Cardiac Arrest Research Articles

Major adverse cardiovascular events after modified morrow surgery in hypertrophic obstructive cardiomyopathy: A 12-year cohort study

This study investigates the incidence and risk factors for major adverse cardiovascular events (MACE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow surgery. It also aims to develop a predictive model for MACE to improve clinical risk assessment. This retrospective cohort study included 292 HOCM patients who underwent modified Morrow surgery. The primary endpoint was the incidence of MACE. Univariate and multivariate logistic regression were used to identify independent risk factors for MACE, and a predictive model was developed. MACE occurred in 39.04% of patients (114/292), with 4.7% mortality (14/292), 3.1% cardiac arrest, 2.7% requiring intra-aortic balloon pump (IABP) support, and 1.0% requiring extracorporeal membrane oxygenation (ECMO). Low cardiac output syndrome occurred in 19.2%, atrial fibrillation in 18.2%, and third-degree atrioventricular block (AVB) in 3.1%. Key risk factors included age (OR=1.044), eGFR (OR=1.025), preoperative pulmonary hypertension >30mmHg (OR=2.274), interventricular septal thickness (OR=1.084), MRI delayed enhancement (OR=2.021), and postoperative leukocytosis (OR=1.061). The predictive model demonstrated strong performance (AUC=0.815, P<0.001). Patients with HOCM undergoing modified Morrow surgery are at high risk of MACE. Key risk factors include age, eGFR, pulmonary artery pressure, septal thickness, MRI delayed enhancement, and postoperative leukocytosis. A predictive model based on these factors aids in tailoring perioperative management.

Prognostic value of brain magnetic resonance imaging in children after out-of-hospital cardiac arrest: predictive value of normal MRI for a favorable 2 year outcome.

Prognostic value of brain magnetic resonance imaging in children after out-of-hospital cardiac arrest: predictive value of normal MRI for a favorable 2 year outcome.

Characteristics of intracranial hemorrhage and acute aortic syndromes resuscitated with ECPR

Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to describe the characteristics of refractory OHCA patients resuscitated with ECPR due to ICH and AAS. This was a descriptive study and a secondary analysis of the SAVE-J II study, which was a multicenter ECPR registry. Among the 1589 cases, the causes of arrest were ICH in 48 patients (3%), AAS in 112 patients (7%), and cardiac causes in 1429 patients (90%). Patients in the ICH group were younger (ICH: 47 years [interquartile ranges (IQR) 40-63], AAS: 68 years [IQR 59-74], cardiac causes: 61 years [IQR 50-68]; p < 0.001), and had fewer signs of life on hospital arrival (ICH: 2%, AAS: 12%, cardiac causes: 19%; p = 0.001) compared to the cardiac causes group. Patients in the ICH and AAS groups were also less likely to present with an initial shockable rhythm (ICH, 19%; AAS, 27%; cardiac causes, 74%; p < 0.001). Survival to hospital discharge was significantly lower in the ICH and AAS groups than in the cardiac cause group (ICH, 4%; AAS, 4%; cardiac causes, 29%; p < 0.001). Of the 112 patients in the AAS group, 54 (48%) were presumptively diagnosed as cardiac etiologies before ECPR. ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.

Response to “Effectiveness of route selection in patients with out-of-hospital cardiac arrest”

Response to “Effectiveness of route selection in patients with out-of-hospital cardiac arrest”

Management of permissive hypercapnia after cardiac arrest: a strategy to improve quality of recovery and optimizing resuscitation outcome

Management of permissive hypercapnia after cardiac arrest: a strategy to improve quality of recovery and optimizing resuscitation outcome

Effects of canagliflozin preconditioning on post-resuscitation myocardial function in a diabetic rat model of cardiac arrest and cardiopulmonary resuscitation.

Canagliflozin can reduce the risk of cardiovascular disease in patients except for its targeted antidiabetic effects. However, it remains unknown whether canagliflozin alleviates the post-resuscitation myocardial dysfunction (PRMD) in type 2 diabetes mellitus. To explore the effects and potential mechanisms of canagliflozin on myocardial function after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) in a type 2 diabetic rat model. Twenty-four type 2 diabetic rats were randomized into four groups: (1) sham+canagliflozin, (2) sham+placebo, (3) CPR+placebo, and (4) CPR+canagliflozin. Except for the sham+canagliflozin and placebo groups, both the CPR+placebo and canagliflozin groups underwent 8min of CPR after the induction of ventricular fibrillation for 6min. Myocardial function and hemodynamics were assessed at baseline and within 6h after autonomous circulation (ROSC) return. Left ventricular tissues were sampled to determine the expressions of relevant proteins in the NLRP3 inflammasome pathway. The results demonstrated that the mean arterial pressure (MAP) was significantly improved in the CPR+canagliflozin group after ROSC compared with the CPR+placebo group (p<0.05). Meanwhile, both ejection fraction (EF) and fraction shortening (FS) were dramatically increased in the CPR+canagliflozin group when compared with the CPR+placebo group at 2h, 4h, and 6h after ROSC (p<0.05). In addition, the levels of NT-proBNP, cTn-I, and NLRP3 inflammatory inflammasome-associated proteins were significantly decreased in the CPR+canagliflozin group compared with the CPR+placebo group. In type 2 diabetic rats, pretreatment of canagliflozin alleviates PRMD. The potential mechanisms may include inhibition of the NLRP3/caspase-1 signaling pathway.

Development and validation of a screening tool for sepsis without laboratory results in the emergency department: amachine learning study.

Sepsis is a significant health burden on a global scale. Timely identification and treatment of sepsis can greatly improve patient outcomes, including survival rates. However, time-consuming laboratory results are often needed for screening sepsis. We aimed to develop a quick sepsis screening tool (qSepsis) based on patients' non-laboratory clinical data at the emergency department (ED) using machine learning (ML), and compare its performance with established clinical scores. This retrospective study included patients admitted to the ED of Zhongnan Hospital of Wuhan University (Wuhan, China) from 1/1/2015 to 5/31/2022. Patients who were under 18 years of age, had cardiopulmonary arrest upon arrival at the ED, or had missing and abnormal medical record data were excluded. The qSepsis was derived by three ML algorithms, including logistic regression (LR), random forest (RF), and extreme gradient boosting (XGB). To benchmark the existing clinical tools for assessing the risk of sepsis in the ED, qSepsis was compared with the Systemic Inflammatory Response Syndrome (SIRS), the Quick Sepsis-Related Organ Failure Assessment (qSOFA), and the Modified Early Warning Score (MEWS). The external validation was performed with the Medical Information Mart for Intensive Care IV ED database (United States), and adopted the same inclusion and exclusion criteria. The predictive power of qSepsis and other clinical scores was measured using the area under the receiver operating characteristic curve (AUROC). The primary outcome of the study was the diagnosis of sepsis in the ED based on the Sepsis 3.0 criteria, which served as the basis for developing the qSepsis tool. A total of 414,864 patients were finally included in the cohort (median ([IQR]) patient age, 43 (29, 60) years; 202,730 (48.87%) females, 212,134 (51.13%) males), and 200,089 in the external testing cohort (median (SD) patient age, 57 (39, 71) years; 107,427 (53.69%) females, 92,663 (46.31%) males). For internal testing, LR outperformed RF and XGB with an AUROC of 0.862 (95% CI, 0.855-0.869). In external testing, the AUROC decreased to 0.766 (95% CI, 0.758-0.774) for LR, 0.725 (95% CI, 0.717-0.733) for RF, and 0.735 (95% CI, 0.728-0.742) for XGB. In addition, the AUROC for the qSOFA, MEWS, and SIRS scores in external validation cohort were 0.579 (95% CI, 0.563-0.596), 0.600 (95% CI, 0.578-0.622), and 0.704 (95% CI, 0.683-0.725), respectively. The area under the precision-recall curve (AUPRC) for the qSepsis model was 0.213 (95% CI: 0.204-0.222). The AUPRC values for the other scores were as follows: SIRS, 0.071 (95% CI: 0.013-0.099); qSOFA, 0.096 (95% CI: 0.003-0.186); and MEWS, 0.083 (95% CI: 0.063-0.111). This retrospective study demonstrated that qSepsis had better predictive performance in terms of AUROC and area under the precision-recall curve (AUPRC) compared to existing assessment scores. It has the potential to be used in pre-hospital settings with limited access to laboratory tests and in the ED for quick screening of patients with sepsis. However, due to its low positive predictive value (PPV), the false alarms may increase in actual clinical practice. Transformation of Scientific and Technological Achievements Fund Project of Zhongnan Hospital of Wuhan University.

AI-derived automated quantification of cardiac chambers and myocardium from non-contrast CT: Prediction of major adverse cardiovascular events in asymptomatic subjects.

The significance of left ventricular mass and chamber volumes from non-contrast computed tomography (CT) for predicting major adverse cardiovascular events (MACE) has not been studied. Our objective was to evaluate the role of artificial intelligence-enabled multi-chamber cardiac volumetry from non-contrast CT for long-term risk stratification in asymptomatic subjects without known coronary artery disease. Our study included 2022 asymptomatic individuals (55.6±9.0 years; 59.2% male) from the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) trial. Multi-chamber cardiac volumetry was performed using deep-learning algorithms from routine non-contrast CT scans for coronary artery calcium scoring. MACE was defined as cardiac death, acute coronary syndrome, and late (>180 days) revascularization. A total of 215 individuals (11%) suffered MACE at a mean follow-up of 13.9±3 years. Individuals with MACE had higher left ventricular mass (115.1g vs. 105.2g, p<0.001). In a multivariable analysis adjusted for cardiovascular risk factors and medications, left ventricular mass (HR 2.76, p<0.001) and coronary artery calcium score (HR 1.34, p<0.001) were independent predictors of long-term MACE. Adding left ventricular mass to the coronary calcium score improved the Receiver Operating Characteristic Area Under the Curve (AUC 0.753 vs 0.767, p=0.031) with continuous net reclassification index of 18% (p=0.011). Left ventricular mass (HR 3.89, p<0.001), but not the coronary artery calcium score predicted cardiovascular death. Left ventricular mass quantified automatically by AI from routine non-contrast CT independently predicted long-term MACE over and above the coronary calcium score in asymptomatic participants without known coronary artery disease.

Definition and Validation of PrognosticPhenotypes in ModerateAortic Stenosis.

Adverse outcomes from moderate aortic stenosis (AS) may be caused by progression to severe AS or by the effects of comorbidities. In the absence of randomized trial evidence favoring aortic valve replacement (AVR) in patients with moderate AS, phenotyping patients according to risk may assist decision making. This study sought to identify and validate clusters of moderate AS that may be used to guide patient management. Unsupervised clustering algorithms were applied to demographics, comorbidities, and echocardiographic parameters in a training data set in patients with moderate AS (n=2,469). External validation was obtained by assigning the defined clusters to an independent group with moderate AS (n=1,358). The primary outcome, a composite of cardiac death, heart failure hospitalization, or aortic valve (AV) intervention after 5 years, was assessed between clusters in both data sets. Four distinct clusters-cardiovascular (CV)-comorbid, low-flow, calcified AV, and low-risk-with significant outcomes (log-rank P< 0.0001 in both data sets) were identified and replicated. The highest risk was in the CV-comorbid cluster (validation HR: 2.00 [95%CI: 1.54-2.59]; P< 0.001). The effect of AVR on cardiac death differed among the clusters. There was a significantly lower rate of outcomes after AVR in the calcified AV cluster (validation HR: 0.21 [95%CI: 0.08-0.57]; P = 0.002), but no significant effect on outcomes in the other 3 clusters. These analyses were limited by the low rate of AVR. Moderate AS has several phenotypes, and multiple comorbidities are the key drivers of adverse outcomes in patients with moderate AS. Outcomes of patients with noncalcified moderate AS were not altered by AVR in these groups. Careful attention to subgroups of moderate AS may be important to define treatable risk.

Impact of CT-angiography derived plaque characteristics on cardiac events in patients with a negative invasive fractional flow reserve.

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR>0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events. We examined 373 consecutive CCS patients undergoing CTA followed not more than 90days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32months. Revascularization was performed in 131 of the 373 patients due to an FFR≤0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR>0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4% versus 10.1%, p=0.90), whilst in the Defer group they were higher in patients with HRP (21.1% versus 4.7%, Log-rank-p<0.0001). In multivariate Cox hazard analysis the presence of HRP (Hazard-ratio 12.79, 95%confidence-intervals: 3.57-45.83, p<0.0001) was an independent predictor for cardiac events in the Defer group. HRP on CTA was associated with future cardiac events in patients in whom revascularization was deferred due to a negative invasive-FFR (UMIN000054067; CAPTURE).

Defining variances in practice for use of electrophysiology studies in risk stratification of patients with repaired tetralogy of Fallot: a PACES survey.

Sudden cardiac death poses a significant risk in patients with surgically repaired tetralogy of Fallot. Despite extensive research, risk stratification practices vary. This study surveyed the Pediatric and Adult Congenital Electrophysiology Society to identify these differences. Results showed diverse practices in indications, methods, and interpretation of electrophysiology studies, highlighting a need for standardised algorithms to improve patient outcomes.

Exercise-induced intraventricular pressure gradient may be the cause of sudden cardiac death in patients with unknown cardiac disease

Exercise-induced intraventricular pressure gradient may be the cause of sudden cardiac death in patients with unknown cardiac disease

Screening and Interpretation Rules for Resting Electrocardiograms in Polish Air Force Aircrew

INTRODUCTION: The resting 12-lead electrocardiogram (ECG) is one of the basic screening tests used in assessing fitness for military service and in periodic examinations of professional soldiers. Its purpose is to reduce the risk of death from cardiovascular disease by early detection of cardiac pathologies predisposing to sudden cardiac arrest. Commonly used electrocardiographic standards do not perform well in screening, accounting for the recognition of a large number of abnormalities unrelated to structural heart disease. METHODS: A comprehensive literature review was performed using electronic databases such as PubMed®, Google Scholar, and relevant aerospace medical journals. The search focused on keywords, including “screening ECG,” “electrocardiographic criteria,” “military aircrew,” and “aviation medicine.” Articles that discussed ECG interpretation rules and the implementation of screening protocols in military aircrew were included. The review also involved an examination of guidelines and policies from major aviation regulatory bodies. RESULTS: This review includes information on topics relevant to the application of 12-lead ECG in screening diagnostics, such as general ECG interpretation criteria, limitations of ECG as a screening tool, objectives of ECG-based screening, and past experiences with the use of screening ECG in athletes within the context of military medicine. DISCUSSION: We discuss various criteria for the interpretation of screening ECG in athletes and soldiers to increase the specificity of this test. We also present a proposal for a system of criteria for interpreting ECGs in aircrew of the Polish Air Force, which may help improve the detection of cardiac pathologies in this professional group. Kurek MA, Rola M. Screening and interpretation rules for resting electrocardiograms in Polish Air Force aircrew. Aerosp Med Hum Perform. 2025; 96(2):135–142.

Observational study of sudden cardiac arrest risk (OSCAR): Rationale and design of an electronic health records cohort.

Out-of-hospital sudden cardiac arrest (SCA) is a major cause of mortality and improved risk prediction is needed. The Observational Study of Sudden Cardiac Arrest Risk (OSCAR) is an electronic health records (EHR)-based cohort study of patients receiving routine medical care in the Cedars-Sinai Health System (CSHS) in Los Angeles County, CA designed to evaluate predictors of SCA. This paper describes the rationale, objectives, and study design for the OSCAR cohort. The OSCAR cohort includes 379,833 Los Angeles County residents with at least one patient encounter at CSHS in each of two consecutive calendar years from 2016 to 2020. We obtained baseline cohort characteristics from the EHR from 2012 until the start of follow-up, including demographics, vital signs, clinical diagnoses, cardiac tests and imaging, procedures, laboratory results, and medications. Follow-up will continue until Dec. 31, 2025, with an expected median follow-up time of∼7 years. The primary outcome is out-of-hospital SCA of likely cardiac etiology attended by Los Angeles County Emergency Medical Services (LAC-EMS). The secondary outcome is total mortality identified using California Department of Public Health - Vital Records death certificates. We will use conventional approaches (diagnosis code algorithms) and artificial intelligence (natural language processing, deep learning) to define patient phenotypes and biostatistical and machine learning approaches for analysis. The OSCAR cohort will provide a large, diverse dataset and adjudicated SCA outcomes to facilitate the derivation and testing of risk prediction models for incident SCA.

Effect of lower body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrest

Effect of lower body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrest

SherpaPak Cardiac Transport System: Experience in Pediatric Heart Transplantation.

The present study aimed to assess the clinical outcomes of pediatric heart transplant patients whose donor hearts were preserved with the SherpaPakCardiac Transport System. All pediatric patients undergoing heart transplantation at our center between January 2020 and June 2024 were included and described. Vasoactive inotropic score (VIS) was calculated. The cohort was divided into two groups by recipient diagnoses (cardiomyopathy vs. congenital heart disease [CHD]). They were compared based on demographics, operative details, and postoperative outcomes. The χ2 and Fisher exact tests were used for categorical variables and the Mann-Whitney U test or t-test for continuous variables. A total of 18 patients were included. The median recipient age was 11.9 years (IQR: 2.5, 13.9). Half had cardiomyopathy, median total ischemic time was 236 min (IQR: 211.5, 283.5). Upon comparing the two groups, there were no significant differences observed in VIS or primary graft dysfunction (PGD) even though the median circulatory arrest time and bypass times were significantly longer in the CHD group (p < 0.05). Three patients experienced early rejection (all with CHD), but there was no mortality. The SherpaPak Cardiac Transport System provides safe outcomes for pediatric heart transplant patients, including those with complex CHD. Further multi-institutional and registry studies are needed to evaluate this method for pediatric heart transplantation.

Technical Considerations in the TCD Evaluation of Cerebral Circulatory Arrest in Death by Neurological Criteria.

Ancillary testing is essential for diagnosing brain death/death by neurologic criteria (BD/DNC) when clinical determination (neurologic exam and apnea testing) cannot be fully or safely performed. Transcranial Doppler ultrasound (TCD) has been recommended as an ancillary test; however, the technical descriptions have been heterogeneous. We aimed to consolidate the technical considerations related to the use of TCD as an ancillary test in the evaluation of BD/DNC. We performed a scoping review of the available literature from inception to December 2024. Articles describing TCD as an ancillary test for BD/DNC were included using appropriate Medical Subject Headings terms. The focus was on technical details and clinimetric properties of TCD (e.g., signal quality, frequency, gate, probe location, etc.). Technical categories were curated as full-text reviews were completed. We reviewed 181 articles to extract technical descriptions of TCD under several categories. Image acquisition was divided into machine-related factors (59 studies, four questions), exam-related aspects (82 studies, 13 questions), and patient anatomical factors (19 studies, three questions). Image interpretation concerns were addressed in 50 studies (three questions). Patient-related clinical factors affecting TCD utility were addressed in 44 studies (seven questions). Legislative priorities were discussed in 19 studies; in 13 studies, authors commented on their recommendations for research priorities. We found significant inconsistencies and a lack of technical details described in the literature. Next steps include a national survey of current TCD protocols for BD/DNC evaluation, and an expert consensus guidelines report on the technical use of TCD as an ancillary test.

Understanding the Molecular Mechanisms of H2's Regulatory Effect on miR-29s for Brain Protection during Deep Hypothermic Circulatory Arrest.

Research regarding post-operative brain protection after deep hypothermic circulatory arrest (DHCA) has gained attracted significant attention. We previously demonstrated that hydrogen can significantly reverse DHCA-induced brain damage. In the current research, we have established the DHCA model successfully using a modified four-vessel occlusion method and injected miR-29s compounds into the hippocampal tissue of rats. We were surprised to find hydrogen increased miR-29s expression in the hippocampal tissue of a DHCA rat model. The administration of agomiR-29s counteracted DHCA-induced hippocampal tissue injury, while the antamiR-29s had the opposite effects. Based on the above facts, the brain protection mechanism of hydrogen in DHCAtreated rats may be related to the upregulation of miR-29s, which can exert its beneficial effects by alleviating apoptosis, inflammation, and oxidation.

Comparative Effectiveness of Intranasal Naloxone and Nalmefene in a Translational Model Assessing Reversal of Cardiac Arrest Induced by Synthetic Opioid Overdose

Comparative Effectiveness of Intranasal Naloxone and Nalmefene in a Translational Model Assessing Reversal of Cardiac Arrest Induced by Synthetic Opioid Overdose

Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres - A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm.

Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage. This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6months, OHCA patients had conveyance as standard of care. For the next 6months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30days. Secondary outcome was survival with favourable neurological outcome. Of 330 patients (mean age 67.5±13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98-1.24) p=0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95-1.15), p=0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05-2.13) p=0.02 and in those with a MIRACLE2 score≤5 [(63%% vs 38%, RR 0.59 (95% CI 0.61-0.86) p=0.005]. The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE2 score, to a dedicated CAC may improve survival.