tbuckley/cabot-search huggingface dataset:
Abstract Su305: Chest Compression Fraction, Bag-mask Ventilation, And Survival From Out-of-hospital Cardiac Arrest: A Multicenter Study
Authors: Betty Yang, ELISABETE ARAMENDI, Brian Leroux, Xabier Jaureguibeitia, Sarah Shaver, Mary Chang, Thomas Rea, Peter Kudenchuk, Jim Christenson, Christian Vaillancourt, Clifton Callaway, David Salcido, Jonas Carson, Jennifer Blackwood, Henry Wang, Ahamed Idris
Journal: Circulation (2024)

Background: Ventilation during cardiopulmonary resuscitation (CPR) is poor. Better lung inflation during chest compression pauses is associated with better return of spontaneous circulation (ROSC), survival, and functional neurological survival. Chest compression quality, quantified by chest compression fraction (CCF) &gt;80%, has also served as a guideline target for improved outcomes. We hypothesized that greater chest compression fraction modifies the association between ventilation quality and outcomes. Methods: We studied patients suffering out-of-hospital cardiac arrest from six sites of the Resuscitation Outcomes Consortium (ROC) Trial of Continuous or Interrupted Chest Compressions during CPR. We performed a subanalysis of patients assigned to the 30:2 CPR arm with ≥ two minutes of thoracic bioimpedance signal recorded with a cardiac defibrillator/monitor. Detectable ventilation waveforms were defined as having a bioimpedance amplitude ≥0.5 Ohm (corresponding to ≥ 250 ml tidal volume) and duration ≥1 sec. We defined a chest compression pause as a break in chest compressions of 3 - 15 sec duration. We dichotomized ventilation into two groups: 1) better lung inflation (≥ one lung inflation waveform in ≥50% of chest compression pauses), and 2) poor lung inflation (waveforms in &lt;50% pauses). We analyzed CCF during bag-mask prior to intubation (if any). We used multivariable logistic regression to assess the relationship among CCF, ventilation, and the outcomes of ROSC, survival, and functional neurologic survival. Results: Among 1,976 patients, mean age was 65 years, 66% were male. Most patients received poor ventilation (60%, n=1177) over ventilation over 9.8 ± 4.9 minutes. Median CCF was 0.78 (0.71, 90.84) and 0.78 (0.70, 0.83) for poor and better lung inflation, respectively. For CCF &lt;85%, survival was significantly greater in those who received better ventilation, when compared to poor ventilation, and had greater pauses per minute (Figure A). The beneficial interaction between ventilation and outcome was greater with CCFs of 85% or less, compared to higher CCFs (Figure B). With CCFs &gt;85%, survival did not improve significantly with better ventilation. These results persisted after adjustment for Ustein variables and ROC site. Conclusions: We observed improved survival with better ventilation until CCF exceeded 85% in the preintubation period, suggesting an optimal strategy with better ventilation and chest compression fractions of 85% or less.
Abstract Su301: Longer Chest Compression Intervals Between Pulse Checks in Patients with Non-Shockable Rhythms are Associated with Increased Subsequent Return of Spontaneous Circulation Events
Authors: Ghania Haddad, Daniel Jafari, Timmy Li, Molly Pineo, Amina Essaihi, Elizabeth Young, Xueqi Huang, Lance Becker, Daniel Rolston
Journal: Circulation (2024)

Background: Chest compressions are a cornerstone of cardiopulmonary resuscitation (CPR), and evidence shows that fewer interruptions and higher chest compression fractions improve outcomes in cardiac arrest. Interruptions in chest compression are important in patients with shockable rhythms to assess the need for defibrillation; however, in pulseless electrical activity (PEA) or asystole, a pause in chest compressions every 2 minutes may be detrimental, as it decreases chest compression fraction and reduces myocardial, cerebral, and systemic perfusion. Hypothesis: We hypothesize that patients with non-shockable rhythms on whom chest compression intervals were greater than 2 minutes have better odds of achieving return of spontaneous circulation (ROSC). Objective: Our primary objective is to determine if longer chest compression intervals are associated with improved subsequent ROSC in patients with initial PEA or asystole rhythms. Methods: We conducted a retrospective cohort study of video-recorded adult atraumatic cardiac arrest resuscitations in a quaternary care Emergency Department from 1/30/2018 to 2/20/2024. We only examined patients in PEA or asystole and determined the duration of all chest compression intervals for each patient. We grouped the chest compression interval durations into 3 groups (&lt;1min 45sec, 1min 45sec to 2 min 14sec, ≥2min 15 sec) and determined the odds of subsequent ROSC for each chest compression interval duration. We assessed the association between chest compression interval duration and ROSC episodes using a logistic regression model. Results: Out of 326 video-reviewed patients, 235 patients had an initial rhythm of PEA or asystole of which 44 (18.7%) survived to admission and 9 (3.8%) to hospital discharge. The 235 patients yielded 1724 chest compression intervals and 151 ROSC episodes. The ROSC rate for the chest compression intervals &lt;1:45sec was 7.3% (49 out of 673) versus 8.1% (51 out of 632) for intervals 1:45 to 2:14 versus 12.2% (51 out of 419) for intervals ≥2 min 15sec. In a logistic regression model, using the 1min 45 sec to 2min 14 sec interval as the reference group, the &lt;1min 45sec group had 10% lower odds of ROSC (OR: 0.90; 95% CI: 0.60, 1.35) and the ≥2min 15 sec group had 58% higher odds of ROSC (OR: 1.58; 95% CI: 1.05, 2.38). Conclusion: In cardiac arrest patients presenting with non-shockable rhythms, chest compression intervals ≥2 min15sec are associated with higher odds of achieving ROSC.
Abstract Su1201: Alteration in cerebrospinal fluid flow in out-of-hospital cardiac arrest patients who underwent target temperature management.
Authors: So Young Jeon, Yeonho You, Jung Soo Park, Changshin Kang, Jin Hong Min, Wonjoon Jeong, YONGNAM IN, Hong Joon Ahn
Journal: Circulation (2024)

Background: Various parameters of cerebrospinal fluid (CSF) flow measured through magnetic resonance imaging (MRI) flowmetry are utilized to assess the progression of certain diseases. Our study evaluated changes in CSF flow using MRI flowmetry in survivors of out-of-hospital cardiac arrest (OHCA) who underwent target temperature management (TTM). Methods: This prospective observational cohort study was conducted from May 2023 to April 2024 at a single center. We performed Wilcoxon signed-rank tests to compare maximum velocity (V max ), stroke volume (SV), maximum flow (flow max ), and stroke distance measured immediately after return of spontaneous circulation (ROSC) with those measured at 72 h after ROSC. Results: Of the 20 patients enrolled, 7(35.0%), 1(5.0%), 2(10.0%), 5(25.0%) and 5(25.0%) patients had CPC scores of 1, 2, 3, 4, and 5, respectively. V max , SV, flow max , stroke distance measured immediately after ROSC were 3.41 (2.03~4.96), 14.00 (4.00~23.38), 0.09 (0.06~0.22), -0.07 (-0.17~0.05), respectively. V max , SV, flow max , stroke distance measured at 72h after ROSC were 5.26 (2.76~9.28), 24.00 (10.38~42.25), 0.14 (0.08~0.31), -0.07 (-0.18~0.03), respectively. Although V max , SV, and flow max measured at 72 h after ROSC were statistically significantly higher compared to those measured immediately after ROSC (p = 0.002, 0.02, 0.002), there was no significant difference between the stroke distances measured immediately after ROSC and at 72 h after ROSC (p = 0.43). Additionally, the caudocranial direction of CSF flow was observed in 13 (65.0%) patients immediately after ROSC, and in 14 (70.0%) patients 72h after ROSC. Conclusion: This study demonstrated that alterations in cerebrospinal fluid flow were observed in OHCA patients. However, Further studies are needed to determine whether there are differences in alteration in CSF flow based on neurological prognosis.
Abstract Su407: Implementing An Effective Standardized Bystander CPR Protocol For US Golf Courses
Authors: Donald Casey, Mark Adelman, Clara Baumgarten, Mark Butler, Michael Collins, David DiClementi, Mitchell Fenton, Luke Pastore, Craig Smith, William Tansey
Journal: Circulation (2024)

Background: A golf course is the fifth most common public place for cardiac arrest (CA). Informal interviews with golfers and golf course personnel revealed striking incomplete and variable knowledge about what to do in the event of a CA on a golf course in accordance with most current bystander resuscitation guidelines. Hypothesis: We hypothesized that the development and implementation of a standardized protocol (called “911-CPR-AED”) for the three most critical first steps to assure aperson’s survival of an on-golf course CA will improve chances of surviving if playing partners, caddies and club staff are well prepared to respond urgently and appropriately to such an emergency. Aim: To successfully implement the standardized “911-CPR-AED” protocol for 4 different golf clubs. Approach: We achieved full support and involvement of the Club Boards, professional staff, club management, grounds crew and membership as well as coordination with local Emergency Medical Systems (EMS) and communications to all golfers and caddies. We created a specific four-panel laminated infographic customized for each club and designed to fit easily into every golfer’s bag and caddy vest, assuring a readily available “911-CPR-AED” guide for lay bystanders to notify EMS and Club staff, immediately initiate chest compressions, ensure rapid delivery of an AED and BLS certified persons to the arrest site, and safely guide EMS on their arrival. We also staged live “dry run’ simulations on the golf courses with all key team members and timed each and every step of the simulation from start to finish. All aspects of this process were shared with leaders of the closest EMS and hospital emergency departments (EDs). Results: Within the past 2 years, we have successfully implemented a standardized emergency resuscitation protocol we call “911-CPR-AED” at 4 different golf clubs for immediate initiation of bystander CPR in the event of full CA on a golf course. Since implementation, we have witnessed 3 CA events and achieved successful full “on course” resuscitations that deployed this protocol for all three survivors who are now back to playing golf. We intend to share the details and many lessons learned for these ongoing efforts. Conclusion: An effective, standard bystander CPR protocol now exists for use at any US golf course. We intend to expand Implementation to 3 new golf courses and will continue to raise awareness and encourage widespread local implementation across the US.
Abstract Su202: Physiological response to vasopressor administration during hemodynamic-directed CPR
Authors: Takayuki Sueishi, Hunter Gaudio, Luiz Silva, Tiffany Ko, Julia Slovis, Constantine Mavroudis, Misun Hwang, Jeremy Zuckerberg, Jeremy Herrmann, Kumaran Senthil, Robert Berg, Robert Sutton, Ryan Morgan, Todd Kilbaugh
Journal: Circulation (2024)

Background: The hemodynamic response to successive vasopressor doses during CPR and its association with survival is poorly defined. Understanding these relationships can facilitate identification of alternative vasopressor strategies. Hypothesis: Non-survival is associated with lower responsivity to successive vasopressors. Methods: We performed retrospective analysis of hemodynamic data acquired in pediatric swine models (sus scrofa, 9-12kg) of asphyxia-associated ventricular fibrillation cardiac arrest with use of hemodynamic-directed CPR (n=175). Starting 2m into CPR, if hemodynamic targets were not met, vasopressors were given in cycles comprising two doses of 0.02mg/kg epinephrine (Epi) followed by vasopressin (Vaso, 0.4U/kg), separated by a minimum of 1m. After a minimum of 2m, the cycle was repeated. Hemodynamic response was evaluated using the peak diastolic blood pressure (DBP) within 1m for Epi, 2m for Vaso administration and the difference between the initial and peak DBP (delta DBP). Subjects were classified as “responder” if either a delta DBP &gt; 5 mmHg or a peak DBP &gt; 25 mmHg was achieved, and a “non-responder” otherwise. Animals were deemed “survivors” if ROSC was achieved following initial defibrillation. The change in delta DBP for successive vasopressors was compared in survivors versus non-survivors using two-sided Wilcoxon rank-sum tests. Continuous variables are summarized using the median with interquartile ranges. The burden of “non-response” was used to a construct confusion matrix and calculate performance. Results: Non-survivors (n=30) had lower delta DBP than survivors (n=145) following successive vasopressor administration at the first cycle (first Epi dose: 7.8 [2.4, 14] vs 16 [7.5, 24], p&lt; 0.01; second Epi: 2.0 [0, 4.7] vs 7.1 [2.0, 12], p&lt; 0.01; Vaso : 1.1 [0, 2.3] vs 7.1 [2.0, 12], p&lt; 0.01). Classification as a “non-responder” at the first cycle (Epi-Epi-Vaso) was significantly predictive of non-survival (Sensitivity 32%, Specificity 92%). Animals that failed to respond to all vasopressors at the first cycle had a significantly increased rate of mortality (86%; 6 non-survivors, 1 survivors) compared to animals that responded to all 3 vasopressors (13%; 16 non-survivors, 111 survivors). Conclusion: Mortality was significantly associated with lower DBP response to successive vasopressors during hemodynamic-directed CPR in pediatric swine models of cardiac arrest, which may suggest a critical timepoint to activate ECPR.
Abstract Su204: Association between delta E <sub>T</sub> CO <sub>2</sub> and Return of Spontaneous Circulation in a National US Cohort
Authors: Bartholomew Grabman, Benjamin Fisher, N. Clay Mann, Darren Braude, Ryan Huebinger
Journal: Circulation (2024)

Introduction: International guidelines support use of end-tidal carbon dioxide (E T CO 2 ) for monitoring resuscitation in out-of-hospital cardiac arrest (OHCA). Specific E T CO 2 cutoffs have been proposed for termination of resuscitation, though data on rates of ROSC based on changes in E T CO 2 is limited. We aimed to evaluate the relationship between change in E T CO 2 in OHCA and its relationship to return of spontaneous circulation (ROSC) using a US national database. Methods: This retrospective analysis of National Emergency Medical Services Information System (NEMSIS) datasets from 2020 to 2022 evaluated all adult patients who underwent resuscitation for OHCA and had multiple E T CO 2 measurements. We excluded cases with missing data. The highest difference between two sequential E T CO 2 measurements (MΔE T CO 2 ) and total difference between minimum and maximum E T CO 2 measurements [TΔE T CO 2 ] were calculated for each case. ΔE T CO 2 groups were stratified into 10-unit increments and we compared rates of ROSC between groups. We then used multivariable logistic regression to evaluate the association between each 5 unit increase in ΔE T CO 2 and ROSC. We adjusted for age, sex, location, witness status, initial shockable rhythm, and CPR or AED prior to EMS arrival. Results: We included 274,516 total patients with 1,686,390 E T CO 2 measurements. The median number of E T CO 2 measurements was 5 (IQR 3-8). Median age was 65, 62.8% were male, 60.1% had witnessed arrests, and 78.3% received CPR and 32.3% received AED placement prior to EMS arrival. ROSC rates based on MΔE T CO 2 were 0-10 mmHg [33.3%], 10-20 mmHg [42.3%], 20-30 mmHg [49.7%], 30-40 mmHg [53.2%], and &gt;40 mmHg [56.6%]. ROSC rates for TΔE T CO 2 were 0-10 mmHg [29.6%], 10-20 mmHg [36.7%], 20-30 mmHg [43.5%], 30-40 mmHg [48.9%], and &gt;40 mmHg [54.6%]. Adjusted odds of ROSC per 10 mmHg increase in MΔE T CO 2 was 1.21 [1.21-1.22] and TΔE T CO 2 was 1.19 [1.19-1.19]. Conclusions: Increasing max and overall ΔE T CO 2 was associated with increased rates and odds of ROSC for OHCA.
Abstract Su306: Impact of Ventricular Fibrillation on Myocardial Infarct Size: A Clinical and Experimental Study
Authors: Neven STEVIC, Alexandre Pinede, Nathan Mewton, Laurent Argaud, Michel Ovize, Sandrine Lecour, Thomas Bochaton, martin cour
Journal: Circulation (2024)

Background: Ventricular fibrillation (VF) - induced cardiac arrest is a frequent complication of ST-segment elevation myocardial infarction (STEMI). Although larger infarct sizes (IS) are associated with a higher risk of VF, there has been no investigation into the influence of VF itself on IS. To address this knowledge gap, we analyzed the impact of VF on IS in patients and 2 experimental models. Methods: From the prospective cohort HIBISCUS-STEMI, 30 STEMI patients with VF were matched on common determinants of IS in a 1:2 ratio with patients without VF. The primary endpoint was IS, assessed using the 48-hour area under the curve (AUC) for troponin. We compared IS in pigs with/without spontaneous VF during STEMI (n=15/group), and in an isolated rat heart model of acute myocardial infarction with/without electrically induced VF (n=7/group); IS was assessed using the ratio of the area of necrosis (AN) to the area at risk (AAR). Results: While patient characteristics were similar after matching (including AAR), IS was 33% lower in the VF group than in the control group (troponin AUC 1.6 [0.5-3.3] 10 6 vs. 2.4 [0.9-4.1] 10 6 arbitrary units; p=0.049). In pigs, IS was lower (p&lt;0.01) in the VF group (24% [11-40]) than in controls (71% [48-75]). In the isolated heart model, IS was lower (p&lt;0.05) in the VF group (9% [7-15]) than in controls (42% [38-44]). Conclusion: When common determinants of IS are comparable, the occurrence of VF prior to MI reperfusion is associated with significantly smaller IS.
Abstract Su206: Early Metabolic Effects of Prehospitally Administered High-Dose Glucocorticoids in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest
Authors: Rasmus Beske, Laust Emil Roelsgaard Obling, Martin Meyer, Johannes Grand, Jakob Josiassen, Jacob Moller, Jesper Kjaergaard, Per Johansson, Christian Hassager
Journal: Circulation (2024)

Background: Administration of glucocorticoid in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) mitigate the inflammatory response within the first 24 hours. The anti-inflammatory action is mediated through genomic effects, taking hours to days to set in, but glucocorticoids may also exert acute, non-genomic effects. The interplay between inflammation and metabolism is becoming more evident and emerging evidence suggests that early metabolic interventions can reduce reactive oxygen species, thus preventing cell apoptosis and necrosis. Hence, it is pivotal to investigate whether glucocorticoids cause significant metabolic effects in this context. Methods: Sub-study of a two-center, blinded, randomized controlled trial (NCT04624776) examining the effects of prehospital administration of 250 mg methylprednisolone versus placebo in comatose patients resuscitated from OHCA of presumed cardiac cause. Blood samples were collected upon hospital arrival (T0) and 48 hours later (T48). A total of 60 metabolites were quantified by mass-spectrometry and compared between groups following adjustment for sex, age, time to return of spontaneous circulation (ROSC), ST-elevation myocardial infarction, and time from intervention to sampling (only at T0). All results were corrected using the false-discovery rate method to account for multiple tests. Results: In the modified intention to treat population (mITT) 68 (50%) had been randomized to glucocorticoid and 69 (50%) to placebo. Blood samples were available for 121 (88%) and 117 (82%) patients at T0 and T48, respectively. Median age was 66 years (IQR: 56- 74) and 100 (83%) patients were men. Median time to ROSC was 16 min (10-20), and study medicine was administered prehospital 20 min (13-29) following ROSC with blood samples at T0 being drawn after 107 min (64-180). Though a nominal difference was observed at hospital arrival (Figure 1 left), we found no metabolic effects following correction for multiple testing. At T48, glucocorticoid showed increased plasma levels of many amino acids, especially tryptophan (Figure 1 right), while prostaglandin E2 and free fatty acids associated with inflammation were higher in the placebo group. Discussion: We did not find evidence for early metabolic effects of glucocorticoid treatment after OHCA. In contrast, several metabolites were affected at T48, including an increase in plasma tryptophan levels in the glucocorticoid group and lower levels of prostaglandin E2.
Abstract Su203: Development of Bioimpedance for the Measurement of Ventilation During Cardiopulmonary Resuscitation
Authors: Rithika Prakash, Philip Jarrett, Ahamed Idris
Journal: Circulation (2024)

Introduction: Previous studies have shown that ventilation during cardiopulmonary resuscitation (CPR) produces better patient outcomes. However, research regarding ventilation during the early stages of basic life support CPR is limited. Prior studies showed that thoracic bioimpedance, recorded by the LifePak 12 defibrillator device, can be used to count ventilations with a tidal volume at least 250 mL during CPR. However, the relationship between thoracic bioimpedance and tidal volume has yet to be studied for the Phillips MRx device, excluding a large data set from ventilation studies. Hypothesis: Bioimpedance, measured by the Phillips MRx device has a linear relationship with tidal volume. Aims: To determine the relationship between bioimpedance measured by the Phillips MRx device and tidal volume in males and females. Methods: We conducted the study in a respiratory laboratory at a University Hospital. We asked 27 volunteers to breathe fixed volumes (250 mL, 300 mL, 400 mL, 600 mL, and 800 mL) delivered by a mechanical ventilator while recording bioimpedance simultaneously with the Philips MRx monitor-defibrillator through electrode pads placed on the chest. Six measurements of bioimpedance waveform amplitudes (Ohms) were taken at each tidal volume. Results: Of 27 volunteers, 11 were female and 16 were male. In the female sample set, a linear equation of y=0.003x + 0.837 with an R^2 value of 0.9995 was calculated. In the male sample set, a linear equation of Y=0.0016x +0.1039 with a R^2 value of 0.995 was calculated. Females had a higher median bioimpedance amplitude than men at each tidal volume, and a steeper linear regression slope. At the minimum threshold tidal volume used for counting ventilations (250 mL), the median bioimpedance amplitude was 0.5 (0.4, 0.6) ohm for males and the median bioimpedance amplitude was 0.8 (0.6, 1) ohm for females. Conclusion: As measured and recorded with the Philips MRx monitor-defibrillator, there is a linear relationship between tidal volume and thoracic bioimpedance. The linear models created in this study can be used in future studies to count ventilations during CPR using the Philips MRx device.