tbuckley/cabot-search huggingface dataset:
Abstract 277: Characterizing the Components of Impulsiveness for Manual Chest Compressions During Out-of-Hospital Cardiac Arrest
Authors: Jose Antonio Urigüen, Mikel Leturiondo, Koldo Redondo, Jose Julio Gutiérrez, James K Russell, Mohamud R Daya, Sofia Ruiz De Gauna
Journal: Circulation (2023)

Introduction: Current resuscitation guidelines recommend depth, rate and complete recoil of chest compressions (CCs) to be monitored as part of CPR quality metrics. The literature also suggests CC impulsiveness as an additional measure of CPR quality. The impulsiveness of CCs has mainly been examined through reduced compression duration, but this fails to incorporate information of the waveform, especially for manual CCs. Aim: To retrospectively characterize impulsiveness and its components within manual CC series defined between pauses. Methods: Monitor-defibrillator recordings of adult out-of-hospital cardiac arrest cases, attended by TVF&amp;R (OR, USA), containing depth signal, were processed to identify series of CCs between pauses. We calculated the compression impulsiveness index (see figure), CII = IF/DR, of each CC. IF is the impulse factor of the waveform, defined as its maximum depth divided by its mean depth; DR is the duration ratio, defined as the ratio between the duration of the compressive part and the total duration of the compression. We obtained variations of CII, IF and DR within series between pauses for sets of 10 consecutive CCs. Results: A total of 6,073 series of median (IQR) length 190 (119-222) CCs were used. Overall, CII was 5.27 (4.80-5.86), IF 2.19 (2.05-2.36) and DR 0.42 (0.38-0.45). From the beginning to the end of the series, median CII, DR and IF decreased 2.01%, 1.53% and 3.41%, respectively; all p trend &lt; 0.05. This reflects that CCs change from being spikier to more rounded and shallower (see figure). Conclusion: Impulsiveness decreases moderately within CC series, which indicates that rescuers are able to maintain it during each series. The drop in IF is mainly responsible for the loss of impulsiveness, despite the decrease in DR (since IF declines twice as much). Thus, impulsiveness is better characterized by the CC waveform than by its duration. The observed overall variability of all metrics reveals differences between rescuers.
Abstract 308: Comparison of Cardiopulmonary Resuscitation Performance Between Integrated CPR Device Performing Chest Compression and External Defibrillation versus LUCAS3 With Automated External Defibrillator: A Animal and Manikin-Based Pilot Study
Authors: Woo Jin Jung, Young-Il Roh, Sung Oh Hwang, Hyeonyoung Im, Yujin Lee, Dahye Im, Kyoung-Chul Cha
Journal: Circulation (2023)

Background: Early chest compression and defibrillation are important components for successful resuscitation. The use of mechanical CPR has increased after the outbreak of COVID-19, and this trend continued in the post-pandemic period. We developed an automatic CPR performing chest compression and external defibrillation simultaneously following current CPR algorithm. Methods: This study was designed as a study to compare the performance of CPR and AED between automatic CPR apparatus (A-CPR) and commercially proven mechanical CPR device (LUCAS3) plus AED (C-CPR) during CPR in swine cardiac arrest model and the study to evaluate feasibility of A-CPR in simulated cardiac arrest model. Results: There were no significant differences in hemodynamic variables between the groups. Time to ECG analysis [38.0 sec in A-CPR, 48.0 sec in C-CPR, p =0.010], time to initial shock advice plus subsequent chest compression [46.0 sec in A-CPR, 57.0 sec in C-CPR, p =0.017], time to first defibrillation [48.5 sec in A-CPR, 65.0 sec in C-CPR, p =0.004], charge to shock interval [3.0 sec in A-CPR, 8.0 sec in C-CPR, p =0.001], and hands-off time [11.0 sec in A-CPR, 22.5 sec in C-CPR, p =0.001] were significantly shorter in A-CPR group than C-CPR group. In the simulation study, the pure chest compression time [101 sec in A-CPR, 110 sec in C-CPR, p&lt; 0.001], hands-off time [75 sec in A-CPR, 94 sec in C-CPR, p&lt; 0.001], time from power-on to first chest compression [55 sec in A-CPR, 82 sec in C-CPR, p&lt; 0.001], time to first shock delivery [40 sec in A-CPR, 51 sec in C-CPR, p= 0.001] were significantly shorter in A-CPR group than C-CPR group, respectively. Chest compression fraction showed a significant higher in A-CPR than C-CPR [57% in A-CPR, 54% in C-CPR, p &lt;0.001]. Conclusions: The A-CPR device demonstrated significant time savings effect than conventional mechanical CPR device and automated external defibrillation device. In addition, A-CPR and C-CPR showed similar hemodynamic effects and resuscitation outcomes in a swine model of cardiac arrest
Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course
Authors: Scott Goldberg, Greg Peters, Rebecca E Cash, Dawei Jiang, Conor O'Brien, Mohammad Adrian Hasdianda, Eric Eberl, Kathleen Salerno, Jacob Lees, Jenson Kaithamattam, Jeremiah Tom, Eric Goralnick
Journal: Circulation (2023)

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.
Abstract 222: Real Time Feedback of Chest Compressions by Hands-Free Carotid Doppler in a Porcine Model
Authors: Bjoern Faldaas, Erik Nielsen, Benjamin S Storm, Knut Tore Lappegård, Ole-jakob How, Bent Aksel Nilsen, Gabriel Kiss, Eirik Skogvoll, Hans Torp, Charlotte B Ingul
Journal: Circulation (2023)

Background: Real-time hemodynamic feedback devices provide information on cardiopulmonary resuscitation (CPR) quality. This can improve hand positioning and technique, thereby maximizing blood flow and potentially improve survival. Hypothesis: We hypothesize that a newly developed hands-free Doppler for carotid blood flow velocity (RescueDoppler, RD), can identify optimal vs. suboptimal chest compression sites during CPR. Aim: To assess the potential of the RD device to continuously monitor the effect of each compression by ultrasound metrics and waveforms in a porcine model. Methods: Ventricular fibrillation was induced in 5 pigs using an ICD. Manual CPR (blinded for hemodynamic data) was performed for 10 seconds at 3 different compression sites in random order (Fig.), and repeated 6 times. We analyzed ultrasound waveforms with Time Average Velocity (TAV) in a linear mixed model with site as fixed effect, and animal and site within animal as random effects. We further compared TAV to invasive systolic blood pressure (SBP) from the contralateral carotid artery. Results: Data from 5 pigs (mean weight 31.2 kg) and 29 of 30 sequences were included. Overall, blood flow velocity was highest at compression site 2 (TAV 33 cm/s, P&lt;0.01), but there was significant variability (P&lt;0.01) in animals (SD= 3.7) and at sites within animal (SD= 7). A compression site yielding the highest TAV (range 19 to 48 cm/s) or lowest TAV (6-25 cm/s) was successfully identified in all animals with corresponding SBPs 50-81 mmHg, and 46-64 mmHg, respectively. The correlation between TAV and SBP was 0.62-0.90 within animals. Conclusions In this animal study, a newly developed hands-free Doppler enabled assessment of blood flow velocity during CPR and detected significant variation according to chest compression site. RD identified the sites with both high and low blood flow velocities and is thus a promising device for effectively identifying the optimal and suboptimal chest compression sites during CPR.
Abstract 316: Reperfusion With Mild versus Moderate Hypothermia in a Swine Model of Extracorporeal Cardiopulmonary Resuscitation
Authors: Alexandra M Marquez, Marinos Kosmopoulos, Rajat Kalra, Deborah Jaeger, Christopher Gaisendrees, Adrian Ripeckyj, Alejandra Gutierrez, Tamas Alexy, Andrea M Elliott, Marie E Steiner, Jason Bartos, Davis Seelig, Demetris Yannopoulos
Journal: Circulation (2023)

Background: Targeted temperature management (TTM) at lower temperatures has shown variable neuroprotective benefits in clinical trials of cardiac arrest. We hypothesized that moderate hypothermia at the time of VA-ECMO reperfusion followed by early rewarming would reduce brain injury in a swine model of refractory VF, compared to mild hypothermia. Methods: Fourteen female pigs had electrically induced VF and conventional CPR for 30 minutes. Animals were cannulated to VA-ECMO and randomized to TTM to 34°C for 4 hours (mild hypothermia, n=7) or 24°C for 1 hour followed by early rewarming to 34°C over 3 hours (moderate hypothermia, n=7). Cooling was initiated upon ECMO reperfusion by circulating ice water through the oxygenator. Brain temperature and cerebral and systemic hemodynamics were continuously monitored. After four hours of post-arrest and ECMO care, brain tissue was obtained for examination. Groups were compared using paired t- and Wilcoxon rank sum tests. Results: The mean time to target brain temperature was 5 and 35 minutes in the mild and moderate groups, respectively (Panel, A). CPR hemodynamics were similar. Carotid blood flow (CBF) was higher in moderate hypothermia animals (79.0±1.56 vs 60.7±1.86% pre-arrest baseline, P &lt;0.001) throughout the post-arrest period. There were no differences in ECMO flow, mean arterial pressure, vasopressor/fluid requirement, bleeding, or thromboelastography. No significant difference in histologic damage score was observed between groups (10.5 [7, 11.8] vs 13 [9, 20], with 24°C vs 34°C respectively P =0.25; Panel, B). Immunohistochemistry markers for white matter and neuronal injury also did not significantly diverge. Conclusion: In a swine model of refractory cardiac arrest treated with ECPR, moderate hypothermia initiated upon reperfusion followed by early rewarming did not appear to be neuroprotective. Histological brain injury at 4 hours post-resuscitation was not affected by the degree of hypothermia.
Abstract 320: Survival and Neurological Function With Rapid versus Delayed Automated Head-Up CPR in a Porcine Model of Prolonged Cardiac Arrest
Authors: Pouria Pourzand, Johanna C Moore, Anja Metzger, Bayert Salverda, Mithun Suresh, Susana Arango, Henry Rosenhagen, Alex Kaizer, Guillaume P Debaty, Keith G Lurie
Journal: Circulation (2023)

Background: Rapid Basic Life Support (BLS) treatment with controlled sequential elevation of the head and thorax, active compression-decompression CPR, and an impedance threshold device, collectively termed automated Head Up Position (AHUP)-CPR, is associated with better outcomes versus conventional CPR (C-CPR) in animal models and human observational studies. Hypothesis: Rapid AHUP-CPR should improve survival and neurological function vs rapid C-CPR followed by delayed AHUP-CPR. Aim: Determine if AHUP-CPR should be initiated as a BLS or ALS intervention. Methods: Male and female farm pigs (n=22) weighing~40kg were anesthetized and ventilated. Central venous and aortic pressures, as well as end-tidal CO2 (ETCO2) and cerebral oximetry (rSO2) were measured continuously. After 15 min of untreated VF, pigs were randomized to either rapid AHUP-CPR for 25 min or 10 min of C-CPR followed by 15 min of AHUP-CPR. Pigs received intravenous epinephrine and amiodarone after 24 min of CPR and were defibrillated 60 sec later. For the primary endpoint, 24-hour neurologic function, a veterinarian blinded to the CPR intervention assessed pigs using a Neurological Deficit Score (0 = normal and 260 = worst deficit score or death). Secondary outcomes included 24-hour survival rates and hemodynamic parameters. Data were expressed as mean ± SD. Statistical significance was determined by log-rank, Mann-Whitney-U and unpaired t-tests. Results: Sustained return of spontaneous circulation was achieved in 10/11 pigs with rapid AHUP-CPR vs 6/11 with delayed AHUP-CPR and cumulative 24-hour survival rates were 45.5% (5/11) vs 9.1% (1/11), respectively (p=0.01). Neurological Deficit Scores were 202.7 ± 80.3 with rapid AHUP-CPR vs 259.1 ± 3.0 with delayed AHUP-CPR group (p=0.04). Ten minutes after initiating CPR, ETCO2 (mmHg) was 45.0 ± 3.8 vs 26.9 ± 5.4 (p&lt;0.001), and rSO2 (%) was 67.3 ± 3.9 vs 61.4 ± 6.3 (p=0.01) with rapid AHUP-CPR vs delayed AHUP, respectively. Conclusion: In a severe and prolonged model of porcine cardiac arrest, rapid AHUP-CPR, delivered as a BLS intervention, significantly improved the survival rate, neurological function and hemodynamics when compared with rapid C-CPR followed by delayed AHUP-CPR.
Abstract 230: Epidemiology of Out-of-Hospital Cardiac Arrest Incidence and Field Termination in the US
Authors: David G Buckler, Samuel Sondheim, Ethan Abbott, Brendan G Carr, Michael Redlener, alexis zebrowski
Journal: Circulation (2023)

Introduction: While registry-based OHCA research produces high quality information on treatment and outcomes, it lacks the ability to place OHCA in context with EMS-treated conditions. We sought to estimate the rate of OHCA in a national sample of EMS emergency responses and describe national trends in occurrence and field termination. Methods: Using the National EMS Information System (NEMSIS) Public-Release Datasets, we conducted a retrospective analysis of EMS runs for OHCA. EMS agencies were analyzed using a masked ID constant across data years. To be included, a run must be documented as “cardiac arrest prior to EMS arrival” and the agency must report more than 10 total Emergency Response runs for each data year. The OHCA rates were calculated and presented as OHCA per 1000 runs. Median rates were compared using Mood’s test. To compare agency level trends in care delivery, agencies had to document &gt;5 OHCA runs in each study year. Results: From 2019-2021, there were 83,914,470 Emergency Response runs submitted to NEMSIS. Of these, 840,620 (1.0%) were documented as cardiac arrest (CA) prior to EMS arrival. The OHCA cohort was 37% female, 13% Black, 5% Hispanic/Latinx, 39% White and 41% Not Documented. The mean age was 59 years (SD 21) with 21% missing. The national incidence of OHCA was 10 CA per 1,000 runs. Most agencies saw 13 or fewer OHCA per year (median: 13, IRQ: 5, 44). Agency level rates varied with a median annual rate of 12.6 per 1,000 runs (IQR: 8.5, 18.7). Median agency rates were similar across all three years (11.4 vs 13.0 vs 12.5, p&gt;0.05 for all). Overall, field termination was 47%, with more occurring in 2020 compared to 2019 and 2021 (19-20: 44% vs 49%; 20-21: 49% vs 47%; p &lt;0.001 for all). Agency field termination percentage was positively correlated with ROSC percent among transported patients (ρ = 0.12, p &lt;0.001) but negatively correlated with overall ROSC (ρ = -0.34, p&lt;0.001). Conclusion: Despite perceived limitations of non-registry data, significant information about OHCA care is widely available from existing public data. Absent a population-level OHCA rate, by benchmarking OHCA with all EMS runs, we can monitor for significant changes in OHCA incidence. Field terminations appear to be associated with more ROSC among transported patients, but not overall.
Abstract 223: What Affects Chest Compression Depth in Out-of-Hospital Cardiac Arrest?
Authors: James K Russell, Joshua Lupton, Mikel Leturiondo, Mohamud R Daya, Sofia Ruiz De Gauna
Journal: Circulation (2023)

Introduction: Adherence to CPR guidelines for chest compressions depth (CCD) is poor. Compressors tend to converge on an individualized depth for each patient. Aim: Determine the factors affecting CCD in adult out-of-hospital cardiac arrest (OHCA). Methods: Patient, event, and EMS characteristics extracted from a regional registry (age, sex, estimated weight, witness status, bystander AED use, location, time to reach patient, initial ECG rhythm, number of shocks delivered, advanced airway use, initial EtCO2, number of EMS responders) were linked to depth and stiffness (force/depth) data from CPR monitors of resuscitation efforts for adult OHCA collected by a first response agency in suburban Portland, Oregon during 2018-21. With generalized linear models we examined the relationship of case-wise CCD in relation to stiffness and arrest characteristics, as well as the determinants of stiffness, a dominant predictor of CCD. Significant univariate predictors (p &lt; 0.05) were combined into multivariate models, where we assessed statistical significance with a limit of 0.05/(number of predictors). Results: Case-wise median (IQR) chest compression depth was 50.3 (44.2 - 56.1) mm. Weight and stiffness dominated multivariate predictivity for depth (Table). Age had a modest effect overall and was not predictive in witnessed cases. Depth decreased with increasing stiffness and weight and increased slightly with age. Sex, weight and responder count were predictors of stiffness. Responder count did not predict initial stiffness. Stiffness increased with weight and decreased with number of responders. Conclusions: Depth of chest compressions is best predicted by patient stiffness and weight. Age contributes little, sex is non-significant. Responders do not vary depth in relation to other arrest characteristics. Age, weight and number of responders were the best predictors of stiffness.
Abstract 16763: Complete Heart Block as a Complication of Diffuse Large B Cell Lymphoma
Authors: Jose A Luna Alvarez Amezquita, Victor G Becerra, Moises A Vazquez, ALFREDO PEREZ TAGLE TEJEDA, Yoana Palatianos de Araujo, Ivan A Mijares, Marian Calfa
Journal: Circulation (2023)

Abbreviations: DLBCL (diffuse large B cell lymphoma), CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). Description of case We present the case of a 78-year-old female who presented initially with a right neck mass, abdominal pain, diarrhea, and recurrent pericardial effusions requiring pericardial window procedure. Biopsy of the neck mass demonstrated a DLBCL. Involvement of a right atrial mass attached to the septum in close relation to the tricuspid valve was seen on TEE. Metastatic disease to the lungs and liver was demonstrated on CT chest and abdomen respectively. The patient posteriorly developed symptomatic bradycardia that on electrocardiogram and telemetry monitoring was shown to be due to a complete heart block with junctional and ventricular escape beats with a rate of 30-40 beats per minute. Due to the anatomical characteristics of the right atrial mass, placement of a right ventricle leadless pacemaker (micra) was decided. The patient was started on mini-CHOP chemotherapy shortly afterwards. Discussion Primary cardiac lymphomas are a rare presentation accounting for less than 1% of all cardiac malignancies. Although rare, secondary involvement of the heart is more frequent than primary involvement and represents 20-25% of the cases. From all the broad subtypes of lymphomas, DLBCL is the most commonly found to affect the cardiac system, often being represented by alterations in the conduction system and causing congestive heart failure. The exact mechanism of the conduction abnormalities in the setting of cardiac lymphoma has not yet been well elucidated but is presumed to be either caused by an infiltration of the conduction system, direct mass burden effect, or a combination of both. It has been seen in similar cases that initiation of chemotherapy can help decrease the pacing requirements or even resolve completely the conduction abnormalities. In a few cases, permanent pacing is required. Metastatic disease to the heart is a marker for poor outcome and median survival with therapy after diagnosis is between 7 to 18 months.
Abstract 18390: Ibrutinib Increases Ventricular Arrhythmia Burden Independently of Atrial Arrhythmia
Authors: Stefan Torelli, Yunqiu Jiang, Alyssa Ayala, Muhammad Fazal, Ronald M Witteles, Tina Baykaner, Han Zhu, June W Rhee, Paul Cheng
Journal: Circulation (2023)

Introduction: Use of Bruton Tyrosine Kinase inhibitors (BTKi) such as ibrutinib is frequently limited by atrial arrhythmia, possibly through off-target inhibition of C-Terminal-Src-Kinase (CSK). Whether BTKi can directly trigger ventricular arrhythmia is less clear. Case reports and retrospective analysis have suggested a link, but causal effect is not established. The association is further put into doubt by absent expression of CSK or BTK in ventricular cardiomyocytes, and absence of ventricular arrhythmia signals in meta-analyses of BTKi RCTs. Further study is critically needed. Hypothesis: Ibrutinib induces ventricular arrhythmia through a unique mechanism. Methods: We performed a retrospective crossover study of ibrutinib-treated patients with serial cardiac monitoring both on and off ibrutinib (pacemakers, loop recorders, or multiple holters) across a 10-year span in a large academic center to compare burden of atrial/ventricular ectopy on and off ibrutinib. A separate group of Chronic Lymphocytic Leukemia (CLL) patients with serial cardiac monitoring not on BTKi was used as additional controls. To determine biological correlation, we tested the ability of ibrutinib to induce arrhythmia in cultured human Induced Pluripotent Stem Cell derived ventricular cardiomyocytes (iPSC-vCMs). Results: 88% (15/17) of patients on ibrutinib with serial cardiac monitoring had increased burden of Premature Ventricular Contractions (PVCs), with an average increase of 155 PVCs/hour (p&lt;0.0001). An increase was not observed in the control cohort. Ventricular arrhythmia burden was not associated with atrial arrhythmia burden. Removing patient-related confounders, in vitro analysis of iPSC-vCMs demonstrated that ibrutinib induced arrhythmia following three days of treatment in a dose-dependent manner. Conclusions: In patients with continuous/serial cardiac monitoring, ibrutinib is associated with a significant increase in ventricular ectopy (average of 155 PVCs/hr). Lack of ventricular and atrial arrhythmia concordance suggests an alternative mechanism of arrhythmia induction. Increased arrhythmogenicity of human ventricular cardiomyocytes treated with ibrutinib indicates a direct myocardial mechanism.