.71, and article 0.94. Mean quality scores varied from 1-2.5/3. First-biphasic shock success (pooled mean) for TOF were similar: Biphasic Truncated Exponential (BTE) 200J 90.5%, BTE 150J 89.9%, Rectilinear Biphasic (RLB) 120J 84.9% but were lower and divergent for both ROOR BTE 200J 43%, BTE 150J 38%, RLB 23% and ROSC; BTE 200J 39%, BTE 150J 78%, RLB 46%. Median time to first shock (min) varied across trials (5.1 BTE 200/150J, 10.4 RLB) and may contribute to observed differences.
Conclusion: First shock success rates as measured by the industry standard of TOF do not significantly differ across biphasic waveforms and energy levels.
Abstract 218: Cerebral Oximetry as a Post-ROSC Predictor of Neurologic Outcome After OOHCA
Authors: Medado Patrick , Thomas Craig J , Scott Timothy , Kessler Justin , O’Neil Brian 
Published: April 2024

No reliable early predictors of neurological outcome exist for patients resuscitated from an OOHCA.
Objectives: We investigated the prognostic utility of cerebral oximetry (rSO2) obtained after Return of Spontaneous Circulation (ROSC) on neurological outcome after OOHCA.
Methods: This IRB approved, observational trial collected data on a convenience sample of patients presenting to an academic, urban Emergency Department with OOHCA. Cerebral Oximetry uses near infrared spectroscopy to measure oxygen in the brain independent of pulse using adhesive rSO2sensors that were placed on patient’s forehead upon ED arrival and data recorded for at least 4 hours post ROSC. We followed Utstein criteria for demographics and data recording. Blinded investigators abstracted CPC scores for all patients. Outcome measure defined as good CPC (≤ 2) at hospital discharge. We analyzed data with descriptive statistics and logistic regression.
Results: We analyzed 32 patients: 69% were male, mean age 62.5 years (52 to 75), 30 (93.8%) witnessed and 23 (71.9%) had bystander CPR. Initial rhythm was VF/VT 19%, PEA 40%, Asystole 34% and 2 unknown. There were 7 (22%) with good CPC at hospital discharge. Univariate analysis showed only the average rSO2 during first 4-hours post ROSC predictive of good outcome (p<0.003). Initial Mean Arterial Pressure (MAP) was a good prognosticator (p<0.087). Logistic regression revealed only average rSO2 4-hours post ROSC as indicative of good outcome (p<0.086).
Conclusion: The average cerebral oximetry in the first 4 hours post ROSC was an excellent predictor of good neurological outcome at hospital discharge. This study is limited by small sample size and observational nature.
Abstract 219: Prognostic Significance of Serum Albumin on Long-Term Mortality in Survivors of Out-of-Hospital Cardiac Arrest
Authors: Park In Won , Lee Jae Hyuk , Kim Joonghee , Kim Kyuseok , Jo You Hwan , Kang Kyeongwon , Kang Changwoo , Lee Soohoon , Rhee Joong Eui 
Published: April 2024

Introductions:
Hypoalbuminemia is known as a reliable predictor of mortality in patients with various illnesses. However, the prognostic value of serum albumin on out of hospital cardiac arrest (OHCA) patients has not been established. The purpose of study is to investigate whether serum albumin concentration on hospital arrival may be useful in predicting the long-term mortality in survivors from OHCA.
Methods:
Retrospective analysis of emergency departments OHCA registry from January 2008 to December 2011 has been conducted. The individual medical records were reviewed for the data including Utstein predictors of OHCA, underlying disease, and initial laboratory finding including serum albumin. Primary outcome was survival at 6 months. The secondary outcome was CPC (Cerebral Performance Category) at 6 months. Albumin was categorized as quartiles as < 2.7g/dL, 2.7 to 3.2g/dL, 3.2 to 3.9 g/dL and > 3.9g/dL. Hazard ratios (HRs) were estimated using Cox-proportional hazard models in both univariate and multivariate analysis. All prognostic variables with their p value < 0.1 in univariate analysis were used in multivariate analysis for adjustment.
Results:
Of 546 OHCA patients, 139 patients had sustained ROSC. Of those, 23 patients (16.5%) survived at 6 month and 16 patients (11.5%) had favorable neurological outcome (CPC 1,2). Survival rate at 6 months were significantly higher in patients with a higher albumin group and neurological outcomes were also more favorable in higher albumin group.
In a Cox proportional hazard regression analysis for 6-month survival, patients with lower categories of albumin had increased mortality rates before and after multivariable adjustment. (p value for linear trend < 0.05)
Conclusion:
Serum albumin is a robust predictor of long-term mortality and associated with neurological outcome in patients with sustained ROSC from OHCA
Abstract 254: Quality of 2-Minute Continuous Chest Compressions by Medical Students and Lay Rescuers
Authors: Gianotto-Oliveira Renan , Gonzalez Maria Margarita , Gianotto-Oliveira Gustavo , Podolsky-Gondim Guilherme , Vianna Caio B , Timerman Sergio , Kalil Filho Roberto 
Published: April 2024

Background: The performing of quality chest compressions is highly emphasized in the American Heart’s 2010 Guidelines. Moreover, it addresses the importance of continuous chest compressions (hands-only) as the best approach when faced with a sudden cardiac arrest victim when a ventilation barrier device is not available.
Hypothesis: We hypothesized that first-year medical students perform two-minute continuous chest compressions with lower quality than those performed by lay rescuers who had Heartsaver ® CPR AED training at least every 2 years.
Methods: The volunteers initially attained the Heartsaver® CPR AED course. After approximately 30 minutes they performed 2 minutes continuous chest compressions in the Resusci Anne training mannequin, with a PC reporting system.
Results: When comparing the 76 medical students with the 74 trained lay rescuers, the average age (20 vs. 40 years), the male gender (54% vs. 92%), the mean body mass index (24.9 vs. 27.3 kg/m2) and physical activity (55% vs. 36%) presented significant differences, p<0.01, p<0.01, p<0.01 and p=0.04, respectively. Regarding the quality of chest compressions, the average rate (121 vs. 124 compression/minute), duty cycle (47% vs. 45%), the percentage of compressions with correct hand positioning (87% vs. 90%) and the average depth (45 vs. 49 mm), showed no significant difference, p=0.05, p=0.06, p=0.32 and p=0.10, respectively. However, the percentage of adequate depth compressions (43% vs. 58%) and the percentage of compressions without error (36% vs. 50%) revealed a significant difference, p=0.01 and p<0.01.
Conclusion: In conclusion, the results show that important parameters like the percentage of compressions with adequate depth and compressions without error had a significant difference, demonstrating that although being lay rescuers, the constant cardiac resuscitation training allows performing higher quality chest compressions than those performed by medical students. It’s need ongoing training of medical students, because they must perform good-quality chest compressions too.
Abstract 305: The Patients’ Experiences in Emergency Research (PEER) Study
Authors: Dickert Neal W , Mah Victoria , Jill Baren E , Biros Michelle , Govindarajan Prasanthi , Pancioli Arthur M , Silbergleit Robert E , Wright David W , Pentz Rebecca D 
Published: April 2024

Background
Resuscitation research requires enrolling patients under an exception from informed consent (EFIC), but there remains ethical controversy and confusion about EFIC regulations. One concern is that patients may find enrollment unacceptable, but no study has systematically assessed views and experiences of patients enrolled in an EFIC study. The “Patients’ Experiences in Emergency Research (PEER)” study addresses this gap.
Methods
PEER was nested within the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) of pre-hospital treatment of status epilepticus. PEER included 61 EFIC enrollees (or surrogates) from 5 sites. Interviewers used a structured interactive guide containing open and closed-ended questions focusing on views of personal and general acceptability of EFIC enrollment in RAMPART and existing regulatory protections. Closed-ended responses were directly coded. Simple descriptive and bivariate statistics were generated, consistent with our hypothesis-generating goals. Textual data were analyzed for common themes and to contextualize the data.
Results
24 patients and 37 surrogates were interviewed. Two interviews were incomplete. 49 (82%) subjects were glad they (or family member) were included in RAMPART; 54 (92%) felt research on emergency seizure treatment is important. 43 (72%) found their inclusion in RAMPART under EFIC acceptable. 10 (17%) found it unacceptable, and 6 (10%) were neutral. There were no statistically significant demographic associations with enrollment attitudes. In textual analysis, 24 (41%) subjects expressed concern about absence of consent; 11 (19%) felt they were not told enough about the study. Positive responses mostly related to perceived medical benefits (53%) from RAMPART and trust in doctors/researchers (25%). More than a quarter had difficulty understanding concepts of clinical trials and EFIC.
Conclusions
Most subjects had positive views of their enrollment in RAMPART. A significant number were concerned about absence of consent, and many had difficulty understanding EFIC and clinical research. These approval rates cohere with data from other populations. They are largely reassuring but suggest the importance of post-enrollment communication.
Abstract 310: Evaluation of the Appropriate Timing for Inducing Therapeutic Hypothermia with Extracorporeal Membrane Oxygenation for Out-of-Hospital Cardiac Arrest in Acute Coronary Syndrome
Authors: Arimoto Hideki , Rinka Hiroshi , Miyaichi Toshinori , Fuke Akihiro , Ishikawa Junichi , Morooka Takaya 
Published: April 2024

Purpose: Mild therapeutic hypothermia has been integrated into management strategies for improving the neurological outcome of cardiac arrest for out of hospital cardiac arrest. On the other hand, acute coronary syndrome (ACS) cases should be treated as earlier. We have the dilemma between two procedures when we face any cases of post cardiac arrest syndrome (PCAS). We reported rapid and safe hypothermia induction with Less Invasive Cardiopulmonary bypass Hypothermia (LICH) before. This study aimed to evaluate an appropriate timing to induce LICH ‘before or after’ investigations for coronary angiography (CAG).
Methods: Sixteen PCAS patients for ACS were treated with LICH. These patients were divided into before CAG (Group B, N=12) and after CAG (Group A, N=4) groups. The LICH procedure was indicated for unconscious ROSC patients under 75 years of age, and excluded with brain hemorrhage, traumatic cardiac arrest, and any risk of bleeding. Target temperature was set at 34 to 35°C for 36 to 48 hours. The specifications LICH procedure were quickly induced hypothermia via narrow pediatric cannulas on low-perfusion (1 l/min) artery-venous extra corporeal membranous oxygenation with minimal anticoagulation. Any complications, time to target temperature, temperature stability, cytokines and neurological outcomes were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.
Results: There were no significant characteristic differences except the time to target temperature (69min vs. 161min, p<0.01) between group B and A. Any complications and favorable outcomes were no significant differences in both groups.
Conclusions: We suggest that we can choice both way early and late induction for hypothermia with LICH. These results mean an early coronary reperfusion is acceptable because of the advantages of quick induction to the target temperature.
Abstract 36: Etiology of In-Hospital Cardiopulmonary Arrest as a Predictor of Outcome
Authors: Husa Ruchika , Scyoc Dorothy , Gordon James , Chappel Ruth , Sell Rebecca , Minokadeh Anushirvan , Davis Daniel 
Published: April 2024

Background: Inpatient cardiopulmonary arrest (CPA) is poorly defined. However, understanding the factors contributing to incidence and outcome is critical in designing effecting CQI programs.
Objective: To explore the effectiveness of an arrest taxonomy, using specific etiologies of inpatient CPA, to predict incidence and outcomes and direct CQI efforts.
Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. Clinical and demographic data were abstracted from the institutional resuscitation database. Broad categories regarding arrest etiology [sepsis, hemorrhage, pulmonary embolus, VF/VT, vagal, neurologic, heart failure, intubated respiratory, and non-intubated respiratory] were incorporated into a multivariate logistic regression model using survival-to-hospital discharge as the primary outcome. In addition, chi-square analysis of incidence and graphical analysis of incidence and survival trends for specific etiologies before and after ART implementation were performed.
Results: A total of 332 inpatients suffered CPA during the study period [pre-ART n=182, post-ART n=150]. Multivariate logistic regression revealed an independent association with outcome for each of the etiologies but not for other covariates. A decrease in the incidence and improvement in survival for certain arrest etiologies was observed following ART implementation.
Conclusion: We observed important associations between arrest etiology and both incidence and outcome from inpatient CPA. This taxonomy may be helpful in guiding CQI efforts.
Abstract 43: Comparative Study of Survival After In-Hospital Cardiac Arrest in Patients with Chagas Cardiomyopathy and Idiopathic Dilated Cardiomyopathy
Authors: Gonzalez Maria Margarita , Vianna Caio B , Gianotto-Oliveira Renan , Timerman Sergio , Kalil Filho Roberto 
Published: April 2024

INTRODUCTION: Chagas Cardiomipathy, among all causes of cardiac insufficiency, appears to be what brings the worst prognosis. The evolution of these patients after in-hospital cardiac arrest is not adequately evaluated in the medical literature.
METHODS: To this propose, from April 2004 to June 2008, Utstein-style data, were prospectively collected from 1027 consecutive in-patient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Of them, 715 (77%) patients performed echocardiograms during admission or until three months pre arrest. We compare the evolution of hospital patients with moderate or severe systolic dysfunction (LVEF <45%) and diagnosis of Chagas Cardiomyopathy (74 patients) and Idiopathic Dilated Cardiomyopathy (74 patients), by univariate and multivariate (logistic regression). The primary end-point was survival to discharge. Secondary outcomes were return of spontaneous circulation for more than 20 minutes, 24-hour survival after cardiac arrest, and discharged with satisfactory neurological evaluation, defined as cerebral performance category 1 or 2.
RESULTS: Survival to discharge was 15% in patients with Idiopathic Dilated Cardiomyopathy compared with 4% in patients with Chagas Cardiomyopathy (after logistic regression; “odds ratio” adjusted = 0.89, 95% CI, 0.09 to 0.907, P <0.001). Another factor associated with lower hospital survival was use of atropine during resuscitation. The rhythm of VF /VT pulseless as the initial rhythm of arrest was associated with higher hospital survival. Both groups did not differ regarding return of spontaneous circulation (54% vs. 58%, P = 0.468), 24-hour survival (39% vs. 41 %, P =0.550), or survival with CPC 1 or 2 (100% vs. 91%, P =0.660).
CONCLUSION: As hypnotized, Chagas Cardiomiopathy was associated with lower rates of survival to hospital discharge, despite similar rates of sustained return of spontaneous circulation and 24-hour survival post-arrest. Peculiarities of Chagas Cardiomyopathy associated with myocardial dysfunction, hyperadrenergic state, postresuscitation inflammatory response seem to contribute strongly to this development more unfavorable.
Abstract 53: Abnormal Continuous Electroencephalography Recordings Are Not Predictive of Survival Outcomes Following Cardiac Arrest
Authors: Shrestha Archana , Campbell Jenny A , Larabee Todd M 
Published: April 2024

Background: Cerebral anoxia following cardiac arrest can lead to poor neurological outcomes. Post-arrest therapeutic hypothermia (TH) has been shown to be neuroprotective in this setting. Early prognostication of survival outcomes is important for patient care and resource management. The use of continuous electroencephalography (cEEG) may be an important tool for prognostication of survival outcomes after cardiac arrest.
Objectives: To determine if abnormal cEEG recordings are associated with survival outcomes following cardiac arrest.
Methods: Retrospective study of all patients who suffered an in- or out-of-hospital cardiac arrest and were entered into the post-arrest management protocol (PAMP) at a single academic institution between May 2011 and May 2012. As part of the PAMP, cEEGs are recorded during TH, during the rewarming phase, and at normothermia. All cEEG reports were assessed for routinely described abnormal patterns: severe suppression, burst suppression, status epilepticus, intermittent epileptiform discharges (IED), generalized periodic epileptiform discharges (GPED), either α,β, or [[Unable to Display Character: ▵]] coma, or diffuse intermixed slowing. Descriptive statistics were analyzed.
Results: Ninety-one patients were admitted to the ICU after cardiac arrest and 42 patients had PAMP and TH initiated. Of these, 36 (86%) received a neurologic consultation and 27(64%) had a cEEG placed. 24/27 (89%) survived to 24 hours and 7/27 (26%) survived to hospital discharge. Of the 7 survivors to discharge, 1 had severe suppression, 3 demonstrated α,β, or [[Unable to Display Character: ▵]] coma, and 3 demonstrated diffuse intermixed slowing during MTH. During early rewarming and normothermia, 3 had diffuse intermixed slowing, 2 demonstrated either α,β, or [[Unable to Display Character: ▵]] coma, and 1 demonstrated IEDs.
Conclusion: Abnormal cEEG during MTH and early rewarming is not predictive of survival outcomes following cardiac arrest in this small, retrospective study. This study is limited by the small number of enrolled patients who have completed the protocol to date.