bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 240: Teaching Basic Life Support: Controlled Study with a 2-Stage Versus the Standard 4-Stage Approach
Authors: Sopka Sasa , Biermann Henning , Ott Matthieu , Skorning Max , Rossaint Rolf , Beckers Stefan K 
Published: April 2024

Introduction
Quality of external chest compressions (ECC) is of paramount relevance within Basic Life Support (BLS). Recent guidelines describe the so called 4-Stage-Approach for teaching practical skills within resuscitation training. However, this methodology was questioned in recent studies when used for simple skills teaching.
Hypothesis
To observe whether a structured 2-Stage-Approach leads to sufficient practical performance in BLS-Training compared to the standard 4-Stage-Approach.
Methods
Overall 270 Laypersons were trained in BLS after randomization either to the standard method group using a 4-Stage-Approach (4S) or a modified 2-Stage-Approach-group (2S) lasting the same course duration. All participants were tested on a manikin (Skillreporter ResusciAnne® with PC SkillReporting Software (Version 1.3.0), Laerdal, Stavanger, Norway) in the same cardiac arrest mock scenario prior to the BLS-course and after one week with each time 2 min of continuous ECC each. Practical Endpoints: mean compression rate; mean compression depth.
Results
Data from 255 subjects (4S: n=127; 2S: n=128) was analyzed. The standard group (4S) as well as the intervention group (2S) improved significantly compared to baseline testing after one week concerning compression depth (4S: 47.8±10.4 mm to 52.4±7.6 mm, p<0.0001; 2S: 47.7±10.7 mm to 55.8±5.4 mm; p<0.0001) and compression rate (4S: 116.1±23.4 min-1 to 118.7±16.0 min-1, p<0.0001; 2S: 114.1±22.8 min-1 to 119.6±13.8 min-1; p<0.0001). The participants trained with the 2-Stage-Approach showed superior performance one week after training in respect of the mean compression depth (4S: 52.4±7.6 mm vs. 2S: 55.8±5.4 mm; p<0.0001).
Conclusions
Teaching ECC within BLS is sufficiently accomplished with a structured 2-Stage-Approach. Compared to the standard 4-Stage-Approach this methodology leads to comparable skill performance with significantly improved compression depth. Therefore this approach should be further evaluated and offers the option to standardize instructors performance more easily.
Abstract 255: CT Imaging of Pediatric Heart Deformation During Chest Compressions
Authors: Glass George F , Kent Richard , Maltese Matthew , Bass Dale , Sochor Mark 
Published: April 2024

Background: Adequate chest compression (CC) depth is associated with increased survival to hospital discharge, yet specific data guiding CC depth targets in children are lacking. Current guidelines for pediatric CCs are based on extrapolation from adults, animal models, and expert consensus. Given this lack of data, investigation into the biomechanical effect of CCs on the pediatric thorax is warranted.
Methods: Three non-injurious CC simulations were performed on a single 7 year-old post-mortem human subject with intended compression depth of 0%, 15%, and 25% of external thoracic depth. A Phillips CPR Force Deflection Sensor replica was positioned at the inter-nipple line of the subject. Force was statically applied to reach the desired compression depth. Non contrast-enhanced CT imaging was obtained for each compression level. External thoracic depths were measured at the inter-nipple level from the most anterior to most posterior skin surface at midline. Internal depths were measured from the posterior sternal border to the anterior border of the corresponding vertebral body. Left ventricular volumes were calculated using three-dimensional multiplanar reconstruction and a 4-level modified Simpson method.

Results: Intended 25% compression resulted in change of 25mm in external chest depth and 20mm of internal depth (a 16.4% and 29.6% change, respectively). Total left ventricular volume (inclusive of myocardium and ventricular cavity) was reduced by 8.8% (62.7cm
3
to 57.2cm
3
). Right ventricular volumes were not measured due to difficulty in right heart border visualization, but subjective deformation of the right heart was greater than left.

Conclusions: This is the first reported CT visualization of thoracic contents during compression of the pediatric chest. Our results indicate a proportionally greater decrease in internal thoracic depth than external depth for a given compression depth. Previous studies extrapolating the desired compression depth from CT-data have assumed internal compression directly proportional to external compression depth. These studies may overestimate the target depth necessary to achieve a given amount of internal thoracic compression.
Abstract 259: National Variability in Survival Outcomes of Out-of-Hospital Cardiac Arrest: The All-Japan Utstein Registry
Authors: Hasegawa Kohei , Tsugawa Yusuke , Hiraide Atsushi , Brown David F M 
Published: April 2024

Introduction
Health and policy implications of national variability in survival outcomes of out-of-hospital cardiac arrest (OHCA) remain to be determined.
Hypothesis
We tested the hypothesis that survival outcomes of OHCA would differ across geographic regions in Japan.
Methods
Analysis of a prospective nation-wide population-based dataset of the whole population across Japan involving all patients who had a non-traumatic OHCA resuscitated by emergency responders from January 2005 through December 2010. The study endpoints were 1-month survival and favorable neurological survival 1 month after an OHCA, defined as Cerebral Performance Category 1 or 2. We compared unadjusted and multivariable-adjusted rates of the outcomes among 7 geographic regions using regression model with generalized estimating equations to control for patient- and prehospital-level characteristics (Table).
Results
In the total catchment population of 128 million, 670 313 patients with OHCA were documented. Of 660 672 resuscitation attempts, 539 641 non-traumatic OHCA patients were eligible for analysis. The adjusted incidence of OHCA per 100 000 population ranged from 58.9 to 78.8 (median, 65.3). One-month survival ranged from 3.7% to 6.1%, with a median of 5.6%; we observed a large variation among regions in multivariable adjusted rate of 1-month survival, ranging from 3.8% to 6.5% (median, 4.7%). Similarly, neurologically favorable survival varied by region from 1.9% to 3.0%, with a median of 2.5%; adjusted rate of neurologically favorable survival ranged from 1.9% to 3.6% (median, 2.7%), with significant differences across regions (P<.001).
Conclusion
In this nation-wide population-based study in Japan, there were significant and important regional differences in OHCA survival outcomes.
Abstract 271: Detection of Ventricular Fibrillation with Continuing Chest Compression Using Adaptive Least Mean-Square Estimation of Cardiopulmonary Resuscitation Artifacts and Removal of the Artifacts
Authors: Lin Chen , Ko Patrick Chow-In , Lo Men-Tzung , Chiang Wen-Chu , Hsieh Wan-Hsin , Lin Lian-Yu , Huang Chien-Hua , Lin Jiunn-Lee , Chen Wen-Jone , Ma Matthew Huei-Ming 
Published: April 2024

Introduction: Adequate perfusion during cardiopulmonary resuscitation (CPR) is crucial for successful defibrillation after ventricular fibrillation (VF), but the effects of chest compressions (CC) are compromised from interruptions due to rhythm analysis. A novel algorithm utilizing corrupted ECG signal to detect VF during continuing CC is developed.
Method: VF waveforms were retrieved from automatic external defibrillator (AED) records of adult non-traumatic cardiac arrests. Ten CC artifacts were retrieved from arrests with asystole. Corrupted ECG was constructed by adding a scaled CC artifact to a VF with strength determined by signal-to-interference ratio (SIR). Using empirical mode decomposition, the fluctuation and frequency of CC were retrieved. VF was detected by subtracting the CC artifacts, modeled by least mean-square (LMS) algorithm, from ECG signals. Amplitude spectrum analysis (AMSA) was used to quantify the component with frequency range 0.7[[Unable to Display Character: ‐]]30 Hz.
Result: One-hundred and fifty VF (36 successful and 114 unsuccessful defibrillation, p<0.01) were included. After removing CC artifacts with the algorithm, successful vs unsuccessful cases remained distinguished (p<0.05) in SIR ranged 0 to -9dB. The detected and the original VFs had similar AMSA with correlation of 0.98, 0.95, 0.93 and 0.86 when SIR were 0, -3, -6 and -9dB (p<0.001). The mean of difference between the detected VFs and the original VFs were 0.19, 0.56, 1.36 and 3.33 for SIR of 0, -3, -6 and -9dB, respectively, in Bland-Altman plot.
Conclusions: The proposed adaptive algorithm using LMS could model CPR artifact without external signals, and effectively detect VF with continuing CC.
Abstract 3: Detailed Description of All Deaths in Both the Shock and Traumatic Brain Injury Cohorts of the Resuscitation Outcomes Consortium Hypertonic Saline Trials
Authors: Tisherman Samuel A , Schmicker Robert , Brasel Karen J , Bulger Eileen M , Kerby Jeffrey D , Minei Joseph P , Powell Judy , Reiff Donald A , Rizoli Sandro B , Schreiber Martin A 
Published: April 2024

Introduction: In trials conducted by the Resuscitation Outcomes Consortium (ROC) in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to demonstrate improved survival. We sought to identify causes of mortality in this patient population to determine targets for future studies.
Methods: Retrospective review of patients enrolled in a multicenter, randomized, clinical trial performed 2006-2009 by 114 EMS agencies in North America within ROC. Inclusion criteria were injured patients, age ≥ 15 years with hypovolemic shock (SBP ≤ 70 mm Hg or SBP 71-90 mm Hg with HR ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤8]. Initial resuscitation fluid administered by out-of-hospital providers was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline.
Results: 2071 subjects were enrolled (821 shock, 1250 TBI). Survivors were younger than non-survivors [30(IQR 23) vs 42(34)] and had a higher GCS, though similar hemodynamics. Greater than 90% of deaths occurred despite ongoing resuscitative efforts. Forty six percent of the deaths in the TBI cohort were within 24 hours, compared with 81% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both.
Conclusion: Most deaths from trauma occur within the first 24 hrs from hypovolemic shock or TBI. Late deaths from sepsis and multiple organ failure are rare. Novel resuscitation strategies should focus on early deaths.
Abstract 39: Donating Automated External Defibrillators May Not Be Enough
Authors: Ludgate Melissa B , Kern Karl B , Bobrow Bentley J , Ewy Gordon A 
Published: April 2024

Background: In response to the out-of-hospital sudden death of their son, parents and friends established a local foundation in Tucson, Arizona to help prevent sudden cardiac death. One of their projects was to provide Automated External Defibrillators (AEDs) predominately to public and private schools, places of worship, boys and girls clubs and museums in Tucson, Arizona and surrounding area. Prior to receiving the AED, the majority of sites attended training in the use of the AED, that included information concerning the need to replace the electrodes pads before they expired.
Methods: The first author of this abstract (a trained Emergency Medical Technician and a recent college graduate) visited sites that responded to the offer of assistance to retrain individuals in the proper use of their AED. Included in the visit, she determined the status of the donated AED and provided education about future maintenance.
Results: Each site visited had received their AED between 7/2009 and 4/2011. Of the 36 sites visited, the majority of the units had potential problems. One had been stolen, and one was missing (2/36 or 6%). Of the remaining 34 units, 23/34 (68%) had outdated electrode pads, and in 2/34 (6%) the battery had expired. Thus only 11/34 (32%) were emergency ready. Of these, 7/11 had been donated within two years (the average shelf-life of AED electrode pads). The other 4/11 had replaced their expired AED electrode pads.
Conclusions: Providing AEDs alone may not be the optimal approach. A system must be in place to assure that they are properly stored and maintained. AED pads with longer “shelf-life” should also be a goal of AED manufacturers.
Abstract 60: Prognostic Performance of Diffusion-Weighted Magnetic Resonance Imaging in Comatose Patients Treated with Mild Hypothermia After Cardiac Arrest and Its Added Value in the Context of Neuron-Specific Enolase-Based Prognostication
Authors: Noh Kyonghee , Kim Joonghee , Kim Kyuseok , Choi Byung Se , Jung Cheolkyu , Lee Jae Hyuk , Jo You Hwan , Rhee Joong Eui , Kim Tae Yun , Kang Kyeong Won 
Published: April 2024

Objective: MRI-based prognostication of comatous resuscitated cardiac arrest patient has shown promising results. However, it was not validated in patients treated with therapeutic hypothermia and it is unknown how it might add to NSE-based prognostication. We sought to evaluate the prognostic performance of regional apparent diffusion coefficient (ADC) in comatose OHCA patients treated with mild hypothermia and its added value to NSE-based prognostication.
Methods: OHCA registry was analyzed to identify OHCA patients older than fifteen who were treated with therapeutic hypothermia and underwent brain MRI between 2008 and 2011. Quantitative measurement of regional ADC was done by a radiologist blinded to clinical outcome.
Results: Among 43 eligible patients, 11(18.6%) achieved good outcome (6-month CPC 1 or 2). Regional ADC of occipital cortex showed highest discriminatory power with its area under the curve of receiver- operating-characteristic (AUROC) 0.943 (95% CI, 0.872-1.000) and predicted poor outcome with a sensitivity of 90.6% and a specificity of 100%. For NSE (48-hour), its AUROC was 0.911 (95% CI, 0.801- 1.000) and it was correlated with the regional ADC significantly (Pearson’s r=-0.674, p<.001). The ADC- based prognostication could identify additional 5 (35.7%) poor outcome patients among 14 with 48- hour NSE <78.9ng/mL, a cutoff point suggested by a previous study. However, it did not provided additional prognostic information if 48-hour NSE was >78.9ng/mL.
Conclusions: Regional ADC-based prognostication was accurate in OHCA patients treated with mild hypothermia. However, in the context of 48-hour NSE-based prognostication, it provided additional prognostic information only when 48-hour NSE indicated good prognosis (48-hour NSE <78.9ng/mL).
Uploaded image: A scatterplot depicting the relationship between 48-hour NSE level and regional (occipital) ADC value. Vertical gray dash line: 33 ng/mL; Vertical black dash line: 78.9ng/mL
Abstract 75: Time to Awakening Is Often Delayed After Therapeutic Hypothermia for Post--Cardiac Arrest Patients
Authors: Swor Robert , Pinawin Ashley , Sawyer Kelly , Jung Dawn , Devore Nancy J , Capoccia Diane 
Published: April 2024

Introduction Withdrawal of care in patients after cardiac arrest has traditionally been based on the neurological exam at 72 hours after hospital arrival. For patients receiving post-cardiac arrest therapeutic hypothermia (TH), however, there is limited data to guide prognostication. We sought to describe the time to awakening for patients treated with TH and the relationships between time to awakening and outcome.
Methods We performed a retrospective chart review of adult (age > 18) cardiac arrest patients from January 2006 to January 2012 who were subsequently treated with TH at a large, academic community hospital. We abstracted demographic data, neurological assessments recorded by ICU nurses, including Glasgow Coma Scale (GCS), and survival data, including cerebral performance category (CPC) at discharge. We abstracted time intervals including intervals from arrival to target temperature (33.5°), interval to rewarming (35°C), and interval from arrival and rewarming to awakening. We defined awakening as GCS greater than 8, or GCS motor >4 for intubated patients. Our primary outcome measure was good neurological outcome at discharge (CPC of 1 or 2). Descriptive statistics are reported.
Results During the study period, 96 patients received TH (average age 60.3 years, 64.2% male). Overall, 39 (40.6%) patients survived to discharge, six were excluded (five did not awaken, one missing time data). Time (median, IQR) from ED arrival to rewarming was 41.0 (39,43) hours, ED arrival to awakening was 52.8 (43, 89) hours, and awakening to rewarming was 12.0 (2, 42) hours. The relationship between awakening and outcome is shown in table 1.
Conclusion Although most patients with a good outcome awoke within 72 hours of hospital arrival or shortly after rewarming, a number of patients had awakening delayed more than 72 hours post arrival and rewarming. Our results support the need for longer periods of observation to determine outcomes for patients who receive post arrest TH.
Abstract 9193: Variation in Quality of Care Among Patients Hospitalized With Acute Heart Failure in an International Trial: Findings From ASCEND-HF
Authors: Howlett Jonathan G , Ezekowitz Justin A , Podder Mohua , Hernandez Adrian F , Diaz Rafael , Dickstein Kenneth , Armstrong Paul W , Fonarow Gregg C 
Published: April 2024

BACKGROUND: Translation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may be subject to international variation. We compared key HF quality indicators in acute HF (AHF) patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial.
METHODS: Patients were admitted to hospital for AHF and comprised 5 regions (North America n=3149, Latin America n=658, Asia- Pacific n=1744, Central Europe n=966 and Western Europe n=490). Quality indicators assessed at hospital discharge from the US-based Get With The Guidelines program were used, including: medications (ACEI/ARB, beta blockers, aldosterone inhibitors, hydralazine-nitrates, statin therapy and warfarin) for eligible patients, use (or planned use) of implantable intracardiac devices (ICD, CRT) for eligible patients and blood pressure control (<140/90 mmHg).
RESULTS: 7007 intent-to-treat AHF patients in 398 centres were enrolled. There was significant variation in conformity between different quality indicators, ranging from 0% to 89% (See Table). Of all potential performance opportunities, 24,807 of 39874 (62%) were met, with Central Europe highest at 68%, followed by North America (65%), Western Europe (63%), Latin America (59%) and Asia-Pacific (56%), P<0.0001.
CONCLUSION: Quality of care for patients hospitalized with AHF remains suboptimal even within a randomized clinical trial. Moreover, significant unexplained inter-regional variability in quality of care exists. Further study is required to understand and overcome the global barriers to delivery of optimal evidence-based care.
Abstract 99: A Modified Dispatch Protocol Based on a Layperson’s Description of Breathing Styles of Sudden Cardiac Arrest Victims Is Effective in the Performance of Bystander Cardiopulmonary Resuscitation
Authors: Fukushima Hidetada , Okuchi Kazuo , Seki Tadahiko , Kawai Yasuyuki , Norimoto Kazunobu , Urizono Yasuyuki , Hata Michiaki , Nishio Kenji 
Published: April 2024

Introduction: To increase survival from out-of-hospital cardiac arrests (OHCAs), the current guideline for resuscitation emphasizes the role of dispatcher-assisted bystander cardiopulmomary resuscitation (CPR). However, previous studies show that identification of OHCAs by dispatchers is unsatisfactory. Since the callers tend to recognize agonal respiration as a sign of life and perceive as various breathing styles, the current two-question protocol asking the callers whether the unresponsive victim is breathing normally or not is insufficient for the dispatchers to identify OHCA. The aim of this study is to verify a modified protocol for dispatcher-assisted bystander CPR based on the layperson’s description of sudden OHCA breathing styles.
Method: “Not breathing”, “weak breathing”, “unusual breathing or snoring”, and “breathing or not breathing cannot be determined” were identified as the typical layperson descriptions of sudden OHCA breathing styles, based on analysis of dispatcher records from 2007 to 2009 in Nara prefecture, Japan. According to the modified dispatch protocol, dispatchers were to provide CPR instruction when the callers report those key breathing styles. The protocol was implemented in four fire departments which covered an area including 840,000 residents. All data were collected prospectively, using Utstein Style guidelines.
Results: This protocol was carried out for 82 cases of layperson-witnessed OHCA during August to December 2011. Dispatchers instructed CPR for 59 cases of OHCA (71.9%) and callers performed bystander CPR in 41 cases (50.0%). Compared to data from August to December 2010, both the performance of dispatch instruction and dispatcher-assisted bystander CPR significantly improved with the modified dispatch protocol.
Conclusion: A modified dispatch protocol based on the layperson’s description of breathing styles of victims experiencing sudden OHCA significantly improved the performance of bystander CPR.
Abstract 293: More Nursing Care Increases In-Hospital Cardiac Arrest Survival
Authors: Rochman Monica F , Kalisch Beatrice J 
Published: April 2024

The objective of this study was to investigate the association between shift level nurse staffing, and survival to discharge for patients sustaining an in-hospital cardiac arrest (IHCA). In many instances, the most likely first responder to witness IHCA and provide needed treatment is the registered nurse. Delays in treatment are associated with decreased survival; every minute is important during cardiac arrest. Little if any comprehensive research has been undertaken to determine the features of nursing that are important in the outcomes of cardiac arrest, however. Thus, there is a critical need to thoroughly examine if and how nursing affects survival patients experiencing in-hospital cardiac arrest. This study was a cross sectional secondary analysis of an in-hospital cardiac arrest registry and staffing data obtained from hospital productivity reports.
Registered nurse hours per patient day were analyzed during the nursing shift that the cardiac arrest occurred. Generalized estimating equation models were used account for the clustering of patients within units.
The sample consisted of adult patients aged 18 and older who sustained an in hospital cardiac arrest between May 2004 and December 2009 in one Mid-western academic hospital. The final analytic sample consisted of 299 patients in 22 medical surgical, rehabilitation and intensive care units.
One additional hour per patient day of RN care results in 19% greater odds of surviving to discharge while controlling for patient and unit characteristics in the model.
Shift- level staffing measured at the time of the event was found to positively predict in-hospital cardiac arrest survival. The findings from this study will serve to inform nursing practice with regard to the importance of staffing levels which can impact survival. Response times to cardiac arrests depend on recognizing the arrest and the ability to respond and provide treatment in a timely manner. This is directly the result of the availability of staff to react to such a situation. Moreover, a closer perspective in examination of a specific event and shift-level staffing, the more likely important process improvement initiatives will be appropriate and successful.