tbuckley/cabot-search huggingface dataset:
Abstract 39: Donating Automated External Defibrillators May Not Be Enough
Authors: Melissa B Ludgate, Karl B Kern, Bentley J Bobrow, Gordon A Ewy
Journal: Circulation (2012)

Background: In response to the out-of-hospital sudden death of their son, parents and friends established a local foundation in Tucson, Arizona to help prevent sudden cardiac death. One of their projects was to provide Automated External Defibrillators (AEDs) predominately to public and private schools, places of worship, boys and girls clubs and museums in Tucson, Arizona and surrounding area. Prior to receiving the AED, the majority of sites attended training in the use of the AED, that included information concerning the need to replace the electrodes pads before they expired. Methods: The first author of this abstract (a trained Emergency Medical Technician and a recent college graduate) visited sites that responded to the offer of assistance to retrain individuals in the proper use of their AED. Included in the visit, she determined the status of the donated AED and provided education about future maintenance. Results: Each site visited had received their AED between 7/2009 and 4/2011. Of the 36 sites visited, the majority of the units had potential problems. One had been stolen, and one was missing (2/36 or 6%). Of the remaining 34 units, 23/34 (68%) had outdated electrode pads, and in 2/34 (6%) the battery had expired. Thus only 11/34 (32%) were emergency ready. Of these, 7/11 had been donated within two years (the average shelf-life of AED electrode pads). The other 4/11 had replaced their expired AED electrode pads. Conclusions: Providing AEDs alone may not be the optimal approach. A system must be in place to assure that they are properly stored and maintained. AED pads with longer “shelf-life” should also be a goal of AED manufacturers.
Abstract 44: Outcomes of OHCA Not Improved After New Guideline Implementation in Taiwan: Nationwide Population-Based Research Using National Health Insurance Data
Authors: Dorji Harnod, Mathew Huei-Ming Ma, Chu-Hui Chang
Journal: Circulation (2012)

Background: Survival after out-of-hospital cardiac arrest (OHCA) depends on the integrity of the community chain of survival, including high quality CPR, early defibrillation, better hospital and post-resuscitation care. Recent studies from US showed the outcomes from OHCAs improved significantly after implementation of new resuscitation guideline. Our study, by using the population- based National Health Insurance data, was aimed to assess the factors associated patient outcomes and the improvement after guidelines 2005 implementation in Taiwan. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2005 to 2008, all of patients who were sent to emergency department with diagnosis of OHCA were identified from the database (ICD 798, 798.1, 798.2, 798.9). Traumatic OHCA and patients without codes for intubation and CPR were excluded in our study. Factors such as age, gender, preexisting co-morbidities and different hospital levels were adjusted in a logistic regression model for survival analysis. All the survival cases were followed up for one year in our data-set. Results: 2,375 OHCA cases were identified from the four-year dataset. The survival rates were 7.3%(2005), 7.5%(2006), 7.2%(2007) and 6.5%(2008) (p&gt;0.05). And the survival rates was 7.4% in medical centers, 7.8% in regional hospitals and 5.0% in district hospitals (p&gt;0.05). In the logistic regression analysis model, for all the OHCA patients admitted to ER and to hospitals, none of the factors (including the age, gender, preexisting co-morbidities and different hospital levels) were significant for survival. Conclusions: After adjusting for age, gender and preexisting co-morbidities, our study shows that OHCA patients had equal outcomes between medical centers and non-medical centers. And our data also showed non-significant outcome improvement after guidelines 2005 implementation in Taiwan.
Abstract 248: Continuous Chest Compressions with Interposed Ventilations Are Associated with Improved Outcomes from Suspected Asphyxial Arrest
Authors: Justin Lemieux, Ruchika Husa, Dorothy Scyoc, James Gordon, Rebecca Sell, Ruth Chappel, Anushirvan Minokadeh, Daniel Davis
Journal: Circulation (2012)

Background: A continuous chest compression (CCC) approach to CPR avoids pauses that decrease coronary perfusion pressure. However, the ability to provide adequate ventilation during CCC remains unclear. Cardiopulmonary arrest (CPA) victims with suspected asphyxia would be expected to be the most impacted by inadequate ventilation during CPR. Objective: To explore the impact of CCC on outcome from inpatients with suspected asphyxial CPA. Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. The ART program advocates CCC with interposed ventilations performed at a 10:1 ratio. Ventilations are initiated with the onset of compression recoil for both unprotected and protected airways. Data for all CPAs are entered into a resuscitation database. CPA events are categorized based on suspected etiology. Survival-to-discharge rates before and after implementation of the ART protocol were evaluated using chi-square analysis including test for trend. Ventilation rates were measured over the final 18 months of the study. Results: A total of 140 inpatients had suspected asphyxial CPA during the study period. Survival-to-discharge increased from 21.8% to 47.2% following implementation of the ART CCC protocol (p&lt;0.001). Average ventilation rates associated with CCC were 9.7 breaths/min. Conclusions: An inpatient CCC protocol with ventilations interposed at a 10:1 ratio was associated with marked improvements in outcome among patients with suspected asphyxial CPA. These data suggest that adequate ventilation can be achieved with synchronous delivery of breaths with the recoil phase of compressions. Controlled ventilation rates were also achieved.
Abstract 241: Neurocognitive Functioning and Quality of Life After Successful Resuscitation from Cardiac Arrest
Authors: Stefanie G Beesems, Kim M Wittebrood, Rob J de Haan, Rudolph W Koster
Journal: Circulation (2012)

Objective Neurocognitive function (NCF) and Quality of Life (QoL) of patients (pts) with an out-of-hospital cardiac arrest (OHCA) may have improved since an increasing number of pts are managed with an AED and Therapeutic Hypothermia (TH) is universally applied. We studied the NCF and QoL of consecutive pts 6-12 months after OHCA and the QoL of their relatives. Materials and methods The study population comprises all consecutive pts (&gt;18 year) who survived 6-12 months after OHCA from mid-2010 to mid-2011. Pts and relatives were interviewed by telephone. The questionnaires used were validated for telephonic application with a validated cut-off score. The QoL was measured with the SF-12, NCF with the Telephonic Interview Cognitive Status (TICS), level of independence with the Modified Rankin Scale (MRS). If needed, the IQ-code was used as proxy-questionnaire to measure the NCF of the pt. The Caregiver Strain Index (CSI) was used to measure QoL of the relatives. The elderly (≥ 80 years) were compared to an open Dutch population of ≥ 80 years. Treatment effect was calculated with an effect size θ. Effect sizes near 0 are small, &gt;0.8 or &lt;-0.8 are considered as significant and relevant. Results The proportion of the pts who scored normal on the questionnaires is shown in the table. When TICS and IQ-code are added up, 180 of 220 pts (82%) had a normal NCF. The mean score of elderly on the mental SF-12 was 40.5 and on the physical SF-12 53.2, while the compatible population scored 38.1 (θ =-0.20) and 54.4 (θ =0.15), respectively. Pts with TH scored 54.2 on the mental SF-12, while pts without TH scored 52 (θ=0.26). The mean score on the physical SF-12 of pts with TH was 46.4 and without the need of TH 44.8 (θ=0.16), respectively. Conclusion QoL, NCF and independency in daily-life 6-12 months after OHCA is normal in the great majority of pts. Mental QoL is better compared to physical QoL. Pts ≥80 years score equal to age comparable persons of the normal population. Outcome after TH is equal to those not needing TH.
Abstract 250: Effect of a Single First 4 Minutes BLS Training Session on BLS Skills Acquisition and 6-Month Retention for First-Year Medical Students
Authors: Mehdi Draoua, Elizabeth Sinz
Journal: Circulation (2012)

Introduction : First 4 Minutes (FFM) incorporates experiential learning and real-time problem solving using simulated emergencies that require individuals to work collaboratively for success. This study examined the effect of a Basic Life Support-based FFM exercise on novice students’ BLS individual and team skill acquisition and retention. Method : 41 first year medical students were randomly assigned to teams in one of 2 groups. All participants had completed and passed a standard classroom BLS course including lecture, manikin practice and written exam and manikin-based skills test. The experimental groups then participated in a FFM-BLS training session using a feedback manikin (Laerdal ACS manikin with PC skills reporting software). Students’ BLS skills were compared using the associated computer software on day 1 with and without the FFM-BLS training at baseline and again 6 months later on the same manikin. Individual performance of chest compressions was compared for all participants. Group code response data (time to first AED shock, first shock pause, total hands off time during code, and percent of correct depth of compression) as well as subjective teamwork analysis scores were measured. Statistical analysis was performed using a Signed Rank Test and Wilcoxon Rank Sum Test. Results : Initial performance in BLS simulation prior to the FFM-BLS activity was similar. Analysis of individual data both immediately after the BLS course with or without FFM-BLS and at 6 months showed a significantly increased percentage of correct depth of compression (p=0.006 &amp; 0.016) and of average depth (p=0.008 &amp; 0.012) in the FFM-BLS group compared with the control group. Group code response data and teamwork analysis scores were significantly better in the experimental group on day 1 but only showed a trend toward better performance in the experimental group at 6 months in this small sample. Conclusion : Supplemental simulation training using the FFM approach is associated with improved acquisition and retention of individual and teamwork BLS skills by first year medical students and should be considered to enhance their acquisition of these skills.
Abstract 256: Novel Universal Field Termination-of-Resuscitation Decision Rules for Predicting Nonsurvivors After Refractory Out-of-Hospital Cardiac Arrest
Authors: Yoshikazu Goto, Tetsuo Maeda, Yumiko Goto, Keisuke Ohta
Journal: Circulation (2012)

Introduction : Pre-hospital termination-of-resuscitation (TOR) decision rules have been introduced for emergency medical services personnel to identify non-survivors after refractory out-of-hospital cardiac arrest (OHCA) according to their life support care levels. Hypothesis : We assessed the hypothesis that our newly developed universal TOR rules for mixed levels of providers can predict non-survivors with an appropriate positive predictive value (PPV). Methods : We analyzed 495607 OHCA adult patients with all causes, using a prospectively recorded nationwide Utstein-style database in Japan over 5 years (2005-2009). Main outcome measures were specificity and PPV of newly developed TOR rules for predicting 1-month survival with unfavorable neurological outcome (cerebral performance category = 3-5). Secondary outcome measures were specificity and PPV of new rules for predicting 1-month death. We developed new TOR rules using data from 4 years (2005-2008, n = 390577), with validation using external data from 2009 ( n = 105030). Results : Multivariate logistic regression analysis showed that no return of spontaneous circulation had the strongest association with outcome (odds ratio [OR] 38.3; 95% confidence interval [CI] 35.9-41.0). Unshockable initial rhythm (OR 3.38; 95%CI 2.98-3.84) and witnessed by bystanders (OR 2.01; 95%CI 1.87-2.17) were also independently associated with neurological outcomes. Three variables were incorporated into new TOR rules. New rules showed 0.939 specificity (95%CI 0.933-0.945) and 0.998 PPV (95%CI 0.998-0.999) for identifying survivors with unfavorable outcome, and had a c-statistic of 0.922. The specificity, PPV, and c-statistic for external validation data were 0.966 (95%CI 0.958-0.973), 0.999 (95%CI 0.999-0.999), and 0.942, respectively. The specificity and PPV in developing group for predicting 1-month death were 0.875 (95%CI 0.870-0.881) and 0.992 (95%CI 0.991-0.992), respectively, and those in validation group were 0.903 (95%CI 0.894-0.911) and 0.993 (95%CI 0.992-0.993), respectively. Conclusions : Novel developed universal field TOR decision rules for mixed levels of providers can predict non-survivors after refractory out-of-hospital cardiac arrest with appropriate PPV.
Abstract 265: For How Long a Period Have Medical Students and Nurses Retained ACLS Skills?
Authors: Migaku Kikuchi, Hisao Matsushima, Yukiko Tosaki, Ikue Tomizawa, Isao Taguchi, Shichiro Abe, Kazuyuki Ono, Teruo Inoue
Journal: Circulation (2012)

OBJECTIVE: To evaluate whether the period of retention of ACLS skills is different between medical students and registered nurses. METHODS: A prospective observational study was performed. Medical students and registered nurses were trained both BLS and ACLS based on the American Heart Association (AHA) 2005 Guidelines tools, and evaluated by skill performance tests based on the AHA 2005 BLS and ACLS tools in simulated environment, at immediately and 3 months after training. The registered nurses were similarly evaluated also at 9 months after training. RESULTS: A total of 197 medical students enrolled was trained, being assigned to 30 groups. Twenty four registered nurses in a general ward were trained, being assigned to 6 groups. In 3 months after training, the medical students retained the core skills of chest compression, which included the correct rate and adequate depth of chest compressions, delivering 30 compressions and 2 ventilations, and resuming chest compressions after shocks, whereas checking breathing, 2 ventilations with bag-valve-mask, or checking carotid pulse was done in only 33% of all groups. The airway management and drug use in the secondary ACLS survey and the effective communication and team dynamics were done in 30%-50% of all groups. The registered nurses also retained the core skills of chest compression and drug use in 3 months after training. Especially, effective communication and team dynamics were well-retained in all groups. In 9 months after training the registered nurses also retained, whereas both opening airway and first 2 ventilations were done in 50% of all groups. Checking carotid pulse or checking breathing was little done for at least 5 seconds but no more than 10 seconds. CONCLUSIONS: Through BLS and ACLS training, the registered nurses have well retained resuscitation skills, but they also have well demonstrated effective communication and team dynamics for longer period than medical students. Medical students are required short interval of retraining ACLS skills with team dynamics, similarly healthcare providers without performing resuscitation as daily work may be. In addition to this, it should be important to apply effectively different way to teach ACLS skills, such as e-learning or self-training.
Abstract 249: Cardiac Arrest in the Emergency Department: A Comparison of Pediatric and Adult Outcomes and Care Processes
Authors: Aaron Donoghue, Benjamin Abella, Raina Merchant, Robert Berg, Vinay Nadkarni
Journal: Circulation (2012)

Background: About 10% of in-hospital cardiopulmonary arrest (CPA) events occur in the Emergency Department (ED). Published outcomes from CPA in the ED are discrepant between adults and children, with much worse survival among children. Reasons for these differences are unclear. We hypothesize a greater prevalence of unfavorable cardiorespiratory physiology among pediatric patients, and less optimal processes of care as a result of lower frequency occurrences among children in the ED. Methods: Retrospective cohort study from the Get With The Guidelines - Resuscitation database. All patients whose CPA event occurred in the ED were included. Univariate comparison between children (age &lt;18 yo) and adults (age &gt; 18 yo) was done for Utstein outcomes (ROSC, 24 hr survival, survival to discharge) as well as patient factors (illness category, pre-existing conditions), event factors (initial rhythm, pulse sequence, total duration), and times to interventions; χ 2 analysis was used for categorical variables, t-testing for continuous variables. Results: 706/10947 (6.4%) of pediatric CPA events and 18473/189,653 (9.7%) of adult CPA events occurred in the ED. Median age for adults was 65 yr (IQR 52 - 77 yr), 21 months for children (IQR 3 mos - 10 yr). Children had a greater prevalence of respiratory insufficiency (51% vs. 43%, p&lt;0.001), septicemia (10% vs. 7%, p=0.05), and trauma (18% vs. 6%, p&lt;0.001). Shockable initial rhythm was less common in children (17% vs. 31%, p&lt;0.001) and CPR prior to pulselessness was more common (28% vs. 8%, p&lt;0.001). In children, total duration of CPR was longer (28.6 + 1.0 mins vs. 22.9 + 0.3 mins, p&lt;0.001) and time to epinephrine was shorter (2.2 + 0.4 mins vs. 2.8 + 0.1 mins, p=0.03). Times to compressions, airway, and defibrillation did not differ significantly. 24 hour survival was worse among children (26% vs. 33%, p=0.001); ROSC (49% vs. 52%) and survival to discharge (26% vs. 24%) did not differ significantly. Conclusions: Compared with adults, 24 hour survival is worse among children with CPA in the ED; other outcomes are less discrepant than in previously published studies. Pediatric CPA in the ED more commonly occurs from respiratory insufficiency or shock. Differences in outcomes do not appear related to timing of critical interventions.
Abstract 26: Impact of Total Occlusion of the Coronary Artery and the Amount of Infarct-Related Myocardium in Patients with Refractory Cardiac Arrest due to Acute Coronary Syndrome
Authors: Eisuke Kagawa, Keigo Dote, Masaya Kato, Shota Sasaki, Yoshinori Nakano, Kiho Itakura, Yusuke Ochiumi, Yu Takiguchi, Hideko Honda, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yasuki Kihara
Journal: Circulation (2012)

Introduction: Acute coronary syndrome (ACS) is a leading cause of sudden cardiac arrest. Percutaneous coronary intervention (PCI) may provide improved outcomes for resuscitated patients; however, prognosis in refractory cardiac arrest patients remains poor. Hypothesis: We assessed the hypothesis that total occlusion of the culprit coronary artery is associated with refractory cardiac arrest that is unresponsive to conventional cardiopulmonary resuscitation (CPR). Methods: Adult out-of-hospital cardiac arrest patients who underwent emergency coronary angiography and were diagnosed with ACS were enrolled in this retrospective study. We divided the patients into 2 groups: patients who achieved return of spontaneous circulation by conventional CPR (group 1) and patients with refractory cardiac arrest who were unresponsive to conventional CPR and were treated with extracorporeal CPR (group 2). Data about thrombolysis in myocardial infarction flow grade were collected at initial coronary angiography. P &lt; 0.05 was defined as statistically significant. Results: We enrolled 54 patients (group 1; n = 35), median age of the patients was 61 y (interquartile range 54-72 y), 87% patients were male, 81% patients were witnessed cardiac arrest, 57% patients were received CPR initiated by by-standers, and 67% patients showed shockable initial recorded rhythm. The rate of culprit lesion in the left main trunk was higher in group 2 than in group 1 (3% vs. 21%, P = 0.04), and that in the left circumflex artery was lower in group 2 (20% vs. 0%, P = 0.04). Thrombolysis in myocardial infarction flow grade 3 was observed in 29% of group 1 and 16% of group 2 patients (P = 0.34), and thrombolysis in myocardial infarction flow grade 0 or 1 was observed in 57% of group 1 and 84% of group 2 patients (P = 0.04). Coronary reperfusion therapy by PCI was performed in 81% of the patients, and all of whom achieved return of spontaneous heart-beat. Conclusions: Total occlusion of the coronary artery and a large amount of infarct related myocardium may be associated with refractory cardiac arrest due to ACS. Coronary reperfusion therapy could achieve higher rate of return of spontaneous heart-beat and may improve outcomes in patients with refractory cardiac arrest.
Abstract 267: Airway Pressure Is a Valid Surrogate for Intrapleural Pressure During CPR
Authors: Younghoon Kwon, Scott McKnite, Timothy Matsuura, Andrew Merriam, Bayert Salverda, Demetris Yannopoulos
Journal: Circulation (2012)

Background: Using direct measurement of intrapleural pressure (Ppl), we sought to assess true intrathoracic pressure during various interventions of CPR and to explore its relationship with airway pressure (Paw). We hypothesized that Ppl would correlate with Paw and with coronary (CPP) and cerebral (CePP) perfusion pressures. Methods: Ppl catheter was inserted into right anterior aspect of pleural cavity. Paw, right atrial (Pra), aortic and intracranial (ICP) pressures were recorded continuously. Proper placements were confirmed in all animals post mortem. Following 4 minutes of untreated ventricular fibrillation in 6 anesthetized female farm pigs (34 ± 2 kg), CPR was performed in the following sequence for 2 minutes per each intervention. Standard CPR (sCPR), Active compression decompression (ACD) CPR, ACD+ inspiratory impedance threshold device (ITD) CPR, ACD + intrathoracic pressure regulator (ITPR) CPR. Data were collected during last 20 seconds of each intervention. Results: Highest and lowest mean Paw and Ppl were observed during sCPR and ACD +ITPR CPR respectively. Mean Paw showed modest correlation with mean Ppl. (r2=0.15, p=0.06). After adjusting for variance between the animals, significant correlation was observed (r 2 =0.81, p&lt;0.0001). In contrary, no significant correlation was observed between mean Pra and Ppl. Among intrathoracic pressure variables mean Ppl and Paw (not mean Pra) showed significant inverse correlations with both CPP and CePP. Mean Pra was strongly correlated with ICP. (Table) Conclusion: A significant correlation of mean Paw with Ppl provides validity of using Paw as a surrogate measurement to monitor intrathoracic pressure during standard CPR and ACD assisted interventions. Table) Within animal correlation between intrathoracic pressure variables and central perfusion pressures.