Risultati per: Circulation

Circulation, Volume 150, Issue 21, Page 1732-1736, November 19, 2024.

Circulation, Volume 150, Issue Suppl_1, Page A4145857-A4145857, November 12, 2024. Objectives:Fontan patients have impaired exercise capacity. Exercise training has been shown to improve exercise performance. We aim to determine the effect of exercise training on SVH function, and its correlation with exercise capacity, body composition and self-reported QOL.Methods:31 paediatric Fontan patients were prospectively recruited to complete 3×30 minute homebased HIIT sessions per week for 20 weeks. Baseline physical activity levels, including structured sports participation, daily step-counts and active-zone-minutes (AZM) were recorded by accelerometer (Fitbit inspire3). Patients were considered active if they met 2 of the 3 criteria:1/Structured sports training ≥ 2 per week (moderate-vigorous intensity >30 minutes)2/Daily steps ≥ 10k3/AZM ≥60 minutes per dayBio-impedance-analysis, cardiopulmonary exercise tests, echocardiography including deformation imaging and PedQL questionnaires were performed at baseline and upon completion.Results:28 participants completed the programme. 86% had good compliance (completed >45/60 sessions). 17 male (60.7%), mean age 14.3±2.03 years, 14 LV-dominant, 14 non-LV dominant (9RV, 5BiV). No serious adverse events reported.The exercise duration improved from 7.56±2.6 to 9.16±2.5 minutes, p

Circulation, Volume 150, Issue Suppl_1, Page A4140997-A4140997, November 12, 2024. Aim:Right ventricle to pulmonary circulation (RV-Pc) uncoupling represents a mainstay in staging progression of heart failure (HF), being an independent predictor of mortality. In addition, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is a well-established diagnostic and prognostic serum biomarker. In lack of clear clinical evidences on the relationship between exercise levels of NT-proBNP and RV-Pc uncoupling, this represents the aim of our investigation.Methods and Results:A cohort of 13 HF stable patients (mean age 71.6 ± 8.1; 48% female, mean left ventricular ejection fraction 57±13%) underwent maximal exercise stress echocardiographic and cardiopulmonary exercise testing (iCPET) with RV 3D-imaging analysis and were compared with a control population. Natriuretic peptides levels were obtained at rest and peak exercise. RV-Pc coupling was addressed by using the length-force relationship TAPSE/PASP ratio (tricuspid annular plane systolic/excursion pulmonary arterial systolic pressure). As expected, HF patients exhibited a higher level of NT-pro-BNP compared to controls (mean 831 ng/ml vs 131 ng/ml, at rest; mean 793.3 vs 138 ng/ml at peak). In HF, TAPSE/PAPS at peak exercise decreased compared to rest (0.73 ± 0.19 vs 0.47 ± 0.15 respectively) with an inverse correlation between NT-pro-BNP and TAPSE/PAPS exercise (r=0.60, p

Circulation, Volume 150, Issue Suppl_1, Page A4138960-A4138960, November 12, 2024. Introduction:More patients with Fontan circulation are surviving into adulthood and transitioning to adult congenital heart disease (ACHD) care. There are limited long-term outcome data in these patients.Research Questions:We sought to describe a cohort of adults with Fontan circulation and determine patient characteristics associated with long-term survival.Methods:A retrospective review of adults with Fontan circulation followed in our ACHD clinic between 2009 and 2023 was performed. The outcome of interest was transplant-free survival. Survival analysis was performed to explore association between patient factors and time from Fontan completion to patient death or transplant. Patients without events were censored at last follow-up date.Results:In our cohort of 429 patients, median age at first ACHD visit was 24 (IQR 22-29) years with median follow-up time of 3.9 (IQR 0.6-6.4) years. The most common underlying anatomies were tricuspid atresia (26.5%) and hypoplastic left heart syndrome (25.4%). Fontan completion, most commonly lateral tunnel (59.1%), was performed at a median age of 29.7 months. Extracardiac comorbidities in our cohort included: cirrhosis (42.9%), cyanosis (25.9%), and protein losing enteropathy (PLE) (7.0%). Forty-one patients (9.6%) died, 17 (4.0%) had a heart-liver transplant, and 2 (0.5%) had a heart transplant. Transplant-free survival at 20, 30, and 40 years after Fontan completion was 99%, 87%, and 63%. In total, 10 patients died from end-stage heart failure, 8 from sudden cardiac arrest, and 5 from post-transplant complications (Figure). Morphologic right ventricle, cirrhosis, cyanosis, and PLE were associated with worse transplant-free survival (Table).Conclusions:Factors associated with decreased transplant-free survival in a cohort of adult patients with Fontan circulation were identified. These data highlight the importance of early identification and potential intervention for these comorbidities to improve long-term outcomes.

Circulation, Volume 150, Issue Suppl_1, Page ASa305-ASa305, November 12, 2024. Background:TEE is increasingly recognized as a valuable imaging modality during cardiac arrest (CA) resuscitation, particularly for assessing the area of maximal compression (AMC) during CPR. Small single center studies have shown that compression of the left ventricular outflow tract or the aortic root (AMC-LVOT/Ao) is common during CPR, and that when CPR is performed with the AMC over the LV, this results in higher ETCO2, and ROSC. This study aimed to investigate the AMC and its relationship to ETCO2, and ROSC, hypothesizing that patients experiencing AMC-LVOT/Ao have lower ETCO2 and are less likely to achieve ROSC.Methods:A prospective, multicenter cohort study of patients with out-of-hospital and in-hospital CA (OHCA/IHCA) in whom TEE was performed during CPR comparing AMC over the LV (AMC-LV) vs AMC-LVOT/Ao. The study was conducted through the Resuscitative TEE Collaborative Registry, an ongoing multicenter research network involving 37 hospitals (NCT04972526). Collected data included patient and procedure characteristics, hemodynamics, and outcomes according to Utstein-style guidelines. Primary outcome was ROSC, and the secondary outcome was ETCO2 at the time of AMC determination. We performed univariate analysis and multivariate regression evaluating variables known to impact resuscitation outcomes.Results:271 patients including 205 OHCA and 66 IHCA were included. Only 133 (49%) of the total cohort had AMC-LV, with AMC-LVOT/Ao in 47% of OHCA and 42.1% of IHCA. There was no significant difference in the location of the AMC when analyzed by demographic characteristics, height, weight, or comorbidities between patients who received manual vs mechanical CPR. In OHCA, there was no difference in ROSC between AMC-LV and AMC-LVOT/Ao, however the group of patients with AMC-LVOT/Ao had on average 10 units lower ETCO2 compared to AMC-LV (Beta -10; 95% CI -19 – 1.5; p = 0.023). In IHCA, after controlling for factors known to impact outcomes, patients with AMC-LVOT/Ao had significantly lower probability of ROSC (OR 0.25, 95% CI 0.06-0.88; p=0.038).Conclusion:Obstruction of the LVOT/Ao during CPR is a common finding in CA patients evaluated with TEE. This multicenter study extends previous animal and smaller clinical studies suggesting the mechanistic association between the AMC during CPR, with ETCO2 and ROSC, and the potential of TEE-guided resuscitation to improve the effectiveness of CPR.

Circulation, Volume 150, Issue Suppl_1, Page A4140280-A4140280, November 12, 2024. Background:The Child Opportunity Index (COI) is a validated, comprehensive measure of social context, comprised of 29 indicators of child neighborhood opportunity, split into three domains (education, health and environment, and socioeconomic). Our previous work showed that low COI is associated with a 10% lower percent of predicted peak VO2post-Fontan. Exercise intolerance is a known prognostic factor for this patient population. Previous studies have shown that health inequities in education, environment, and socioeconomics factor into worse exercise outcomes. Cardiac MRI (CMR) measured muscle mass is a novel practical technique to evaluate muscle mass. We hypothesized that lower muscle mass by CMR is associated with lower exercise capacity and lower COI z-scores.Methods:A retrospective, single-center study was performed, analyzing 75 post-Fontan patients who had CMR completed between 2010 and 2022. The anterior and paraspinal muscles were measured (Figure). COI z-scores were split into low and high levels, and univariate analyses were subsequently performed to determine associations between COI levels, exercise capacity and muscle mass.Results:The mean age of the population was 19.09 years ± 8.58 with the majority being male (65.3%). Most patients underwent an extracardiac conduit repair (65.3%) (Table). There was a positive correlation between anterior (r=0.36, p=0.007) and paraspinal (r=0.34, p=0.01) muscle mass to peak VO2. There was no significant difference in paraspinal (p=0.15) or anterior (p=0.72) muscle mass between COI groups. Similarly, there were no significant associations between muscle mass and specific COI domains.Conclusion:Muscle mass correlated with exercise capacity in our population and is easy to measure by CMR. There was no correlation between COI level and muscle mass in this study, suggesting that the COI impact on exercise capacity is not directly mediated by lower muscle mass and that other factors should continue to be explored.

Circulation, Volume 150, Issue Suppl_1, Page ASu605-ASu605, November 12, 2024. Introduction:Despite validated Termination of Resuscitation (TOR) rules for Out of Hospital Cardiac Arrest (OHCA) some OHCA patients are transported prior to Return of Spontaneous Circulation (ROSC), sometimes with long transport times. There are certain therapies unavailable in the prehospital setting which could make transport prior to ROSC beneficial for some OHCA patients.Hypothesis:We hypothesized that longer transport times for patients with ongoing Cardiopulmonary Resuscitation (CPR) would be associated with progressively lower probability of achieving ROSC.Aims:To determine if there is a transport time interval beyond which ROSC becomes so unlikely that transport time could be determinant factor for TOR.Methods:We performed a retrospective study of the 2020-2022 NEMSIS national prehospital dataset. We included adult OHCA patients that did not have ROSC prehospital, were transported to the hospital, and had outcome and timestamp data available. We calculated transport time for each encounter and stratified encounters into 5-minute transport time intervals. We defined our outcome as ROSC after transport. We used multivariable logistic regression evaluating the association between 5-minute increases in transport time and ROSC. We performed a secondary analysis of patients that met termination of resuscitation (TOR) criteria (unwitnessed OHCA with no CPR or AED placement prior to EMS arrival).Results:Of 1,409,692 OHCAs, we included 137,957 OHCAs that were transported without prehospital ROSC. The median transport time was 8.9 minutes (IQR 5.4-13.8), and 17,957 (13.1%) had ROSC after hospital arrival. In 5-minute intervals from 0-30 minutes, ROSC rates were 13.5%, 13.1%, 12.0%, 11.1%, 12.1%, and 13.9%. Odds of ROSC per 5-minute increase in transport time was 1.00 (95% CI 1.00-1.00). For patients that met field TOR criteria, rates of ROSC for each 5-minute interval from 0-30 minutes were 9.2%, 8.7%, 7.6%, 5.9%, 6.1%, 4.2%, 7.5%. Odds of ROSC per 5-minute increase in transport time was 0.93 (95% CI 0.88-0.98).Conclusion:In this dataset we were unable to identify a transport time interval up to 30 mins beyond which transport is futile, even in patients who were transported despite meeting the universal TOR rule. Decision to transport based on case-by-case OHCA characteristics could have influenced results. Further research is needed to identify the subset of patient in whom transport prior to ROSC may be beneficial.

Circulation, Volume 150, Issue Suppl_1, Page A4142198-A4142198, November 12, 2024. Background:Patients with single ventricle congenital heart disease palliated to Fontan circulation have increased all-cause mortality compared to age-matched controls. The reason for this increased mortality is not clear and cannot be fully explained by the underlying cardiac disease alone. We hypothesize that premature biologic aging contributes to this increased mortality.Methods:We collected demographic, clinical data and blood from patients with Fontan circulation and controls with structurally normal hearts. We assessed biologic age using telomere length (TL) measured by quantitative PCR from buffy coat DNA. Telomeres are repeating nucleoprotein structures at the end of chromosomes which shorten with age. Between group differences were assessed using t-test. Data was presented as mean±SD and p

Circulation, Volume 150, Issue Suppl_1, Page A4139481-A4139481, November 12, 2024. Background:The physiology of the Fontan circulation is consistent with chronic heart failure, characterized by elevated central venous pressure and reduced cardiac output. In adults with conventional heart failure, iron deficiency is common and is associated with increased morbidity and mortality. However, data is lacking on the prevalence of iron deficiency and its relationship with cardiovascular outcomes in pediatric patients with Fontan circulation.Aim:To characterize the relationship between iron profiles and measures of cardiovascular health in pediatric patients with Fontan circulation.Hypothesis:Iron deficiency is associated with worse measures of cardiovascular health.Methods:Cross-sectional study comprising patients with Fontan circulation who had iron labs measured from 2010 – 2024 at a single urban center. Exclusion criteria were hematologic disease other than iron deficiency, acute bleeding, and acute illness other than heart failure. Cardiovascular health was evaluated with NYHA or Ross class, echocardiogram, and cardiac MRI. Kruskal-Wallis tests and linear regression were used to analyze associations between iron labs and measures of cardiovascular health. Indexed oxygen delivery (iDO2) was calculated from cardiac index measured by cardiac MRI, pulse oximetry, and hemoglobin.Results:100 patients (mean 12.5±4.7 years, 46% female) were included. Iron deficiency was present in 45% or 51% based on conventional criteria of transferrin saturation (TSAT)

Circulation, Volume 150, Issue Suppl_1, Page ASu301-ASu301, November 12, 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 (

Circulation, Volume 150, Issue Suppl_1, Page A4146967-A4146967, November 12, 2024. Objectives:Physically active lifestyles are important for patients with congenital heart disease, including Fontan. This study aims to establish the effect of an active lifestyle in paediatric Fontan patients, determine its relationship with body composition, exercise capacity, ventricle function and quality of life.Methods:30 Fontan patients were recruited. Mean age of 14.8±2 years.Cardiopulmonary exercise tests, bio-impedance analyser, echocardiography and PedsQL questionnaires, generic (V4.0) and cardiac modules (V3.0) were performed. Physical activity level includes structured sports participation, daily stepcounts, and active-zone-minute, AZM (minute spend doing activity ≥ moderate intensity) measured by accelerometer (Fitbit Inspire3).Patients were considered active if they met 2 of the 3 criteria:1/ Structured sports training ≥ 2 per week (moderate-vigorous intensity >30 minutes)2/ Daily steps ≥ 10k3/ AZM ≥ 60 minutes per dayResults:60% of patients were considered active, predominantly male, mean age of 14.1 years old. Overall BMI was normal, however 17% (5 of 30) were overweight or obese (Table 1).The less active Fontan had higher fat% (24.8±8.7 vs 16.6±5.2%; p=0.003), lower percentage appendicular skeletal muscle mass, SMMa%(29.8±3.6 vs 33.7±3.1%; p=0.004), and muscle to fat ratio, MFR (1.4±0.8 vs 2.3±0.9; p=0.015).The less active group had lower peak oxygen consumption, VO2peak(23.5±7.2mL/kg/min vs 35.1±3.96mL/kg/min; p < 0.001), lower peak oxygen pulse (7.9±1.2 vs 10.01±2.9) ml/beat; (p=0.024). No statistical significant differences observed in the ventricle function.Higher self-report PedQL V4.0 scores noted in the active group, indicated better HRQOL (child’s QOL 88.26±8.6 vs 72.89±17.2%; p=0.003 and parent’s QOL 87.22±10.8 vs 71.6±23.4%; p=0.020).Higher physical activity level is associated with lower body fat% (r=– 0.521, p=0.003), greater SMMA% (r=0.513, p=0.004), higher peak and submaximal VO2, [VO2/kg peak (r=0.787, p < 0.001) VO2 at ventilatory threshold 1, VT1 (r=0.451, p=0.012)], peak O2pulse (r=0.411, p=0.024), and importantly, higher HRQOL reported [child’s QOL V4.0 (r=0.524,p=0.003), parent’s QOL V4.0 (r=0.423, p=0.020)].Conclusions:Higher physical activity levels in paediatric Fontan patients are associated with normal skeletal muscle mass, higher exercise capacity and better HRQOL. Conversely, lower physical activity levels are associated with skeletal muscle mass deficit, increased adiposity and reduced exercise capacity.

Circulation, Volume 150, Issue Suppl_1, Page A4142224-A4142224, November 12, 2024. Introduction:Right heart failure under the support of a left ventricular assist device (LVAD) presents a life-threatening condition characterized by organ edema and limited LVAD support. Implementing an inferior vena cava-pulmonary artery (IVC-PA) bypass graft may mitigate these complications by reducing central venous pressure (CVP) and improving LVAD support efficiency. This study aimed to elucidate an adequate graft diameter for an IVC-PA bypass in terms of CVP reduction during LVAD-assisted circulation using an in vitro biventricular pulsatile circulatory system.Methods:We developed a biventricular pulsatile circulation system capable of providing circulatory assistance via an LVAD (centrifugal pump) connected to the apex of a left ventricular model （Fig）. A representative condition of cardiogenic shock was produced by adjusting LV systolic pressure, aortic pressure, and CVP to 80 mmHg, 80/40 mmHg, and 7.5 mmHg, respectively. A right heart failure model was produced by adjusting LV systolic pressure, aortic pressure, and CVP to 45 mmHg, 70 mmHg, and 16 mmHg, respectively, under LVAD support at 1700 rpm. Then, an adequate IVC-PA bypass diameter was investigated in terms of reducing CVP and increasing bypass flow support among 4mm and 18 mm with 2mm interval. The diameters of PA and IVC, and systolic PA pressure were set to 19 mm, 19 mm, and 18 mmHg, respectively. Elastic LV and RV models were driven by pneumatic positive and negative pressures.Results:We found a linearly increasing trend of bypass flow and a decreasing trend of CVP with increasing bypass diameters from 4 to 12 mm. When applying the bypass graft over 12mm diameter, bypass flow and CVP plateaued at 3.4 L/min and 7.5 mmHg, respectively (Fig).Conclusion:Our sophisticated in vitro biventricular circulation study suggests that in scenarios of right heart failure under LVAD support, implementing a bypass graft from the IVC to the PA is effective for decreasing CVP and reducing right ventricular preload. This study indicates that the optimal bypass diameter for reducing CVP is 12 mm when the diameters of the IVC and PA are 19 mm. These findings encouraged us to evaluate the efficacy in in vivo clinical settings.

Circulation, Volume 150, Issue Suppl_1, Page ASa202-ASa202, November 12, 2024. Background:During cardiopulmonary resuscitation (CPR), identifying the return of spontaneous circulation (ROSC) is challenging. Methods such as manual palpation, end-tidal carbon dioxide, and point-of-care ultrasound to detect ROSC are inaccurate, time-consuming, or intermittent. They may also require halting or prolonging no-compression time to identify signs of circulation. Maintaining a high compression fraction is associated with an increased likelihood of achieving ROSC.Aim:This study aimed to investigate if using a novel continuous hands-free carotid Doppler system (RescueDoppler (RD)) could identify ROSC during chest compressions by distinguishing between spontaneous and chest compression-generated carotid blood flow velocity.Methods:We used a porcine cardiac arrest model to investigate the RD. The RD probe was positioned and fixated over the carotid artery. An invasive blood pressure catheter was inserted in the contralateral carotid artery. An implantable cardioverter defibrillator (ICD) was utilized to induce sequences of ventricular fibrillation followed by defibrillation and chest compressions (cardiac arrest sequences). Compressions were administered manually at a rate of 100 or 50 compressions per minute or using a mechanical chest compression device (LUCAS). Doppler blood flow velocity curves were retrospectively analyzed for signs of ROSC by examining both spontaneous and/or compression-generated velocities (Fig. 1,2). We combined color M-mode and Doppler spectrum (Fig. 1) to differentiate between chest compression and spontaneous velocities.Results:Data from eight animals (mean weight 30 kg) and 56 cardiac arrest sequences were included. In the analysis, chest compressions were identified as tissue movements through the whole spectrum of the color M-mode, in the spectral display (Fig. 1), or both. Spontaneous velocities were identified in a specific carotid depth of the color M-mode and between compression-generated peak velocities in the Doppler specter (Fig. 1). ROSC was confirmed by pausing chest compressions and evaluating ECG and invasive blood pressure. We identified spontaneous circulation during manual and mechanical chest compressions in 55 of 56 sequences.Conclusions:In a porcine cardiac arrest model, with ROSC, we could differentiate between spontaneous circulation and chest compression-generated blood flow velocity of the carotid artery using RescueDoppler.

Circulation, Volume 150, Issue Suppl_1, Page ASa902-ASa902, November 12, 2024. Introduction:Patients who regain return of spontaneous circulation (ROSC) after in-hospital cardiac arrest are often critically ill and at risk of re-arrest. However, re-arrest is insufficiently studied. Pre-hospital data indicate a re-arrest rate ranging from 3% to 39%. Our study aims to assess the immediate hazard of re-arrest after ROSC, depending on whether the patient’s last observed rhythm before ROSC was shockable or not.Methods:We analyzed defibrillator recordings and clinical data from 763 cardiac arrest episodes at four different hospitals. ROSC was defined as an organized ECG rhythm compatible with a pulse, accompanied by the absence of chest compressions for at least one minute. An organized rhythm with a QRS frequency ≥ 12 was categorized as pulseless electrical activity (PEA). Conversely, a QRS frequency < 12 or a flat line represented asystole. Ventricular fibrillation or tachycardia (VF/VT) was identified based on its distinct morphology. We further stratified ROSC based on whether the preceding rhythm was shockable or not. After comparing four different parametric time-to-event models, we chose the most useful one and estimated the immediate hazard of re-arrest along the timeline of resuscitation.Results:After the initial event of cardiac arrest, we observed 316 re-arrests. Among these, 68% relapsed to PEA, 25% relapsed to VF/VT, and 7% relapsed to asystole. Summarized in the figure, the initial hazard of re-arrest from ROSC after PEA or asystole to a non-shockable rhythm was 0.02 per minute. By the 9th minute, this hazard decreased to 0.01 per minute. Meanwhile, the hazard for re-arrest to a shockable rhythm remained constant at 0.01 per minute. For re-arrest from ROSC after VF/VT back to VF/VT, the hazard was 0.05 per minute initially, decreasing to 0.03 per minute by the 12th minute. The corresponding hazard for re-arrest to PEA or asystole remained at 0.01 per minute.Conclusion:The hazard of re-arrest after return of spontaneous circulation (ROSC) to either pulseless electrical activity (PEA), asystole, or ventricular fibrillation/tachycardia (VF/VT) varies by the last observed state before ROSC. Notably, re-arrest to VF/VT following ROSC after previous VF/VT poses the highest risk. This understanding can assist healthcare professionals in anticipating events during the critical minutes following successful resuscitation and adjusting treatment accordingly.

Circulation, Volume 150, Issue Suppl_1, Page ASa1006-ASa1006, November 12, 2024. Introduction:Maintaining cerebral blood flow during cardiopulmonary resuscitation (CPR) is vital, yet establishing a dynamic indicator of cerebral blood flow during CPR remains challenging. Near-infrared spectroscopy (NIRS) is a non-invasive technique capable of continuously detecting changes in cerebral blood volume and has the potential to assess cerebral blood flow in real-time during cardiac arrest. Despite its potential, limited research exists on cerebral perfusion indexes measured by NIRS during CPR and their clinical outcomes.Research Questions:Can assessing cerebral perfusion indices (CPI) using NIRS during CPR in out-of-hospital cardiac arrest patients serve as a prognostic indicator?Aims:To evaluate the association between increased CPI measured by NIRS during CPR by EMS personnel on-scene and return of spontaneous circulation (ROSC) after adult out-of-hospital cardiac arrest (OHCA).Methods:Between January 2021 and March 2023, we included consecutive out-of-hospital cardiac arrest patients due to internal causes who were attempted resuscitation by emergency medical services (EMS) in Sapporo city, Japan. EMS placed a NIRS monitor probe (NIRO 200-NX; Hamamatsu Photonics, Japan) on the patient’s forehead and began measurements simultaneously upon contact with the patient. Patients treated with a mechanical chest compression device were excluded. We focused on the change of NIRS pulse waves during CPR at the scene and analyzed the values of NIRS pulse waves at two points: patient contact and scene departure by EMS. NIRS technology measures changes in total hemoglobin (ΔcHb) and oxygenated hemoglobin (ΔO2Hb) concentrations. Patients were divided into groups based on whether their ΔcHb and ΔO2Hb levels increased or decreased between patient contact and scene departure. The primary outcome was prehospital ROSC, and no cases of ROSC were observed at the scene.Results:During the study period, 91 patients were included. The prehospital ROSC rate was 16.4% (11/67) in the group with an increasing ΔcHb trend, compared to 0% (0/24) in the group with no increasing trend (p = 0.034). Regarding ΔO2Hb, the rate was 14.7% (10/68) in the group with an increasing trend and 4.3% (1/23) in the group with no increasing trend (p = 0.279).Conclusion:The increase in CPI measured by NIRS during CPR on-scene was associated with ROSC. Further research is warranted to determine whether CPI can aid in predicting the prognosis of cardiac arrest patients.

Circulation, Volume 150, Issue Suppl_1, Page ASu1001-ASu1001, November 12, 2024. Background:Progressive post-cardiac arrest syndrome (PCAS) ensues within seconds of an out-of-hospital cardiac arrest (OHCA) and results in damage over days, yet longitudinal changes in blood biomarkers during PCAS are poorly understood. We characterize novel biomarkers at early time points after return of spontaneous circulation (ROSC) and determine associations with survival.Methods:Blood plasma samples from OHCA patients were collected at 1, 6, 24, 48, 72 hours and 7 days after ROSC. Samples were analyzed using a Meso Scale Diagnostics 40-plex assay which included proinflammatory, cytokine, chemokine, angiogenesis, and vascular injury panels. The data distribution was heavily skewed, requiring log-transformation. Biomarkers were compared between survivors and non-survivors at each follow-up time point using a two-sample t-test. Mixed-effect and Generalized Estimation Equation models were used to examine the association between biomarkers and survival and assess trends over time.Results:Thirty-three patients were included, of which 54% (N=18) were males, the mean age was 57 (+/-15) years, and 54% (N=18) survived to discharge. Six out of the 40 biomarkers had a statistically significant difference in biomarker levels between survivors and non-survivors at one or more time points. At the 1-hour, macrophage derived chemokine (MDC) and thymus and activation-regulated chemokine (TARC) were significantly higher in survivors. At 6-hour, interleukin-13 (IL-13) was the only pro-inflammatory biomarker that was significantly higher in non-survivors. At 24-hour, pro-inflammatory biomarkers interleukin-12p70 (IL-12p70) and IL-13 were higher in non-survivors, whereas vascular endothelial growth factor A (VEGF-A) was significantly higher in survivors. At 48-hours, VEGF-A was also significantly higher in survivors. At 72 hours, interleukin-8 was the only biomarker with significantly higher levels in non-survivors. Overall, IL-12p70, IL-13, and MDC levels decreased over time (p=0.02, p=0.003, p=0.01, respectively) for both survivors and non-survivors. Survivors had a lower average level for IL-12p70 (p=0.03) and for IL-13 (p=0.04), but higher average level for MDC (p=0.01) than non-survivors at discharge.Conclusion:This pilot investigation extends prior biomarker work by highlighting new biomarkers, their longitudinal changes during PCAS, and their relation to survival. Future analysis will explore differences in biomarkers for neurological outcomes after OHCA.