tbuckley/cabot-search huggingface dataset:
Abstract 243: Comparing the Effectiveness of Extracorporeal and Conventional Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis
Authors: Muhammed K Elfaituri, Ala Khaled, Ahmed BenGhatnsh, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Background: Cardiac arrest is a leading cause of death worldwide, with out-of-hospital cardiac arrest (OHCA) presenting unique challenges in terms of timely and effective treatment. Conventional Cardiopulmonary Resuscitation (CPR) remains the standard intervention; however, the emerging use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) and its potential for superior hemodynamic support necessitates a comprehensive comparison of these interventions in the context of OHCA to guide resuscitation practices. Aim: This study aims to compare ECPR and conventional CPR in patients experiencing OHCA. Methods: We searched several databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) until May 2023. Studies that compared ECPR and conventional CPR in OHCA were included in the analysis. The outcomes assessed included in-hospital mortality following admission, return of spontaneous circulation (ROSC), 30-day mortality, and positive neurological recovery at discharge. Data analysis was performed using a random-effects model, with Relative Risk (RR) computed for each outcome. All statistical analyses were performed using R software (version 4.0.3) with metafor and meta packages. Results: We included a total of 5 studies totaling 8,632 patients (4,315 in the ECPR group and 4,317 in the conventional CPR group). The analysis revealed no significant difference between ECPR and conventional CPR in terms of in-hospital mortality (RR 0.95, 95% Confidence Interval (CI) 0.88 to 1.03, P=0.19, I2=60%) and ROSC (RR 1.01, 95% CI 0.97 to 1.05, P=0.58, I2=0%). However, ECPR was associated with a significant reduction in 30-day mortality (RR 0.93, 95% CI 0.91 to 0.95, P&lt;0.01, I2=0%). No significant improvement was found in positive neurological recovery at discharge with ECPR compared to conventional CPR (RR 1.25, 95% CI 0.80 to 1.93, P=0.33, I2=16%). Conclusion: This study highlights the potential of ECPR in reducing 30-day mortality compared to conventional CPR in OHCA cases, although its effectiveness in other outcomes, such as in-hospital mortality and neurological recovery, remains inconclusive. Given the observed heterogeneity among the studies, further high-quality studies are needed.
Abstract 418: Characteristics of Post-Shock Refibrillation in Out-of-Hospital Cardiac Arrest
Authors: Shujie Chen, Chenguang Liu, Stacy Gehman, Mengqi Gao, Kevin Burgett, Dawn Jorgenson
Journal: Circulation (2023)

Introduction: Early defibrillation is critical for out-of-hospital cardiac arrest (OHCA) patients with shockable rhythms. Following successful shocks, refibrillation is common. The present study investigated three outcomes including shock efficacy, refibrillation rate, and refibrillation time (defined as the interval between shock delivery and refibrillation) in OHCA patients. Methods: Adult cases treated with Philips SMART Biphasic 150 J shocks from four US EMS agencies were included. The shocks were delivered by professional level HeartStart FR3 AEDs which are more likely to encounter longer patient down time compared to public access AEDs. Two rhythm experts independently annotated shock success, defined as the presence of a non-shockable rhythm for at least 5 seconds (s) after the shock. Successful shocks followed by a CPR period of ≥ 60 s were further annotated with refibrillation time if it occurred. If post-shock outcome could not be determined due to excessive artifact or post-shock data &lt; 5 s, the shock success and/or the refibrillation were annotated as undeterminable. Annotator disagreements were resolved by review with a third rhythm expert to reach consensus. Results: A total of 464 shocks from 254 cases were analyzed. Shock efficacy was 87.7% for the first shock and 85.5% for all shocks. Shockable rhythms were successfully terminated at least once in 94.2% of the patients. Following successful shocks, the refibrillation rate was 55.9% for the first shock and 61.0% for all shocks. The median refibrillation time was 32.7 s (range: 5.1-582.4 s). The distribution of the refibrillation time is shown in Figure 1. Conclusions: Most patients needed more than one shock mainly due to refibrillation. About 50% of the refibrillations occurred within 30 s, which suggests that identification of early refibrillation for prompt defibrillation may be beneficial.
Abstract 375: Resuscitative Endovascular Balloon Occlusion of the Aorta With Downstream Intra-Aortic Irrigation Using Hydrogen-Containing Solution Mitigates Ischemic Injury in a Swine Hemorrhagic Shock With Liver Injury Model
Authors: Tadashi Matsuoka, Koichiro Homma, Tomoyoshi Tamura, Sayuri Suzuki, Takahiro Yamanaka, Daiki Kaito, Soichiro Ono, Katsuya Maeshima, Junichi Sasaki
Journal: Circulation (2023)

Background: Recently, the resuscitative endovascular balloon occlusion of the aorta (REBOA) has become widespread in hemorrhagic shock (HS). It temporarily increases the proximal blood pressure (pBP); but sacrifices the distal blood flow to the visceral organs, causing ischemic injury. We previously reported that hydrogen (H 2 ) gas inhalation mitigated ischemic injury and improved survival in rats with HS; however, during REBOA use, the H 2 gas was not delivered to the ischemic organs as it is distributed via the bloodstream. Therefore, we hypothesized that intra-aortic irrigation of H 2 -containing solution into the downstream of REBOA would mitigate ischemic injury. Methods: Herein, a swine liver injury with volume-regulated HS model was used. The female swine (around 40 kg, n = 16) were divided into two groups; a H 2 -containing solution irrigation (H 2 group) and saline irrigation (C group). After HS induction (20% of estimated total blood volume), the liver injury was initiated (20% of total liver volume). The REBOA was inflated during predefined time (60 min and 90 min) and intra-aortic irrigation to downstream of REBOA was started. The hemodynamic parameters, blood samples, and pathological changes were evaluated. Results: The elevation in lactate, interleukin 6, and syndecan levels were significantly suppressed over time in the H 2 group than in C group (p &lt; 0.05). The pBP tended to decrease during REBOA in the C group; however, it remained higher in H 2 group (p &lt; 0.05). Pathologically, the ischemic changes, such as liver sinusoidal enlargement and intestinal villi flattening and inflammatory infiltration were identified in the C group but not in H 2 group. Conclusion: The REBOA with downstream intra-aortic irrigation using H 2 -containing solution for liver injury with HS stabilizes hemodynamics, suppresses cellular injury, and mitigates organ damages. These results in large animals can be immediately applied to clinical use in humans.
Abstract 360: Clinical Characteristics and Outcome in Out-of-Cardiac Arrest Patients With Type A Aortic Dissection Diagnosed by Non-Contrast Computed Tomography
Authors: Keiichiro Komiya, Shoji Kawakami, Yosuke Matsumoto, Kenichi Kitahara, Aya Katasako, Hidenobu Koga, Tetsuhisa Yamada, Nobutoshi Miura, Takashi Matsumoto, Takayuki Uchida, Jun-ichiro Nishi
Journal: Circulation (2023)

Background: Although type A aortic dissection (AAD) remains a life-threatening disease, the exact epidemiology of out-of-hospital cardiac arrest (OHCA) with AAD is unclear. It has been reported that the non-contrast computed tomography (CT) is useful for diagnosing AAD in patients whose hemodynamic status was unstable. Aim: We evaluated the clinical features and outcome of OHCA patients with AAD diagnosed by non-contrast CT. Methods: Between 2017 and 2022, we retrospectively collected Utstein-style data on non-traumatic adult OHCA patients transferred to our hospital and performed non-contrast full-body CT scan. We divided OHCA patients into 3 groups: patients with AAD diagnosed by CT (Group-AAD), patients with non-cardiac cause without AAD (Group-NC), and patients with cardiac cause (Group-C). The diagnostic criteria of AAD by CT were as follows: visible intimal flap; crescentic high attenuation hematoma; and inward shift of calcified intima. The clinical outcome was defined as return of spontaneous circulation (ROSC). Results: Of the 1018 non-traumatic adult OHCA patients were registered during the study period, 1015 patients underwent non-contrast CT (Group-AAD, n=79; Group-NC, n=159; Group-C, n=779). The patients who achieved return of spontaneous circulation (ROSC) was 271 (26.8%). The proportion of patients who achieved ROSC in Group-AAD was significantly smaller than the other groups (Group-AAD 10.1%, Group-NC 27.7%, Group-C 28.3%, P=0.002). Multivariable logistic regression analysis revealed that patients with AAD diagnosed by CT independently predicted failure to achieve ROSC. The presence of witnessed arrest and initial shockable rhythm were significant indenpent predictors of achieving ROSC ( Table ). Conclusion: OHCA patients with AAD diagnosed with CT were more difficult to obtain ROSC than patients with other cause.
Abstract 241: Neurologic Complications Associated With Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest
Authors: Ben Deverett, Andrea O'Riordan, Karen G Hirsch, Melissa Vogelsong
Journal: Circulation (2023)

Background: Neurologic complications are frequently encountered after ECPR and there is a limited understanding of the associated clinical trajectories following ECPR for in-hospital cardiac arrest (IHCA). Aim: To determine the prevalence, properties, and outcomes of radiographic neurologic complications following ECPR for IHCA. Methods: In this single-center retrospective chart review, we collected data on all adult IHCA patients who underwent ECPR from 1/1/2018 to 12/31/2019. Measured variables included demographics, clinical data, timing of diagnostic studies, and outcomes. Results: Data were analyzed from 36 adult ECPR patients, 16 (44%) of whom survived to hospital discharge. Twenty (56%) underwent head computed tomography (CT) and 9 (25%) had pathology identified, diagnosed a median of 1.8 days afterECPR. The most common complications were intracranial hemorrhage and focal ischemia (4/9 patients each). Neurologic complications were not associated with total ECMO duration (median 4 vs 5 days, p=0.57) and patients with complications trended toward poorer survival outcomes (22% vs 52% survival to discharge; p=0.25). Conclusions: Radiographic neurologic complications occurred in one quarter of IHCA ECPR patients and were associated with trends towards poorer clinical outcomes. Consistent with data in the non-ECPR literature, rates of global anoxic injury and hospital mortality were lower in this IHCA cohort than in previously published OHCA and mixed ECPR cohorts. This study is limited by its small sample size, single center design, and lack of a standardized neuroimaging protocol. Future prospective studies are needed to assess the efficacy of ECPR for IHCA.
Abstract 372: Age-Dependent Effect of Trauma Center Transport on Survival Outcomes Among Severe Trauma Patients: Nationwide Observational Study
Authors: Hakrim Kim, Kyoung J Song, Kijeong Hong, Jeong Ho Park, Tae Han H Kim, Ki Hong Kim, Stephen G LEE, Young Sun Ro, Joo Jeong
Journal: Circulation (2023)

Introduction: Previous studies showed that the prognosis for severe trauma patients is better after transport to trauma centers compared to non-trauma centers. However, the benefit from transport to trauma centers may differ according to age group. This study aimed to evaluate the age-dependent effect of trauma center transport on survival outcomes among severe trauma patients. Methods: A cross-sectional study using the Korean national emergency medical service (EMS) based on Severe Trauma Registry in 2018-2019 was conducted. EMS-treated trauma patients whose injury severity score was above or equal to 16, and who were not out-of-hospital cardiac arrest or death on arrival were included. Patients were classified into 3 groups: pediatrics (age &lt;19), working age (age 19-65), and elderly (age&gt;65). The primary outcome was in-hospital mortality. Multivariable logistic regression analysis was conducted to evaluate the effect of trauma center transport on outcome after adjusting age, sex, comorbidity, mechanism of injury, Revised Trauma Score, and Injury Severity Score. All analysis was stratified according to the age group, and subgroup analysis for traumatic brain injury was also conducted. Results: Overall, a total of 10,511 patients were included in the study, and the number of patients in each age group was 488 in pediatrics, 6,812 in working age, and 3,211 in elderly, respectively. The adjusted odds ratio (95% confidence interval [CI]) of trauma center transport on in-hospital mortality were 0.76 (95% CI, 0.43-1.32) in pediatrics, 0.78 (95% CI, 0.68-0.90) in working age, 0.71(95% CI, 0.60-0.85) in elderly, respectively. In the subgroup analysis of traumatic brain injury, the benefit from trauma center transport was observed only in elderly group. Conclusion: We found the age-dependent effect of trauma center transport in severe trauma patients. There was no beneficial effect of trauma center transport in pediatric group. Further research is warranted to evaluate and develop the response system for pediatric severe trauma patients in Korea.
Abstract 231: Assessing the Effectiveness of Food Delivery Service Integration for Automated External Defibrillator Delivery in Out-of-Hospital Cardiac Arrest Response Through Computer Simulation
Authors: Kuan-Chen Chin, Yen-Ju Lee, Jen-Tang Sun, Sheng-En Chu, HaoYang Lin, Matthew Huei-Ming Ma, Albert Y Chen, Wen-chu Chiang
Journal: Circulation (2023)

Background: The number of food delivery (FD) motorcycle riders in Taipei has rapidly increased. These riders often wait near popular restaurants during rush hours and could potentially act as first responders to retrieve automated external defibrillators (AED) for out-of-hospital cardiac arrests (OHCA). Objectives: This study aimed to assess the feasibility of integrating FD riders into the emergency medical service (EMS) system as OHCA responders. Methods: We enrolled OHCAs from the Taipei registry between 2017 and 2019. Using the Uber Eats website, a prominent FD service platform, we obtained data on FD hotspots to establish a reference point. Assumptions were made in our simulation to develop an integrated system where FD riders could participate in a crowdsourcing program. In the simulation, FD riders were assigned to respond to an OHCA within a 2-km distance by retrieving an AED or directly responding to the OHCA if bystander CPR was unavailable. We tested response rates from 10 to 100% and compared simulated AED arrival time with documented EMS response time in the registry. Results: During the study periods, 8,952 of 11,660 OHCA cases were accessible by FD riders. There were 418 restaurants clustered around 24 hotspots, and 2,050 AEDs were found within range of these restaurants (Image1). For FD-accessible OHCA cases, with simulating response rates ranging from 10 to 100%, the AED arrival time was reduced by 2.99 to 3.67 minutes. The effect was more pronounced during peak hour (Image 2). Conclusion: The results indicate that incorporating FD riders as OHCA responders into the EMS system is practical and beneficial in reducing the defibrillation waiting time for OHCA patients.
Abstract 412: Targeted Temperature Management for Patients With Out of Hospital Cardiac Arrest: A Comparison of the TTM2 Trial Population With Real World Data
Authors: Mustafa Al-Taei, Abbas Alshami, Carol Fernandez Hazim, Joseph Varon
Journal: Circulation (2023)

Introduction: The TTM2 trial demonstrated no improvement of the functional status in survivors of Out-of-Hospital Cardiac Arrest (OHCA). However, the external validitiy of the trial remains to be investigated. Aim: We aimed to compare the patient population of the TTM2 trial to the real world data. Methods: We obtained the data from multiple national registries including Cardiac Arrest Registry to Enhance Survival (CARES), the Australasian Resuscitation Outcomes Consortium (Aus-ROC), the Danish Cardiac Arrest Registry (DCAR), and the Swedish Cardiopulmonary Resuscitation Registry (SCRR). We pooled the data from these registries and compared them to the data from the TTM2 trial. Results: We identified a total of 262,482 encounters from all the databases and 1,861 encounters from the TTM2 trial. The average age was comparable between both groups (64 years), females gender (registries 35% vs trial 20%), arrest event happened at the place of residence (registries 72% vs trial 53%), Bystander-witnessed arrest (registries 57% vs trial 91%), Bystander-performed CPR (registries 38% vs trial 80%), initial shockable rhythm (registries 25% vs trial 74%), non-shockable rhythm (registries 75% vs trial 26%). Conclusion: Large discrepancies were identified between the data from the TTM2 and the pooled data obtained from multiple registries. This needs to be further investigated.
Abstract 235: Smartphone Dispatch of Trained and Untrained Volunteer Responders for Out-of-Hospital Cardiac Arrest: A Big Data Study Based on Five Years of Experience With the SAUV Life App
Authors: Tal Soumagnac, Maayane Tamar Soumagnac, Caroline Cazes, Lionel Lamhaut, Alice Hutin
Journal: Circulation (2023)

Introduction: The use of smartphones to dispatch volunteer responders for out-of-hospital cardiac arrest (OHCA) has emerged as a promising strategy for improving response times. The SAUV Life app was progressively implemented in France since 2018. In the event of a suspected OHCA, volunteer responders were dispatched by emergency medical services and received remote guidance through the app to the location of the alert, enabling them to initiate or assist in CPR. Hypothesis: Trained volunteers were more likely to arrive at the scene before medical teams and to initiate CPR compared to untrained volunteers. Methods: We conducted a retrospective observational study to analyse user profiles and interventions from January 1, 2018, to November 30, 2022. Data were automatically collected during interventions and stored in a confidential and anonymized file. Statistical analyses were performed using Python libraries. Volunteers were classified as trained if they possessed a first aid training certificate or an equivalent qualification. Results: During the study period, a total of 631,221 volunteers subscribed to the app. The mean age of volunteers was 40.5 ± 14.5 years. Among them, 461,892/631,221 (73.2%) were categorized as trained volunteers, while 169,329/631,221 (26.8%) as untrained volunteers. There were 1,102,317 alerts recorded, resulting in a total of 21,986 interventions. Among these interventions, 3,687/21,986 (16.8%) involved a volunteer arriving before medical teams, with 4602/4850 (94.9%) being trained volunteers and 248/4850 (5.1%) being untrained volunteers. Trained volunteers were more likely to arrive at the scene before medical teams compared to untrained volunteers, 4602/798102 (0.6%) vs 248/304215 (0.1%) respectively (p &lt; 0.001). Trained volunteers were more likely to initiate CPR compared to untrained volunteers: 3137/4602 (68.2%) vs 121/248 (48.2%) respectively (p &lt; 0.001). During the study period, 522 patients for whom an alert was triggered achieved return of spontaneous circulation. Conclusion: The development of smartphone applications for emergency dispatch following OHCA must continue to be promoted for both trained and untrained populations, but it is essential to prioritize first aid training.
Abstract 419: Incidence of True Refractory Ventricular Fibrillation in Patients Meeting a Pragmatic Definition of Refractory Ventricular Fibrillation
Authors: Bas J Verkaik, Rob G Walker, Rob Marx, Mette M Ekkel, Tyson G Taylor, Remy Stieglis, Vera G van Eeden, Hans van Schuppen, Fred W Chapman, Christian van der Werf
Journal: Circulation (2023)

Introduction: Refractory VF, pragmatically defined as a shockable presenting rhythm that is still observed after three shocks and associated 2-minute CPR cycles, is often encountered in out-of-hospital cardiac arrest (OHCA) and is associated with worse outcomes. A recent clinical trial tested alternative strategies for treating patients meeting this definition of refractory VF. It is unknown how often standard defibrillation truly fails to terminate VF in these patients. Methods: Using the prospective AmsteRdam REsuscitation STudies (ARREST) registry of OHCA patients, we examined termination of VF in patients meeting the pragmatic definition of refractory VF between 2016 and 2019. All patients received standard defibrillation. We reviewed ECG waveforms from all AEDs and manual defibrillators to analyze termination of VF to a non-shockable rhythm at five seconds after each of the first 3 shocks. Refibrillation was defined as recurrence of VF after a shock terminated VF. Results: Out of 1573 OHCAs with an initial shockable rhythm, we analyzed the 453 cases (29%) that met the pragmatic definition of refractory VF. Median time to first shock was 8.0 (IQR 6.3-9.7) minutes; in 65% an AED was used. The first three shocks terminated VF at least once in 96% of the patients, at least twice in 81%, and all three times in 57%. Altogether, VF was terminated by 78% of all individual shocks. In 4% of patients all three shocks failed to terminate VF (Figure). Median time to refibrillation was 32 (IQR 12-61) seconds. ROSC at any time occurred in 59% of patients; 27% survived to discharge. Conclusions: In patients meeting a pragmatic definition of refractory VF, true refractory VF without termination of the shockable rhythm by any of the first three shocks was rare. Instead, VF was successfully terminated by most shocks and recurred during the ensuing CPR cycle. Therefore, the mechanism of benefit from alternative defibrillation strategies in these patients is unclear.