tbuckley/cabot-search huggingface dataset:
Abstract 430: Impact of the COVID-19 Pandemic on Out-of-Hospital Cardiac Arrest (OHCA) in Wayne County, Michigan
Authors: Yasin Almri, Howard A Klausner, Matthew Ball, Robert B Dunne, Marc Rosenthal, Joseph B Miller, Satheesh Gunaga, Christine Brent, Nathaniel R Hunt, Ryan Reece, Christine Chien, Brandon Page, Hannah Evans, Teri Shields
Journal: Circulation (2023)

Background: The COVID-19 pandemic has affected the incidence, presentation, care, and survival of OHCA. Early in the pandemic, healthcare systems were challenged by work force reduction due to illness and supply chain disruptions. We hypothesize there was an increase in the number of OHCA and a decrease in patient survival during the COVID-19 pandemic. Methods: We analyzed data from the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) from 2018-2022 in Wayne County from two systems of care, Health Emergency Medical Services (HEMS) and Detroit East Medical Control Authority (DEMCA). We compared patient arrests and response characteristics during time periods: 2018-2019 (pre COVID-19), 2020-2021 (COVID-19), and 2022. Descriptive statistics were utilized for this retrospective review. Results: 40 EMS agencies are included, and 12,695 OHCA cases were identified. HEMS and DEMCA recorded a total of 2,262 OHCA in 2018 and 2,401 in 2019. OHCA increased to 2,797 in 2020, 2,652 in 2021, and to 2,583 in 2022. There was a 6.1% increase in OHCA from 2018 to 2019, and a 16.5% increase in 2020, with a decrease of 6.4% in both 2021 and 2022. This trend is similarly observed in the rate of asystole as presenting rhythm. In 2018 and 2019, an average of 46.8% of patients were pronounced in the emergency department (ED) or on scene. This average rose to 56.8% in 2020 and 2021 and was 47.9% in 2022. There was also a decline in the average percentage of patients surviving until hospital admission, 23.3% in 2018 and 2019 and decreased to 18.4% in 2020 and 2021, and 22.5% in 2022. ( Figure 1. ) Conclusion: The COVID-19 pandemic may have impacted pre-hospital mortality and morbidity. There was an increase in OHCA and asystole as a presenting rhythm. The percentage of patients pronounced in the ED or on scene also increased. This data demonstrates that as a region, we have not returned to pre-pandemic levels and survivability for OHCA. Figure 1. Comparison of OHCA EMS Runs from 2018-2022 in Wayne County, MI
Abstract 385: Comparison of Rapid Implementation of Automated Head and Thorax Elevation With Active Compression Decompression Cardiopulmonary Resuscitation and an Impedance Threshold Device versus National Outcome Data: A Prospective Observational Study
Authors: Johanna C Moore, Kerry bachista, Ryan Quinn, Lauren D Emanuelson, Joe e Holley, Jeffrey Goodloe, James Reynolds, Lewis Siegel, Chris Williamson, Bayert Salverda, Keith G Lurie, Guillaume P Debaty, Paul E Pepe
Journal: Circulation (2023)

Background: Pre-clinical work has shown automated head and thorax elevation with active compression decompression CPR and an impedance threshold device (AHUP-CPR) improved 24-hour neurological survival. Propensity matched studies of out-of-hospital-cardiac arrest (OHCA) patients have shown a time dependent association between survival to hospital discharge (SHD) and application of AHUP CPR.Hypothesis: Rapid application of AHUP CPR for OHCA will have a higher incidence of SHD compared to national data. Methods: This is an ongoing prospective observational study of patients from an AHUP-CPR registry of non-traumatic adult OHCA receiving AHUP CPR as part of first responder care. OHCA patients from pre-hospital sites that consistently implemented rapid AHUP CPR were included. Patient demographics, arrest characteristics, ROSC, SHD, and SHD with favorable neurological function, defined as a Cerebral Performance Category score of 1 or 2, were recorded. Data are reported as means ± SD. Combined 2021 and 2022 data from the Cardiac Arrest Registry to Enhance Survival (CARES) were used for comparison of the primary study endpoint, SHD, and secondary endpoints. Chi-square testing was used to compare outcomes. Results: Of 11 registry sites, 7 (US States AL, FL, IL, MN, OK, TN, VA) met inclusion criteria and 1457 patients from January 2020 to June 2023 were enrolled. Average age was 65 ± 16.4 years, 61.8% (901) were male, and 71% (1035) received AHUP CPR. Average time (mm:ss) from 9-1-1 call to start of CPR was 9:52 (6:47) and time to start of AHUP CPR was 12:59 (5:51). Presenting rhythms were: asystole 47.8% (696), PEA 25.8% (376), and VF 20.5% (298). For all AHUP patients, SHD was 13.6% (198) versus 9.2% (26316/286525) for CARES (p &lt; 0.0001). SHD with favorable neurological function was higher for AHUP (10.3% (150) versus 7.3% for CARES (20889), p &lt; 0.0001) and ROSC (29.4% (428) vs 27.0% (77301), p = 0.039). Conclusions: In an unadjusted analysis, the incidence of SHD, ROSC, and neurologically favorable SHD with rapid implementation of AHUP-CPR was higher than nationally reported data. These results support prior findings of a time sensitive association between survival and time to AHUP-CPR. Additional analyses and study are needed for confirmation.
Abstract 431: Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest and Prolonged Mechanical Ventilation Period: Insight From the National Inpatient Sample Database 2019
Authors: Mustafa H Al-Taei, Abbas Alshami, Steven Imburgio, Claudia M Ramirez, Anton Mararenko, Ndausung Udongwo, Joseph Varon
Journal: Circulation (2023)

Introduction: The TTM2 trial showed that targeted temperature management (TTM) did not improve the functional status of survivors of out-of-hospital cardiac arrest (OHCA). However, the TTM2 trial OHCA survivors cohort had short mechanical ventilation (MV) duration (3.8 days in the hypothermic group and 2.9 days in the normothermic group). Aims: We aimed to investigate the functional status of OHCA survivors who required a prolonged MV duration. Methods: We utilized the National Inpatient Sample Database 2019. Participants were included if they were primarily admitted for cardiac arrest regardless of initial rhythm. Prolonged MV was defined as &gt; 4 days. Patients who have ICD-10 codes for both short and prolonged MV durations were excluded as they potentially had multiple intubations. The primary outcome was discharge from the hospital to home, as a surrogate for good functional status on discharge. Results: A total of 28,890 patients were admitted for cardiac arrest in 2019 in the United States. Of them, 67.5% (n=19,515) had MV. Of the mechanically ventilated patients, 74.3% (n=14,490) were ventilated for ≤ 4 days, 24.8% (n=4,835) had prolonged MV, and 190 admissions were excluded for possible multiple MV episodes. TTM utilization was comparable between survivors with prolonged MV (8.7%, n=200) and short MV (7.6%, n=380)(p=0.083). Discharge to home was higher in the short MV group [33.8% (n=1,690) vs 15% (n=345), p&lt;0.001]. After adjusting for age, sex, race, insurance, Elixhauser comorbidity index, renal replacement therapy, and coronary angiography, TTM was not independently associated with discharge to home in the short MV group (aOR 0.951, 95% CI 1.008-0.795, p=0.992). However, TTM was associated with significantly higher odds of discharge to home in the prolonged MV group (aOR 2.441, 95% CI 1.591-3.744, p&lt;0.001). Conclusions: One-fourth of the OHCA survivors, mechanically ventilated, cohort required prolonged MV. These patients have poorer functional status (discharge to home rate) that the short MV cohort. TTM seems to correlate with improved adjusted functional status on discharge from the hospital in the prolonged MV group. Future clinical trials should investigate the TTM impact on this subgroup of OHCA survivors.
Abstract 415: Standard versus Early Abdominal Counter-Constriction During Circumferential CPR
Authors: Matt T Oberdier, Aidan Paradis, Luca Neri, Norman Paradis
Journal: Circulation (2023)

Introduction: Circumferential constriction CPR (CC-CPR) applied by pneumatic vest may be superior to standard sternal compression, and the addition of alternative pumping modalities may further enhance efficacy. Interposed abdominal counterpulsation (IAC-CPR) CC-CPR is one such modality. Early canine studies of IAC reported greater efficacy when the abdominal counterpulsation was started 30% before the thoracic compression, rather than fully counterphase timing as is used clinically. This may be thought of as “Abdominal Preload” IAC (Pre-CPR). Hypothesis: Addition of IAC-CPR to CC-CPR may be associated with improved perfusion pressures, and Pre-CPR may be even more effective. Methods: We compared CC-CPR to IAC-CPR and Pre-IAC in a porcine model of VF (n=6). In IAC-CPR, the constrictions are fully counterphase. In Pre-IAC, abdominal constriction is initiated 30% before thoracic constriction. Alternating 30 second epochs of each treatment were applied via a circumferential abdominal vest. Aortic (Ao) and Right Atrial (RA) pressures were measured by micromanometer catheters. IAC-CPR and Pre-CPR end-epoch pressures were each compared to preceding CC-CPR end-epoch pressures. Results: Addition of IAC-CPR and Pre-IAC to CC-CPR were both associated with similar, significant increases in CPPs. However, the source of these improvements differed (See Table 1). For IAC-CPR, the increase appeared to result from an Ao increase greater than an associated increase in RA. For Pre-CPR, the increase appeared to be solely due to increased Ao. Limitations: Small sample. Surrogate biomarkers. Non-human model. Conclusions: The addition of pulsatile abdominal counter-constriction to vest CC-CPR may be a promising path to multimodality, regardless of the particulars of cycle timing. We do not confirm earlier observations that Pre-CPR may be superior to IAC-CPR.
Abstract 428: Clinical and Molecular Characterization of Post-Resuscitation Phenotypes: Cardiac vs. Neurorespiratory Etiology
Authors: David B Seder, Mary W Sorcher, Joanne T deKay, Jeanne Wishengrad, Peter Michalakes, Christine Lord, Meghan Searight, Alison Daley, Sarah Bockian, Teresa May, Richard R Riker, David Gagnon, Sergey RYZHOV
Journal: Circulation (2023)

Background: Establishment of clinical and molecular phenotypes is needed to individualize post-resuscitation cardiac arrest (CA) care. Leukocyte subpopulations may characterize ongoing organ injury, and strongly correlate with outcomes. We analyzed patients determined to have a cardiac (COR) vs. neurorespiratory (NR) etiology of CA. Hypothesis: Clinical and molecular phenotypes differ according to the etiology of CA. Goals: Prospectively characterize clinical and molecular phenotypes of patients with cardiac or neurorespiratory etiology of CA. Methods: After IRB approval and informed consent, we collected blood samples at 24, 48, and 72 hours after return of spontaneous circulation. We excluded patients &lt;18 years of age, moribund, Hgb &lt;7mg/dL, or whose CA etiology could not be determined. Flow cytometry was performed on fresh blood; outcomes were established by 6-month telephone call. Results: Among patients with COR (n=61) vs. NR (n=42) etiology of CA, COR patients were older (61±14 vs 54 ±14, P=0.021), more often had shockable rhythm (74% vs. 7.1%, P&lt;0.001), had higher initial blood glucose (227±89 vs 195±95, P=0.046), higher incidence of moderate or severe left ventricular dysfunction on presentation (67% vs 33.5%, P=0.004), lower EEG suppression ratio at 6 hours [22 (4,84) vs. 88 (66,93), P&lt;0.001), lower NSE levels [30 (19,140) vs 104 (33,268), P=0.034], higher in-hospital survival (64% vs. 33%, P=0.002), less neurological-etiology death (25% vs 55%, P&lt;0.001) and more CPC 1-2 at 6 months (49% vs 12%, P&lt;0.001). There were no differences in total number of leukocytes, but flow cytometry revealed leukocyte subsets, characterized by variable expression of CD4, CD8, CD10, CD14, CD16, CD54, CXCR1 and other surface proteins, indicating a trend toward enhanced neutrophil maturation and a preserved pool of circulating T cells in COR vs. NR patients. Conclusions: Separating CA survivors into a cardiac vs. neurorespiratory etiology reveals different clinical risk profiles and inflammatory responses during the acute phase after resuscitation. Further research should evaluate how specific interventions affect patients with dissimilar risk profiles, and how various therapies modulate the immuno-inflammatory response.
Abstract 17334: Association of BIN1 Deletion With Electrical and Structural Remodeling in a Transgenic BIN1 KO Mouse Model of Heart Failure-Novel Option for Effective Therapy Using VK-II-86
Authors: Hector Barajas-Martinez, Roi Westreich, Summer Mari-Reilly Sedano, Victoria Robinson, John-Luke Cadogan, Jose Acuna, Maria Alvarado-Cervantes, Charles N Antzelevitch, George Prendergast, Anthony Ashton, Lisa Laury-Kleintop
Journal: Circulation (2023)

Introduction: Cardiac deletion of Bridging Integrator 1 (BIN1) membrane protein produces an age-related cardiomyopathy in mice. Our hypothesis was to determine whether electrical accompanies this structural remodeling and examine the utility of VK-II-86, a structural analog of carvedilol with minimum β-blocking activity, as a potential antiarrhythmic therapeutic strategy. Methods: A cardiac-specific transgenic BIN1 KO mouse was employed. Structural and electrical cardiac changes were assessed using echocardiography and EKG (Visual Sonics-Vevo Heart Image). Murine ventricular cardiomyocytes were studied using patch-clamp techniques to examine changes in ion channel function and to study the effects of VK-II-86 on the action potential (AP). Results: Loss of BIN1 (KO) significantly reduced Left Ventricular Ejection Fraction (LVEF) and Cardiac Output (CO) when compared to WT mice, with a relative reduction of nearly 20% and 35% in EF and CO, respectively. Heterozygotic mice (HET) also exhibited significant reduction in EF and CO compared to WT mice. Loss of BIN1 (KO and HET) significantly prolonged the QT interval on surface ECG by approximately 15%. This finding correlates with the increase in AP duration (APD) demonstrated in ventricular cardiomyocytes using current clamp. BIN1 deficient hearts displayed significant reduction in expression of I to , I K1 and peak I Na (80%, 40% and 20% respectively) as well as augmented expression of late I Na (50%). This electrical remodeling is likely responsible for the increased expression of early (EAD) and late (DAD) afterdepolarization observed in APs. In BIN1 deficient ventricular cardiomyocytes, the addition of 1 μM VK-II-86 prevented the development of APD prolongation and suppressed EAD and DAD development. Conclusions: Our study adds to the understanding the role of BIN1. We demonstrate the first-time electrical remodeling in the form of QT and APD prolongation associated with BIN1 deficiency, due to reduced I to and I K1 and increase in late I Na , an increase in EAD and DAD events. Additionally, VK-II-86 is shown to normalize APD in isolated cardiomyocytes and suppress afterdepolarization events, making it a potentially novel and effective therapeutic strategy in HF associated with BIN1 deficiency.
Abstract 411: Characterization of Pediatric In-Hospital Cardiac Arrest in Denmark
Authors: Kasper G Lauridsen, Elakiya Naveendran, Bea Brix, Bo Lofgren
Journal: Circulation (2023)

Background: Pediatric in-hospital cardiac arrest occurs frequently and is associated with high mortality. However, the epidemiology of pediatric in-hospital cardiac arrest outside of the US is poorly characterized. Aim: We aimed to characterize pediatric in-hospital cardiac arrests in Denmark. Methods: This is a nationwide cohort study. We collected data from the Danish in-hospital cardiac arrest registry (DANARREST) from 2013-2021. We included all pediatric in-hospital cardiac arrests (&lt;18 years of age) with a clinical indication for CPR. Neonatal cardiac arrests were excluded. Results: We identified 318 cases of which 137 had a cardiac arrest with an indication for CPR and complete data. Overall, the median (quartile 1; quartile 3) age was 2 (0; 13) years and 90 (66%) were male. In total, 34 (25%) occurred in the pediatric intensive care unit, 79 (58%) were monitored, 121 (90%) were witnessed, and 42 (31%) were intubated prior to the cardiac arrest. The initial rhythm was PEA (51%), asystole (19%), VF/ VT (13%) and pulse generating rhythm (17%). The cause of arrest was cardiac (23%) vs. non-cardiac (77%). Median time to first rhythm check was 1 (0;3) minutes and median time to arrival of the cardiac arrest team was 3 (2; 5) minutes. Overall, 81% achieved return of spontaneous circulation or return of circulation on ECMO, whereas 49% survived to 30 days, and 43% survived to one year. Conclusion: Most pediatric in-hospital cardiac arrests in Denmark occurred outside of the pediatric intensive care units, and almost half were not monitored. However, almost half survived to 30 days.
Abstract 396: A Novel Machine Learning Approach for Identifying Subgroups With Differential Responses to Amiodarone in Patients With Cardiac Arrest With Shockable Rhythm
Authors: Mitsuaki Nishikimi, Ryo Emoto, Shinichiro Ohshimo, Shigeyuki Matsui, Nobuaki Shime
Journal: Circulation (2023)

Introduction: Although there is a possibility that the effectiveness of amiodarone may differ among a particular subgroup, there are few studies on the differential effects of amiodarone for the out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm. Objective: To identify subgroups with differential responses to amiodarone in OHCA with shockable rhythm by a novel machine learning approach. Methods: We used data from the Japanese nationwide OHCA registry of the Japanese Association for Acute Medicine. The OHCA patients who had initial shockable rhythm upon hospital arrival were included. The primary outcome was a good neurological outcome at 30 days, defined as a Cerebral Performance Categories score ≤2. We developed a linear score by outcome weighting learning (OWL) method with logistic loss to identify subgroups with differential effects of amiodarone. The difference in the effect of amiodarone between subgroups based on the developed score was evaluated by repeated cross-validation (RCV), and hypothesis testing was performed by the permutation method. Results: Among 68,111 OHCA patients in the registry, data of 2333 patients with initial shockable rhythm upon hospital arrival were analyzed. Our developed score showed that the longer duration from call to EMS to hospital arrival, hypothermia at hospital arrival, and no defibrillation until hospital arrival were important variables that had a trend of increasing the beneficial effect of amiodarone (Table). The effect of amiodarone on neurological outcomes varied significantly among the subgroups identified by the developed scores (OR: 1.05 (95%CI: 0.99-1.13), P [RCV] = 0.038). Conclusions: We successfully developed a model that discriminates between the patients for whom amiodarone had a harmful effect on their neurological outcome from those for whom amiodarone had a beneficial effect. In the patients for whom amiodarone had a harmful effect, the other treatment approaches may be needed.
Abstract 409: Burden of Overdose in Young Adult Cardiac Arrest Cases
Authors: Shaveta Khosla, Marina Del Rios, Pavitra Kotini-Shah, Elizabeth Froelich, Courtney Schwerin, Teri Campbell, Eddie Markul, Katie Tataris, Joseph Weber, Terry Vanden Hoek
Journal: Circulation (2023)

Introduction: Overdose related out-of-hospital cardiac arrests (OHCA) are preventable devastating occurrences, often affecting young adults, leading to many years of productive life lost. The purpose of this study was to characterize overdose related OHCA over time and assess its excess burden in young adult cases in the state of Illinois. Methods: The Cardiac Arrest Registry to Enhance Survival (CARES) database was used. We excluded pediatric and trauma cases. Bivariate associations were assessed. Population attributable fractions (PAF) were also calculated. Results: During 2018 to 2022, a total of 23,637 non-traumatic adult OHCA cases were reported to CARES from Illinois (with a population catchment &gt;40% in 2022). Of these, 8.2% (N=1,928) were overdose related. Overdose accounts for 9.5% of the OHCA in males, and 5.9% in females. By race and ethnicity, 9.6% of cases in Hispanics, 9.3% in Blacks and 7.3% in Whites are due to overdose. The number of overdose related OHCA peaked in 2020 (n=449); however, 2022 (n=432) contributed to the historically highest proportion of overdose related OHCA (8.5%). While the overall mean age for OHCA was 63.7 (SD=17) years with a peak at 60 years, the mean age for overdose cases was 44.7 (SD=13.5) with a peak at 50 years. While young adults (18-34-year-olds) have a lower likelihood of cardiac arrests accounting for only 6% of the total OHCA, they contribute 26% of the overdose OHCA. Young adult OHCA cases are nearly six times more likely to be overdose related (Relative Risk=5.5; 95% CI: 5.0 - 6.0) as compared to older cases. In terms of population impact, 21% of the overdose related OHCA are attributed to young adult cases (PAF=0.212). If young adults had the same risk of overdose-related OHCA as older cases, we would expect 408 fewer overdose-related OHCA, and the rate of overdose-related OHCA would drop from 8.2% to 6.4%. Similarly, for adults &lt;40 years of age, 31% of the overdose related cardiac arrests are attributed to these young cases (PAF=0.309), and we would expect 596 fewer cases had the risk of overdose related OHCA been same as older cases. Conclusion: Overdose related OHCAs represent a significant burden in younger patients. Prevention strategies that reduce the burden of overdose related OHCA should be a public health priority.