tbuckley/cabot-search huggingface dataset:
Abstract Sa602: Novel gas mixture combined with an auto-transfusion tourniquet enhances cerebral O <sub>2</sub> transport and hemodynamic indices in CPR swine
Authors: Noam Gavriely, Jukka Rasanen, Sharon sofia Abadi Saar, Lionel Lamhaut, Alice Hutin, fanny lidouren, Yara Abi Zeid Daou, Renaud Tissier
Journal: Circulation (2024)

Background: The cognitive outcome of CPR is poor. This study aims to evaluate if enhancing blood flow to the brain and oxygen dissociation from the hemoglobin, improve cerebral O 2 delivery during CPR in cardiac arrest swine. Methods: Standard swine-CPR model of induced VF and recovery was treated with an auto-transfusion tourniquet (A-TT®; HemaShock® (HS) Oneg HaKarmel Ltd. Israel) and ventilation with a novel mixture of Oxygen – 30%, CO 2 – 5%, and Argon 65% (COXAR™). Five swine received the study treatment and 5 controls standard therapy. All animals were anesthetized, ventilated, and instrumented for blood draws and pressure measurements. Five minutes of no-CPR arrest were followed by 10 minutes of mechanical CPR with and without COXAR-HS enhancement followed by defibrillation and 45 minutes post ROSC follow-up of. Results: All 5 COXAR-HS™ animals were resuscitated successfully as opposed to 3 of the control animals (p=0.09 NS). Hemodynamic indices: Systolic (p&lt;0.05), and diastolic (p&lt;0.01) blood pressures, coronary (p&lt;0.001) and cerebral (p&lt;0.05) perfusion pressure were higher in the COXAR-HS group after ROSC, as well as cerebral flow and O 2 delivery (p&lt;0.05). Blood pressure maintenance after ROSC required dose of norepinephrine in the 3 control animals that had ROSC vs the 5 COXAR-HS animals (p&lt;0.05). PO 2 and SO 2 in the jugular vein exceeded 50 mmHg and 50%, respectively with COXAR-HS. Discussion: The COXAR-HS group hemodynamic and gas exchange were significantly superior post ROSC compared to the control. The higher PjvO 2 and SjvO 2 indicate enhanced O 2 delivery to the brain mitochondria, while limb compression by the HS counteracts the vasodilatory effect of the CO 2 . The much lower and less toxic F I O 2 in the COXAR-HS group was sufficient and there were no adverse effects of Argon. Conclusions: The combination of the HemaShock peripheral vasoconstrictive effect with the COXAR vasodilative effect enhance ROSC and brain oxygen delivery.
Abstract 4147186: Impact of Naples Prognostic Score on Clinical Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.
Authors: Ahmed Mazen Amin, Mustafa Turkmani, Saman Al Barznji, Hossam Elbenawi, Donna Salam
Journal: Circulation (2024)

Background: Naples prognostic score (NPS) is a recently developed tool for assessing inflammatory and nutritional status. It is commonly used to evaluate cancer patients. Purpose: We aimed to investigate the impact of NPS on clinical outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through June 2024. We conducted a systematic review and meta-analysis pooling dichotomous data using risk ratio (RR) with a 95% confidence interval (CI). All analyses were performed using R V. 4.3.1. Results: We included five studies with a total of 12,785 patients. Comparing high NPS (3-4) to low NPS (0-2), high NPS (3-4) was significantly associated with an increased incidence of overall mortality (RR: 2.21, 95% CI [1.85, 2.65], P &lt; 0.01), shock (RR: 1.85, 95% CI [1.33, 2.57], P &lt; 0.01), acute kidney injury (RR: 1.54, 95% CI [1.15, 2.08], P &lt; 0.01), left ventricular thrombus (RR: 2.93, 95% CI [1.44, 5.94], P &lt; 0.01), and no-reflow (RR: 1.35, 95% CI [1.17, 1.57], P &lt; 0.01). However, there was no significant difference between high NPS (3-4) and low NPS (0-2) regarding in-hospital mortality (RR: 1.82, 95% CI [0.99, 3.37], P = 0.06). Conclusion: Our meta-analysis highlights the importance of evaluating inflammation and malnutrition status in STEMI and shows that routine blood tests can provide prognostic insights. NPS can help predict different clinical outcomes in STEMI patients undergoing PPCI. While it does not affect in-hospital mortality, its simplicity and accessibility make it useful for clinical risk assessment and long-term prognosis. Further studies are needed to investigate its predictive value further.
Abstract Sa306: View Adequacy and Compression Delays During CPR: Carotid vs Cardiac Ultrasound In Out-of-Hospital Cardiac Arrest
Authors: Casey Patrick, L. Michael Wells, Kevin Crocker, Brad Ward, Nicolas Smith, James Seek, Robert Dickson, Jonathan Powell, Christopher Gage, Ashish Panchal
Journal: Circulation (2024)

Introduction: Manual pulse palpation during cardiopulmonary resuscitation has poor reliability in both hospital and prehospital settings. Recently, point-of-care ultrasonography (POCUS) of the carotid artery has been used for pulse determination in the in-hospital setting. However, this approach has not been evaluated for out-of-hospital cardiac arrest (OHCA) events where adequate views and prolonged pauses during pulse checks could be challenges. Our objective was to evaluate the potential use of POCUS for pulse determination by paramedics using carotid artery and subxiphoid cardiac views. We hypothesized that carotid POCUS views may be obtained more quickly and successfully in the prehospital setting than the traditional subxiphoid cardiac view. Methods: This was a retrospective analysis of carotid and subxiphoid POCUS use for pulse determination at a high-volume, ground-based EMS agency. Adult patients suffering from medical OHCA with POCUS attempted were included. Those under 18 years of age, protocol deviations, missing data, or uninterpretable data were excluded. Video was recorded throughout each CPR pause in which ultrasounds were conducted. EMS clinicians alternated carotid and subxiphoid views. Pause length and view adequacy were evaluated by two expert paramedic reviewers. Disagreements were adjudicated by an EMS physician. Statistical analysis: McNemar’s test was used to evaluate for differences between adequate view and compression pauses &lt; 10 seconds between carotid and subxiphoid approaches. Generalized estimating equations were used to evaluate the association of adequate view and compression pauses &lt; 10 seconds to POCUS approaches. Results: A total of 196 POCUS recordings from 94 patients were analyzed. Videos were evaluated by rates for adequate views with k=0.83 with 92% agreement. Overall, 73% (n=143) had a pause length &lt; 10 seconds, and 62% (n=121) had an adequate view. Adequate views and compression pauses &lt; 10 seconds were achieved more frequently using carotid POCUS (Figure). Adjusting for body mass index, carotid views had increased odds (AOR 9.3, 95% CI: 4.3-20.4) of combined adequate view and compression pause &lt; 10 seconds as compared to subxiphoid imaging. Conclusion: Paramedic-obtained carotid POCUS demonstrated improved view adequacy and fewer extended CPR pauses. Limitations include the high level of POCUS training for paramedics and the single agency data source, making generalizability difficult to determine.
Abstract 4147358: Outcomes of ECMO vs. Impella as a Bridge to Heart Transplant: A Nationwide Analysis in the United States
Authors: Manoj Ghimire, Sajana Poudel, Kalpana Ghimire, Karun Shrestha, Prakriti Subedi, Salomon Chamay, Redi Nikollari, Dinesh Kadariya, Sulejman Celaj
Journal: Circulation (2024)

Introduction: Heart transplantation (HT) is the gold standard for end-stage heart failure, but limited donor availability and increasing disease prevalence have necessitated the use of mechanical circulatory support (MCS) devices. There is a rising trend of MCS devices used as a bridge to transplant with variable outcomes. This study examines trends and outcomes of MCS devices, specifically Extracorporeal Membrane Oxygenation (ECMO) and Impella, used as bridges to HT. Hypothesis: Impella support leads to better survival and post-transplant outcomes than ECMO. Methods: A retrospective cross-sectional study was conducted using National Inpatient Sample data from 2016-2021. Trends in utilization and patient outcomes were compared for those who received ECMO and Impella as bridges to HT. International classification of disease (ICD-10) codes were used to extract the data. Results: During the study period, 17,570 HTs were performed, with a rising trend in using MCS devices as a bridge to transplant, especially Impella. ECMO was used in 1,635 patients and Impella in 755 patients. The mean age of the study population was 52.5 years and 610 (25.5%) were female. Cardiogenic shock was more common among patients with Impella (94.04% vs. 67.28%, p&lt;0.001). Severe sepsis (9.27% vs. 23.24%, p&lt;0.001) and transplant failure (0% vs. 13.15%, p&lt;0.001) were higher with ECMO use. Mortality was lower with Impella (1.99% vs. 27.22%, p&lt;0.001). Hospital stay and costs were similar for both groups. Conclusion: In patients undergoing HT, the use of the Impella device was associated with lower in-hospital mortality, severe sepsis, and transplant failure compared to ECMO.
Abstract Su102: Brain and plasma metabolic profiles after molecular hydrogen inhalation in a rat model of cardiac arrest
Authors: Kanako Ito-Hagiwara, Lance Becker, Yusuke Endo, Jun Hagiwara, Kei Hayashida
Journal: Circulation (2024)

Background: Inhaled molecular hydrogen gas (H 2 ) has been shown to improve outcomes in both animal models and patients of cardiac arrest (CA). Although the molecular mechanisms of H2 have been studied, the impacts of H 2 on metabolic alterations following CA remain to be elucidated. Methods: Rats were subjected to 10 minutes of asphyxial CA followed by CPR to achieve a return of spontaneous circulation (ROSC). Ten minutes after achieving ROSC, rats were mechanically ventilated with 21% O 2 (Air group) or with 21% O 2 plus 1.3% H 2 (H 2 group). Whole-brain and plasma samples were obtained 2 h post-ROSC in each group (n = 5 for each). Unbiased GC/MS analysis was performed and the data were analyzed using MetaboAnalyst 6.0. Results: In brain, a total of 117 metabolites were analyzed. In H 2 group, 15 were significantly increased and 3 were decreased metabolites in comparison with Air group (raw P &lt; 0.05, Fold Change (FC &gt; 1.2 or &lt; 0.8). By using metabolites with the variable importance in projection score &gt; 1.0 based on partial least squares discriminant analysis, pathway enrichment analysis (PEA) was conducted. PEA identified specific metabolic pathways that are significantly changed in the brain following H 2 inhalation, including “Alanine, aspartate and glutamate metabolism”, “Glycine, serine and threonine metabolism”, “Arginine biosynthesis,” and “Arginine and proline metabolism” (all FDR &lt; 0.01). These pathways are integral to cellular processes such as neurotransmitter synthesis, energy production, and cell signaling, highlighting the potential neuroprotective mechanisms of H 2 . In plasma, a total of 123 metabolites were analyzed. The H 2 group had 2 increased and 3 decreased metabolites compared to the Air group (raw P &lt; 0.05, FC &gt; 1.2 or &lt; 0.8). PEA identified the “Valine, leucine and isoleucine biosynthesis” pathway (FDR &lt; 0.01), suggesting the involvement of branched-chain amino acid metabolism, which plays a critical role in energy homeostasis and protein synthesis. These findings emphasize the systemic impact of H 2 inhalation on post-CA metabolic regulation. Conclusion: Our analysis reveals that inhaled H 2 induces significant metabolic alterations in both brain and plasma post-CA. The data highlight the broad metabolic impacts of H 2 in modulating several pathways crucial for cellular recovery and protection. Further research is warranted to elucidate biomolecular mechanisms and clinical applications of H 2 therapy in CA patients.
Abstract Sa205: Resuscitation and Antiarrhythmic Effects of Artificial Oxygen Carrier of HbV in Perioperative Severe Hemorrhagic Shock during Total Pneumonectomy Model
Authors: Bonpei Takase, Yuko Higashimura, Nobuyuki Masaki, Manabu Kinoshita, Takeshi Adachi, Masayoshi Nagata, Hiromi Sakai
Journal: Circulation (2024)

Perioperative bleeding is fetal complication of thoracic surgery (0.3-1.8% of all lung resection). We reported effects of Liposome-encapsulated hemoglobin vesicle (HbV) in hemorrhagic shock. Phase I clinical trial of HbV was successfully performed. For future clinical trials, we investigated resuscitation and antiarrhythmic effects of HbV in pneumonectomy model by using optical mapping analysis (OMP) with Langendorff's method. Left total pneumonectomy was performed in SD rats (N=30). Immediately after pneumonectomy, repetitive 50% blood hemorrhage and resuscitation were conducted. HbV-administration (HbV-group), washed red blood cell-administration (wRBC-group), and 5% albumin-administration (ALB-group) were studied. Right mean ventricular pressure (RMVBP) and systemic mean blood pressure (SMBP) were measured. OMP including lethal arrhythmia (SVT/VF) induction by electrophysiological study (EPS) was performed. Ventricular arrhythmia (PVC/NSVT) numbers were counted. Blood chemistry of ALT, AST, CPK, Cr, troponin I (TnI) and lactate (LT) were measured. Tissue HIF1alpha expression were examined in heart, lung, liver, kidney and spleen. RMVBP increased to 20±4 to 45±3 mmHg by pneumonectomy, presumably worsening systemic circulation and proarrhythmic effect. Observation for 40 min after resuscitation showed that SMBP remained normal in HbV-group and wRBC-group, but not in ALB-group (Fig. 1). SVT/VF induction and PVC/NSVTs were observed in ALB-group, but suppressed in HbV-group and wRBC-group (Fig. 2). The values of action potential duration dispersion (APDd; index of lethal arrhythmias) in LV determined by OMP was comparable in the HbV-group and wRBC-group (APDd; HbV-group, wRBC-group vs. ALB-group;12±4,14±3 vs. 24±4* ms, P&lt;0.01, Fig. 3). ALT, CPK, TnI and LT were increased in ALB-group only, but not those in HbV- and wRBC-group (values after resuscitation, HbV-group, wRBC-group vs. ALB-group; ALT, 28±8, 24±6 vs. 72±6* U/L; CPK, 241±61,154±76 vs. 732±175* U/L; TnI, 0.21±0.07, 0.21±0.06 vs. 3.54±0.84*ng/mL; LT, 0.8±0.2, 1.1±0.1 vs. 2.6±0.6* mmol/L; *P&lt;0.01). HIF1alpha staining was observed in heart, liver and kidney only in ALB-group, but not in HbV- and wRBC-groups. Conclusions: HbV effectively preserves cardiac circulatory function due to anti-shock effect even in RVMBP overload, and it has anti-hypoxic effect leading to prevent lethal arrhythmias in perioperative hemorrhagic shock following total lung resection, which is useful finding in future HbV trials.
Abstract 4146924: Endothelial lipase mediates LDLR-independent uptake of LDL by a combination of enzymatic and non-enzymatic mechanisms.
Authors: Diego Lucero, Olivia White, Zahra Aligabi, Kendall Burks, Nathan Stitziel, Ira Goldberg, Alan Remaley
Journal: Circulation (2024)

Background: Current lipid-lowering drugs rely on the LDL receptor (LDLR) pathway to lower LDL cholesterol. This leaves patients with null mutations in the LDLR, such as those with homozygous familial hypercholesterolemia (FH), potentially without an effective treatment. Remarkably, inhibitors of angiopoietin-like3 were found to reduce LDL-cholesterol in FH patients in an endothelial lipase (EL)-dependent mechanism. Recently, we found that EL overexpression enhances the cellular uptake of LDL in LDLR-knockout (KO) hepatocytes; however, the mechanism remains unclear. Aim: to investigate the mechanisms by which EL mediates LDLR-independent uptake of LDL in hepatocytes. Methods: CRISPR/Cas9-generated control and LDLR -KO HepG2 cells were transfected by lipofection with an empty plasmid or a plasmid containing the human LIPG gene (EL). Cellular uptake of fluorescent human LDL was measured by FACS. To test the contribution of heparan sulfate proteoglycans (HSPG), the cellular uptake of LDL was assessed with and without the pre-incubation with 5 U/ml heparin or a cocktail of heparinases I, II, and II. Furthermore, to analyze the role of EL enzymatic activity, LDL uptake was measured after incubating the cells with 25 µg/ml tetrahydrolipstatin (THL). Finally, we measured the expression of potential receptors by RT-qPCR to explore alternative mechanisms of internalization. Results: As previously shown, LIPG -transfected LDLR -KO hepatocytes showed a 2-fold increase in LDL uptake compared to LDLR-KO cells non-overexpressing EL (p&lt;0.001). LDL uptake was completely blocked by heparinases and heparin in LDLR -KO cells regardless of EL over-expression. Treatment with THL partially reduced the cellular LDL uptake in LDLR-KO cells over-expressing EL (p=0.08). In addition, LDLR-KO cells showed a 2-fold increase in the mRNA levels of cluster of differentiation 36 (CD36) (p&lt;0.01), a known scavenger receptor. Conclusions: Our findings demonstrate that, in LDLR deficiency, EL mediates the uptake of LDL by a combination of enzymatic and non-enzymatic mechanisms. Furthermore, our data shows that HSPG play a crucial role in the LDLR-independent LDL uptake in hepatocytes, possibly acting as a bridge facilitating LDL internalization. Further studies will determine the role of scavenger receptors in the EL-mediated uptake. These mechanisms may represent a potential druggable target to treat homozygous FH patients.
Abstract Su1102: The Effect of Structured Team Training on Basic Life Support Rates in General Wards of a German University Hospital
Authors: Nils Jacobsen, Jan Wnent, Hanna Hoffmann, Saskia Friebe, Felix Neuenfeldt, Leonie Hannappel, Jens Scholz, Jan-Thorsten Graesner
Journal: Circulation (2024)

Background: Basic CPR (B-CPR) is recognized as a crucial intervention in managing in-hospital cardiac arrest (IHCA). In 2020, only 80% of patients with cardiac arrest attended by an emergency medical team (EMT) at The University Medical Center Schleswig-Holstein (UKSH) received B-CPR by ward staff in advance. Hypothesis: It is anticipated that nursing staff in general wards of a hospital will significantly increase the initiation of basic resuscitation following education on the significance of basic resuscitation during a structured resuscitation training. Aims: The objective is to achieve a resuscitation rate of over 90% among ward staff within a two-year period through training efforts. Methods: The UKSH employs 16,000 individuals at two locations. All employees are required to participate in basic cardiopulmonary resuscitation (CPR) training every two years. A retrospective data analysis was performed using data from the German Resuscitation Registry for Kiel Campus. The primary outcome parameter was the frequency of basic resuscitation performed on general wards. Secondary outcome measures included the rate of return of spontaneous circulation (ROSC), mortality at the scene of the emergency, and the rate of discharge from the hospital. Results: Between 2020 and 2022, the number of calls for EMTs and the proportion of resuscitations remained stable at approximately 35%. However, the rate of basic life support initiated by ward staff increased significantly from 80% in 2020 to 98.6% in 2022 (χ2 = 11.52, p &lt; 0.001). Other parameters, such as ROSC or mortality on scene, remained unchanged. The hospital discharge rates rose from 8.1% in 2020 to 12.2% in 2022, but this increase was not statistically significant (p = 0.408). Approximately 60% of employees participated in the training, equating to 5000 staff members attending a 2-hour session per year. This participation rate is likely due to personnel changes and the impact of the COVID-19 pandemic. Conclusions: The enhancement of resuscitation training resulted in an increase in basic cardiopulmonary resuscitation (B-CPR) performed on general wards. However, there was no statistically significant increase in hospital discharge rates, suggesting that while training enhances immediate resuscitation efforts, additional factors influence long-term survival outcomes. It is crucial to continuously emphasize the importance of basic resuscitation skills and training to sustain and further improve these outcomes.
Abstract Sa605: The Trend of Standardized ETCO <sub>2</sub> After ROSC May Reveal Cellular Damage During Cardiac Arrest
Authors: Jose Antonio Uriguen, JOSE JULIO GUTIERREZ, Mikel Leturiondo, Koldo Redondo, James Russell, Mohamud Daya
Journal: Circulation (2024)

Introduction: Cardiac output and oxygen supply to vital organs cease after cardiac arrest, resulting in cellular damage with the brain being one of the most affected organs. From collapse to ROSC, no-flow and low-flow phases lead to primary injury due to ischemia. Then, at normal-flow phase after ROSC, reperfusion of the ischemic cerebrovascular bed triggers secondary injury. Both effects combined may cause post-cardiac arrest brain injury (approximately 2/3 of all deaths 48-72h after ROSC). Recently, standardization of ETCO 2 to constant ventilation rate and chest compression depth has been proposed as a potential indicator of the patient’s physiological status during resuscitation. Aim: Retrospectively assess how the trend of standardized ETCO 2 during CPR in patients achieving ROSC may reflect an increment in cellular damage that could promote brain injury. Methods: Out-of-hospital cardiac arrest cases of patients achieving sustained ROSC, with defibrillator and clinical data. ETCO 2 was standardized to 10 ventilations per minute and 50mm (ET s ). Trends were calculated as the percent variation between the initial and the final values of ET s in the low-flow phase before the onset of ROSC and in the normal-flow phase after ROSC. We used the modified Rankin Score (mRS, from 0 to 6) to classify the patients into good (mRS ≤ 3) or poor functional outcome (mRS &gt; 3) Results: Forty-two sustained ROSC cases were included, 8 with good and 34 with poor functional outcome. The median (IQR) trend of ET s was +0.9 (–3.9, +3.6) %/min in the low-flow phase, and –1.8 (–4.1, +0.3) %/min in the normal-flow phase ( p = 0.03). The low-flow phase lasted 12.0 (11.2, 14.7) min in patients with good outcome, and 16.2 (14.1, 19.2) min in those with poor outcome ( p = 0.02). The trend of ET s in the normal-flow phase was +0.1 (–0.2, +1.2) %/min in patients with good outcome and –2.4 (–4.2, –1.0) %/min in those with poor outcome ( p = 0.01). Conclusion: The trend of standardized ETCO 2 was significantly different in the normal-flow phase after ROSC than in the low-flow phase before ROSC. The negative trend in the normal-flow phase combined with a longer low-flow phase may reflect an increment of cellular damage, with a major impact on the brain. This is possibly because reperfusion aggravates primary injury the longer the low-flow phase has lasted.