AHA Guidelines Research Articles

Infliximab Superior to IVIG for Rescue in IVIG-Refractory Kawasaki Disease

Infliximab Superior to IVIG for Rescue in IVIG-Refractory Kawasaki Disease

Study on Awareness of Basic Life Support/Cardio Pulmonary Resuscitation among Medical Undergraduate Students in Nashik

Background: Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) is a core skill in which all health care professionals should be proficient, in case of an emergency to save lives. It is logical to provide BLS training during undergraduate years ensuring basic competence in all graduating healthcare students. Objectives: The present research was undertaken with an objective to know the knowledge of BLS and awareness about BLS among medical students in Nashik. Methods and Materials: This cross sectional study was carried out among randomly selected 358 medical undergraduate students. Pre-tested semi-structured questionnaire was used to collect data. The questionnaire included the following parts: 1. Basic characteristics of the study participants, 2. Knowledge about BLS/CPR, 3. Awareness about BLS/CPR. The components of knowledge and awareness based questions were scored. The data was analyzed using SPSS version12. Results: The majority (87.8%) of students had heard of BLS/CPR, among them 40.6% could give the correct order of performing CPR as per the AHA guidelines (Year 2010). Only 20% of students had undergone prior training in BLS while 19.7% had been in a situation that needed BLS/CPR. Overall awareness was not favorable and approximately 68.9% of the students were no tconfident of performing BLS/CPR. Only 46.5% of students had adequate knowledge about BLS/CPR. Conclusions: The major lack of knowledge and awareness is due to lack of training. Hence it is essential to train the students in CPR/BLS early in the curriculum to improve their knowledge and repeated training would increase their confidence.

Abstract TP105: Optimizing The Utilization Of Cardiac Magnetic Resonance Imaging Among Patients With Ischemic Stroke

Background: The current AHA guidelines recommend (class IIb) advanced cardiac imaging in an embolic stroke of unknown source (ESUS). We aim to better characterize the role of cardiac MRI (cMRI) in the evaluation of stroke patients and determine patient characteristics that may increase the positive predictive value of cMRI. Method: A retrospective review of stroke patients at a comprehensive stroke center, who had cMRI between 12/2016 and 11/2020 was conducted using institutional registries. Ischemic stroke patients with ESUS, cryptogenic (with ESUS as a competing etiology), and cardioembolic etiologies were included. Cases with TIA, large vessel, small vessel, or hemodynamic etiologies were excluded. Cardioembolic etiology was defined as newly diagnosed Afib patients with TTE abnormalities including wall motion abnormalities and/or reduced LVEF <50%, stroke while compliant with anticoagulation for known Afib, or among whom the timing of restarting anticoagulation was in question. TTE and cMRI results from all cases were reviewed for remarkable findings, most notably intracardiac thrombus, and analyzed if a change in anti-thrombotic therapy was directly attributable to cMRI results. Results: As per our criteria, 250 cases (Female 44.4%, Black 29.6%, Age mean: 65.2 years) were included, of whom 146 (58.4%) were ESUS, 86 (34.4%) were cryptogenic, and 18 (7.2%) were cardioembolic. Sixteen (6.4%) revealed intracardiac thrombus, of which 10 had LV thrombus, 5 had LA thrombus, and 1 had RA thrombus along with questionable PFO on cMRI. Of these, 14 (87.5%) had an escalation of anti-thrombotic therapy. For the other 2 cases, despite cMRI obtained due to low LVEF and revealing LA thrombus, antithrombotic regimen was not changed. Eight (3.2%) additional patients were placed on anticoagulation secondary to incidental findings. Conclusion: In this large retrospective analysis of 250 select stroke cases, escalation of anti-thrombotic therapy from anti-platelets to full dose anti-coagulation was indicated in 14 patients (5.6%) with addition of cMRI. Further analysis of data is in process to determine the subset of stroke patients who would benefit the most from cMRI.

Dentists' knowledge and practices about infective endocarditis antibiotics prophylaxis among children in aseer region, Southwestern Saudi Arabia.

Infective endocarditis (IE) is a disease endangering human lives. Therefore, several prophylactic measures are required to improve the protection of endocarditis-prone patients from bacteremia resulting from various dental actions. These measures range from developing the dental hygiene to trials of different antimicrobial agents. To examine the knowledge and practices of dentists in Aseer Region, Saudi Arabia, regarding antibiotic prophylaxis against IE. Cross-sectional study. Aseer Region, Saudi Arabia. The participants were interviewed at their workplaces and the data collection sheet was constructed based on the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC, 2017). The examination of the data gathered was calculated using Statistical Package for Social Sciences (SPSS, version 25) such as to test the significance of variation in dentists' mean knowledge scores as per their personal characteristics. An output with P values <0.05 was statistically significant. 182 Dentists. Dentists' mean knowledge score was 17.5 ± 3.7 (out of 24). The least correct responses regarding dental procedures that require prophylactic antibiotics were "root canal treatment" (30.8%). Regarding cardiac conditions that require prophylactic antibiotics, dentists' least correct responses were "heart failure" (50%). Dentists' mean knowledge scores differed significantly according to their age groups (P = 0.032), nationality (P = 0.002), education/qualification (P = 0.002). Mean knowledge scores differed significantly according to dentists' years of experience (P = 0.018) and sources of information (P < 0.001). Amoxicillin was the most regularly recommended antibiotic (90.7%), while 86.8% correctly stated 30--60 min. before the procedure as the time for prophylactic antibiotic administration. The knowledge of dentists in Aseer Region regarding the use of preventive drugs for the control and prevention of IE is suboptimal. The inclusion of the latest AHA guidelines into the dentistry curricula is highly recommended. Outcome are simultaneously assessed.

Abstract WP43: Modeling The Decay In Probability Of Receiving Endovascular Thrombectomy Based On Time From Stroke Onset

Introduction: Large-vessel occlusion (LVO) stroke patients with infarct core volumes greater than 70 mL do not meet current AHA guidelines for thrombectomy eligibility. Therefore, it is important to understand how time-dependent infarct core growth translates to a patient’s declining probability of thrombectomy eligibility. Modeling the probability that a suspected LVO patient would qualify for thrombectomy can help inform the optimal prehospital emergency transport strategy which maximizes the likelihood of an excellent patient outcome. Methods: We determined the time from stroke onset required for an infarct core to grow to 70 mL as a function of penumbra volume and collateral score. After applying a series of numerical interpolations, our framework outputted the probability a suspected LVO patient qualifies for thrombectomy (based on core volume threshold) as a function of time from stroke onset to imaging. We then incorporated this function into an existing model of prehospital emergency transport, which previously assumed all patients were thrombectomy-eligible, in order to assess the impact that considering treatment eligibility had on optimal transport decisions. Results: An exponential decay curve best fit the numerically-generated probability function. We found that after integrating this eligibility model into the emergency transport decision tool the optimal transport strategy changed from drip and ship to mothership in 8.5% of possible patient pickup locations in Alberta, Canada. Conclusions: This methodology provides a novel, mechanistic approach to deriving a thrombectomy eligibility curve. As a result, we are able to better optimize prehospital transport decisions to improve outcomes of suspected LVO patients.

Abstract TMP93: Limited Value Of Routine Thrombophilia Screening In Childhood Arterial Ischemic Stroke

Introduction: Congenital and acquired thrombophilias are associated with childhood arterial ischemic stroke (AIS), especially if multiple thrombophilias or other risk factors are present. The 2019 AHA guidelines recommend thrombophilia evaluation for all children with AIS, although the optimal extent of testing is unknown. The objective of this study was to determine the utility of routine thrombophilia screening in management of children following AIS. Methods: Thrombophilia screening sent as part of clinical care was collected from patients with childhood (1 month-18 years) AIS during an 11 year period at a single institution. Results: Factor V Leiden was sent on 56%, Prothrombin gene on 47%, homocysteine on 50%, lipoprotein a on 52%, antithrombin on 44%, protein C on 57%, protein S on 54%, and anticardiolipin antibodies on 51% of children. Five percent of patients were FVL heterogenous, and 1% were PT gene heterogenous. Three percent had mildly elevated homocysteine. Twenty percent had elevated lipoprotein a. Two patients had transiently low antithrombin, 4 had transiently low protein C activity, and one had transiently low protein S activity. One patient with sickle cell disease had persistently low protein S activity. One low protein S was not repeated. Ten patients had elevated ACLAs: 6 were transient, two had mildly elevated IgM that was not repeated, and 2 had known APLA syndrome. Two patients (cardioembolic stroke; moyamoya) had two thrombophilias. Conclusion: Rates of thrombophilias were consistent with expected incidence for the general population and did not predict stroke recurrence. Patients with elevated lipoprotein a and homocysteine were referred for treatment, otherwise results from the remainder of thrombophilia evaluation did not alter patient care in a population already known to be at risk for thrombosis.

Abstract WP63: The Effect Of Inpatient Rehabilitation Facility Treatment On 90 Day Outcomes: A Shift Analysis Of Modified Rankin Scale Score In Ischemic Stroke Patients

Introduction: Several AHA Guidelines recommend inpatient rehabilitation facility (IRF) care to enhance post-stroke recovery. We evaluated the IRF treatment effect on modified Rankin scale (mRS) score change at 90 days in ischemic stroke (IS) patients. Methods: Using prospectively collected data from Get With the Guidelines-Stroke, the Uniformed Data System for Medical Rehabilitation registry and the electronic medical record, we identified IS patients with discharge disposition of home or IRF between 1/1/2018-12/31/2020. Sociodemographics, clinical variables and IS treatment rates were summarized. IRF outcomes, including length of stay (LOS), improvement in mobility and self-care scores and discharge disposition were compared in thrombectomy vs no thrombectomy groups. mRS at IRF discharge was calculated with a Cronbach interrater score of 0.88; shift analyses of mRS at hospital discharge and 90 days were completed for IS patients in the Home and IRF care groups. Results: Among 738 patients, 499 went home, 239 went to IRF. IRF patients were more likely to have Medicare insurance (49.2 vs 28.9%), undergo thrombectomy (16.3 vs 4.6%) have increased LOS (12.7 vs 4.8 days) and stroke severity (mean NIHSS 7.8 vs 4.8; mean mRS 3.1 vs 1.7) compared to Home (Table 1). At IRF, 39 patients previously underwent thrombectomy, 200 did not. Both groups had a IRF LOS &gt;14 days and considerable recovery in the self-care and mobility domains (Table 2). Shift analysis of mRS at hospital discharge compared to 90 days yielded significant improvements in mRS of 0-2 and lower mortality in the IRF group compared to home group (Figure). Conclusion: In ischemic stroke patients with higher disease severity, IRF treatment is a catalyst for improved functional recovery.

Vitamin-D deficiency in adults of Mumbai city: Change in the last decade.

ABSTRACTBackground:Vitamin-D deficiency is a pandemic that is being linked to various noncommunicable diseases. The present study is an attempt to study the demographic profile and the prevalence of comorbidities in association with the vitamin-D status of the Mumbai-based study population. The authors also attempt to understand the change in prevalence over the last decadeMethodology:Fasting blood samples were collected from consenting asymptomatic adults visiting the hospital and were analyzed for the prevalence of vitamin-D deficiency and diabetes mellitus, and participants were clinically examined for the presence of hypertension (as defined by AHA guidelines) and obesity (as defined by body mass index of more than equal to 30)Results:It was found that 57% of participants were deficient, 25% had insufficient, and 18% had adequate vitamin-D levels. There were a greater number of younger (P = 0.003) and upper-middle-class participants in the deficient group (P = 0.043816). Prevalence of obesity, hypertension, and diabetes mellitus and the distribution of genders was comparable in the deficient and sufficient vitamin-D groups. However, diabetic vitamin-D-sufficient participants had better control of blood sugar compared to diabetic vitamin-D-deficient participantsConclusion:Although the prevalence of vitamin-D deficiency has slightly reduced compared to the previous decade, it is still highly prevalent. Diabetic vitamin-D-sufficient participants had better glycemic control compared to diabetic vitamin-D-deficient participants. Thus, it is highly recommended for primary care physicians to screen everyone for vitamin-D deficiency.

A study on physicians' adherence to joint national committee guidelines for hypertension

Background: Increased blood pressure (BP) is the second leading risk factor for death and disability globally according to the Global Burden of Disease Study. Therefore, various guidelines have been issued. The American College of Cardiology/American Heart Association issued guidelines and Joint National Committee (JNC) 7 and JNC 8 guidelines, which were laid down by the JNC are a few guidelines for hypertension (HTN) management. Many countries have not implemented effective public policies to prevent and control HTN. Objective: The objective of this study was to assess the number of physicians' adherent to JNC 7, JNC 8, and AHA guidelines when prescribing medications to patients. In addition, the efficacy of the medications, trends in prescribing medications, and adverse drug reactions that a few patients presented with were assessed. Materials and Methods: A cross-sectional, questionnaire-based observational study was conducted on hospitalized hypertensive patients in a tertiary care hospital in South India. Data were collected on a detailed interview basis after receiving an informed consent based on a specific set of preformulated questions. The sample size was met, and the obtained data were analyzed appropriately using the SPSS software version 21. Results: Seventy two patients had diabetes and/or CKD along with hypertension out of 198 patients who participated in the study.Maximum number of prescriptions were adherant to JNC 8 and the least were observed with AHA guidelines.The blood pressure was more controlled in those patients where physicians were adherant to guidelines.The most commonly prescribed drugs were Calcium channel blockers followed by Angiotensin receptor blockers,beta blockers and ACEinhibitors. Adverse drug reactions were seen in only 5 patients Conclusion: The overall adherence to antihypertensive medications guidelines by physicians in India is only modest and much lesser when comorbidities are associated. There is a need to build awareness. Further the antihypertensive classes of medications currently recommended appear to be efficacious and safe.

Radial Artery Versus Saphenous Vein as Third Conduit in Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease: a Ten-Year Literature Review.

Coronary artery bypass grafting is the gold standard strategy for obtaining complete coronary revascularization in patients with multivessel coronary artery disease. The recent AHA and EACTS guidelines on myocardial revascularization recommend total arterial revascularization, especially in younger patients, whenever possible. However, the use of saphenous vein grafts in association with single or bilateral internal thoracic artery (SITA, BITA) instead of arterial grafts (radial arteries, right gastroepiploic artery and inferior epigastric artery) is widespread. We analyzed literature from the last ten years (January 2010 to December 2020) looking for evidence in favour of the use of a radial artery compared to a saphenous vein in association with BITA. We identified nine studies (4 Systematic Reviews and Meta-analyses and 6 large cohort observational studies with propensity score-matching) that compared arterial with saphenous grafts as third conduit. The main finding of the review is the higher rate of freedom from any cardiac adverse event in the population which reached Total Arterial myocardial Revascularization (TAR). A probable reason for the limited application of TAR as a strategy is the shortage of Randomized Controlled Trials (RCTs). (www.actabiomedica.it)

Managing Hypertension: An Audit of Local Practice in A Tertiary Care Hospital

Background Hypertension is a prevalent non-communicable disease in the Indian subcontinent and its inadequate management results in increased rates of morbidity and mortality. This study aimed to identify the lack of management and assess the overall approach of the treating physicians per the American Heart Association AHA guidelines following an initial audit.Methodology A re-audit was conducted to establish if the action plan proposed in the initial audit had improved the practice.Results Of the 247 hypertensive patients 68.5 were well controlled BPlt14090. Out of the total patients 137 patients needed combined treatment either at the beginning or during the follow-up. There was an improvement noted across most parameters in the audit tool compared to the initial audit especially in the classification of hypertensive patients uarr99 device on lifestyle modifications uarr64 and follow-up with monitoring of side effects uarr48.Conclusion An improvement was noted across all parameters initially assessed in the audit. This indicates the need for checklists employed in active management. Scope for improvement was deemed necessary in differentiating secondary from primary hypertension.

A comparative study to assess vascular health in previously diagnosed patients of kawasaki disease

Background: Kawasaki disease, the commonest cause of multisystem vasculitis in children, was believed initially as a one-time disease. Long-term follow-up reveals that endothelial dysfunction persists in post-Kawasaki disease patients with and without coronary lesions and predisposes to atherosclerosis.Aims and Objectives: To establish the endothelial dysfunction and to correlate it with premature atherosclerosis in Kawasaki disease patients.Settings and Design: Prospective comparative study.Materials and Methods: Thirty patients of Kawasaki disease (age, 6 months to 20 years) were compared to the age matched control population and evaluated 2 times (1st F/U and 2nd F/U) at an interval of 6 months. USG Doppler was used to measure intimal thickness of carotid arteries CAD-IT, flow character and Resistive Index of anterior ATA-RI and posterior tibial arteries PTA-RI. Echocardiography was used to detect perivascular hyperintensity, dilatation and aneurysm of coronary arteries. Ongoing inflammation was documented by C- reactive protein (CRP) level. Coronary involvement (dilatation, small, medium, giant CAA) was determined by the z-scores adjusted to patients' body surface area (BSA) (AHA guidelines 2017).Statistical analysis used: Mean, paired t-test, GEE model, Odds ratio.Results: Significantly elevated CRP levels were observed in both the 1st follow up (p=0.0005) and 2nd follow up (p=0.000001) compared to control value. A significant rise (p<0.05) in total cholesterol, triglyceride levels, ATA-RI, PTA-RI and CAD-IT were seen. Seven patients developed coronary aneurysm of which three had persistent lesion.Conclusions: Kawasaki disease is not a one -time disease. Persistent endothelial dysfunction continues. CRP, total cholesterol, triglyceride, and USG doppler of coronary, carotids as well as peripheral arteries were found abnormal in follow up. So, these patients need to be followed up for a long period.

Abstract 11488: Ventilation Rate and Sustained Return of Spontaneous Circulation in In-Hospital Cardiac Arrest: Is More Better?

Introduction: Current consensus holds that CPR must balance chest compressions and ventilation rate (VR), with a low VR being essential for venous return and cardiac output. AHA guidelines recommend a VR of 10 ventilations per minute (vpm) after advanced airway placement. We sought to examine VR adherence and its impact on end-tidal CO 2 (ETCO 2 ) and ROSC &gt;20 minutes. Methods: This is a retrospective analysis of data from AWARE II, a multicenter prospective observational study of adult in-hospital cardiac arrest (IHCA) outcomes at 14 US and UK sites. Inclusion criteria were: 1) adult patient in CA, 2) advanced airway already in place or placed during the CA, and 3) at least one minute of VR and ETCO 2 data available after removal of the last minute of CPR in subjects achieving ROSC (due to the rise of ETCO 2 just prior to ROSC). Results: A total of 563 subjects were enrolled in the parent study. Of these, 225 had ETCO 2 and VR tracings available, and 201 had sufficient data for inclusion. Mean age was 69.3 (range 18-100), patients were 63.7% male, and 16.4% had a shockable initial rhythm. A total of 116 subjects (57.7%) achieved ROSC, which was sustained in 76 (37.8%), leading to survival to hospital discharge with favorable neurological outcomes in 9 (4.5%). Mean VR was 16.3 vpm, with 171 (85.1%) subjects being ventilated in excess of guidelines; only 16 (8.0%) subjects received 8-10 vpm. Higher VR had a weak but significant association with increased mean ETCO 2 (linear R 2 = 0.11, p &lt; 1x10 -6 ) and sustained ROSC (OR 1.05; 95% CI: 1.01-1.11; p = 0.02). Patients with sustained ROSC had a significantly higher VR at 17.7 vpm than those without sustained ROSC at 15.6 vpm (p = 0.007). Patients receiving a VR close to AHA guidelines (6-12 vpm) had a significantly lower rate of sustained ROSC (26.1%, n = 46) than patients receiving &gt;12 vpm (42.0%, n = 148) (OR 2.30; 95% CI: 1.08-4.89; p = 0.031 using a multivariate model including patient age, shockable initial rhythm, known cardiac disease, witnessed IHCA, and use of mechanical compressions). Conclusions: VR within AHA guidelines is rare during IHCA. However, ventilation in excess of current guidelines may increase rates of sustained ROSC, an essential predicate to survival. AHA guidelines on VR in CPR with an advanced airway may not yet be optimized.

Abstract 12789: Development of the Tool to EMPOwer Surrogate Decision Makers of Comatose Survivors of Cardiac Arrest

Introduction: Surrogate decision makers (SDMs) for comatose survivors of cardiac arrest are often charged with making time-sensitive complex decisions with regard to life-sustaining therapies in a sudden critical illness. We describe the development of a decision aid for SDMs of comatose survivors of cardiac arrest. Methods: Applying recommendations from the International Patient Decision Aid Standards, we developed this decision aid iteratively with the purpose to educate families on post-arrest care and evidence based decision-making. We obtained feedback from stakeholders, including surrogate decision makers, patients, caregivers, nurses and physicians, in focus groups and semi-structured interviews. Results: Informed by interviews with SDMs and the AHA Guidelines, we designed a prototype of the decision aid. Each iteration resulted in a refined version of the aid (Figure). Step 1 included feedback from the Shared Decision-Making Core at the Adult and Child Consortium on Outcomes Research and Delivery Science (ACCORDS). Step 2 incorporated feedback from the ACCORDS Community Engagement Stakeholder group. Step 3 consisted of 10 semi-structured interviews with informal caregivers and patient pairs within the Advanced Heart Failure or Seniors clinics. The document was then reviewed by a team of expert cardiac arrest stakeholders. The aid includes key definitions, a timeline of post-arrest care, factors that support decisions to discontinue or pursue life sustaining therapies, commonly asked questions and an illustration of a patient undergoing post-arrest treatment. The decision aid, entitled T ool to EMPO wer (TEMPO) Surrogate Decision Makers, is written at a 7 th grade reading level. Conclusions: Through a robust iterative process, we designed a decision aid for SDMs of comatose survivors of cardiac arrest. The aid is intended to support the decision to pursue or forego further life-sustaining therapy and to be informative about post-arrest care.

Abstract 14213: Injury Characteristics of Chest Compressions in a Swine Model of Infant Asphyxial Cardiac Arrest Using Either 1.5 inch or 1/3 Anterior-Posterior Diameter Depth Targets

Background: Current AHA guidelines for the delivery of chest compressions (CC) for infants and children are largely consensus based, and recommended depths of 1.5 inches or 1/3 anterior-posterior chest diameter (APD). It is unclear whether these have equal potential for injury. Objectives: We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant-sized model of asphyxial OHCA. Methods: Thirty-six juvenile swine weighing 10.6kg +/- 0.84 (approximating the 50 th percentile for a 12-month-old) were anesthetized, paralyzed, intubated, and mechanically ventilated (FiO2 21%). APD was measured and by two investigators via a sliding T-square. After instrumentation, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 minutes. Animals with an organized rhythm after 8 minutes 45 seconds of asphyxia received a single, 3-second transthoracic shock to induce ventricular fibrillation. At 9 minutes, each was then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. ALS drugs were administered after 13 minutes, followed by initial defibrillation attempt at 14 minutes. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 minutes of failed resuscitation. Survivors were sacrificed with KCl after 20 minutes of observation. Veterinary staff blinded to group assignment conducted necropsies to assess lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Characteristics were compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05. Results: Group 1 had n=18 and Group 2 had n=18 animals. Mean (SD) APD overall was 5.58 (0.22) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups (Group 1: 66.7% vs Group 2: 83.33%; p = 0.248. No injury characteristics differed significantly between groups. Airway bleeding rates were noteworthy though not different between groups (Group 1: 18.8% vs Group 2: 42.1%; p = 0.219). Conclusions: In a swine model of infant OHCA and resuscitation, both CC depth strategies had similar injury characteristics.

Abstract 13198: Impact of Targeted Resident Education on Perceptions of Communication and Participation in Cardiac Arrest

Introduction: Debriefing sessions after in-hospital cardiac arrest have been demonstrated to improve teamwork and survival outcomes. Though recommended in 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, implementation remains low. Hypothesis: We postulated that a didactic training session provided to code leaders would increase rates of participation of AHA-recommended post-arrest debriefing sessions. Methods: Surveys were distributed to hospital personnel who participate in code blue/ERTs at an academic, tertiary-care medical center. Questions were graded on Likert scale to assess provider-reported perceptions of teamwork, communication, and confidence in conducting and participating in Code Blues. Participants were stratified in groups depending on whether they had previously participated in debriefing sessions. Primary outcomes were quantified using a Likert-type scale ranging from 1 to 5. Surveys were compared to surveys from prior years to assess if the intervention of a code blue didactics lecture delivered to code leaders resulted in any change in overall participation rate in the debriefing protocol. Results: Among 181 participants (61% female), 32% were residents, 54% nurses, 1.7% respiratory therapists. Self-evaluated current knowledge of ACLS protocols was significantly higher in the debriefing group (p = 0.0098), while there were no differences in perceived communication (p=0.76), and confidence in leading (p = 0.2) and participating (p = 0.2). We did not find a statistically significant difference in debriefing participation rate after our intervention (57% pre vs 58% post intervention, p=0.8), even when stratified by hospital role: critical care nurses (50% vs 71%, p=0.3), non-ICU nurses (68% vs 57%, p=0.3) and residents (67% vs 50%, p=0.2). Conclusions: Our study demonstrated that participation in post-code debriefing sessions was associated with a statistically significant increase in knowledge of cardiac arrest protocols. A code blue didactics lecture did not result in a statistically significant increase in post-arrest debriefing participation. Further study to elucidate methods to enhance adoption of this crucial, guideline recommended practice is warranted.

Abstract 12155: Detecting Peripheral Arterial Stenosis and Monitoring Atherosclerosis Severity

Background: The AHA guidelines recommend measuring the Ankle-Brachial Index (ABI) for assessing the severity of atherosclerosis. There is also an unmet need for early detection of peripheral artery stenosis to reduce morbidity and tissue loss. However, the sensitivity of ABI in detecting arterial stenosis is limited in the presence of arterial stiffening (arteriosclerosis), especially in diabetic and elderly patients, since arteriosclerosis yields fictitious higher ABI. We hypothesize that non-invasive quantification of the peripheral perfusion dynamics, instead of a single pressure point, can improve the diagnosis and differentiate between focal stenosis and general arteriosclerosis. Methods: Impedance plethysmography (IPG) were measured from the calf of patients that underwent peripheral revascularization, before and shortly after the interventions. The characteristic perfusion dynamics curves were derived from the cardiac complexes of the IPG that were recorded over at least 3 minutes. Successful interventions were defined according to the guidelines as a post-operational ABI increase of at least 0.15. Results: Twenty-four patients (60.9±9.3 years old, 16 (66.6 %) diabetics) that underwent above-knee revascularization were analyzed. The perfusion upstroke consisted of two characteristic phases: an initial slow phase followed by a fast vigorous rise. Improvement in the perfusion after the revascularization appeared only in the initial slow duration, denoted as the ‘Perfusion Deficit Index` (PDI). Of those, 15 (62%) had a successful intervention and the PDI decreased from 115±48 ms to 22±10 ms (p&lt;0.0001) while the ABI increased from 0.53±0.26 to 0.94±0.22. In 9 limbs (37%) with unsuccessful interventions, there were no significant changes in PDI and ABI (from 143±31 ms to 117±40 ms and from 0.38±0.11 to 0.48±0.11, respectively). There was no significant change in the pulse transit time (p=0.19), a well-known index of arteriosclerosis, before and after the interventions. Conclusions: The PDI is a novel sensitive index for detection of focal arterial stenosis and it is independent of the severity of arteriosclerosis. This simple to use method can be used for monitoring atherosclerosis severity.

Artificial intelligence measuring the aortic diameter assist in identifying adverse blood pressure status including masked hypertension

ABSTRACT Introduction and objectives Artificial intelligence (AI) made it achievable that aortic dilation could be measured in CT images indirectly, while aortic diameter (AD) has the certain relationship with blood pressure. It was potential that the blood pressure condition be determined by AD measurement using the data obtained from a CT scanning especially in identifying masked hypertension and predicting the risk of poor control of blood pressure (BP) which was easy to elude diagnosis in clinic. We aimed to evaluate the possibility of utilizing AD by AI for predicting the risk of adverse BP status (including masked hypertension or poor BP control) and the optimal thoracic aortic position in measurement as well as the cutoff value for predicting the risk. Methods Eight hundred and one patients were enrolled in our study. AI-Rad Companion Cardiovascular (K183268 FDA approved) was used to perform automatic aorta measurement in thoracic CT images at nine key positions based on AHA guidelines. Data was post processed by software from AI-Rad Companion undergone rigorous clinical validation by both FDA and CE as verification of its efficacy and usability. The AD’s risk and diagnostic value was assessed in identifying hypertension in the general population, in identifying the poor BP controlled in the hypertension population, and in screening masked hypertension in the general population respectively by multiple regression analysis and receiver operating curve analysis. Results AD measured by AI was a risk factor for adverse BP status after clinical covariates adjustment (OR = 1.02 ~ 1.26). The AD at mid descending aorta was mostly affected by BP particularly, which is optimal indicator in identifying hypertension in the general population (AUC = 0.73) and for screening masked hypertension (AUC = 0.78). Conclusion Using AI to measure the AD of the aorta, particularly at the position of mid descending aorta, is greatly valuable for identifying people with poor BP status. It will be possible to reveal more clinical information reflected by ordinary CT images and enrich the screening methods for hypertension, especially masked hypertension. PLAIN LANGUAGE SUMMARY HTN has a significant adverse effect on arterial deformation. BP and arterial dilation promote each other in a vicious circle. Arterial dilation may not be restricted by apparent fluctuations in BP and is objective evidence of an undesirable BP state. The accuracy of AD measurements by AI on chest CT images has been verified. There has not been the application of AD measurement by AI in the scene of poor BP status in clinical practice. In this study, we applied AI to measure the diameter of the aorta in nine consecutive positions. We explored the association between AD at various positions and BP levels and the possibility that AD in identifying poor BP status in different populations. We found that the AD at the MD is of great value in screening MH and evaluating the control state of BP in HTN. It will be possible to significantly expand the clinical information reflected by ordinary CT images and enrich the screening methods for HTN, especially MH.

Automated Quantitative Stress Perfusion Cardiac Magnetic Resonance in Pediatric Patients.

Background: Myocardial ischemia occurs in pediatrics, as a result of both congenital and acquired heart diseases, and can lead to further adverse cardiac events if untreated. The aim of this work is to assess the feasibility of fully automated, high resolution, quantitative stress myocardial perfusion cardiac magnetic resonance (CMR) in a cohort of pediatric patients and to evaluate its agreement with the coronary anatomical status of the patients.Methods: Fourteen pediatric patients, with 16 scans, who underwent dual-bolus stress perfusion CMR were retrospectively analyzed. All patients also had anatomical coronary assessment with either CMR, CT, or X-ray angiography. The perfusion CMR images were automatically processed and quantified using an analysis pipeline previously developed in adults.Results: Automated perfusion quantification was successful in 15/16 cases. The coronary perfusion territories supplied by vessels affected by a medium/large aneurysm or stenosis (according to the AHA guidelines), induced by Kawasaki disease, an anomalous origin, or interarterial course had significantly reduced myocardial blood flow (MBF) (median (interquartile range), 1.26 (1.05, 1.67) ml/min/g) as compared to territories supplied by unaffected coronaries [2.57 (2.02, 2.69) ml/min/g, p < 0.001] and territories supplied by vessels with a small aneurysm [2.52 (2.45, 2.83) ml/min/g, p = 0.002].Conclusion: Automatic CMR-derived MBF quantification is feasible in pediatric patients, and the technology could be potentially used for objective non-invasive assessment of ischemia in children with congenital and acquired heart diseases.

Students’ knowledge and attitudes toward basic life support

&lt;span lang="EN-US"&gt;Students spend a significant proportion of their day in colleges and healthcare facilities where they might experience medical emergencies, or unexpected accidents, that occur in these places. Nursing students are expected to play a key role in performing basic life support. This study is to evaluate knowledge, attitudes and training status with regard to basic life support (BLS). An online cross-sectional survey was conducted in Taif University, Saudi Arabia. 170 students agreed to fill out a questionnaire. The questions used in the questionnaire were prepared according to 2015 AHA guidelines. The majority of subjects (52.9%) reported that they had attended a BLS course. The mean age of the study population was 21.64 years. Previous CPR training had a significant effect on the correct responses (P &amp;lt;0.01). This study found significant differences between the students observed: (58.3%) of students with previous BLS training felt capable of providing CPR to their fellow college students, compared to (42.7%) in the group without previous training (P =0.01). Importantly, over all subjects the attitude to learning on a BLS training course was positive. Inconclusions this study corroborates previous reports that the knowledge, skills and attitudes of trained students are better than those of untrained students.&lt;/span&gt;