tbuckley/cabot-search huggingface dataset:
Abstract 397: Hydrogen Inhalation in Combination With Hypothermic Temperature Control Improves Survival After Out-of-Hospital Cardiac Arrest
Authors: Koji Minami, Tomoyoshi Tamura, Hiromichi Narumiya, Masaru Suzuki
Journal: Circulation (2023)

Background: In a randomized trial, we demonstrated that hydrogen (H 2 ) inhalation improves the outcomes after cardiac arrest (CA). All patients underwent target temperature management (TTM) in this trial, but the selection of a target temperature between 32 and 36 °C varied per institutional protocol. This study aimed to investigate the interaction of H 2 and hypothermic TTM on survival after CA. Methods: This post-hoc analysis of a randomized controlled trial (HYBRID II Trial; jRCTs031180352) included comatose patients after cardiogenic out-of-hospital CA (OHCA). They received either 2% H 2 mixed oxygen (H 2 group) or oxygen alone (control group) for 18 hours under hypothermic TTM (&lt;35°C) or normothermic TTM (35-36°C). A target temperature was reached quickly, maintained for 24 hours, and rewarmed over 48 hours. The survival rate was compared between the H 2 and control groups under hypothermic or normothermic TTM. Results: The analysis included 72 patients with outcome data (39 and 33 patients in the H 2 and control group, respectively). Hypothermic TTM was implemented in 25 (64%) and 24 (73%) patients in the H 2 and control group, respectively (P=0.46). Under hypothermic TTM, the 90-day survival rate was 88% (22/25) and 46% (11/24) in the H 2 and control group, respectively (P=0.01). In contrast, under normothermic TTM, 78% (7/9) and 79% (11/14) of patients survived 90 days in the H 2 and control group, respectively (P=0.93). The interaction between H 2 and hypothermic TTM was independently associated with 90-day survival in a multivariable logistic regression model (adjusted odds ratio 7.79 [95%CI: 1.46-41.6]), however, it was marginally significant in the Cox proportional hazards model (adjusted hazard ratio 0.33 [95%CI: 0.10-1.17]) after adjusting for confounding factors including age, sex, witness status, bystander CPR implementation, shockable rhythm, CA duration, and time from the return of spontaneous circulation to gas inhalation, respectively. Conclusions: H 2 in combination with hypothermic TTM improved 90-day survival after OHCA but not under normothermic TTM.
Abstract 285: A Prospective Evaluation of Indicators of Psychological Distress in Surrogates of Cardiac Arrest Survivors
Authors: Isabella M Tincher, Sabine Abukhadra, Danielle A Rojas, Mina Yuan, Christine DeForge, Sachin Agarwal
Journal: Circulation (2023)

Background: Family surrogates of cardiac arrest (CA) patients have unique needs due to thesudden, life-threatening, and traumatic nature of the CA. We prospectively assessed the prevalenceof psychological distress among CA surrogates and characterized their preferences for resourcesto reduce uncertainty throughout the illness trajectory of their loved ones. Methods: Between August 1, 2021 and May 31, 2023, English-speaking family surrogates (&gt;18years old) of consecutive CA patients were recruited to complete an in-person assessment beforehospital discharge. Indicators of psychological distress were measured using the Post TraumaticStress Disorder (PTSD) Checklist 5 (PCL5; cut-off &gt;33), Generalized Anxiety Disorder-2 (GAD2;cut-off &gt;3), and the Patient Health Questionnaire-8 (PHQ8; cut-off &gt;9). An investigator-developedsurvey of eight unique interventions, composed by a multidisciplinary research team of patient andsurrogate stakeholders, aimed to alleviate the identified measures of psychological distress.Participants ranked their top choice among these eight interventions, focusing on patient-centerededucation and logistical needs (n=4) or on surrogate-centered self-care and psychological supportneeds (n=4). Results: Of the 163 family surrogates approached, 83 participated (66% female; age 51±15 years;41% white, 25% black, 31% Hispanic/Latino). Nearly all participants presented withpsychological distress; 66% (n=55) experienced elevated generalized anxiety, 29% (n=24)experienced characteristics of PTSD, and 57% (n=47) had moderate depression. Of the eightinterventions, 22% of surrogates (n=18) ranked increased access to the care team as the mosthelpful intervention. The next most highly prioritized intervention was increased information onpotential recovery, chosen by 20% (n=17). Conclusion: Family surrogates experience a high burden of PTSD, anxiety, and moderatedepression symptoms in response to a loved one experiencing CA. Their needs and lack ofresources have yet to be tangibly addressed within the hospital system. Future research shouldexplore the impacts of CA on family surrogates.
Abstract 256: Quantitative Assessment and Visualization of Hypoxic Ischemic Brain Injury in Survivors of Cardiac Arrest Using Unenhanced Computed Tomography Images
Authors: Dong Young Lee, Jung Soo Park, Kang Changshin
Journal: Circulation (2023)

Aim: This study aimed to investigate whether the distribution of Hounsfield units (HU) values in head computed tomography (HCT) images can serve as an effective tool for assessing the severity of hypoxic ischemic brain injury (HIBI) in survivors of out-of-hospital cardiac arrest (OHCA). Methods: This retrospective study included adult comatose OHCA survivors who underwent first HCT scans within 6 hours and second HCT scans between 72-96 hours on the same CT machine after the return of spontaneous circulation. Automated quantitative analysis was used on CT images to eliminate artifacts and identify differences in the proportion of HU values (HUp) at specific intervals across the intracranial area based on neurological outcome. Additionally, correlation analysis was conducted between serum levels of neuron-specific enolase (NSE) at 48 hours post-ROSC and the sum of HUp values in the aforementioned intervals. Poor outcome was defined as cerebral performance categories 3-5 at 6 months post-ROSC. Results: Of the 55 included patients (84% male), 23 (42%) had poor outcome. Significant differences in HU values were observed between outcomes in the second HCT scan at HU=1-14, 23-35, and 39-56 (P&lt;0.05). Within the same HU interval, the poor outcome group showed a greater change between the first and second HCT scans compared to the good outcome group (Figure). The correlations between the sum of HUp and NSE levels within the range of HU=1-14, 23-35, and 39-56 in the second HCT were 0.34, 0.60, and 0.49, respectively (Figure). The second HCT scans demonstrated better prognostic performance than the first HCT scan for HU=1-14 (area under the curve 0.75 vs. 0.60), 23-35 (0.85 vs. 0.62), and 39-56 (0.75 vs. 0.59), while no significant difference was observed compared to GWR (0.78) (all P≥0.05). Conclusions: The proportional sum of HU values within specific intervals in the entire cerebral area on CT images can effectively assess and visualize the extent of HIBI in survivors of OHCA.
Abstract 266: Texas Out of Hospital Cardiac Arrest Gender Disparities From Statewide Out-of-Hospital Cardiac Arrest Data Registry - The Texas Cares Project
Authors: Benjamin L Karfunkle, Ryan Huebinger, Richard Witkov, Kevin Schulz, Joseph Gill, Carrie A Bakunas, John Waller-Delarosa, Micah Panczyk, Normandy W Villa, Bentley Bobrow
Journal: Circulation (2023)

Introduction: Female out-of-hospital cardiac arrest (OHCA) victims experience differences in care and worse rates of survival compared to male victims. Gender differences in time spent by prehospital care teams on scene with patients has not been studied. Hypothesis: There are gender disparities in scene time and outcomes. Increased scene time is associated with worse outcomes for Males and Females. Methods: We performed a retrospective, cohort study of the Texas Cardiac Arrest Registry to Enhance Survival (CARES) from 2014-201. We included adult OHCAs not witnessed by prehospital personnel that included scene time data and did not result in return of spontaneous circulation in the field that were transferred to emergency departments for ongoing resuscitation. We described OHCA demographics. We evaluated the association between gender and scene time. Using multivariable logistic regression, we evaluated the association of scene time with favorable neurologic outcome, (cerebral performance category (CPC) of 1 or 2). Results: We include 11,782 encounters with OHCA not witnessed by prehospital personnel, of these 7,185 were male and 4,597 female. Female OHCAs were older than male (mean 63.7 vs 61.3, p &amp;lt; 0.01). Female patients had slightly longer scene times than males (mean 29.2 vs 27.9). Female patients were less likely to have favorable neurologic outcomes (12.5% women vs 17.3% men, p &lt; 0.01 by chi2). Adjusting for age, gender, race, initial rhythm and bystander CPR in the multivariable model, increased scene time remained associated with a lower odds of favorable neurologic outcome (OR 0.96, 95%CI 0.95-0.96). Conclusions: OHCAs with longer duration scene time were associated with a lower likelihood of favorable neurologic outcome. Female patients were likely to have longer scene time duration and worse rate of favorable neurologic outcome.
Abstract 253: The Recovery of Consciousness via Evidence-Based Medicine and Research Program: An Innovative Paradigm for Advancing Neuroprognostication After Cardiac Arrest
Authors: David Fischer, Benjamin Abella, Geoffrey Bass, Jeremy Charles, Stephen Hampton, Catherine Kulick-Soper, Matthew Mendlik, Oscar Mitchell, Aliza Narva, William Pino, Morgan Sikandar, Saurabh Sinha, Genna Waldman, Jeffrey Ware, Joshua Levine
Journal: Circulation (2023)

Introduction: Prognostication of neurologic recovery in post-cardiac arrest coma often dictates whether life-sustaining treatments are continued or withdrawn. However, the conventional approach to prognostication is fragmented and inconsistent, impeding clinical care, research and education. Goals: We sought to establish an innovative approach to prognostication -- the Re covery of Co nsciousness V ia E vidence-Based Medicine and R esearch (RECOVER) program -- that provides specialized, comprehensive, and longitudinal care. Methods: Inpatients with post-arrest coma are evaluated by a dedicated RECOVER consult service, which collects data per evidence-based guidelines and advises clinical teams and families. Patients are discussed in a weekly interdisciplinary conference (with neurology, physiatry, radiology, palliative care, social work, physical therapy, ethics, and others) to formulate holistic prognostic determinations and treatment plans. For surviving patients, the RECOVER program provides continuity through partnered post-acute facilities and outpatient clinics. This clinical infrastructure is leveraged to build a registry of clinical data and outcomes. Trainees are incorporated throughout. Results: Between August 2022 and June 2023, the RECOVER program evaluated 70 patients with post-arrest coma (mean age 55y [SD = 16]). Of those, 34 (49%) survived to hospital discharge without transition to hospice care. Of the 25 patients ≥3 months from discharge, four have returned to clinic (16%). Functional MRIs are interpreted with the aid of neuroradiology and ethics. Preliminary data suggest high caregiver satisfaction with the RECOVER program (mean of 4.7 on a 5-point Likert scale). Conclusion: The RECOVER program enables systematic, guideline-based and interdisciplinary care, provides continuity, and facilitates clinical translation of research in patients with post-arrest coma. The RECOVER program helps provide ongoing healthcare access to this vulnerable population, although clinic retention is low. The RECOVER program also promotes trainee education and serves as an effective platform for data collection. If adopted broadly, the RECOVER program may advance post-arrest care and facilitate multi-center research.
Abstract 351: Novel Quantitative Imaging Biomarkers From Acute Brain CT Using Artificial Intelligence for Predicting Neurological Prognosis in Cardiac Arrest Patients: A Pilot Study
Authors: Kei Nishiyama
Journal: Circulation (2023)

Background: Effective use of information extracted from medical images has attracted attention for decision support in primary care of patients with cardiac arrest (CA). Hypothesis and Aims: This study aimed to predict the neurological prognosis of patients with cardiac arrest by quantitative imaging biomarkers (QIBs) extracted from acute CT brain images before admission using artificial intelligence. Methods: Eighty-six CA patients (good prognosis; Glasgow-Pittsburgh cerebral performance categories [CPC]=1 or 2 at 90 days after the CA : 32 patients, poor prognosis; CPC=3, 4, or 5 at 90 days after the CA : 54 patients) treated at three hospitals between 2017 and 2019 were retrospectively analyzed. None of the CA patients caused by trauma or brain damage were included in the database. The data were divided into training and test data, and the training data were used to select informative QIBs for classification between the good and poor neurological prognosis in this analysis. Results: Seven CA patients’ data were excluded from the study due to severe metal and bone artifacts broadly spreading on the brain image, and 1170 QIBs were extracted from whole brain and regional brain interest volumes on CT images of each patient. The QIBs were composed of first-order histogram and texture features and informative QIBs for the classification were selected by feature selection algorithms using the training dataset. The feature corresponding to the gray level having a maximum gradient in the image histogram from the brain region of interest on CT images showed the strongest significant difference between the good and poor neurological prognosis of the test data set with p=0.009 and AUC=0.775 (95% CI; 0.590-0.960). Conclusions: We have shown that QIB can be used to predict neurological prognosis in patients with CA. Because this is a pilot study for methodological development and there are limitations in sample size and outcomes, new studies on a larger number of patients are required.
Abstract 219: Prediction of Shock-Refractory Ventricular Fibrillation Amidst Continuous Chest Compressions During Out-of-Hospital Cardiac Arrest Resuscitation
Authors: Jason Coult, Heemun Kwok, Betty Yang, J. Nathan Kutz, Jennifer E Blackwood, Peter J Kudenchuk, Thomas Rea
Journal: Circulation (2023)

Background: Shock-refractory (SR) ventricular fibrillation (VF) patients (requiring ≥ 3 shocks) have relatively poor outcomes. Prediction of SR-VF may enable preemptive interventions targeted to improve SR-VF outcomes, such as earlier antiarrhythmics, alternative shock delivery strategies, or early transport for hospital-based interventions. We recently demonstrated prediction of SR-VF in the context of current practice whereby chest compressions (CCs) are interrupted for electrocardiogram (ECG) analysis prior to the initial shock. However, since pausing CCs is detrimental to outcome, ideally next-generation defibrillator algorithms will analyze during uninterrupted CCs, precluding CC interruption for SR-VF prediction. Aim: We designed a machine learning algorithm to predict SR-VF based on ECGs surrounding the first shock during CCs. Methods: We performed a retrospective study of adult out-of-hospital VF cardiac arrests treated by paramedics from 2008-2020 in King County WA. From each patient we collected a pair of 3-s VF ECG segments during uninterrupted CCs prior to and 1 minute following the first shock. Patients were randomized into 80%/20% groups for training/test. A random forest classifier was trained to predict SR-VF using dimensionally-reduced ECG scalograms. Performance was assessed by area under the receiver operating characteristic curve (AUC) and sensitivity for &gt;90% specificity. Results: Of 940 included patients, 584 (62%) had SR-VF, median age was 62, 206 (22%) were female, and 429 (46%) survived to hospital discharge. AUC for predicting SR-VF was 0.80 (95% CI: 0.72-0.85) in 188 test patients (Figure), with specificity of 92% and sensitivity of 52%. Conclusion: Automated SR-VF prediction during ongoing CCs is possible using the ECG surrounding the initial shock. Early identification of SR-VF during CCs could prompt preemptive, patient-specific treatments without compromising CPR, potentially improving resuscitation outcome.
Abstract 305: Practice How You Play! An Innovative Two-Pronged Approach at Improving Resident and Allied Health Staff Performance During Code Blue Events
Authors: Olubadewa A Fatunde, John Odneal, Valarie Schwind, Tiffany Egbe, Belinda Wright, Karin Kirbow, Prithvi Muddana, Beth A Neidlinger, Michelle Stokes
Journal: Circulation (2023)

Introduction/Background: Cardiopulmonary arrest (Code Blue or CB) is a feared complication of severe medical illnesses. In-hospital CB events (CBE) have been estimated to have a mortality rate of only 30.4%. CBEsare difficult to prepare for and execute due many factors, including their low frequency, high complexity, and unpredictability. Research Questions/Hypothesis: Over 6 months (March - September 2019), we tested the effects of both adaptation of a Code Blue (CB) Team Leader (TL) checklist—aimed at improving resident leadership and communication—as well as implementation of an interdisciplinary in-hospital CB simulation to improve the performance of both resident physicians. Methods/Approach: Primary outcomes included change in resident confidence leading a CBE (i.e. Level of comfort as TL , confidence of diagnosis and management, confidence in code-related procedural skills), and familiarity with the institutional rapid response protocol. Secondary outcomes included self-reported confidence of nurses to execute their role, and both physician and nurse time to response. Confidence parameters were measured by a 10 point Likert scale. Pre-intervention, baseline cross-sectional survey values of the primary outcome were obtained from 24 internal medicine residents (12 PGY2s, 12 PGY3) over 6 months. Post-intervention, the cross-sectional survey was repeated. Results/Data (descriptive and inferential statistics): Statistics for residents displayed in table and figure 1. The level of nurse confidence increased from 7.5 to 8.25 over 5 months. The time to first response by residents has decreased by more than 50%. Conclusion(s) Our project improved the quality and resident level of comfort running Code Blue events among both residents and nurses.
Abstract 275: Point-of-Use Ultrasound in Out-of-Hospital Cardiac Arrest: A Meta-Analysis of Diagnostic Accuracy and Outcome Prediction
Authors: Muhammed K Elfaituri, Ala Khaled, Ahmed BenGhatnsh, Ahmed Elfaituri, Hazem Abdelkarem A Faraj, Ahmed Msherghi
Journal: Circulation (2023)

Background: Out-of-hospital cardiac arrest (OHCA) is a significant global health issue where accurate and rapid decision-making can often be the difference between life and death. Point-of-use ultrasound has been proposed as a potential tool to assist in such decisions by predicting patient outcomes. However, the current body of literature presents diverse results, thus emphasizing the need for an all-encompassing meta-analysis to assess the diagnostic accuracy of point-of-use ultrasound. Aim: This study aimed to determine the diagnostic accuracy of point-of-use ultrasound in predicting the outcomes of adult OHCA. Methods: We undertook a search of databases, including PubMed, Embase, and Cochrane Library, for studies published until November 2022 that investigated the role of point-of-use ultrasound in adult OHCA and its relation to patient outcomes. We utilized R software (version 4.0.3) equipped with the mada package for our statistical analysis, which allowed for pooling sensitivity, specificity, and false-positive rate estimates. Results: Nine studies were included in the final analysis. For survival to hospital discharge (four studies with a total of 1144 patients), the pooled sensitivity was 6.4% (95% Confidence Interval (CI): 1.2%-27.2%, I2=97.5%), specificity was 1.9% (95% CI: 0.9%-4.2%, I2=58.2%), the false-positive rate was 98.1% (95% CI: 95.8%-99.1%), the diagnostic odds ratio was 0.001 (95% CI: 0-0.009), positive LR was 0.065 (95% CI: 0.013-0.319), and negative LR was 49.15 (95% CI: 22.08-109.37). For the return of spontaneous circulation (ROSC) (six studies with a total of 1476 patients), the pooled sensitivity was 26.1% (95% CI: 17%-37.8%, I2=91.2%), specificity was 76.1% (95% CI: 42.1%-93.3%, I2=94.1%), the false-positive rate was 23.9% (95% CI: 6.7%-57.9%), diagnostic odds ratio was 1.13 (95% CI: 0.23-5.44), positive LR was 1.09 (95% CI: 0.33-3.61), and negative LR was 0.97 (95% CI: 0.66-1.42). Conclusion: Our study suggests that point-of-use ultrasound's predictive value for survival and ROSC in adult OHCA may be lower than anticipated, given high false-positive rates and low diagnostic odds ratios. These results underscore the need for further research before integrating ultrasound into OHCA decision-making.
Abstract 373: Traumatic Bleeding Severity Score: An External Validation Study for the Predictive Accuracy of the Need for Massive Transfusion
Authors: Kei Kimoto, Takayuki Ogura, Kensuke Fujita, Takuya Kimura, Kayo Misumi, Yoshihiro Hagiwara
Journal: Circulation (2023)

Background: The Traumatic Bleeding Severity Score (TBSS) was developed to predict the need for massive transfusion (MT). The aim of this study was to conduct the first external validation study about the TBSS in Japan, and to compare its prediction value to other pre-existing MT prediction scores. Methods: A multicenter retrospective observational study was conducted in Japan (Japanese observational study for coagulation and Thrombolysis in Early Trauma 2 : J-OCTET 2). Twenty-five tertiary critical care centers in Japan participated in this study, and severe trauma patients (Injury Severity Score : ISS ≥ 16) admitted from 2018 to 2019 were enrolled. At the analysis of the TBSS external validation, patients with isolated head injuries were excluded from the analysis. In this study, MT was defined as 10 units or more of red blood cells transfusion within 24 hours from injuries. The TBSS on admission was retrospectively calculated and its accuracy in predicting MT was analyzed by the area under the receiver operating characteristic curve (AUROC). To compare the predictive value between the TBSS and the pre-existing scores, the Trauma Associated Severe Hemorrhage score (TASH score) and the Assessment of Blood Consumption score (ABC score) on admission was similarly calculated, and the ROC comparison analysis was performed. Results: Totally, 1202 severely injured trauma patients were enrolled in the J-OCTET 2 study, and 889 patients were analyzed after the matching of the exclusion criteria. The median age was 66 years (IQR: 47-77), 71.4 % was male, 97.9% was blunt trauma, median ISS was 22 (IQR:16-29), and 13.8% received MT. The AUROC of the TBSS for was 0.848 (95% CI:0.81-0.88). According to the ROC comparison, the AUROC of the TASH score was 0.848 (95% CI: 0.81-0.88) and there was no significant difference between both prediction scores. (Bonferroni adjusted p=1.00). The AUROC of the ABC score was 0.751(95% CI: 0.70-0.80), which was significantly lower to TBSS’s (Bonferroni adjusted p&lt;0.01). Conclusion: This TBSS external validation study showed that the accuracy of TBSS in the MT prediction was moderate accuracy. The predictive value of the TBSS was comparable to that of the TASH score and superior to the ABC score.