tbuckley/cabot-search huggingface dataset:
Abstract 232: Predicted One Third Improvement in Survival for Shockable Rhythms of a Proposed First Responder and Drone Automated External Defibrillator Delivery Program in North Carolina
Authors: Jamal Chu, Monique A Starks, K.H. Benjamin Leung, Audrey L Blewer, Christopher B Granger, Bryan F McNally, Daniel B Mark, Timothy Chan
Journal: Circulation (2023)

Background: Drone-delivered AEDs can improve access to defibrillation for OHCA. If drone-delivered AEDs arrive at the OHCA before EMS, then the OHCA’s first recorded rhythm may differ from that recorded by EMS. We estimate the clinical impact of a proposed program of first responder (FR) and drone AED delivery in North Carolina while accounting for this potential unobserved change in shockable rhythm. Methods: Using the CARES registry data, we identified OHCAs in 48 counties between Jan. 2013-Dec. 2019. OHCAs were stratified by whether they were bystander-witnessed. For each subpopulation three separate logistic regression models were trained to predict: 1) shockable initial rhythm 2) survival to discharge for shockable OHCAs and 3) survival to discharge for non-shockable OHCAs. Predictions from these models were combined to predict overall survival of a proposed program of first responder and drone AED delivery optimized for 5-minute coverage (proportion of OHCAs with response within 5 minutes). Results: We included 21,987 OHCAs to fit the outcome prediction models and used these models to predict the estimated clinical impact on the OHCAs with improved response time due to the FR and drone intervention (n=16, 321). For witnessed OHCAs, predicted rates of shockable initial rhythm increased by 14.9% (29.5% to 33.9%), and predicted rates of survival to discharge rose by 31.1% (13.2% to 17.3%). For unwitnessed OHCAs, predicted rates of shockable initial rhythm increased by 5.1% (11.8% to 12.4%), and predicted survival to discharge rose by 14.6% (4.8% to 5.5%). Witnessed OHCAs with &lt;5-min response had the largest predicted benefit with survival rates increasing by 34.5% (14.5% to 19.5%). Conclusion: When accounting for changes in the likelihood of shockable rhythm due to improved response time, we estimated that a FR and drone AED delivery program may substantially improve survival rates of witnessed arrests and marginally improve survival rates of unwitnessed arrests.
Abstract 361: Effect of Percutaneous Ventricular Assisted Device on a Recovery of Myocardial Function in Swine Model With Prolonged Cardiac Arrest
Authors: Takahiro Nakashima, Mohamad Hakam Tiba, Adam Gottula, Cindy H Hsu, Brendan McCracken, Nicholas Greer, Traci Cramer, Nadia R Sutton, Kevin Ward, Robert W Neumar
Journal: Circulation (2023)

Background: Percutaneous ventricular assist device (pLVAD) support and Transient aortic balloon occlusion (AO) can preserve cerebral and cardiac blood flow during cardiopulmonary resuscitation (CPR), but it remains unclear if pLVAD reduces post-cardiac arrest myocardial dysfunction. Hypothesis: pLVAD support immediately after the return of spontaneous circulation (ROSC) improves early recovery of myocardial function following prolonged cardiac arrest. Aims: Evaluate the association between early post-ROSC pLVAD support and recovery of myocardial function in a swine model of prolonged cardiac arrest. Methods: This is a secondary analysis of a subset of animals that achieved ROSC in a study comparing pLVAD, transient AO or both during CPR after prolonged cardiac arrest. pLVAD, aortic occlusion, or both were initiated after 24 minutes of ventricular fibrillation cardiac arrest (8 min no-flow and 16 min mechanical CPR). AO was discontinued post-ROSC, and pLVAD support or standard care were continued. Beginning 60 minutes post-ROSC, pLVAD support was weaned to &lt;1.0 L/min while maintaining a MAP &gt;70 mmHg, and subsequently removed at 4 hours when feasible. The primary outcome was the recovery of cardiac index (CI) and left ventricular ejection fraction (LVEF) at 4 hours post-ROSC. Data are shown as mean (standard error). Results: Seventeen animals achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 [8 were removed from pLVAD], and standard care group, n = 6). For the primary outcome, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m2 (p=0.043) and LVEF 60(3) vs. 49(4) % (p=0.029) at 4 hours after ROSC, respectively, when compared with the standard care group. Focusing on the early period within 60 minutes after ROSC when maximum pLVAD flow was maintained, the pLVAD group had significantly higher coronary perfusion pressure (62[4] vs. 47[5] mmHg, p=0.019), lower LV stroke work index (3.9[3.0] vs. 14.9[4.4] cJ/m2, p=0.043), and lower total pulmonary resistance index (13.2[4.8] vs. 21.5[14.4] Wood Unit, p=0.001). Conclusion: These results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.
Abstract 289: Volunteer Responders Find It Meaningful to Attend to Pediatric Out-of-Hospital Cardiac Arrests
Authors: Sofie Have Kjærholm, Astrid Rolin R Kragh, Anne Juul Grabmayr, Liv Borch-Johnsen, Fredrik Folke, Tine Tjørnhøj-Thomsen, Carolina Malta Hansen
Journal: Circulation (2023)

Background: In Denmark, volunteer responders have been dispatched to suspected pediatric out-of-hospital cardiac arrests (OHCAs) through a smartphone application since February 2022. However, it is unknown how volunteer responders experience assisting pediatric OHCAs. Aim: To explore how volunteer responders experienced being involved in pediatric OHCAs. Method: The study population comprised volunteer responders alerted to an OHCA patient &lt;6 years of age in Denmark (2020-2023). Data was collected through individual, semi-structured interviews. Data analysis followed an inductive process with a phenomenology-hermeneutical interpretative approach. Using thematic analysis data was indexed into codes and themes, generated to draw out meaning from the text. Results: Eight volunteer responders had assisted at six different pediatric OHCAs. Participant age ranged from 24-60 years, five were men, three were healthcare workers, and four provided CPR. Among the pediatric OHCAs, three were &lt; 6 months and three were 2-5 years old, none survived. Five themes emerged from the analysis: “The shock when realizing the patient is a child”, “Volunteer responders’ capability to act and initiate CPR in a child”, “Doubts and thoughts during resuscitating a child”, “Interaction with the family during resuscitation” and “The aftermath: the overwhelming fact, that it was a child”. Despite experiencing the sight of a child with OHCA as overwhelming, volunteer responders managed to act and provide CPR. Volunteer responders also considered the provision of psychological support to the parents as an important task. Taken together, volunteer responders found it meaningful to be alerted to a child and were ready to do it again, even though it is a severe experience. Conclusion: Volunteer responders found it meaningful to assist a pediatric OHCA, despite the shock of discovering that the patient was a child. Including information on suspicion of pediatric OHCA in the app alert may mitigate this shock and better prepare volunteer responders to assist pediatric OHCAs.
Abstract 420: The Association Between Ventricular Fibrillation Duration and Successful Termination After the First Shock in Witnessed Out-of-Hospital Cardiac Arrest Patients
Authors: Bas J Verkaik, Remy Stieglis, Hanno Tan, Hans van Schuppen, Rudolph W Koster, Christian van der Werf
Journal: Circulation (2023)

Introduction: In OHCA patients with an initial shockable rhythm, a longer time interval between onset of VF and the first shock decreases the likelihood of survival. The exact mechanism to explain this decrease is not clear. We investigated the time interval between delay to the first shock and outcomes VF termination, return of organized rhythm (ROOR), ROSC and survival. Methods: We studied witnessed OHCA patients with VF as an initial rhythm using the prospective ARREST registry. Patient- and resuscitation data, including time-synchronized AED and manual defibrillator data, were analysed to determine VF termination at 5 seconds after the first shock. Shock delay was defined as the time from initial emergency call till first shock by any defibrillator. Outcomes were rates of termination of VF, ROOR 5 seconds after the first shock, ROSC before transport, and survival to discharge, all in relation to the delay to the first shock. A logistic regression corrected for age, sex and basic life support before EMS arrival was used to analyse the association between VF duration and outcomes. Results: A total of 3676 cases were analysed. VF termination rates declined from 95% when the first shock was delivered &lt;2 minutes after the call to 75% when delivered after &gt;16 minutes (Figure 1). Rates of ROOR (49% to 23%), ROSC before transport (86% to 33%), and survival to discharge (79% to 23%) all declined significantly. Every additional minute in VF was associated with a 9% increased odds of failure to terminate VF (OR 1.09 [95% CI 1.07-1.12]), a 7% reduced odds of ROOR (OR 0.93 [95% CI 0.91-0.95]), a 12% reduced odds of acquiring ROSC before transport (OR 0.88 [95% CI 0.86-0.90]), and a 15% reduced odds of surviving to discharge (OR 0.85 [95% CI 0.83-0.87]). Conclusions: Every additional minute of delay to the first shock was associated with significant decreases in rates of VF termination, ROOR, and ROSC during transportation. This may explain the worse outcomes in patients with a long delay to defibrillation.
Abstract 395: Outcomes Of Mechanical Circulatory Support for Cardiogenic Shock in the United States: An Analysis of the 2017-2020 National Inpatient Sample Database
Authors: Claudia M Ramirez, Abbas Alshami, Ndausung Udongwo, Mohamed Ziad-M.Said, Kameron Tavakolian, Anton Mararenko, Viraaj Pannu, David Grzybacz, Steven Imburgio, Joseph Varon, Jesus Almendral
Journal: Circulation (2023)

Introduction: Mechanical circulatory support devices, such as Extracorporeal membrane oxygenation(ECMO), Impella, and intra-aortic balloon pump(IABP), play a crucial role in managing patients with cardiogenic shock(CS). This study aimed to compare the outcomes and patient characteristics of different mechanical circulatory support modalities. Methods: We utilized the National Inpatient Sample Database(NIS) data from 2017 to 2020 to identify patients with the diagnosis of CS who received mechanical circulatory support. The study population was categorized into six groups: ECMO, Impella, IABP, ECMO + Impella, and ECMO + IABP. The groups were compared based on patient characteristics, length of stay(LOS), complications, need for a heart transplant, mortality, and total charges. Results: A total of 715,470 patients were identified with CS, 17%(122,100) received mechanical circulatory support, 5,675 had ECMO therapy, 33,360 Impella, 79,540 IABP, 1,890 cases ECMO+Impella, and 1,635 cases ECMO+IABP. Age significantly differed, with ECMO patients being the youngest 54[36-65] years. There were higher proportions of females in the ECMO-only(37.4%) and males in the ECMO+Impella(76.7%). LOS was prolonged in the ECMO group(14 [5-28] days) compared to other groups(p&lt;0.001). Mortality rates were higher in the ECMO group(47.1%), followed by ECMO+Impella(45.8%) and ECMO+IABP (40.1%) (p&lt;0.001). Higher rates of stroke, disseminated intravascular coagulation, and continuous renal replacement therapy requirements were observed in the ECMO group. Bleeding requiring transfusion was more frequent with ECMO+IABP, and limb ischemia was more common in the ECMO+Impella group (p&lt; 0.001). Heart transplant rates were highest after ECMO+IABP therapy. Over the years, ECMO utilization increased, while Impella and IABP utilization remained stable. Notably, the ECMO+IABP had the highest total charges among all the therapy modalities evaluated (p &lt; 0.001). Conclusions: The rising utilization of ECMO and ECMO-IABP therapies indicates a changing treatment landscape. However, these approaches exhibit lower survival rates, potentially due to the severity of CS, heightened complications, and increased costs compared to standalone IABP or Impella therapies.
Abstract 278: Injuries and Outcomes Associated With Manual vs Mechanical CPR Post Out of Hospital Cardiac Arrest
Authors: Connie Chen, Julian Sit, Jacob Keeley, Robert A Swor
Journal: Circulation (2023)

Objectives: Mechanical CPR is increasingly being used for field out of hospital cardiac arrest (OHCA) care. However, existing literature does not identify a survival benefit of mechanical versus manual CPR. We hypothesized that CPR related injury may impact patient outcomes. For that reason, our primary objective is to compare mechanical and manual CPR-related injury in resuscitated OHCA patients. Our secondary objective is to compare hospital outcomes including length of stay (LOS) and survival between these two CPR methods. Methods: We performed a retrospective study of adult OHCA patients admitted to three teaching hospitals in Southeastern Michigan from 2017-2021. Resuscitated patients were matched to hospital electronic medical records (EMRs), included if they had CT imaging of chest or abdomen/pelvis, and then dichotomized by CPR method. Patients were excluded if no EMR match or CPR method was unknown. Hospital EMRs were queried for CT imaging results, LOS variables and survival to hospital discharge. Injuries are identified using hospital ICD-10 codes. Univariate statistics are reported. Results: There were 808 patients admitted after OHCA, with 235 (103 mechanical CPR, 132 manual CPR) meeting the inclusion criteria. Demographics between groups were similar in age, gender, or body mass index (BMI). There were no abdominal/visceral injuries and few patients (4) had a pneumothorax. CPR associated injury was more common with manual CPR (28.8% vs 15.5%, p=0.02) and an increased rate of rib(s), sternum, or thoracic spine fracture (27.3% vs 14.6%, p=0.02). . We identified no differences in survival to hospital discharge (39 (29.5%) vs. 29 (28.2%), p=0.8), median hospital LOS, ICU LOS, and ventilator time between groups. Paradoxically amongst survivors, mechanical CPR was associated with longer LOS (15.7 vs 11.0 days, p=0.012) and a non-significant increased ventilator time (143 vs 99 hours, p=0.23). Conclusion: We identified a higher rate of injury with manual CPR compared to mechanical CPR in resuscitated OHCA patients We also did not identify any association between CPR method and ICU LOS, ventilator time, and survival. Further work is needed to assess the impact on outcome of CPR method and injuries typically associated with resuscitation.
Abstract 288: The Tool to Empower (TEMPO) Surrogate Decision Makers of Comatose Survivors of Cardiac Arrest: A Pilot Trial of a Novel Decision Tool
Authors: Sarah M Perman, Shelby Shelton, Bonnie Siry-Bove, Amanda Martinez, Dan D Matlock, Stacie L Daugherty, Ed Havranek
Journal: Circulation (2023)

Introduction: OHCA is a sudden unexpected event that frequently renders patients incapable of decision-making. Surrogate decision makers are often thrust into the position of deciphering complex medical information while representing their loved one’s wishes with little support. Hypothesis: An evidence based, iteratively designed decision tool will be feasible to deploy, acceptable to surrogates, increase knowledge of post-cardiac arrest care and impart self-efficacy for decision making. Goal: To measure the efficacy of a novel decision aid for surrogates. Methods: We conducted a pilot trial of the T ool to EMPO wer (TEMPO) decision makers to examine feasibility, acceptability, knowledge, and self-efficacy. Surrogates were given a pre-intervention survey on the day of arrest, provided the tool and a post-intervention survey at least 24 hours later. The survey included an 8-question knowledge questionnaire. The post-interventions survey included the same knowledge questions, the Ottawa acceptability survey and a measure of self-efficacy for decision-making for the unconscious patient. Results: We enrolled 41 surrogates into the TEMPO Pilot Trial between 9/20 and 12/22. Subjects identified were predominantly women (75.6%, n=31), 53.7% were White, 22% Black and 24.4% Hispanic. Participants had varied relationships to the patient including spouse (44%), sibling (17%), adult child (17%) and parent (12%). Knowledge increased from 56.4% to 85.9%, an absolute improvement of 29.5%. Significant improvements were noted in self-efficacy in the following domains after exposure to TEMPO: 1) receipt of resuscitation; 2) care at the end-of-life; and 3) continued desire to fight the disease. Surrogates found the tool to be useful (84.6%) and that it made their choice easier (91.2%). One participant reported “I had never dealt with this and did not know what to expect so the information given was very helpful” and another stated “Now I know what type of questions to ask and what to look for.” Conclusion(s): In a pilot trial of TEMPO, a novel decision tool for surrogate decision makers of comatose survivors of cardiac arrest, we found the intervention was feasible, acceptable, improved knowledge and increased feelings of self-efficacy in decision making.
Abstract 310: Impact of "Cognitive Aids" on Responder Performance During Pediatric Code Blue Simulations - Results From Performance Improvement Project at a Tertiary Care Center in Saudi Arabia
Authors: Muzammil M Noorani, Naila Mehboob, Tahira Hashmat, Zaib Asif, Amjad Alshehri, Hakem Alomani, Muhammad Zaid, Viqaruddin Mohammed, Rana Aldawalibi
Journal: Circulation (2023)

Introduction: Despite advances such as high-fidelity code blue simulations, pediatric In-Hospital Cardiac Arrest mortality rate has plateaued at 62% in the USA. It is expected to be higher in low-income countries. Studies show deviations from the PALS guidelines despite regular PALS training due to skills and knowledge decay. Use of simple, easily accessible resources as “Cognitive Aids”, that decrease reliance on memory during stressful events, however, has not been studied well. Aim: To evaluate impact of cognitive aids on resuscitative capabilities of code-blue responders during simulations. Method: Performance Improvement (PI) project by Pediatrics Department at King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia. Simulations were run by Consultant, Pediatric Intensivist and PICU nurse on regular pediatric floors. A performance assessment checklist and a scoring tool were designed to evaluate team members for responsiveness, effective resuscitation, effective communication and resource utilization. Results: A total of 94 responders participated multiple times in 35 simulations that were conducted in two phases: Codes 1 - 19 as the Pre-PI phase and Codes 20 - 35 as Post-PI phase. Cognitive aids were not utilized during the Pre-PI codes and based on the assessment scores, interventions were introduced in the form of A3 size PALS resuscitation cards, “Pediatric Cardiac Arrest Resuscitation Direction” document with prompts to facilitate smooth running of the code and SBAR notes. Based on the scores, improvement was observed in responsiveness by 27% (Pre-PI:192/262 vs. Post-PI:222/223), effective resuscitation by 38% (Pre-PI:293/511 vs. Post-PI:409/431), effective communication by 46% (Pre-PI:94/245 vs. Post-PI:173/207) and resource utilization by 56% (PrePI:37/94 vs. Post-PI:76/80). Total of 36 (38%) responders participated in actual pediatric cardiac arrests after project completion and 97% (35/36) reported higher confidence. Conclusion: Cognitive aids were helpful supportive tools in overcoming skills and knowledge decay and enhance team performance and quality of resuscitation during code blue simulations. We suggest use of such tools wherever high-fidelity simulation training may not be available.
Abstract 280: Effectiveness of Bag-Valve-Mask Ventilation During Out-of-Hospital Pediatric CPR
Authors: Yacine B Issioui, Ava E Pierce, Ahamed H Idris
Journal: Circulation (2023)

Background: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 15 or 30 chest compressions to deliver ventilations for children. The effectiveness of bag-valve-mask (BVM) ventilation delivered during the pause in chest compressions is unknown. Hypothesis: Lung inflation occurs infrequently with BVM ventilation during 30:2 (and 15:2) CPR. Aim: To determine the incidence of lung inflation with BVM ventilation during 15:2 or 30:2 CPR for pediatric OHCA. Methods: This is a retrospective, observational study of 63 OHCA patients, &lt;18 years of age, with non-traumatic cardiac arrest from the Dallas-Fort Worth Center for Resuscitation Research registry. Emergency medical service rescuers provided 30:2 or 15:2 CPR with BVM ventilation and ≥ 2 min of recorded CPR. We measured bioimpedance ventilation (lung inflation) waveforms in the pauses between chest compression segments recorded through defibrillation pads. A detectable ventilation waveform had a bioimpedance amplitude ≥0.5 Ohm and duration ≥1 sec. We measured the incidence of ventilation in two pre-specified groups: patients with ventilation waveforms in &lt;50% of pauses (Group 1) vs. those with waveforms in ≥50% of pauses (Group 2). Results: The mean duration of 30:2 or 15:2 CPR was 15(8) min prior to advanced airway placement. During this period, we identified 683 pauses in chest compressions, 386 measurable ventilations, and the median (IQR) number of ventilations was 2 (0-4). Of 20 advanced airway attempts, nine were successful.Group 1 (N=48) had a median 8 pauses and 1.5 ventilations/patient, Group 2 (N= 15) had a median 10 pauses and 12 ventilations/patient (Table). Return of spontaneous circulation for Group 1 (15%, 7/48) vs. Group 2 (33%, 5/15). Conclusion: This study shows that use of a BVM device results in infrequent lung inflation during 30:2 or 15:2 CPR in pediatric patients.
Abstract 374: Modified Physiologic Criteria for the Field Triage Scheme: Efficacy of Major Trauma Recognition in Different Age Groups Across Asia
Authors: HaoYang Lin, Yu-Chun Chien, Ying-Chih Ko, Min-Shan Tsai, Kuan-Chen Chin, Matthew Ma, Wen-chu Chiang
Journal: Circulation (2023)

Introduction: Identifying patients with major trauma in prehospital settings by Field Triage Scheme (FTS) is of paramount importance. The goal of the FTS was set with a sensitivity (Sn) of 95% and specificity (Sp) of 50% to identify patients with major trauma, although many studies showed it unachievable. A simplified FTS (sFTS) may offer a more rapid prehospital triage of patients. However, evidence of its accuracy remains unclear. Hypothesis: We examined the performance of identifying patients with major trauma by triage tools of sFTS, modified sFTS, and adding shock index (SI) in different age groups. Methods: We conducted a multinational retrospective cohort study involving a total of 51,622 adult trauma patients in the studied countries from 2016 to 2020, using data from the Pan-Asia Trauma Outcomes Study. We tested (1) sFTS comprising only physiological and anatomical criteria, (2) modified sFTS defined by fine-tuning the physiological criteria of GCS score &lt; 15, respiratory rate &lt;10 or ≥ 24 beats/minute, and systolic blood pressure &lt; 110 mmHg, and (3) sequentially added a SI of ≧0.8, to compare their performance in identifying patients with major trauma. Major trauma was defined by injury severity score ≥ 16. The cubic-spline method was used to smooth the curves of Sn/Sp across ages. Results: The overall sensitivity and specificity of the sFTS, modified sFTS, and adding SI of 0.8 to modified sFTS were, 80.6%, 82.8%, 84.3%, and 58.5%, 53.7%, 49.2%, respectively. The trade-off of Sn/Sp was illustrated in Figure 1. The top Sn/Sp of the three triage tools was constantly at patients’ age of 50, with rapidly declining in both younger and older patients. The modified sFTS showed increasing sensitivity with more pronounced changes in the younger group. Adding the shock index further increased sensitivity in both younger and older groups.