tbuckley/cabot-search huggingface dataset:
Abstract Sa407: Chest Compression Oscillations and Computed Airway Opening Index during CPR Depend on Waveform Capnography Measurement Approach.
Authors: Mikel Leturiondo, Jose Antonio Uriguen, Mohamud Daya, Nicholas Johnson, Shiv Bhandari, Jennifer Blackwood, Sofia Ruiz de Gauna
Journal: Circulation (2024)

Introduction: Chest compressions during CPR cause oscillations in capnography waveforms. The airway opening index (AOI) was proposed to measure the amplitude of these oscillations. Studies indicate that AOI is inversely correlated with the change in intrathoracic pressure and that lower AOI values may reflect airway closure. However, little has been reported about how different waveform capnography approach may affect the appearance or amplitude of these oscillations. Aim: Quantify the differences in AOI values obtained from mainstream and sidestream waveform capnography. Methods: We retrospectively analyzed 25 monitor-defibrillator recordings having both concurrent mainstream and sidestream waveform capnography and spirometry-based tidal volume and inspiratory flow. Ventilations were automatically detected in the volume signal. Each ventilation was characterized by the end-tidal carbon dioxide (ETCO 2 ) values measured using both tracings and annotated for the presence of chest compression oscillations. If the latter were found, oscillation amplitudes were measured in absolute value (mmHg) and AOI was computed as the average difference between each pair of peaks and troughs normalized to the ETCO 2 value of that ventilation. Results: A total of 3,275 ventilations were annotated with concurrent mainstream and sidestream capnography signal. From these, 695 had oscillations (21.2%) captured by either technology or both. All the oscillations were captured by the mainstream technology, but only 660 (95%) appeared in the sidestream recordings. The median (IQR) oscillation amplitude was 21.8 (7.5, 33.5) mmHg and 14.0 (5.0, 20.0) mmHg ( p &lt; 0.001), for mainstream and sidestream, respectively; and the AOI was 45.7% (31.3%, 62.8%) and 29.5% (12.9%, 41.8%), ( p &lt; 0.001). Conclusion: Oscillations in the capnogram generated by chest compressions during CPR were almost always larger when measured with mainstream technology, and 5% were missed entirely when measured by sidestream capnography. Likewise, calculated AOI values were also greater most of the time. Therefore, in the context of monitoring the quality of CPR through oscillations present or not in the capnogram, as well as regarding their amplitudes, waveform capnography approach should be considered.
Abstract Su1006: Mean Arterial Pressure During the First 72 hours after Extracorporeal Cardiopulmonary Resuscitation is not Associated with Survival to Discharge and Neurologic Outcomes in Children with Cardiac Disease
Authors: Priscilla Yu, Sierra Foster, Priya Bhaskar, Lucas Zeida Haar, Xilong Li, sumit singh, Michael Morriss, DEEPA SIRSI, Tyler Burr, Lakshmi Raman, Javier Lasa
Journal: Circulation (2024)

Introduction: While studies have shown an association between post-cardiac arrest hypotension and mortality after conventional CPR in children, there is a lack of evidence regarding optimal mean arterial pressure (MAP) targets after ECPR. Hypothesis: Amongst children with cardiac disease undergoing ECPR, the lowest MAP &lt; 5 th percentile for age during the first 72 hours after return of circulation (ROC) is associated with decreased survival to hospital discharge (SHD) with favorable neurologic outcome (FNO). Methods: This is a single center retrospective cohort study of children admitted to a pediatric cardiac intensive care unit (CICU) from 2010 to 2022 that underwent ECPR. Chi-square test was used to analyze the association of the lowest MAP values, percentile adjusted for age, during the 72 hours post-ROC with SHD with FNO (defined by Pediatric Cerebral Performance Category [PCPC] score of 1,2 or 3 or no change in PCPC from baseline). Our secondary outcomes included acute composite injury (defined by the presence of seizures in the first 72 hours or neuroimaging injury within 14 days post arrest), and abnormal EEG background (defined as moderate or severe). As an exploratory analysis, we used Wilcoxon Rank Sum test to analyze the association of burden of MAP &lt; 5 th percentile for age with our outcomes. Results: We analyzed 83 index ECPR events. SHD with FNO was observed for 35 index events (42%). Table 1 displays the characteristics of patients with SHD with FNO compared to those who died or had SHD without FNO. Patients with SHD with FNO had shorter duration of CPR and lower maximum lactate during the first 6 hours post ROC compared to both survivors without FNO and non-survivors. The majority of the cohort (79.5%) experienced a lowest MAP &lt; 5th percentile for age during the first 72 hours post-ROC. Table 2 and 3 reveal no associations between MAP &lt; 5 th percentile for age and primary or secondary outcomes. Conclusion: This retrospective cohort study of children with cardiac disease undergoing ECPR reveals no association between MAP &lt; 5 th percentile for age during the 72 hours post-ROC and our primary outcome of SHD with FNO as well as secondary outcomes of acute composite injury and abnormal EEG background. Given heterogeneity in the cardiac population as well as the high incidence of hypotension &lt;5 th percentile for age in our cohort, further investigation is warranted into whether certain subgroups may benefit from targeting higher MAP values after ECPR.
Abstract Su105: Evaluation of a Novel Oxygen Carrier for Resuscitation in Hemorrhagic Shock Model Using a Target Mutation of Recombinant Heme-Protein
Authors: Joshua Lawrence, Youmna Abdelghany, Alay Gandhi, Jesus Tejero, Anthony DeMartino, Matthew Dent, Qinzi Xu, Hyon Hwang, Kaitlin Bocian, Xue Huang, Xiukai Chen, Ronald Poropatich, Mark Gladwin, Jason Rose
Journal: Circulation (2024)

Introduction: Hemorrhage remains a leading cause of preventable death in warfare and acute trauma. Given blood shortages, ongoing research is looking into successful artificial oxygen carriers. We engineered a non-globin heme-based molecule, the Bacterial Regulator of Carbon Monoxide Metabolism (RcoM), has oxygen carrier properties suitable for resuscitation in hemorrhagic shock. Hypothesis: We hypothesize that resuscitation with RcoM would improve mean arterial pressure (MAP) in hemorrhagic shock. Methods: A murine model of traumatic hemorrhagic shock was used to investigate the hemodynamic effects of RcoM. Mice were anesthetized with 1.5% isoflurane and received a laparotomy to induce soft-tissue trauma. The left femoral artery and vein were cannulated. The arterial cannula was used for blood pressure monitoring, and the venous cannula was used for bleeding and intravenous infusion. Upon stabilization, hemorrhage was induced by a 30-minute controlled pressure bleeding (25 to 40 mmHg) through the venous cannula then shock was maintained for another 30 minutes. This was followed by resuscitation infusion for 30 minutes by either lactated Ringer (LR) solution, human hemoglobin (HHb), or RcoM with a volume equal to the shed blood volume. The concentration was 2 mM for HHb and Rcom. Baseline MAP, post-resuscitation MAP, and MAP change were compared across the three groups using a one-way ANOVA. Results: There was no difference in the ratio of shed blood volume to the total blood volume (26.8 ± 3.4% for LR (n=7), 26.0 ±2.6% for HHb (n=3) and 27.6 ± 1.3% for Rcom (n=5), p = 0.7295). There was no difference for the baseline MAP between LR (83.5 ± 5.7 mmHg), HHb (87.4 ± 3.0 mmHg) and Rcom (82.3 ± 1.9 mmHg, p = 0.2931). The post-resuscitation MAP was significantly higher for RcoM (67.0 ± 6.3 mmHg) and HHb (60.4 ± 16.0 mmHg) compared to LR (25.9 ± 21.4 mmHg, p = 0.0029). There was no difference between Rcom and HHb in the post-resuscitation MAP (p = 0.8573). The MAP increase during resuscitation was significantly higher for Rcom (25.6± 5.8 mmHg) compared to LR (-8.5 ± 21.6 mmHg, p = 0.0197), but the difference between the HHb (19.0 ± 23.2 mmHg) and LR (p = 0.1155) was not statistically significant. Conclusion: This study demonstrates that resuscitation with RcoM supports the blood pressure in a murine traumatic hemorrhagic shock model, suggesting its potential application as a non-globin artificial oxygen carrier for hemorrhagic shock.
Abstract 4147290: The association between alcohol intake and pericarditis and myocarditis: The "All of Us” Research Program
Authors: Andrew Ndakotsu, Yakoub Bene-alhasan, Samuel Mensah, Isaac Acquah, Amrit Devkota, Albert Osei
Journal: Circulation (2024)

Introduction: Alcohol consumption is associated with an increase in pro-inflammatory cytokines. Acute non-infectious pericarditis may be a consequence of the alcohol-related inflammatory process. This study investigates the association between excessive alcohol consumption and the risk of acute pericarditis and myocarditis. Hypothesis: Alcohol use may be associated with myocarditis and pericarditis through oxidative stress, immunological dysfunction, and direct toxicity to the heart muscle. Methods: This is a cross-sectional study of participants in the All of Us study at the time of enrollment. Alcohol use, our primary exposure was measured using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score. Participants were stratified based on their AUDIT scores into Low risk-(males with Audit less than 4, females with Audit less than 3),moderate risk (AUDIT 4-5 in males, 3-5 in females), high risk (AUDIT 6-7 in both males and females) severe risk (AUDIT 8-12 in both males and females). The diagnosis of pericarditis and myocarditis was identified using electronic health records at the time of enrollment. The study adjusted baseline age, sex, race, educational status, income, health insurance, and smoking status. Logistic regression models were used to evaluate the association between alcohol intake and myocarditis/pericarditis. Models were adjusted for age, sex, race, educational status, income, health insurance, and smoking status. Results: Out of 135,010 eligible participants at baseline, 220 cases of myocarditis and pericarditis were detected. People with severe alcohol intake were (n=4825) more likely to be male (n, 3125, 64.8%%), less likely to be insured (n, %=4320, 89.5%) and less likely current cigarette smokers (n, %= 1007, 9.3%). The odds of developing myocarditis or pericarditis were not statistically significantly different with increasing AUDIT-C categories as compared to never- after adjusting for confounders. (table 1) Conclusion: There was no significant association found between higher AUDIT scores and an elevated risk of myocarditis and pericarditis.
Abstract 4147797: Clinical Correlations with Longitudinal Echocardiography and Global Longitudinal Strain in the First and Second Genetically Modified Porcine to Human Cardiac Xenotransplantation
Authors: Sarah Leventhal, Muhammad Mohiuddin, Manjula Ananthram, Andrew Tully, Javier Galindo, Timm Dickfeld, Alison Grazioli, Allison Lankford, Albert Hicks, Brian Barr, Anuj Gupta, Erika Feller, Bartley Griffith, Susie Hong-Zohlman
Journal: Circulation (2024)

Background: Our institution performed the first and second genetically modified porcine cardiac xenotransplantation in a human in the world. Our laboratory performed serial and longitudinal transthoracic echocardiograms (TTE) with global longitudinal strain (GLS) for both patients for clinical surveillance and to identify any evidence of xenograft failure. For both recipients, marked myocardial hypertrophy with worsening GLS were noted at the time of graft failure. Study Aim: The aim of this study is to identify noninvasive measurements which may help predict early graft failure and mortality in cardiac xenotransplantation. We hypothesize that a ratio of papillary muscle measurement (PPM) to end diastolic diameter (EDD) measured on TTE with GLS may predict xenotransplant graft failure and mortality. Methods: Echocardiographic measurements were made in both xenotransplanted patients, which included PPM, EDD, and GLS. Serial echocardiographic measurements and ratios were subsequently compared to endomyocardial biopsies (EMBx) and clinical correlation, including terminal graft failure and death. Results: From post-operative day (POD) 1 of xenotransplant to end-of-life for both recipients, PPM thickness increased by 84.5% (CI 78.8-95.2%) while EDD decreased by 40.2% (CI 20.3-64.1%). For the first recipient, PPM/EDD progressively increased from 0.23 (POD 1) to 0.57 (POD 58), when the xenotransplant terminally failed from a restrictive myopathy (LVEF 55%, GLS -7.7) confirmed by EMBx. For the second recipient, PPM/EDD progressively increased from 0.26 (POD 1) to 1.00 (POD 40) (Figure 1), when the graft terminally failed due to combined systolic and diastolic dysfunction (LVEF 25%, GLS -7.6), also confirmed by EMBx. For both xenografts, the global longitudinal strain (GLS) worsened (more positive) by an average of 42.3% (CI 42.2 - 42.4%) when the PPM/EDD ratio reached between 0.5 and 0.6. Conclusion: Increased ratio of PPM to EDD is associated with worsening GLS, cardiac xenotransplant graft failure, and recipient mortality. TTE with GLS provided real-time clinical and noninvasive histological correlation in the first and second transgenic cardiac xenotransplants. Given the interest in cardiac xenotransplantation, serial noninvasive measurements identifying early graft failure will be important for future monitoring and management.
Abstract Sa405: Unlocking the Potential of Mechanical CPR: The Role of Real-Time Feedback Before Device Application
Authors: Mitsuyuki Miyazato, KENSUKE FUJITA, Eri Douno, Yoshihiro Hagiwara, Takayuki Ogura
Journal: Circulation (2024)

Background: Current AHA guidelines do not recommend routine use of Mechanical CPR devices due to the decline in CPR quality during their preparation and application. However, Manual chest compressions during transport can reduce CPR quality. In situations where maintaining high-quality CPR is challenging, Mechanical CPR devices are essential. We hypothesized that real-time feedback (RF) could help maintain the quality of Manual CPR before Mechanical CPR devices are activated. Objectives: To investigate the impact of RF on the quality of Manual CPR before the activation of Mechanical CPR devices. Methods: This retrospective observational study included OHCA cases where Mechanical CPR using the LUCAS 3® device was performed between May 2023 and February 2024. We compared chest compression quality parameters, including Depth Achievement Rate (≥5cm) (%), Depth (cm), Rate Achievement Rate (100-120/min) (%), Rate (/min), Longest Interruption (s), and Chest Compression Fraction (CCF) (%) during Manual chest compressions before the application of the Mechanical CPR device between two periods, using the ZOLL X Series® monitor. During the first 5 months, RF was not used, and EMS teams could not see RF data, but chest compression quality parameters were recorded. During the subsequent 5 months, RF was displayed, and the same parameters were recorded. Results: The results are summarized in the attached figure. There were 10 cases without RF and 37 with RF. The RF group showed significant improvements in depth achievement rate (≥5cm) and compression depth. The rate achievement rate (100-120/min) and compression rate were similar between groups. The longest interruption time was shorter in the RF group, and the CCF was higher, although these differences were not statistically significant. The median duration of Manual CPR before applying the Mechanical CPR device was longer in the RF group [382s, IQR 110-654] compared to the non-RF group [156s, IQR 67-283], p=0.065. Conclusions: RF significantly improved the depth achievement rate and compression depth during Manual CPR before applying Mechanical CPR devices. Trends towards shorter interruption times and higher CCF in the RF group suggest RF may help maintain CPR quality. However, the retrospective nature and limited sample size may affect the generalizability of the results.
Abstract 4147327: Race and Ethnic Differences in Donor-Derived Cell-Free DNA and Gene Expression Profiling in Heart Transplant Recipients in a Negative Biopsy Cohort
Authors: Daniel Oren, Cathrine Moeller, Andrea Fernandez Valledor, Salwa Rahman, Gal Rubinstein, Julia Baranowska, dor lotan, Ersilia DeFilippis, Justin Fried, Adil Yunis, Jayant Raikhelkar, Kevin Clerkin, Stephen J Peterson, Manish Parikh, Farhana Latif, Gabriel Sayer, Nir Uriel
Journal: Circulation (2024)

Introduction: The Donor-Derived Cell-Free DNA-Outcomes AlloMap Registry (D-OAR) study has highlighted the significant capability of dd-cfDNA, showcasing a 97% negative predictive value (NPV) for identifying both acute cellular rejection (ACR) and antibody-mediated rejection (AMR) at a dd-cfDNA threshold of 0.20%. This development has greatly enhanced the range of biomarkers available to clinicians, confirming dd-cfDNA as a reliable clinical biomarker for monitoring heart transplant (HT) recipients. Short and long-term outcomes for African American HT recipients are worse. Given these findings, our study aims to investigate baseline differences in the levels and positivity rates of dd-cfDNA stratified by race in a negative biopsy cohort. Methods: We conducted a single-center retrospective review of all HT recipients from 2019 to 2023 with at least one valid combined dd-cfDNA sample drawn between April 2019 and July 2023. Multiorgan transplant recipients and those without a paired biopsy result were excluded. A positive biopsy result was defined as &gt;= ISHLT grade 1R/1B or pAMR&gt;0. Dd-cfDNA (AlloSure, AS) result was considered positive if ≥0.12%, and as a sub-analysis using a threshold ≥0.20%. A positive peripheral GEP (pGEP, AlloMap, AM) test was defined as &gt;30 in the first five months post-transplant and &gt;34 afterward. Samples associated with a positive biopsy result were excluded. We further stratified our cohort based on race. Results: Of 643 paired dd-cfDNA/GEP samples from 227 patients, the median age was 55 years, and 27% were female. The cohort was stratified into four categories: 53% were white, 18.8% were AA, 20.4% were Hispanic/Latino, and 7.8% were of other races. We observed no baseline differences in the positive dd-cfDNA levels (p=0.39) and positivity rates of dd-cfDNA at a threshold of 0.12% and 0.20% (p=0.08, p=0.06) or GEP positivity rates (p=0.52) between the 4 race categories in our surveillance cohort (Figure 1). Further comparison of patients treated for rejection based on non-invasive monitoring did not reveal a difference. Conclusions: In our surveillance cohort, dd-cfDNA levels and positivity rates were not different between AA and white HT recipients. Further prospective randomized trials are needed to elucidate potential race-related differences in dd-cfDNA levels.
Abstract Sa603: Inhibiting the activation of cGAS-STING signaling pathway can improve brain injury after cardiopulmonary resuscitation
Authors: yi liu, Peng Yao, Zhihao Liu, Yu Cao
Journal: Circulation (2024)

Background: Neuroinflammation-induced injury is closely related to poor prognosis in patients with brain injury after cardiopulmonary resuscitation.The cyclic GMP-AMP synthase-stimulator of interferon gene (cGAS-STING) axis is a cytoplasmic double-stranded DNA (dsDNA) sensing pathway has recently emerged as a crucial mediator of neuroinflammation in ischemic stroke. However, the role of the cGAS-STING pathway in regulating inflammation in post-cardiopulmonary resuscitation brain injury and the underlying mechanisms involved remain unclear. Methods: The cardiac arrest(CA) model of C57BL/6J male mice was induced by transesophageal electric shock. To evaluate the role of the cGAS-STING pathway in brain injury after cardiac arrest in Sting-deficiency (Sting -/- ) mice. In addition, intraperitoneally administered STING inhibitor H151 evaluated the role of the cGAS-STING pathway in brain injury after cardiac arrest in mice. Results: In the mice CA model, we observed significant activation of the cGAS-STING pathway, mainly in mouse brain neurons and microglia. Brain injury after cardiac arrest triggers the release of dsDNA into the cytoplasm and triggers an inflammatory response by activating the cGAS-STING axis. Knockout of STING can reduce the activation of cGAS-STING pathway and the level of downstream inflammatory cytokines in brain injury after cardiopulmonary resuscitation, while maintaining the expression of blood-brain barrier related proteins (occludin, cluadin-5, ZO-1). In addition, H151 can reduce the activation of cGAS-STING pathway and the level of downstream inflammatory cytokines in brain injury after cardiopulmonary resuscitation in mice, and restore the expression of blood-brain barrier related proteins (occludin, cluadin-5, ZO-1). Conclusions: Our data suggest that inhibiting the cGAS-STING pathway reduces the neuroinflammatory burden of brain injury after cardiopulmonary resuscitation, and inhibiting or missing STING preserves blood-brain barrier integrity after cardiac arrest and cardiopulmonary resuscitation, and highlight this approach as a potential treatment strategy for brain injury-mediated pathology after cardiopulmonary resuscitation. Keywords: Neuroinflammation; STING; cGAS, Blood-brain barrier, Neurons
Abstract Su1011: Effect of Constriction Rates on Indicators of Hemodynamics in Circumferential Thoracoabdominal Cardiopulmonary Resuscitation
Authors: Aidan Paradis, David Gaddy, Karen Moodie, Timothy Mader, Alexandre Dufresne, Christine Couturier, Simon Dufresne, Daniel Davis, Christopher Sims, Norman Paradis
Journal: Circulation (2024)

Introduction: Data from human case series suggest that the optimal compression rate for sternal piston type CPR may be in the range of 130 compressions/min. Existing mechanical devices have compression rates of between 80 and 100 per minute. Circumferential thoracoabdominal CPR ( CTA-CPR ) may have enhanced hemodynamic effects and a superior safety profile, but the optimal constriction rate is currently unknown. Hypothesis: Constriction rates are positively correlated with indicators of hemodynamics in CTA-CPR. Methods: Ventricular fibrillation was induced in female Yorkshire swine (n = 9, ~30kg). CPR was provided by a prototype pneumatic CTA-CPR system. Constriction rates were varied in 45s epochs among 80, 100 and 120 per minute. Aortic ( Ao ) and right atrial ( RA ) pressures were measured using micromanometer catheters. Coronary perfusion pressure ( CPP ) was derived as the difference between the Ao and RA pressures. The change in CPP ( Δ-CPP ) from the beginning to the end of each treatment epoch was the principal indicator of hemodynamics. Data from all experiments were grouped by treatment type and subjected to Analysis of Variance. Results: Final Ao pressures for 80, 100, and 120 constrictions per minute were 27, 31, and 28 mmHg, respectively. Final RA pressures were 6, 7, and 7 mmHg. This yields CPPs of 20, 24, and 21 mmHg. The Δ-CPPs trended upward 5.3, 5.7, and 6.0, respectively (p &lt; 0.10). Conclusion: Increasing constriction rates were associated with improved indicators of hemodynamics. The optimal rate may be similar to that seen in sternal piston CPR, and considerably higher than available with commercial automated devices.