tbuckley/cabot-search huggingface dataset:
Abstract 268: Testing ETCO2 as an Indicator of Improved Blood Flow During Prolonged CPR
Authors: Joshua W Lampe, Josiah D Garcia, Tai Yin, George Bratinov, Chrisopher L Kaufman, Lance B Becker
Journal: Circulation (2012)

Introduction: There is renewed interest in end-tidal carbon dioxide (ETCO2) as a metric of chest compression (CC) quality. A detailed study of ETCO2 changes and alterations in blood flow and pressures during CPR has not been performed. Methods: CPR hemodynamics in three domestic swine (~30 Kg) were studied using standard physiological monitoring. Flow probes were placed on the abdominal aorta, the inferior vena cava (IVC), the right renal artery and vein, the right common carotid and external jugular. Ventricular fibrillation (VF) was electrically induced. Mechanical CC were started after ten minutes of untreated VF. 54 min of CC were delivered at a rate of 100 per minute and at a depth of 1.25 in, which was followed by 6 min of 2 in CC. Data are presented at the beginning of chest compressions (CC), after 20 minutes of CC at 1.25 inches, after 48 minutes of 1.25 in CC, and after 6 minutes of 2 inch CC. Paired t-tests were used to determine statistical significance. Results: CPR effectiveness decayed over time (see table) despite continued CC. After increasing CC depth to 2 inches, minimal changes in blood flow and pressure were observed with the exception of a trend in increased net forward flow in the IVC. ETCO2 was significantly increased after increasing chest compression depth and did not change in accordance with changes in net forward aortic blood flow ( r =-0.213). ETCO2 correlated most with CC depth ( r = 0.557), was weakly correlated with IVC flow ( r = 0.332). Conclusions: Blood volume shifts due to prolonged sub-par CC are difficult to repair. After prolonged CC, ETCO2 correlates more with CC depth than with venous return. ETCO2 may not be a reliable metric of CC generated forward flow.
Abstract 269: Relationship Between Characteristics of Early Postresuscitation EEG Activity During Hypothermia and Neurological Outcomes in a Rat Model of Cardiac Arrest
Authors: Bihua Chen, Fengqing Song, Leilei Sun, Lingyan Lei, Yongqin Li
Journal: Circulation (2012)

Background. Therapeutic hypothermia (HT) improves neurological outcomes and survival after resuscitation from cardiac arrest. However, the effects of HT on early recovery of electroencephalographic (EEG) activity after resuscitation are still unknown. In the current study, we investigated the effect of HT on the characteristics of early post resuscitation EEG activity in a rat model of cardiac arrest. Methods. Twenty male Sprague-Dawley rats (289±28 g) were used in this study. Cardiac arrest was induced through high frequency transesophageal cardiac pacing and untreated for 5 mins. Manual chest compression was initiated at a compression rate of 300/min and continued until return of spontaneous circulation. Immediately after resuscitation, animals were randomized to either 2 hrs hypothermia (N=10) or normothermia (N=10). ECG, EEG, aortic pressure, together with core temperature were continuously recorded. Results. There were no differences in baseline measurements between groups. All the animals were successfully resuscitated, however, 80% of rats survived till 48 hrs in the hypothermia group, in contrast to only 20% in the normothermia one ( p =0.023). Characteristics of EEG activity, including the onset time of EEG bursting (15.1±1.9 min vs. 21.5±6.1 min, p =0.008), and the time of recovery of continuous EEG activity (171.2±15.2 min vs. 242.5±44.0 min, p =0.001) were significantly shorter in the HT group. Both of the onset time of EEG bursting (r=0.66, p =0.002) and the time of recovery of continuous EEG activity (r=0.65, p &lt;0.002) were correlated with good 48 hrs neurological outcomes. Conclusion. The characteristics of early post resuscitation EEG activity during HT were associated with good neurological outcome in this rat model of cardiac arrest. EEG analysis therefore has the potential to monitor neurological recovery and guide HT after resuscitation.
Abstract 247: The Impact of the AHA Guidelines on Dispatch-Assisted Cardiopulmonary Resuscitation
Authors: Christian Dameff, Jeffrey Tully, Ryan Anne Murphy, Aaron Dunham, Micah Panczyk, Uwe Stolz, John Tobin, Madalyn Karamooz, Daniel Spaite, Bentley Bobrow, Gordon Ewy
Journal: Circulation (2012)

Background: The wide variability in bystander CPR (BCPR) may be explained, in part, by how thoroughly systems implement dispatch-assisted CPR (DACPR) for out-of-hospital cardiac arrest (OHCA). The extent to which the recommendations in the recently-published AHA DACPR Scientific Advisory Statement have been implemented and their impact remains unknown. The purpose of this study was to measure the impact of implementing these recommendations in an urban 9-1-1 dispatch center. We hypothesized that this intervention would decrease several key dispatch time intervals and increase rates of BCPR. Methods: Prospective before/after observational study of Guideline-based dispatcher training on 5 performance measures: 1) time interval from call receipt to dispatcher recognition of arrest; 2) interval from call receipt to start of CPR instructions; 3) interval from call receipt to first chest compression; 4) % of cases where instructions were started; 5) % of Dispatch-Assisted BCPR (DA-BCPR). Calls were reviewed to determine the need for CPR and data entered into a structured data form. Dispatchers were trained according to AHA DACPR Guidelines using in-person and online modalities. Fisher’s exact and Kruskal-Wallis tests were used to assess statistical significance with α = 0.01 (multiple hypothesis testing). Results: Baseline: 161 suspected OHCA recordings from 10/10/10 to 3/13/11. Post intervention: 285 recordings from 11/7/11 to 1/15/12. See Table. Conclusion: In this 9-1-1 Dispatch Center, implementing the latest AHA DACPR Guidelines significantly improved the time interval to the start of CPR instructions and to first compression. In addition, there were significant increases in the proportion of OHCAs where pre-arrival CPR instructions were started and in dispatch-assisted bystander CPR rates. This intervention holds promise for improving BCPR rates on a large scale.
Abstract 254: Quality of 2-Minute Continuous Chest Compressions by Medical Students and Lay Rescuers
Authors: Renan Gianotto-Oliveira, Maria Margarita Gonzalez, Gustavo Gianotto-Oliveira, Guilherme Podolsky-Gondim, Caio B Vianna, Sergio Timerman, Roberto Kalil Filho
Journal: Circulation (2012)

Background: The performing of quality chest compressions is highly emphasized in the American Heart’s 2010 Guidelines. Moreover, it addresses the importance of continuous chest compressions (hands-only) as the best approach when faced with a sudden cardiac arrest victim when a ventilation barrier device is not available. Hypothesis: We hypothesized that first-year medical students perform two-minute continuous chest compressions with lower quality than those performed by lay rescuers who had Heartsaver ® CPR AED training at least every 2 years. Methods: The volunteers initially attained the Heartsaver® CPR AED course. After approximately 30 minutes they performed 2 minutes continuous chest compressions in the Resusci Anne training mannequin, with a PC reporting system. Results: When comparing the 76 medical students with the 74 trained lay rescuers, the average age (20 vs. 40 years), the male gender (54% vs. 92%), the mean body mass index (24.9 vs. 27.3 kg/m2) and physical activity (55% vs. 36%) presented significant differences, p&lt;0.01, p&lt;0.01, p&lt;0.01 and p=0.04, respectively. Regarding the quality of chest compressions, the average rate (121 vs. 124 compression/minute), duty cycle (47% vs. 45%), the percentage of compressions with correct hand positioning (87% vs. 90%) and the average depth (45 vs. 49 mm), showed no significant difference, p=0.05, p=0.06, p=0.32 and p=0.10, respectively. However, the percentage of adequate depth compressions (43% vs. 58%) and the percentage of compressions without error (36% vs. 50%) revealed a significant difference, p=0.01 and p&lt;0.01. Conclusion: In conclusion, the results show that important parameters like the percentage of compressions with adequate depth and compressions without error had a significant difference, demonstrating that although being lay rescuers, the constant cardiac resuscitation training allows performing higher quality chest compressions than those performed by medical students. It’s need ongoing training of medical students, because they must perform good-quality chest compressions too.
Abstract 233: Initial Arrest Rhythm and Outcome in Patients Undergoing Primary PCI for ST-Segment Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest
Authors: Joseph L Thomas, Richard Tadeo, William Koenig, Gene Sung, Marc Eckstein, William J French, James T Niemann, David M Shavelle
Journal: Circulation (2012)

Background : The prognosis of patients with out of hospital cardiac arrest (OHCA) varies by the initial arrest rhythm. Patients with shockable rhythms such as ventricular tachycardia (VT) or ventricular fibrillation (VF) have better survival than those with nonshockable rhythms including asystole and pulseless electrical activity (PEA). The impact of initial arrest rhythm on outcome in ST-segment elevation myocardial infarction (STEMI) complicated by OHCA is unknown. Methods : The Los Angeles County Emergency Medical Services STEMI Receiving Center System coordinates and provides care for patients with STEMI and OHCA within a network of 33 primary PCI centers serving the 9.8 million residents of Los Angeles County. Between April and December 2011, a total of 61 patients with STEMI with OHCA and restoration of spontaneous circulation (ROSC) were treated with primary PCI. Patient characteristics and outcomes were analyzed based on initial arrest rhythm. Results: 61 patients with STEMI, OHCA and ROSC were treated with primary PCI during the study period. Over 80% of these patients had a door to balloon time of ≤ 90 minutes. 50 patients had a shockable initial arrest rhythm (VT, VF or AED analyzed/defibrillated) and 11 had a nonshockable rhythm (asystole, PEA). Initial neurologic status following ROSC was similar between groups but patients with initial asystole or PEA had worse neurologic status at discharge. The presence of a shockable initial rhythm was associated with a numerically superior rate of hospital survival but this did not reach statistical significance. Conclusions: Similar to the general cardiac arrest population, a shockable initial arrest rhythm is associated with better outcomes in patients with STEMI and OHCA. Analyses of patients with STEMI complicated by OHCA should be stratified by initial arrest rhythm as significant pathophysiologic differences may exist between these groups.
Abstract 31: Mutation of Tnni3k Gene Increased Incidence of Arrhythmias in Culture Cardiomyocytes and In Vivo Mouse Hearts
Authors: Zhong-fang Lai, Yu-Zhen Chen, Jun Chen, Hiroshisa Tsuda, Yasunori Kitamoto, Shokei Kim-Mitsuyama
Journal: Circulation (2012)

Aims : Our recent studies showed that overexpression of TNNI3K promoted cardiac myogenesis, enhanced cardiac performance, and protected the myocardium from ischemic injury. Here, we report that replaced serine of the 835 and 836th in the C-terminal modulation area of TNNI3K gene with alanine increased the incidence of arrhythmia outbreak in culture cardiomyocytes and in mouse hearts in vivo. Methods and results : Wild TNI3K and mutated TNNI3K gene obtained from substitution of serine at 835-836 sites with alanine (S835A, S836A) were transfected respectively into P19CL6 cells for differentiation into cardiomyocytes, or directly transfected into beating hearts for in vivo experiments. Then, beating rhythm and frequency were observed in the cardiomyocytes at 16 day after inducer or in the whole heart of mice. Results obtained from culture cardiomyocytes show that the incidence of arrhythmia-like beating activities including bigeminy, trigeminy and tachycardia was more frequent in the TNNI3K-mutant group than that in the wild-TNNI3K group (P&lt;0.05). By the in vivo experiment, incidence of arrhythmic outbreak was examined in 1) control group (n=9) of the male C57BL6 mouse, 2) the wild TNNI3K group (n=12), 3) the mutant-TNNI3K gene group (n=12). Incidences of bigeminy (66.7%), tachycardia (50.0%) and bradycardia (41.9%) in the TNNI3K mutant group were significantly higher than that in the other two groups. To investigate possible mechanisms involved on the TNNI3K mutant-induced arrhythmias, intracellular Ca 2+ -response was investigated after application of ryanodine at concentrations of 1, 10, 20, and 50μM. The ryanodine-induced increase of Ca 2+ -concentrations in the wild group was stronger than that in the mutant group (P&lt;0.05). Furthermore, action potentials of cultured cardiomyocytes were recorded with glass microelectrode techniques and data showed that the incidence of early or delayed afterdepolarization is significantly increased the mutant group (p&lt;0.01). Conclusions : TNNI3K-mutation increased the incidences arrhythmias in cultured cardiomyocytes and in mouse hearts in vivo. Elucidation of the molecular mechanism involved would be useful for innovation of new anti-arrhythmic drugs.
Abstract 9505: Short-Term Statin Therapy Improves Murine Deep Venous Thrombosis Resolution While Reducing Thrombus Inflammation: An i <i>n vivo</i> Multi-Targeted Imaging Study
Authors: Jin Won Kim, Brian Thompson, Chase W. Kessinger, Peter K. Henke, Jason R. McCarthy, Charles P. Lin, Farouc A. Jaffer
Journal: Circulation (2011)

Background: Improving DVT resolution may limit the development of the post-thrombotic syndrome (PTS). Utilizing confocal intravital fluorescence microscopy (IVFM), we investigated the in vivo effects of short-term statin therapy on thrombus burden, permeability, and inflammation in subacute murine DVT. Methods: In 24 male C57Bl/6J mice with topical FeCl 3 -induced femoral DVT, atorvastatin (1.14 mg/kg/day, ≈ 80 mg/day/human subject, n=12) or PBS (n=12) was administered on days 1-4 via gavage. On day 3, macrophage-targeted nanoparticles (CLIO-AF555, ex/em 555/565 nm) and an MMP activity sensor (MMPsense680, 680/700 nm) were i.v. injected. On day 4, FITC-dextran (490/520 nm) was injected to define thrombus anatomy and to evaluate thrombus permeability. 30 minutes after FITC-dextran injection, IVFM was performed. The in vivo thrombus burden, and average thrombus macrophage, MMP activity, and permeability target-to-background ratio (TBR) in the mid-thrombus zone (z-stack of 40 um thickness) were determined from CLIO, MMPsense and FITC signals. Histopathology and fluorescence microscopy studies were performed. Results: Atorvastatin decreased DVT area on IVFM (0.17±0.01 mm 2 vs. 0.20±0.03 mm 2 in PBS animals, p=0.001), and by microscopy (% thrombus area, 42.2±12.6% statin vs. 71.0±12.7% PBS, p&lt;0.001). Thrombus sections from statin-treated animals showed reduced PAI-1 immunoreactivity (14.8±4.7% positive area vs. 30.7±5.0% in PBS mice, p=0.022). Notably, statin therapy reduced thrombus inflammation compared to PBS-treated animals (macrophage TBR 1.7±0.2 vs. 3.1±0.3, p=0.001; and MMP activity TBR 1.3±0.1 vs. 1.8±0.2, p=0.021, respectively). Thrombus permeability was similar in the two groups (p=NS). Correlative fluorescence microscopy and immunohistochemistry corroborated the in vivo imaging findings. Conclusions: Short-term statin therapy in subacute DVT reduces thrombus burden and improves DVT resolution in vivo . The observed benefits of statin treatment are linked to its anti-thrombotic properties, and occur in the setting of reduced thrombus inflammation and similar thrombus permeability. Statin therapy may offer a clinically translatable approach to improve DVT resolution and to limit PTS.
Abstract 9282: The Accumulation of Epicardial Adipose Tissue is an Independent Risk Factor for the Onset of Atrial Fibrillation
Authors: Koki Nakanishi, Shota Fukuda, Kenei Shimada, Kenichiro Otsuka Otsuka, Shoichi Ehara, Kenji Matsumoto, Haruyuki Taguchi, Takeshi Muro, Junichi Yoshikawa, Minoru Yoshiyama
Journal: Circulation (2011)

Introduction. Atrial fibrillation (AF) is associated with the structural and electrical remodeling of left atrium (LA) as well as the inflammation. The accumulation of epicardial adipose tissue (EAT) is now recognized as an inflammatory tissue, potentially contributing to the pathogenesis of AF. The developed multi-detector computed tomography (MDCT) is accurate for assessing coronary plaques characteristics as well as additional information for the tissue surrounding the heart, including chamber sizes and EAT volume. Methods. This study consisted of 279 patients (176 men, 65 ± 10 years) who had no history of AF. These patients underwent MDCT for the evaluation of coronary artery disease. EAT volume, LA volume, and left ventricular (LV) mass were also measured by MDCT. Patients were divided into 3 groups according to EAT volume (lower tertile; mean 55 ml ranging 21 to 71 ml, middle tertile; mean 87 ml ranging 72 to 100 ml, upper tertile; mean 128 ml ranging 101 to 264 ml). The presence of the onset of AF during follow-up period was confirmed by the findings of electrocardiograms and/or Holter recordings. Results. During follow-up of 3.3 ± 1.0 years, AF occurred in 17 (6.1%) patients. Patients with AF were more likely to be older, had significantly higher level of C-reactive protein, and had larger volumes of LV mass, LA and EAT on MDCT. The independent factors for the onset of AF were EAT volume and LA volume index (both p &lt;0.001). The upper tertile of EAT volume had a significant increased risk for the occurrence of AF compared with the lower tertile (p &lt;0.001), and middle tertile (p = 0.03). Conclusions. We demonstrated that increased EAT volume, as estimated by MDCT, was independently associated with the occurrence of new onset AF.
Abstract 9316: Serial Changes of Neointimal Coverage Condition and Characteristic are Different between Sirolimus-Eluting Stents, Paclitaxel-Eluting Stents and Zotalolimus-Eluting Stents Implantation: Follow-Up Optical Coherence Tomography Study
Authors: Daisuke Nakamura, Masami Nishino, Yasuharu Lee, Takahiro Yoshimura, Masayuki Taniike, Nobuhiko Makino, Hiroyasu Kato, Yasuyuki Egami, Ryu Shutta, Jun Tanouchi, Yoshio Yamada
Journal: Circulation (2011)

Background: The long-term detailed changes of neointima coverage in Sirolimus-eluting stent(SES), Paclitaxel-eluting stent(PES) and Zotalolimus-eluting stent( ZES) remains to be clarified. Methods: Of 20 SES (14 patients),13 PES (12 patients) and 9 ZES(7patients)Optical Coherence Tomography( OCT) was used to visualize 2486, 1361 and 1018 stent-struts at 8 months and 2199, 1309 and 1001 stent-struts at 20 months after respectively. The OCT parameters, including incidence of uncovered struts and malapposed struts and averaged neiointimal hyperplasia thickness (NIH) and NIH% = NIH area / stent area, were compared between 8 months and 20 months follow-up. The neointimal charecteristics were classified into 3 groups: homogenous without PLIA(high density neointima without peri-strut low-intensity area(PLIA);homogenous with PLIA (high density neointima with PLIA);heterogenous (low density neointima and layered neointima) .PLIA was defined as a region around stent struts with a homogeneous,lower intensity appearance than the surrounding tissue on OCT images without significant signal attenuation. Results: Serial OCT study revealed that the prevalence of uncovered struts decreased in SES, PES and ZES and the prevalence of malapposed struts did not change in SES, PES and ZES. Average NIH and NIH% significantly increased in SES, but average NIH and NIH% significantly decreased in PES and did not change in ZES from 8 months to 20 months. Homogenous without PLIA was most frequent in ZES. It was not different between SES and PES. Homogenous without PLIA increased from 8month to 20month after in PES and ZES,but in SES decreased. Homogenous with PLIA(It suggesting the presence of fibrinoid, proteoglycans, macrophages and lymphocytes pathologically) increased in SES. Conclusions: Uncovered struts gradually alleviated in SES,PES and ZES while neointimal hyperplasia condition showed different patters. Neointimal characteristics showed different patterns too.
Abstract 310: Evaluation of the Appropriate Timing for Inducing Therapeutic Hypothermia with Extracorporeal Membrane Oxygenation for Out-of-Hospital Cardiac Arrest in Acute Coronary Syndrome
Authors: Hideki Arimoto, Hiroshi Rinka, Toshinori Miyaichi, Akihiro Fuke, Junichi Ishikawa, Takaya Morooka
Journal: Circulation (2012)

Purpose: Mild therapeutic hypothermia has been integrated into management strategies for improving the neurological outcome of cardiac arrest for out of hospital cardiac arrest. On the other hand, acute coronary syndrome (ACS) cases should be treated as earlier. We have the dilemma between two procedures when we face any cases of post cardiac arrest syndrome (PCAS). We reported rapid and safe hypothermia induction with Less Invasive Cardiopulmonary bypass Hypothermia (LICH) before. This study aimed to evaluate an appropriate timing to induce LICH ‘before or after’ investigations for coronary angiography (CAG). Methods: Sixteen PCAS patients for ACS were treated with LICH. These patients were divided into before CAG (Group B, N=12) and after CAG (Group A, N=4) groups. The LICH procedure was indicated for unconscious ROSC patients under 75 years of age, and excluded with brain hemorrhage, traumatic cardiac arrest, and any risk of bleeding. Target temperature was set at 34 to 35°C for 36 to 48 hours. The specifications LICH procedure were quickly induced hypothermia via narrow pediatric cannulas on low-perfusion (1 l/min) artery-venous extra corporeal membranous oxygenation with minimal anticoagulation. Any complications, time to target temperature, temperature stability, cytokines and neurological outcomes were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2. Results: There were no significant characteristic differences except the time to target temperature (69min vs. 161min, p&lt;0.01) between group B and A. Any complications and favorable outcomes were no significant differences in both groups. Conclusions: We suggest that we can choice both way early and late induction for hypothermia with LICH. These results mean an early coronary reperfusion is acceptable because of the advantages of quick induction to the target temperature.