tbuckley/cabot-search huggingface dataset:
Abstract 337: Bystander Defibrillation in High Risk Neighborhoods
Authors: Anezi Uzendu, Raul A Garcia, Rayan El-Zein, Dan Nguyen, Paul S Chan
Journal: Circulation (2023)

Background: Whether public health efforts successfully prioritize bystander automated external defibrillator (AED) application in areas with highest of hospital cardiac arrest (OHCA) burden is unknown. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified all adult, public OHCAs linked to a census tract between 2013- 2021. We ranked all census tracts by annual public OHCA volume to ascertain relative burden, then assessed the association of census tract OHCA burden and bystander AED application rate (application prior to emergency personnel arrival), using a hierarchical modified poisson regression model, to account for clustering within tracts, and arrest characteristics. Results: Among 25,787 tracts with 90,898 public OHCAs, the mean (SD) age was 57.1 (16.0) years, with 70,900 (78.0%) male and 45,388 (49.9%) White victims. Overall, bystander AED application rates were low (10.9%). There was a modest association between neighborhood OHCA burden and bystander AED application rates (ρ=0.243). After adjustment, neighborhoods with the highest OHCA burden (&gt;2/ year) had a higher relative risk of bystander AED application than those with lowest burden (&lt;1/ every other year) (RR 2.07; 95% CI 1.95, 2.20, p&lt;.0001). However, this was due to a small proportion of high performing communities, as 700/1145 (61.1%) of highest OHCA burden communities had a bystander AED application rate less than the overall mean, 10.9%. Conclusion: High OHCA burdened areas have increased odds of bystander AED application, however this is driven by a few high performing neighborhoods. Targeted, context informed strategies are necessary to improve application rates and survival for the majority of high-risk neighborhoods.
Abstract 307: In-Situ Simulation-Based Booster ACLS Training to Increase the Confidence and Performance of Internal Medicine Residents as Code Blue Leaders - A Quality Improvement Project
Authors: Ali O Ibrahim, Moh'd Alghizzawi, Nisha Patel, Mariam Haji, Afeerah Malik, Abhay Mishra, Nadia Sultan, Julie Banderas, Paul S Chan, David Wooldridge
Journal: Circulation (2023)

Background: In the United States, nearly 290,000 adult patients develop in-hospital cardiac arrest (IHCA) every year. Delivery of guideline-based resuscitation has improved patient outcomes. During 2022, our hospital had 68 inpatient i.e., approximately 1 code/resident. Residents have reported desire for more exposure. The 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommended: 1) booster training, 2) in-situ simulation-based resuscitation training, and 3) specific teamwork and leadership training for healthcare providers. We aimed to implement such training to achieve an improvement in resident confidence and performance as code blue leaders. Methods: Pre-intervention, residents completed a 5-item 0-100 continuous scale to assess confidence in major code leader skills (Fig 1-A). Interventions included: 1) Calling residents to patient rooms to run simulation-based codes, and 2) a didactic session that discussed common errors during codes. Time to key ACLS steps was recorded during the simulations. At the end of the project, residents completed the post-intervention survey of confidence and balancing measures. Results: 13 residents led simulation-based codes, 20 attended the didactic session, and 25 completed the survey. Resident confidence in the defined skills increased by an average of 30%. (P&lt;0.05) (Fig 1-A). Residents who led codes after the didactic session had shorter times to key ACLS steps (Fig 1-B). Balancing measures included resident-reported satisfaction and perceived disruption to clinical workflow (100% and 0% of responses, respectively). Conclusions: In-situ simulation-based booster ACLS training was associated with an increase in the confidence and performance of IM residents as code blue leaders. Incorporation of such training in IM residency curriculum should be considered as a practical application to sustain the gains of this QI initiative.
Abstract 427: Differential Gene Expression in Survivors versus Non-Survivors of In-Hospital Cardiac Arrest
Authors: Jignesh K Patel
Journal: Circulation (2023)

Background: While association of inflammatory cytokines with outcomes in cardiac arrest have become increasingly studied in both animal and human models, sparse published literature exists regarding gene expression and outcomes in adults with cardiac arrest. Accordingly, the goal of the current investigation was to identify proteins that are associated with survival, gender, and time and in what direction these proteins are associated in patients resuscitated from IHCA. Methods: In this prospective study, we assessed blood samples from adult patients with IHCA who underwent ACLS-guided resuscitation between 2014 and 2019 at an academic tertiary care medical center. Blood obtained at 0, 6, and 24 hours of IHCA) was sent for proteomic analysis. The primary outcome of interest was survival to hospital discharge. Results: Of the 95 patients, 22 (23.2%) survived to hospital discharge while 73 (76.8%) did not. A total of 206 samples were obtained from 95 patients, where each patient was measured at up to 6 time points. Given higher number of samples at 0, 6, and 24 hours following IHCA, modeling data was restricted to these time points. Volcano plot and heat map were generated for significant proteins for the survivor versus non-survivor analysis at each of the listed time points. Gene set enrichment analysis was also utilized to identify the top 10 gene sets associated with survivorship at T0, T6, and T12, and visualized via heatmap and a bar graph. Conclusions: In this contemporary proteomic study of 95 adults with IHCA receiving ACLS-guided resuscitative and post-resuscitative care, gene sets associated with survival exist and significant proteins associated with survivorship can be identified. To our knowledge, this is one of the first studies to assess differential gene expression in men and women with IHCA with respect to survival.
Abstract 297: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry
Authors: Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph Walline, Huadong Zhu, Yuguo Chen, Xu Jun
Journal: Circulation (2023)

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: end-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P&lt;0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P &lt; 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.
Abstract 315: Endovascular Aortic Occlusion Preferentially Improves Hemodynamics and Return of Spontaneous Circulation After Longer Periods of Cardiopulmonary Resuscitation: A Translational Study in Swine
Authors: Steven Siemieniak, Craig Nowadly, Tanner Greiving, Jason Rall, Nola Shepard
Journal: Circulation (2023)

Introduction: Non-traumatic cardiac arrest (NTCA) is associated with low survival and substantial societal cost. Standard-of-care treatments, such as cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS), have limitations in restoring cardiac function and improving outcomes. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an adjunct to CPR for NTCA. However, the optimal patient population that will benefit most from REBOA remains uncertain. Goals: This translational study investigated the impact of varying low-flow duration (15- vs 30-mins) on REBOA's hemodynamic performance and ability to achieve return of spontaneous circulation (ROSC) in a swine model of NTCA. Methods: Thirty-two swine were anesthetized and placed into ventricular fibrillation. All animals received a 4-min “no-flow” period before mechanical CPR was initiated. Animals were randomized into four groups to receive: 1) 15- vs 30-minutes of CPR; 2) REBOA vs. no-REBOA (control). After completion of the 15- or 30-minute low-flow period, ACLS was initiated and REBOA was fully-inflated in experimental animals. Results: There were no differences in demographics or hemodynamics at baseline (T = -10-mins) or at randomization (T = +10-mins). In the 15-mins groups, there were no differences in the rates of ROSC between REBOA (4 / 8, 50%) and control (4 / 8, 50%; p = 0.99). However, in the 30-min group the REBOA animals had a significantly higher rate of ROSC (6 / 8, 75%) compared to control (1 / 8, 12.5%; p = 0.04). In the 7-mins (T = 34 - 41 mins) after REBOA deployment in the 30-min animals there was a statistically significant difference in diastolic blood pressure (repeated measures ANOVA; p = 0.027). Importantly, 5 / 6 (83%) animals that received ROSC in the 30-min group with REBOA re-arrested at least once with 3 / 6 (50%) maintaining ROSC until study completion. Conclusion: In our swine model of NTCA, REBOA preferentially improved hemodynamics and ROSC after a 30-mins period of low-flow CPR, compared to 15-mins of low-flow CPR. REBOA may be a viable strategy to improve ROSC after prolonged downtime. More hemodynamic support will be required to maintain ROSC. This has implications for patient selection in upcoming human trials of REBOA in NTCA.
Abstract 336: Bystander CPR Maintains Shockable Rhythm in Sudden Cardiac Arrest Across EMS Response Times
Authors: Kyndaron Reinier, Lauri Holmstrom, Harpriya Chugh, Audrey Uy-Evanado, Faye L Norby, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2023)

Introduction: Presentation with shockable rhythm markedly improves survival from out-of-hospital sudden cardiac arrest (SCA). Shockable rhythms (ventricular fibrillation/tachycardia; VF/VT) are known to deteriorate to asystole or pulseless electrical activity (PEA) over time, but little population-based data is available regarding this phenomenon. Also, bystander CPR (BCPR) improves survival from SCA but its association with maintenance of shockable rhythms is unclear. Hypothesis: With longer EMS response time, the proportion of EMS-assessed shockable initial rhythms will decrease. BCPR may influence this association. Methods: We analyzed EMS-assessed initial rhythm of SCA cases from the Oregon SUDS study in the Portland, OR metro area (pop ~1 million). For this analysis, we included bystander-witnessed SCA cases (2002-2018) aged ≥18 with resuscitation attempted by EMS. SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin. We assessed initial rhythm proportions across EMS response times using Cochran-Armitage trend tests. Results: Among 3,309 SCA cases, 1,748 (53%) were bystander-witnessed, and of these, 706 (40%) received BCPR. Response time was 7.3 ± 3.4 minutes for cases with BCPR and 6.8 ± 3.1 minutes without BCPR (p=0.01). In the group receiving BCPR, the proportion with shockable rhythm remained near 60% across response times from &lt;3 to ≥12 minutes (Figure, solid line; p=0.88), and proportions of PEA and asystole remained stable. In the group without BCPR, shockable rhythm declined from 70% at &lt;3 minutes to 44% at ≥12 minutes response time (Figure, dashed line; p&lt;0.001), while non-shockable rhythms increased. Conclusions: Among community-based SCA cases who received bystander CPR, there was no significant decrease in shockable rhythm as response time increased. In contrast, among SCA cases without bystander CPR, longer response times were associated with a lower proportion of shockable rhythms.
Abstract 325: Two-Year Outcomes of an Electronic Health Record Integrated Rapid Response Team Model
Authors: Dustin Tart, Kelly Kester, Catie Dunn, Adam Glenn, Rosimeire Santos, Bradi B Granger, Cara L O'Brien
Journal: Circulation (2023)

Background: Literature supports improved patient outcomes with dedicated resources for rapid response to patient deterioration in inpatient settings. However, studies of the association of centralized resource allocation and electronic health record (EHR) integration on patient outcomes are lacking. Aim: To improve early, centralized rapid response to patient deterioration and reduce unanticipated transfers to the ICU. Methods: Using a prospective longitudinal quality improvement design, we implemented a centralized, EHR supported patient response team (PRT) at an academic medical center in the southeastern United States. The model served 1,043 inpatient beds. Pre-intervention the PRT used episodic data capture and included 1 critical care RN, 1 physician, and 1 respiratory therapist; each expected to leave assigned patients to respond to non-ICU events. We implemented a dedicated PRT (4 critical care RNs and 1 hospitalist) to provide 24/7 response to code blue, RRT, and stroke code events. The team provided proactive rounding, preventive consultation, and assessment of patients from ICU or emergency within 24 hours. Standardized workflow and outcome documentation was integrated in the EHR. Improvement in processes and outcomes were analyzed using statistical process control charts with 25 data points over a 2-year period. Results: At baseline (FY 2020), the PRT responded to 1739 rapid response calls and 166 code blue events. Unanticipated transfer to ICU occurred in 935 (53.8%) patients. Post-implementation of the integrated PRT model, the rate of early rapid response calls improved (FY 2021 n=2099; FY 2022 n=2239), code blue events decreased (FY 2021 n=151; FY 2022 n=115), and unanticipated ICU transfers also decreased (25%; Figure 1). Conclusions: A centralized PRT model using technology-supported EHR integration, pre-defined workflows, and a dedicated team can reduce non-ICU cardiac arrests and decrease unanticipated transfers to ICU.
Abstract 383: Effect of Audiovisual Feedback Device Type on Prehospital Chest Compression Quality During Prehospital Resuscitation
Authors: Stephen Gyung Won G LEE, Tae Han H Kim, Kyoung J Song, Jeong Ho Park, Ki Hong Kim, Yeongho Choi, Minwoo KIM, Kijeong Hong
Journal: Circulation (2023)

Background: Real-time audiovisual feedback devices have been implemented to optimize cardiopulmonary resuscitation (CPR) performance during out-of-hospital cardiac arrest (OHCA). Emergency medical service (EMS) personnel perceive different levels of usability regarding feedback device type. The study aimed to evaluate the effect of type of audiovisual feedback device used during prehospital CPR on chest compression quality during prehospital resuscitation. Method: Adult OHCA patients who received CPR by EMS personnel utilizing feedback device in Seoul between April 2020 and December 2021 were included. Cases that utilized mechanical chest compression devices were excluded. Feedback devices were classified into two types: sticker-type (S-type) and puck-type (P-type). The quality of chest compressions during prehospital resuscitation was compared based on the feedback device type. The primary outcome assessed was chest compression depth. Subgroup analysis was conducted for cases in which EMS personnel had experience using both types of devices. Results: In total, 2,896 OHCA cases were included. 1,596 cases utilized S-type devices and 1,300 cases utilized P-type devices. The median chest compression depth was significantly higher in cases that utilized the S-type device (Median: 5.2, interquartile range (IQR): 4.5-5.8) compared to those that used the P-type device (Median: 4.3, IQR: 3.7-5.0) (P&lt;0.001). In addition, proportion of chest compressions with adequate depth (5-6 cm) was significantly higher in the S-type group, while average chest compression rate and chest compression fraction were higher in the P-type group. Similar findings were observed in the subgroup analysis. Conclusion: Difference in chest compression quality parameters were observed during prehospital resuscitation according to type of audiovisual feedback device utilized. Chest compression quality regarding chest compression depth was superior when S-type feedback device was used.
Abstract 264: Impact of Receiving Hospital on Disparities in Out-of-Hospital Cardiac Arrest
Authors: Ryan Huebinger, Marina Del Rios, Bryan F McNally, Benjamin Abella, Richard Witkov, John Waller-Delarosa, Bentley Bobrow
Journal: Circulation (2023)

Background: Minority out-of-hospital cardiac arrest (OHCA) victims suffer from worse outcomes. The factors contributing to these disparities are not completely understood, and little is known about the impact of receiving hospital on OHCA. Hypothesis: Receiving hospital plays an important role in OHCA outcome disparities. Methods: We performed a retrospective, cohort study of the national Cardiac Arrest Registry to Enhance Survival (CARES). We included OHCAs from 2014- 2021 that survived to hospital admission. Based on census tract data, we stratified OHCAs based on majority race/ethnicity: &gt;50% White, &gt;50% Black, and &gt;50% Hispanic/Latino. We stratified hospitals into quartiles based on hospital rate of the outcome, survival with favorable neurologic outcome, cerebral performance category of 1 of 2. We evaluated the association between race/ethnicity and care at increasing hospital performance quartile. We compared four models evaluating the association between race/ethnicity and outcome: 1) omitting receiving hospital and bystander CPR (B-CPR), 2) adjusting for B-CPR, 2) additionally adjusting for receiving hospital as a random intercept, and 3) adjusting for hospital performance quartile. We adjusted all models for possible confounders. Results: We include 124,908 OHCAs that survived to hospital admission; 90,034 majority White, 20,600 majority Black, and 14,338 majority Hispanic. Compared to White, Black (OR 0.1, 95% CI 0.1-0.1) and Hispanic OHCAs were less likely to be cared for at high performing hospitals. Ignoring receiving hospital, outcomes were worse for Black (19.7%, aOR 0.43, 95% CI 0.40-0.46) and Hispanic (22.1%, aOR 0.49, 95% CI 0.45-0.54) than White (33.5%). While adjusting for B-CPR did not change survival odds, adjusting for receiving hospital as a random intercept improved outcome odds for Black (aOR 0.60, 95% CI 0.54-0.67) and Hispanic (aOR 0.61, 95% CI 0.53-0.69). Adjusting for hospital performance quartile also improved outcome odds for Black (aOR 0.79, 95% CI 0.73-0.85) and Hispanic/Latino (aOR 0.78, 95% CI 0.70-0.86). Conclusion: OHCAs from minority communities were less likely to be cared for at higher performing hospitals, and adjusting for receiving hospital significantly diminished OHCA outcome disparities.
Abstract 382: The Effect of Stepstool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative
Authors: Karen J O'Connell, Anuj Dutta, Alexis Sandler, Benjamin Kerrey, Sage Myers, Tara Neubrand, Aaron Donoghue
Journal: Circulation (2023)

Background: Delivering chest compressions (CC) of adequate depth and rate during pediatric cardiopulmonary resuscitation (CPR) has known beneficial hemodynamic consequences; however, chest compression quality in this population is often suboptimal. While common, the benefit of stepstool use during pediatric CPR has not been studied. Objective: To analyze the effect of step stool use on chest compression quality (depth, rate) in a pediatric emergency department (ED). Methods: We conducted a prospective observational cohort study involving patients &lt;8 years of age receiving chest compressions in an ED for &gt;2 minutes. Data was collecting via structured video review and from a CC monitoring device. Analysis was by compressor segment. We compared CC rate and depth by step stool use in each of 3 age groups: &lt; 1 year, 1-8 years, 9-18 years. We also examined step stool and CC quality by compressor hand position: 1) two thumbs, hands encircling chest (2T), 2) two fingers, 2 nd and 3 rd digits, pressing on anterior sternum (2F), 3) one hand (1H), and4) two hands (2H). Results: 46 patients received 390 CC segments (565 total minutes of CC). In patient &lt;1 year and 1-8years of age, the majority of compressors utilized a step stool (73% &lt;1 year; 83.3% 1-8 years). For &lt;1year, there was no difference in mean CC rate or depth with or without step stool use. In children &gt;1year of age, a step stool was associated with deeper chest compressions [3.63cm (IQR 3.07 - 4.17)versus 2.74 cm (IQR 2.39 - 3.24) without, p=0.000] and a mean CC rate more consistent with AHA guidelines [115 compressions per minute (IQR 115 - 128) versus 125 (IQR 110 - 121) without p=0.0037]. Stratified by hand placement technique, 1H compressions with a step stool achieved greater depth in children &gt;1 years (p&lt;0.01); 2H compressions with a step stool achieved a more compliant CC rate in children &gt;1 years (p&lt;0.05). Conclusions: CPR depth failed to reliably meet AHA guidelines regardless of stepstool use across all age categories. However, in children between 1 - 8 years of age, step stool use was significantly associated with higher quality chest compressions. Our findings of better CC depth and rate with one and two hand compressions should prompt further investigation and evaluation of CC technique in the pediatric population.