tbuckley/cabot-search huggingface dataset:
Abstract 9622: Baseline Hemodynamics with Cardiac Performance Response to Contrast Media During Diagnostic Cardiac Catheterization Enhances Prediction of Adverse Events in Heart Failure Patients
Authors: Scott J Denardo, David M Vock, Carsten M Schmalfuss, Gregory D Young, James E Tcheng, Melvin R Echols, Karen S Pieper, Christopher M O'Connor
Journal: Circulation (2011)

Background. Anticipating adverse events (death, HF rehospitalization) in heart failure patients (HF pts) could help direct care while reducing event rates and resource utilization. We hypothesized that the combination of baseline pulmonary capillary wedge pressure (PCWP) and change in measures of cardiac performance (ΔCP) following administration of contrast media during diagnostic cardiac catheterization would predict adverse events and add to the predictive value of existing models. Methods. Prospective study of 150 consecutive HF pts referred for non-emergency right and left heart catheterization using iodixanol or iopamidol contrast. Hemodynamic variables measured at baseline and following contrast included PCWP and CP (composite of cardiac output, cardiac index and stroke volume, identified from sparse principal component analysis of all hemodynamic variables). Kaplan-Meier curves were generated for 1 year followup using median baseline PCWP and ΔCP to group pts. The effect of adding these hemodynamic parameters to the predictive value of 4 validated risk models (Seattle HF Score; ESCAPE; CHARM; CORONA) was assessed using Cox proportional hazards regression model. Results. The average contrast load was 120ml. There was a graded worsening of long-term adverse events, with event rates increasing with the composite metric (Figure). Adding baseline PCWP and ΔCP to the 4 risk models significantly improved their predictive capacity (Table). Conclusions. Baseline PCWP with change in CP following administration of contrast predicts adverse events and adds to the predictive value of existing models. The calculations add no cost and can be performed in minutes.
Abstract 62: Direct Comparison of the Effect of Mild Hypothermia and Controlled Normothermia on Reactive Oxygen Metabolites Production and Antioxidant Potential After Cardiac Arrest in a Porcine Model
Authors: Petr Ostadal, Mikulas Mlcek, Andreas Kruger, Svatava Horakova, Frantisek Holy, Tomas Svoboda, Jan Belohlavek, Otomar Kittnar, Petr Neuzil
Journal: Circulation (2012)

Introduction . Mild therapeutic hypothermia was implemented in the management of post cardiac arrest syndrome (PCAS) after publication of clinical trials comparing hypothermia with common practice, i.e. usually with hyperthermia. Current evidence on the comparison of mild hypothermia (HT) and controlled normothermia (NT) is, however, still insufficient. We tested the hypothesis that HT is superior to NT in suppression of oxidative stress, which plays probably an important role in the pathogenesis of PCAS. Methods. We worked on porcine model (females, 45 kg) in general anesthesia and mechanical ventilation (HT and NT groups, four animals per group). Veno-arterial extracorporeal membrane oxygenation (ECMO) was introduced and on minimal ECMO flow (0.5 L/min) ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of cardiac arrest, circulation was restored by increase of ECMO flow to 4.5 L/min and 90 min of reperfusion followed. Target core temperature (33°C in HT and 36.8°C in NT) was maintained using heat exchanger on oxygenator. Blood levels of reactive oxygen metabolites (ROM) and biological antioxidant potential (BAP) were assessed before cardiac arrest, immediately after restoration of blood flow and at 30, 60, and 90 minutes of reperfusion. Results . While the pre-arrest and early post-arrest ROM levels were comparable in both groups, we observed significant differences between HT and NT groups later during the reperfusion: at 30 minutes (HT vs. NT: 277.8 ± 11.4 vs. 363.3 ± 13.4 U Carr, p &lt; 0.01), at 60 minutes (292.8 ± 6.6 vs. 355.8 ± 10.9 U Carr, p &lt; 0.05), and at 90 minutes (278.5 ± 12.3 vs. 340.8 ± 14.1 U Carr, p &lt; 0.05). The levels of BAP were comparable in both groups in all measurements. Conclusion . Our results indicate superiority of mild therapeutic hypothermia over controlled normothermia in the suppression of oxidative stress after cardiac arrest.
Abstract 66: Association of Initial Neurological Examination with Survival Following Out-of-Hospital Cardiac Arrest
Authors: Jon C Rittenberger, Francis X Guyette, Ankur A Doshi, John Clore, David F Gaieski, Anne V Grossestreuer, Benjamin S Abella, Michael Donnino, Michael Cocci, Mary Ann Peberdy, Joseph P Ornato, Clifton W Callaway, None National Post-Arrest Resuscitation Consortium
Journal: Circulation (2012)

Introduction: Following resuscitation from out-of-hospital cardiac arrest (OHCA), failure to awaken from coma remains a common cause for withdrawal of care. Prior investigations have demonstrated initial organ system dysfunction is associated with survival and neurologic outcome. Hypothesis: We hypothesized that initial neurologic examination would be associated with survival following resuscitation from cardiac arrest. Methods: We conducted a retrospective study of 111 comatose OCHA subjects treated with dedicated post-arrest protocols, including therapeutic hypothermia and hemodynamic optimization. These subjects were prospectively enrolled in a multicenter clinical study examining mitochondrial dysfunction from ischemia-reperfusion injury (COMICA Study Group). Subjects not receiving sedation during the initial examination were eligible for analysis. Neurologic examination was classified using the motor and brainstem subscores of the Full Outline of UnResponsiveness (FOUR). For analysis, subjects were dichotomized as deep coma (FOUR Motor+ Brainstem&lt;4) or not. Survival and good neurologic outcome, defined as a Cerebral Performance Category (CPC) of 1-2 and Modified Rankin Scale (mRS) of 0-3 were compared using chi-squared tests. Results: Mean age was 61 (SD 17) years, 66 (59%) male, witnessed in 91 (82%), and received bystander CPR in 49 (44%) of cases. The predominant rhythm was VF/VT in 56 (50%) and low flow time was 19 (IQR 9, 28) minutes. The initial neurologic examination was obtained without sedation in 54 (49%) of subjects. Subjects with deep coma on initial examination were less likely to survive (18% vs. 65%; p&lt;0.001), or have a good outcome using CPC (15% vs. 45%; p=0.01) or mRS (15% vs. 45%; p=0.01). Conclusions: Deep coma on initial neurologic examination is associated with death prior to discharge and poor neurologic outcome. However, depth of coma alone is insufficient to rule out good outcome.
Abstract 70: External Validation of the Hypothermic to Ischemic Ratio as a Predictor of Survival from Out-of-Hospital Cardiac Arrest for Patients Presenting with a Shockable Rhythm
Authors: Kelly N Sawyer, Michael C Kurz, RK Elswick, Chun Zhan, Michelle Gaudio, Laurie J Morrison
Journal: Circulation (2012)

Objectives: The Hypothermic to Ischemic Ratio (H/I Ratio = total hypothermic time (THT) / total ischemic time (TIT)) was derived to predict survival after out-of-hospital cardiac arrest (OHCA) and found to be highly significant in multivariable models. We sought to externally validate these findings. Methods: Adult, non-traumatic, OHCA patients presenting with a shockable rhythm (VF/pVT) and surviving to hospital admission between September 1, 2007, and December 31, 2011, were considered for inclusion. Structured data were abstracted from a population-based dataset (Strategies for Post Arrest Care (SPARC) Network database (Toronto, Canada)). THT was measured from initiation in the ED, through therapeutic hypothermia (TH) and rewarming to at least 36.5°C. TIT was estimated from call to 911 or EMS witnessed collapse to return of spontaneous circulation (ROSC). Patients were excluded for age &gt;90 years, TIT &lt;5 or &gt;90 minutes, cooling initiated &gt;6 hours after ROSC, rewarming time &gt;30 hours, or missing relevant intervals. Stepwise logistic regression was used to fit the most parsimonious model. Results: Overall, 1,170 OHCA patients received TH, average age 65 years (SD 15.4), 71% male, 85% witnessed, and 43% with bystander CPR. A total of 497 VF/pVT patients met our criteria, with 52.5% surviving to discharge. In multivariable modeling (Table), TIT, age, and H/I Ratio were the most significant predictors for survival (Chi-Sq 123.43, p&lt;0.0001, R² = 0.25, area under curve = 0.82). Conclusions: External validation of the H/I Ratio confirmed it is a significant predictor for survival in OHCA patients presenting with a shockable rhythm. Prospective studies should consider H/I Ratio as a potential predictor for investigation.
Abstract 71: A Novel Animal Model of Pulseless Electrical Activity Cardiac Arrest: Adrenergic Blockade and Coronary Occlusion
Authors: Atman P Shah, James T Niemann, Scott T Youngquist, Joseph L Thomas, John P Rosborough
Journal: Circulation (2012)

Introduction: The incidence of VF as the first documented rhythm in out-of-hospital cardiac arrest (OOHCA) has been declining, while the incidence of pulseless electrical activity (PEA) has been increasing. The increasing proportion of PEA as the initial rhythm for OOHCA has paralleled the increasing use of adrenergic antagonist therapy in the population most at risk for cardiac arrest. We hypothesized that PEA cardiac arrest can result from acute coronary occlusion in the setting of pre-arrest adrenergic blockade. Methods: Twenty-six anesthetized and instrumented immature male swine (mean weight 36 kg) were pre-treated with an infusion of labetalol, a β-1 and α-1 adrenergic blocker (mean dose 6 ± 3 mg/kg). Adequacy of adrenergic blockade was determined using an intravenous challenge of epinephrine 0.1 mg IV. After challenge and return to baseline, balloon occlusion of the left anterior descending (LAD) or proximal right coronary artery (RCA) was performed and the rhythm and hemodynamic response observed during sustained occlusion. Results: Occlusion of the RCA was followed by PEA or pseudo-PEA (defined as an organized rhythm with systolic arterial pressure &lt;50 mm Hg) in 10/13 animals (77%). During RCA occlusion, cooling of the vagus nerve (reversible thermal vagotomy) did not prevent the hypotensive hemodynamic response. LAD occlusion was followed by PEA in 6/13 animals (46%). Brief occlusion of the RCA followed by occlusion of the LAD was followed by PEA in 5/7 animals (71%). Conclusions: Adrenergic blockade followed by coronary occlusion may be followed by PEA. This combination may play a role in the declining incidence of VF as the initial cardiac arrest rhythm in out-of-hospital cardiac arrest.
Abstract 45: Medically Educated Bystanders Start CPR Faster than Laypersons and Triple Survival Rates Compared with When No CPR Is Given in OHCA
Authors: Ingela Hasselqvist-Ax, Johan Herlitz, Jacob Hollenberg, Christer Axelsson, Jonny Lindqvist, Leif Svensson
Journal: Circulation (2012)

Background: There has been criticism raised against the value of CPR, whether the result of CPR education merely represents a more awareness of the critical situation thus initiating a more prompt call to dispatching centre and earlier start of CPR, rather than the fact that CPR are given. Aims: To explore different time frames in regards to whether the bystander is Lay persons or Medical educated, and to compare outcome between the two groups of bystanders. Methods: All patients in the Swedish Cardiac Arrest Registry who had a bystander witnessed out-of-hospital cardiac arrest between 1990 and 2010. This survey was divided into three groups: “No bystander CPR”, “Lay person bystander CPR” and “Medical educated bystander CPR”. Results: In all 28 888 patients were included and information on delays from collapse to call and start of CPR was available in 80 %. The mean age was highest (76 years) in the “No CPR” group. Cardiac arrest occurred at home more often (73%) in the “No CPR” and “Lay person” (62%) compared to the “Medical educated” group (33%). There were no differences between the groups in regards to delay from collapse to call (median 3 minutes in all). The median delay between collapse and start of CPR was 12 minutes in the “No CPR” , 6 minutes in the “Lay person” and after 3 minutes in the “Medical educated” group. Survival to 1 month was 4.0% (“No CPR”), 8.4% (“Lay person”) and 13.2% in the “Medical educated” group. Adjusted Odds Ratio (OR) for survival (“lay person” versus “No CPR”) was 2.49 [CI:2.13-2.92]. The corresponding figure for “Medical educated group” versus “No CPR” was 2.84 [2.35-3.44]. Adjusted OR (“Medical educated group” versus “Lay person”) was 1.18 [0.98-1.41]. Conclusions: Bystander CPR was associated with an increase in survival to one month regardless whether it was performed by Medical educated persons or Lay persons. Medical educated persons started CPR more rapidly than Lay persons. When adjusting for confounders CPR given by Medical educated persons did not significantly differ from CPR given by Lay persons in terms of survival to one month.
Abstract 9600: Coronary Artery Disease Patients with Normal Body Mass Index but Central Obesity Have the Worst Long-Term Survival When Compared to Other Patterns of Adiposity
Authors: Thais Coutinho, Kashish Goel, Daniel Correa de Sa, Charlotte Kragelund, Alka Kanaya, Marianne Zeller, Jong Seon Park, Lars Kober, Christian Torp-Pedersen, Yves Cottin, Luc Lorgis, Sang-Hee Lee, Young-Jo Kim, Randal Thomas, Veronique Roger, Virend Somers, Francisco Lopez-Jimenez
Journal: Circulation (2011)

Introduction: In patients with coronary artery disease (CAD), mortality risk increases directly with central obesity (waist circumference [WC] or waist-hip ratio [WHR]) and inversely with BMI (“obesity paradox”). We hypothesized that CAD patients with normal BMI but centrally obese would have increased risk of death compared to other patterns of adiposity. Methods: We studied 15,923 subjects with established CAD who were part of 5 studies from 3 continents. We excluded 373 participants with BMI &lt;18.5 Kg/m 2 and 3863 without either WC or WHR data. Subjects were divided in 6 categories based on BMI (normal, overweight or obese) and either WC or WHR (normal or high). Multivariate Cox-proportional hazard models adjusted for age, sex, BMI, hypertension, diabetes, smoking, heart failure, creatinine level and use of aspirin, beta-blockers, and inhibitors of the renin-angiotensin system assessed mortality risk according to different patterns of adiposity, using subjects with normal BMI and normal WC or WHR as reference. Results: Mean age was 65.7±11.0 yr, and 55% were men. There were 4699 deaths, median follow-up 4.7 years (IQR: 0.5 - 7.6 years). Results are summarized in the Table. Subjects with normal BMI but centrally obese had the worst long-term survival when compared to subjects with other patterns of adiposity. Furthermore, normal weight centrally obese subjects had 1.92 higher risk of dying than individuals with overweight BMI but normal WHR, and 1.63 higher mortality risk than subjects with obese BMI but normal WHR ( P &lt;0.002 for both). Conclusions: Normal weight with central obesity, a body morphology pattern often clinically dismissed, is associated with the highest mortality in patients with CAD, especially when compared to individuals considered overweight or obese but without central obesity. An adverse metabolic milieu or less attention to risk assessment/modification in the setting of normal weight central obesity may explain these findings.
Abstract 6: Bone Marrow Mesenchymal Stem Cells Improved Survival in Septic Rats Induced by Cecal Ligation and Puncture
Authors: Satoru Fujii, Takumi Taniguchi, Ken Yamamoto
Journal: Circulation (2012)

Background: Some studies have suggested that bone marrow mesenchymal stem cells (BMSCs) have beneficial effects on damaged nerves, ischemia/reperfusion injuries and so on. However, their effects on septic shock have never been scrutinized. In this study, we evaluated effects of BMSCs on septic rats Methods: Forty male Sprague-Dawley rats were randomly assigned to either of the following groups: group C (n=20), no medication following cecal ligation and puncture (CLP); group M (n=20), BMSCs were administered following CLP. BMSCs were collected from right and left femurs of two rats, using a specially designed devise for that purpose and administered to one rat in either group. Rats in both groups were anesthetized with intraperitoneal pentobarbital and then underwent cecal ligation and puncture. The puncture was performed with 18G needle and 2 holes were made to disseminate inflammation. After skin closure, rats in group M were given BMSCs intravenously. All the rats were observed for the following 7 days. Mortality was calculated for the 7-day observation period. Result: The mortality rates at 7 days in group M and group C were 30 % and 65%, respectively. There was a significant difference in mortality rate between group M and C. (p&lt;0.05) Conclusions: Bone marrow mesenchymal stem cells improved mortality in septic rats induced by CLP. This result shows us the potential effect of BMSCs to alleviate systematic inflammation that could result in multiple organ failure. Further studies are underway to clarify the underlying mechanism.
Abstract 69: A Time Series Analysis of Cardiac Arrest Incidence in Denver, Colorado
Authors: Comilla Sasson, Ariann Nassel, Chris Colwell, Kevin McVaney, Bill Johnston, Bryan F McNally, Jason Haukoos
Journal: Circulation (2012)

Background: Out-of-hospital cardiac arrest (OHCA) is estimated to cause 250,000 deaths annually in the U.S. Previous research has shown seasonal variation in cardiac arrest incidence. However, little is known about how cardiac arrest varies in Denver, CO across time. Objectives: To analyze cardiac arrest incidence in Denver for 2009-2012 to assess for trends in incidence, seasonal variation and predict future cardiac arrest incidence. Methods: Design: Secondary analysis of the Denver, Colorado component of the Cardiac Arrest Registry to Enhance Survival (CARES) dataset. Setting: Large urban metropolitan community with a two-tiered EMS system. The catchment area for this community is approximately 150 square miles with an approximate residential census of 600,000 people and includes 10 adult acute-care receiving hospitals. Population: Consecutive arrests from January 15, 2009 through March 31, 2012 entered by Denver Health Paramedic Division staff into the CARES dataset. Data Analysis: Arrests were grouped by month using Stata. R software was used to estimate the trend, seasonality and random error associated with events. An ARIMA model was used to fit the data and predict future OHCA incidence for the subsequent 24 months. Results: There were a total of 2,270 cardiac arrests patients during the 39 months. Overall, there appears to be a decreasing trend in the incidence of cardiac arrest in Denver (Figure 1). There does also appear to be seasonality in cardiac arrest events. The maximum number of arrests occurred in October 2010 (97). An ARIMA Model (0,2,2) was used to predict future cardiac arrest occurrence over the next 24 months. Conclusion: It is possible that wide-scale cardiac arrest and prevention efforts have contributed to the decreasing trend in OHCA incidence. Future research will need to examine what factors (e.g., season, temperature, etc.) may be contributing to the observed seasonal variation pattern.
Abstract 50: Time to Defibrillation in Witnessed Out-of-Hospital Cardiac Arrest: Impact on Survival Chances Between Elderly and Younger Patients
Authors: W Keuper, M A Brouwer, J L Bonnes, T Karlsson, J Lindqvist, J L Smeets, F W Verheugt, J Herlitz
Journal: Circulation (2012)

Background Guidelines state that with each minute of delay between the onset of an out-of-hospital cardiac arrest (OHCA) and the first defibrillation survival decreases with 3-4% in case of bystander cardiopulmonary resuscitation (CPR), as compared to 7-10% without CPR. Whether this decrease in survival is more pronounced with aging is unknown. We study how survival varies per minute delay between onset of VF and the first defibrillation in general, and the association with age in particular. Methods Patients with a non-crew witnessed OHCA and VF as presenting rhythm were selected from a 50,000 patient cohort, the prospective Swedish Cardiac Arrest Registry. CPR was performed according to guidelines 2000. Predictors of 1-month survival were assessed according to age (&lt; 70 and ≥ 70 years) and bystander CPR status (yes/no). Interactions between age, bystander CPR, time and 1-month survival were studied. Results In total 7,158 patients were studied. Bystander CPR was provided in 48% and 1-month survival was 11% (n=772). Independent predictors of survival were age, time from cardiac arrest to bystander CPR and from cardiac arrest to first defibrillation. Per minute delay to defibrillation, the decrease in survival was 11.6% (9.9-13.3%) in patients with bystander CPR and 17.1% (14.1-20.0%) in patients without bystander CPR. For patients &lt; 70 years with bystander CPR the decrease in survival per minute delay was 12.8% (10.6-15.0%) versus 9.9% (7.3-12.4%) for patients ≥ 70 years. Without bystander CPR the decrease in survival per minute delay for patients &lt; 70 and ≥ 70 years was 14.9% (10.6-19.0%) and 19.2% (14.9-23.3%) respectively. No interactions between age, time from cardiac arrest to defibrillation and survival were found. Conclusion In this large prospective registry, the relative decrease in survival per minute delay until defibrillation is 10 to 20%, for cases with and without bystander CPR respectively. These figures are much higher than the reported delays in the guidelines, based upon smaller studies. The observed relative decrease in survival per minute delay to first defibrillation did not differ between younger patients and the elderly. Future studies should address these questions for resuscitation according to the 2010 guidelines.
Abstract 3: Detailed Description of All Deaths in Both the Shock and Traumatic Brain Injury Cohorts of the Resuscitation Outcomes Consortium Hypertonic Saline Trials
Authors: Samuel A Tisherman, Robert Schmicker, Karen J Brasel, Eileen M Bulger, Jeffrey D Kerby, Joseph P Minei, Judy Powell, Donald A Reiff, Sandro B Rizoli, Martin A Schreiber
Journal: Circulation (2012)

Introduction: In trials conducted by the Resuscitation Outcomes Consortium (ROC) in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to demonstrate improved survival. We sought to identify causes of mortality in this patient population to determine targets for future studies. Methods: Retrospective review of patients enrolled in a multicenter, randomized, clinical trial performed 2006-2009 by 114 EMS agencies in North America within ROC. Inclusion criteria were injured patients, age ≥ 15 years with hypovolemic shock (SBP ≤ 70 mm Hg or SBP 71-90 mm Hg with HR ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤8]. Initial resuscitation fluid administered by out-of-hospital providers was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: 2071 subjects were enrolled (821 shock, 1250 TBI). Survivors were younger than non-survivors [30(IQR 23) vs 42(34)] and had a higher GCS, though similar hemodynamics. Greater than 90% of deaths occurred despite ongoing resuscitative efforts. Forty six percent of the deaths in the TBI cohort were within 24 hours, compared with 81% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Conclusion: Most deaths from trauma occur within the first 24 hrs from hypovolemic shock or TBI. Late deaths from sepsis and multiple organ failure are rare. Novel resuscitation strategies should focus on early deaths.