tbuckley/cabot-search huggingface dataset:
Abstract 391: Association Between Defibrillation to Epinephrine Interval and Short-Term Outcomes in Out-of-Hospital Cardiac Arrest Patients With Shockable Rhythm
Authors: Shoji Kawakami, Yoshio Tahara, Teruo Noguchi, Satoshi Yasuda, Jun-ichiro Nishi, Kunihiro Nishimura, Naohiro W Yonemoto, Hiroshi Nonogi, Ken Nagao, Takanori Ikeda
Journal: Circulation (2023)

Background: The optimal timing of epinephrine administration after defibrillation in out-of-hospital cardiac arrest (OHCA) patients with shockable rhythm is unknown. Aim: We evaluated the association between defibrillation to epinephrine interval and short-term outcomes. Methods: Between 2011 and 2020, we enrolled 1,259,960 OHCA patients from a nationwide prospective population-based registry in Japan. After applying exclusion criteria, 20,905 patients with shockable rhythm as the first documented rhythm at emergency medical services (EMS) arrival who received epinephrine after defibrillation were eligible for the study. Clinical outcomes included prehospital return of spontaneous circulation (ROSC), survival, and favorable neurological outcome at 30 days. To examine whether each variable predicted a good short-term outcome, multivariable logistic regression models were constructed using age, gender, year, district, origin of cardiac arrest, witnessed arrest, bystander-initiated cardiopulmonary resuscitation, call to EMS arrival interval, EMS arrival to defibrillation interval, and defibrillation to epinephrine interval. Results: At 30 days, 1,618 patients (8%) had a favorable neurological outcome. The defibrillation to epinephrine interval in these patients was significantly shorter than the interval in patients with an unfavorable neurological outcome [8 (5-12) vs 11 (7-16) min; P&lt;0.001]. The proportion of patients who achieved prehospital ROSC, survived, or had a favorable neurological outcome at 30 days decreased as time to epinephrine after defibrillation increased (P&lt;0.001 for trend). Multivariable analysis showed that shorter defibrillation to epinephrine interval independently predicted good outcomes ( Table ). Conclusion: A shorter defibrillation to epinephrine interval is significantly associated with good short-term outcomes in OHCA patients with shockable rhythm.
Abstract 384: The Association of End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation With Survival Outcomes
Authors: Ryan W Morgan, Ron Reeder, Dieter Bender, Kellimarie Cooper, Stuart Friess, Kathryn Graham, Kathleen Meert, Peter Mourani, Robert Murray, Vinay M Nadkarni, C. Nataraj, Chella Palmer, Neeraj Srivastava, Bradley Tilford, Heather A Wolfe, Andrew R Yates, Robert A Berg, Robert M Sutton
Journal: Circulation (2023)

Background: Pediatric resuscitation guidelines recommend monitoring end-tidal carbon dioxide (ETCO 2 ) as an indicator of CPR quality but note that “specific values to guide therapy have not been established in children.” Aims &amp; Hypotheses: We aimed to determine the association of ETCO 2 during CPR with pediatric IHCA outcomes. We hypothesized that event-level average ETCO 2 ≥20 mmHg would be associated with higher rates of survival to hospital discharge. Methods: NHLBI-funded ancillary prospective observational cohort study of pediatric IHCAs in 18 U.S. ICUs from the ICU-RESUS trial (NCT02837497). Children with invasive mechanical ventilation at the start of CPR were included. The primary exposure was event-level average ETCO 2 (≥20 mmHg vs. &lt;20 mmHg). The primary outcome was survival to hospital discharge. Secondary outcomes were ROSC and intra-arrest CPR quality and physiology measurements. Average ETCO 2 &lt;10 mmHg was a secondary exposure. The associations between ETCO2 and outcomes were evaluated with multivariable Poisson regression. Exploratory analyses used receiver operating characteristic (ROC) and spline curves to identify alternative ETCO 2 targets. Results: Among 234 patients, 133 (57%) had average ETCO 2 ≥20 mmHg. After controlling for a priori covariates, average ETCO 2 ≥20 mmHg was associated with higher rates of survival to hospital discharge (aRR 1.33, CI 95 1.04 - 1.69, p=0.023) and ROSC (aRR 1.22, CI 95 1.00 - 1.49, p=0.046) compared to lower values. Average ETCO 2 ≥20 mmHg was associated with higher blood pressures during CPR (diastolic: 46.5 [37.9, 57.9] mmHg vs. 33.3 [26.8, 42.9] mmHg, p&lt;0.01); systolic: 90.6 [75.1, 118.7] mmHg vs. 70.9 [55.5, 86.4] mmHg, p&lt;0.01), higher chest compression fraction (0.98 [0.94, 1.00] vs. 0.97 [0.92, 0.99], p=0.034), and lower ventilation rates (26.2 [19.7, 30.9] min -1 vs 29.5 [22.8, 41.4] min -1 , p&lt;0.01). Average ETCO 2 &lt;10 mmHg was not associated with outcomes. Exploratory analyses did not detect an alternative ETCO 2 target (ROC cutpoint: 19.6 mmHg). Conclusions: In this multicenter study, ETCO 2 ≥20 mmHg was associated with higher quality CPR and superior outcomes. ETCO 2 &lt;10 mmHg was not associated with worse outcomes, suggesting resuscitation should not be terminated based on low ETCO 2 alone.
Abstract 410: Differences in Survivability of Out-of-Hospital Cardiac Arrest in Rural versus Urban Minnesota
Authors: Alexandra Hall, Michael D Klajda, Garima Dahiya, Lucinda Hodgson, Jason Bartos
Journal: Circulation (2023)

Background: Out-of-Hospital Cardiac Arrest (OHCA) survival has improved in North America due to improved awareness, training, and bystander CPR. An important factor complicating OHCA survival is location on initial arrest, due to distance and access to emergency medical services (EMS). Aims: We sought to examine characteristics of OHCA encounters in Minnesota and determine underlying factors for differences in OHCA survival in rural versus urban areas. Methods: We examined data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry between 2013-2021 in Minnesota. The analyses included encounters from 31 EMS services across the state. The Office of Management and Budget (OMB) county rural-urban classification schema was used to designate categories of rural (non-metropolitan counties of less than 50,000 population) versus urban (metropolitan counties with populations of 50,000 or more). Results: We identified 21,257 patient encounters, of which 3,524 (16.6%) of encounters were designated as rural and 17,733 (83.4%) as urban. In our cohort, patients were predominately male. Rural arrest patients tended to be older (mean age, 64.5 vs 60.6 years, p&lt;0.01) and had a higher prevalence of heart disease (32.2% vs 26.9%, p&lt;0.01). Rural arrests were more likely to be witnessed (57.1% vs 51.6%, p&lt;0.01), receive bystander CPR (42.3% vs 35.2%, p&lt;0.01), and have AED use prior to EMS arrival (55.7% vs 53.5%, p&lt;0.01). The average time for EMS arrival at scene of arrest was longer among rural encounters (12.9 vs 10.6 minutes; p&lt;0.01). Overall, survival-to-discharge was significantly lower among rural versus urban communities (9.3% vs 13.1%, p&lt;0.01). Conclusion: In this analysis of the CARES dataset in Minnesota, there were significant differences in survival characteristics between rural vs urban OHCA patients. These findings warrant greater investment in rural EMS agencies and modifiable resuscitation practices to improve survival among rural communities.
Abstract 380: Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model
Authors: Adam Gottula, Man Qi, Bennett Lane, Christopher shaw, Kari Gorder, Elizabeth Powell, Kyle Danielson, Anna Ciullo, Nicholas J Johnson, Joseph Tonna, William Hinckley, Amy Koshoffer, Rabab Al-Araji, Jason Bartos, Justin Benoit, Cindy H Hsu
Journal: Circulation (2023)

Introduction: Evidence suggests that ECPR can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, over 50% of potential ECPR candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the U.S. in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR HEMS-based system (Figure 1). Methods: We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. EMS response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial (Figure 1). The combined model was used to estimate the total ECPR candidates in each system. Results: The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical eligibility criteria, 24,661 (3.4%) patients were eligible for ECPR. When considering overall ECPR eligibility within 45 minutes from OHCA to initiation, only 11.76% of clinically eligible patients qualified in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%). Conclusions: The study demonstrates a two-fold increase in ECPR eligibility for a field-deployable ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based OHCA system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.
Abstract 377: Developing a Novel Oxygen Carrier for Resuscitation and Oxygen Delivery Through Targeted Mutations of Recombinant Heme-Proteins
Authors: Alay Gandhi, Jesus Tejero, Anthony DeMartino, Matthew Dent, Qinzi Xu, Hyon Hwang, Kaitlin Bocian, XueYin Huang, Xiukai Chen, Ronald Poropatich, Mark Gladwin, Jason J Rose
Journal: Circulation (2023)

Introduction: Hemorrhage is a leading cause of death in trauma patients. Interventions dedicated to hemostatic resuscitation have demonstrated benefit in decreasing mortality due to hemorrhagic injury. There remain significant limitations to donor-based blood transfusions. We have identified a heme-binding protein, the Bacterial Regulator of carbon monoxide metabolism (RcoM), with suitable properties to be a robust artificial oxygen carrier. We have engineered a variant that lacks a DNA binding domain and contains cysteine mutations for improved stability (RcoM HBD-CCC). Hypothesis: We hypothesize that engineered RcoM HBD-CCC can be used as an ideal artificial oxygen carrier due to the optimization of 4 factors: ligand binding, nitrite reduction rate, autoxidation rate, and thermal denaturation. Methods: Spectrophotometric methods were used to characterize RcoM HBD-CCC in terms of its biochemical properties for optimal oxygen transport and release. Specifically, ligand binding was tested by determination of the P50 (oxygen pressure for 50% saturation of the molecule) value indicating the affinity of RcoM HBD-CCC towards oxygen. Nitrite reduction assays were carried out to test the rate at which nitric oxide (NO) forms to counteract potential NO scavenging. The autoxidation rate determines how long a protein stays in the reduced state, where it is able to bind to oxygen. Thermal denaturation (T m ) identifies the resistance of a protein to higher temperatures. Results: We determined that RcoM HBD-CCC’s P50 value was 4.2 mmHg which is within the ideal range for oxygen binding affinity given that optimal values for oxygen carriers to mimic hemoglobin oxygen dissociation are between 1 to 26 mmHg. Nitrite reductase rate was 5.6M -1 s -1 which is well above the rate for Hb (K = 0.12 M -1 s -1 ). RcoM HBD-CCC has a low autoxidation rate at 0.016 min -1 . RcoM HBD-CCC has a T m of 71°C which is well above all ambient environmental temperatures. Conclusion: We have designed and synthesized a variant of RcoM that we have demonstrated in in vitro spectrophotometric assays to have ideal biochemical properties for an artificial oxygen carrier. We next plan to test the efficacy of RcoM HBD-CCC in animal models of hemorrhage and assess safety in animal exposure models.
Abstract 417: Advanced vs. Basic Life Support Outcome Variation in the Treatment of Out-of-Hospital-Cardiac-Arrest in Detroit
Authors: Ryan Silvagi, Ryan Reece, James Cranford, Shobi Mathew, Mitchell Byrd, John Pum, Damon Gorelick, Valerie H Mika, Robert B Dunne, Brian O'Neil
Journal: Circulation (2023)

Background: Out-of-Hospital-Cardiac-Arrest (OHCA) may be treated with Advanced Life Support (ALS) and Basic Life Support (BLS). Previous literature has indicated that ALS provides no additional benefit to OHCA patients. This study compared OHCA outcomes between prehospital ALS or BLS care in a city with a preponderance of BLS only care. Study Objectives: To test for associations between prehospital ALS or BLS care stratified by initial cardiac rhythm on ROSC, discharged alive from the hospital, and on favorable neurological outcome at hospital discharge in OHCA of a presumed cardiac origin. Methods: A retrospective cohort of 6746 patients with non-traumatic OHCA who received CPR from a transporting EMS agency was collected using the Cardiac Arrest Registry to Enhance Survival (CARES) database. Patients were sorted into 4 cohorts based on ALS vs BLS care and initial shockable vs non-shockable cardiac rhythms. Cohorts were compared utilizing chi-squared and multivariable logistic regression analysis against the outcome variables of sustained ROSC, discharged alive from the hospital, and a favorable neurological outcome at hospital discharge. Results: After controlling for covariates, the odds of sustained ROSC were statistically significantly higher for S-ALS vs. NS-BLS (OR=4.4, p.001), S-BLS vs. NS-BLS (OR=1.8, p.001), and NS-ALS vs. NS-BLS (OR=2.2, p.001). The association between cohort and discharged alive from the hospital was also statistically significant (p.001), and discharged alive rates were S-ALS (17.9%); S-BLS (11.8%); NS-ALS (3.7%); NS-BLS (4.0%). The association between cohort and favorable neurological outcome was also statistically significant (p.001), and outcome rates were S-ALS (74.6%); S-BLS (58.2%); NS-ALS (36.5%); NS-BLS (41.6%). The odds of favorable neurological outcome were higher for S-ALS vs. NS-BLS (OR=2.6, p.001). Conclusion: In contrast to previous literature, ALS care in the study was superior to BLS care. ALS care was associated with higher rates of ROSC in OHCA patients regardless of rhythm. Further, ALS care was associated with higher rates of being discharged alive from the hospital and favorable neurological outcomes among patients with a shockable rhythm.
Abstract 408: Out-of-Hospital Cardiac Arrest in Children: An Epidemiological Study Based on the German Resuscitation Registry Identifying Modifiable Factors for Return of Spontaneous Circulation
Authors: Stephan Katzenschlager, Inga K Kelpanides, Patrick Ristau, Matthias Huck, Stephan Seewald, Sebastian Brenner, Florian Hoffmann, Jan Wnent, Jo Kramer-Johansen, Ingvild B Tjelmeland, Markus A Weigand, Jan-Thorsten Graesner, Erik Popp
Journal: Circulation (2023)

Aim: This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. Methods: Data from the German Resuscitation Registry (GRR) was used, and we included patients registered between 1 st January 2007 and 31 st December 2021. We included children aged &gt;7 days and &lt;18 years, where cardiopulmonary resuscitation (CPR) was started and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status, and (3) nighttime on the outcome hospital admission with ROSC. Results: OHCA in children aged &lt;1 year had the highest incidence per 100 000 inhabitants, with 23.42, accounting for 42.0% of all included cases. Overall, hypoxia was the leading presumed cause of OHCA; whereas trauma and drowning accounted for a high proportion in children aged &gt;1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1-4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. Conclusion: This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival.
Abstract 429: The Association Between Naloxone Administration and Outcomes for Out-of-Hospital Cardiac Arrest Due to Suspected Overdose
Authors: Nathan Strong, Mohamud R Daya, Matthew R Neth, Matt Noble, Jonathan Jui, Joshua R Lupton
Journal: Circulation (2023)

Background: Opioid overdose is increasingly implicated in the development of out-of-hospital cardiac arrest (OHCA) and is a leading cause of death for adults 25 to 64 years old. Aim: Evaluate the association between naloxone use and outcomes after OHCA due to suspected overdose. Methods: This study was a secondary analysis of data collected in the Portland Cardiac Arrest Epidemiologic Registry, a database containing details of Emergency Medical Services (EMS)-treated cases of cardiac arrest around Portland, OR. Eligible patients had non-traumatic OHCA due to presumed overdose with naloxone (exposed) or without naloxone administration (control). We excluded patients with return of spontaneous circulation (ROSC) before the first dose of naloxone. The primary outcome was ROSC at emergency department (ED) arrival. Secondary outcomes included survival to admission; survival to hospital discharge; and cerebral perfusion category score ≤2 at discharge (functional survival). We performed multivariable logistic regressions adjusting for age, sex, arrest location, witness status, bystander interventions, initial EMS rhythm, time from 911 call to EMS arrival, and year of arrest. We separately assessed the subgroup with non-shockable initial rhythms. Results: Of 3,942 OHCA from 2018-2021, EMS documented an overdose etiology in 249. Of these, 236 (94.8%) had all variables and 18 were excluded for achieving ROSC prior to naloxone, resulting in 218 cases for analysis (171 receiving naloxone). Patients receiving naloxone had no difference in adjusted odds (aOR [95% CI]) of ROSC at ED arrival (1.43 [0.64-3.20]), survival to admission (1.87 [0.85-4.10]), survival to discharge (1.99 [0.39-10.30]) and functional survival (1.99 [0.34-11.55]). The subgroup with non-shockable rhythms showed higher odds of survival to admission (2.55 [1.09-5.92]) but not ROSC at ED arrival (1.60 [0.68-3.75]), survival to discharge (8.43 [0.84-84.20]), or good neurologic outcomes (7.26 [0.75-70.42]). Conclusions: For OHCA due to suspected overdose, those with initial non-shockable rhythms who received naloxone had higher adjusted odds of survival to admission than those who did not. Larger studies are necessary to evaluate the impact of naloxone on OHCA outcomes.
Abstract 406: Texas Out of Hospital Cardiac Arrest Disparities for Rural Patient Care From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project
Authors: Benjamin L Karfunkle, Ryan Huebinger, Kevin Schulz, Joseph Gill, Carrie A Bakunas, John Waller-Delarosa, Richard Witkov, Micah Panczyk, Normandy W Villa, Bentley Bobrow
Journal: Circulation (2023)

Introduction: Out-of-hospital cardiac (OHCA) arrest victims from rural settings suffer worse outcomes. We evaluated the association between rural setting and post-arrest care and outcomes. Hypothesis: Receiving treatment for OHCA at a rural hospital will be associated with a lower rate of post OHCA care and lower rate of favorable neurologic outcomes (cerebral performance score 1 or 2). Methods: We performed a retrospective analysis of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-2021. We included adult OHCAs not listed as DNR. We defined hospital urbanicity as the proportion of OHCAs originating from rural census tracts. We defined hospitals as rural if more than 25% of included OHCAs were rural. We evaluated the association between rural hospital status and patient and prehospital care characteristics - age, race, initial rhythm, response time, bystander CPR - and hospital care characteristics - targeted temperature management (TTM) and percutaneous coronary intervention (PCI) rates. We evaluated the association between rural hospital status and favorable neurological outcomes with logistic regression, adjusted for patient and prehospital factors, hospital care, and census tract median household income. Results: We included 31,569 encounters with OHCA at 161 unique hospitals. The rural hospital group included 1,213 OHCA encounters (3.8%) at 25 hospitals (15.5%). Patient factors between groups were similar other than a higher rate of white patients in the rural group. Rates of angiography (16.1% non rural, 17.1% rural), PCI (8.2%, 8.7%), and TTM (30.6%,34.7%) were not statistically different. Treatment at rural hospitals was not associated with a statistically significant decreased odds of good neurological outcome (aOR 1.02, 95%ci 0.83-1.24). Conclusion: Treatment for OHCA at rural hospitals was not associated with a lower rate of post OHCA care or lower rate of favorable neurologic outcome
Abstract 390: Pre-Hospital Administered Adrenaline in the Presence of a Physician and Neurological Status of Patients With Out-of-Hospital Cardiac Arrest: A Multi-Center Prospective Cohort Study
Authors: Toshihiro Hatakeyama, Takeyuki Kiguchi, Toshiki Sera, Sho Nachi, Nao Urushibata, Kanae Ochiai, Tetsuhisa Kitamura, Shinji Ogura, Yasuhiro Otomo, Taku Iwami
Journal: Circulation (2023)

Background: Little is known about whether pre-hospital administered adrenaline with a physician present could improve the outcome of patients with cardiac arrest. Hypothesis and Aim: We aimed to test the hypothesis that pre-hospital administered adrenaline provided in the presence of a physician could improve neurological survival of patients with a specific type of first-confirmed cardiac rhythm following cardiac arrest compared with pre-hospital administered adrenaline provided in the absence of a physician. Methods: This prospective multi-center cohort study enrolled consecutive patients who were transported to 95 participating hospitals in Japan after out-of-hospital cardiac arrest and later underwent resuscitation at a hospital between June 1 2014 and December 31 2020. We included patients who were administered pre-hospital adrenaline under the presence or absence of a physician, and who were ≥18 years of age with cardiac arrest of a medical etiology. Primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) one month after cardiac arrest. Whether the carotid artery was pulsating and 3-lead electrocardiogram monitor confirmed the first cardiac rhythm. Based on previous findings, those with the first-confirmed cardiac rhythm were subdivided into the non-shockable and shockable groups. Multivariable logistic regression analysis was performed on propensity score-matched patients. Results: We analyzed 11,711 patients. Among the 10,113 patients in the non-shockable group, 0.6% (N = 64) had a favorable neurological outcome. The adjusted odds ratio for a favorable neurologic outcome of pre-hospital administered adrenaline under the presence of a physician was 3.94 (95% confidence interval (CI): 1.58-11.4), compared with the absence of a physician. Of 1,598 patients in the shockable group, 10.3% (N = 164) had a favorable neurological outcome with an adjusted odds ratio of 1.30 (95% CI: 0.73-2.35). Conclusion: This prospective multi-center cohort study showed that pre-hospital administered adrenaline in the presence of a physician was significantly associated with a higher favorable neurological outcome in non-shockable patients with cardiac arrest.