Hospital Cardiac Arrest Research Articles

Evaluation of Cardioprotective action of Suvarna gairik (Redochre) in Indian Cobra Envenomation, Aluminium Phosphide Poisoning and Doxorubicin Cardiotoxicity in Albino Rats- A Protocol

Background: Poisoning is major health issue all over the world. Poisoning is one of basic causes for Out Hospital cardiac arrest (OHCA). P-OHCA (Poison induced Out Hospital cardiac arrest) can be prevented by immediate primary management. The agent for poisoning is unknown in most cases, which leads to difficulty deciding the emergency antidote. In Ayurveda Hridyavaranchikitsa (Cardio protection) is one of the treatment modalities mentioned in all types of poisoning as first aid treatment. Suvarna Gairik (Red ochre) is one of drugs mentioned for the cardioprotection. Snake bite and organophosphate poisoning are the threats to life in India. Doxorubicin is commonly used drug for Chemotherapy in malignancies, and its major side effect is cardiotoxicity. Hence these poisonings are included in study.
 Aim and Objective: Evaluation of cardioprotective activity of Suvarna Gairik (Red ochre) in cardiac biomarker like Lactate dehydrogenase, Creatinine phosphokinase, Alkaline transferase, Cardiac Troponins and Survival Time in Indian Cobra Envenomation, Aluminium phosphide poisoning and Doxorubicin cardiotoxicity in Albino Rats.
 Methodology: Animal study is designed. 56 wistar rats will be divided in 7 groups as Vehicle Control Group, Disease control Group -1 Indian Cobra envenomation, Disease control Group -2Aluminium Phosphide poisoning, Disease control Group -3 Inj. Doxorubicin induced cardiotoxicity, Test Group -1 Indian Cobra Envenomation and Suvarna gairik Test Group -2 Aluminium Phosphide poisoning and Suvarna gairik Test control Group 3- Inj. Doxorubicin cardiotoxicity and Suvarna gairik.
 Results: Outcome will be assessed in between groups and among groups.
 Conclusion: Suvarna Gairik (Red ochre) may show statistical significant cardioprotective activity.

Clinical Significance of Early Echocardiographic Changes after Resuscitated Out-of-Hospital Cardiac Arrest

BackgroundLeft Ventricular Systolic Dysfunction (LVSD) is common after out-of-hospital cardiac arrest (OOHCA) and can manifest globally or regionally, although its clinical significance has not been robustly studied. This study evaluates the association between LVSD, extent of coronary artery disease (CAD) and outcome in those undergoing early echocardiography and coronary angiography after OOHCA. MethodsTrans-thoracic echocardiography (TTE) was performed in OOHCA patients on arrival to our centre between May 2012 and December 2017. Rates of cardiogenic shock and extent of CAD, respectively classified by SCAI grade and the SYNTAX score, were measured. The primary end-point was 12-month mortality. ResultsFrom 398 patients in the King’s Out of Hospital Cardiac Arrest Registry (KOCAR), 266 patients (median age 61 [53–71], 76% male) underwent both TTE and coronary angiography on arrival. 96 patients (36%) had significant LVSD (Left Ventricular Ejection Fraction [LVEF] <40%) and 139 (52.2%) patients had regional wall motion abnormalities (RWMAs). Patients with LVEF <40% had more SCAI grade C-E shock (65.3% vs. 34.5%, p <0.001) and higher 12-month mortality (55.2% vs 31.8%, p <0.001) which was more likely to be due to a cardiac aetiology (27.3% vs 5.3%, p <0.001). Patients with RWMAs had higher median SYNTAX scores (14.75 vs 7, p=0.001), culprit coronary lesions (83.5% vs. 45.3%, p <0.001) and lower 12-month mortality (29.5% vs 52%, p <0.001). ConclusionsPatients with LVEF <40% at presentation have an increased mortality, driven by cardiac aetiology death, while the presence of RWMAs is associated with a higher rate of culprit coronary lesions, representing a potentially reversible cause of the arrest, and improved survival at 1 year.

446 Relationship between out of hospital cardiac arrest and COVID-19 pandemic: impact on outcome

AimsDuring 2020, Italy was hit by the pandemic of the ‘Coronavirus disease 2019’ (COVID-19) with an incidence/100 000 citizens characterized by two peaks. An increase in out-of-hospital cardiac arrest (OHCA) mortality during the first pandemic peak has already been described, but there are few data on the whole year. The goal of our study is to evaluate the impact of the pandemic on post-OHCA mortality.MethodsWe considered patients with OHCA in Varese territory from January to December 2020 with medical aetiology according with Utstein 2014 classification. The primary endpoint of the study was the assessment of acute post-arrest mortality and which parameters influence this outcome. In particular, both the role of pandemic peaks (‘first peak’ from 11 March 2020 to 23rd May 2020 and ‘second peak’ from 7 October 2020 to 31 December 2020) and the average rescue times, i.e.: (i) interval between OHCA and call for first aid (delay in activation of assistance); (ii) the interval between the call and the arrival of the rescue vehicles (delay in the arrival of the first aid) and finally; (iii) the time between the arrival of the rescue vehicles and the end of Cardiopulmonary Resuscitation (CPR), interrupted due to death or Recovery of Spontaneous Circulation (ROSC). Finally, we performed a multivariate analysis to assess which of the variables considered had the greatest impact on the outcome.ResultsWe analysed 708 patients (mean age 76 + 14.09 years; 40% women). Overall mortality was 89%. During the peaks there was an increase in mortality compared to the pre-pandemic period (first peak 96% vs. 83%, OR 4.49; second peak 92% vs. 83%, OR 2.45) (Figure 1). The time between the collapse and the call for help was significantly higher during the first pandemic peak compared to the second peak and the pre-pandemic period (P = 0.003); the time between the call and the arrival on the patient was significantly longer during both pandemic peaks than in the previous period (P = 0.002) and there was no significant difference in CPR duration time between the periods analysed. In a multivariate model, the only time associated with an increase in mortality is the period between the call for help and the arrival on the patient, regardless of the COVID-19 pandemic.Figure 1446 ConclusionsDuring the COVID-19 pandemic there has been an increase in mortality of patients with OHCA. Among the variables considered, the increase in mortality is mainly associated with the delay in the arrival of emergency vehicles on site. This delay, although decreasing, was also maintained during the second peak of the pandemic.

250 Advanced management of out of hospital cardiac arrest: a single-centre experience in a tertiary cardiac intensive care unit

Abstract Aims Out-of-hospital cardiac arrest (OHCA) affects around 1/1000 person-years. Following return of spontaneous circulation (ROSC), the patient can manifest neurological impairment. A targeted temperature management (TTM) protocol is recommended to prevent hypoxic–ischaemic brain damage in patients with coma after cardiac arrest. Neuro-prognostication remains substantial for the prediction of clinical outcomes. To study clinical characteristics, overall survival, and neurological outcome of patients with Glasgow Coma Scale (GCS) &amp;lt;8 after ROSC following an OHCA of presumed cardiac cause at our Institution. Secondly, to investigate determinants of a negative neurological outcome. Methods Observational retrospective study evaluating all patients with OHCA of presumed cardiac cause and with GCS &amp;lt; 8 after ROSC treated in an intensive cardiac care unit of a tertiary centre. The study period was from January 2017 to December 2020. Results One-hundred and five patients out of 107 patients initially selected were included in the study (77% male, mean age 67 years). At 30 days, mortality was 41% and 53% of patients had a poor neurological outcome (Cerebral Performance Category, CPC, 3–5). Sixty-nine patients (66%) underwent TTM. In regard of the circumstances of OHCA, index event in a private place [OR = 3.12 (1.43–7.11), P = 0.005], ineffective rhythm changes during resuscitation manoeuvres [OR = 2.40 (1.05–5.47), P = 0.037] and a greater amount of adrenaline administered during resuscitation [OR = 1.62 (1.27–2.06), P &amp;lt; 0.001] were related to a worse neurological outcome. A history of diabetes mellitus [OR = 3.35 (1.26–8.91), P = 0.015], blood lactates at presentation [OR = 1.33 (1.15—1.53), P &amp;lt; 0.001], neuron-specific enolase (NSE) at presentation [OR = 1.055 (1.022–1.089), P &amp;lt; 0.001] and as peak [OR = 1.034 (1.013–1.054), P &amp;lt; 0.001] were associated with a worse neurological outcome. Among the neurological examinations, the presence of status epilepticus on the EEG [OR = 13.97 (1.73–113.02), P = 0.013] was a predictor of a poor neurological outcome. Treatment with targeted temperature management did not show a significant impact in terms of outcome at univariate analysis [OR = 1.226 (0.547–2.748), P = 0.62]. Two models were developed with multivariate logistic regression for the prediction of neurological outcome. The first one, on a statistical basis, considers pupil reactivity after ROSC, NSE as peak and left ventricular ejection fraction (AUC = 92%). The second model, on a clinical basis, considers age, first blood lactate value and NSE as peak (AUC = 89 %). Finally, the performance of the multiparametric MIRACLE score was tested in our population (AUC 0.81 for neurological outcome at 30 days). Conclusions In our population, at 30 days after cardiac arrest, survival rate and the rate of good neurological outcome were comparable to those of the major international registries and studies. Even though patients treated with TTM did not demonstrate significant differences in terms of neurological outcome, this might be related to study-sample size and patient selection. Results in the literature are still controversial on this topic. The MIRACLE score showed a good performance, making it suitable for clinical use in our population. Similarly, the proposed multivariate models are potentially useful for the elaboration of simple and effective prognostic scores in neurological risk stratification.

Calcium for of out hospital cardiac arrest: the COCA trial

Calcium for of out hospital cardiac arrest: the COCA trial

Time to specialty care and mortality after cardiac arrest.

Out of hospital cardiac arrest (OHCA) patients are often transported to the closest emergency department (ED) or cardiac center for initial stabilization and may be transferred for further care. We investigated the effects of delay to transfer on in hospital mortality at a receiving facility. We included OHCA patients transported from the ED by a single critical care transport service to a quaternary care facility between 2010 and 2018. We calculated dwell time as time from arrest to critical care transport team contact. We abstracted demographics, arrest characteristics, and interventions started prior to transport arrival. For the primary analysis, we used logistic regression to determine the association of dwell time and in-hospital mortality. As secondary outcomes we investigated for associations of dwell time and mortality within 24h of arrival, proximate cause of death among decedents, arterial pH and lactate on arrival, sum of worst SOFA subscales within 24h of arrival, and rearrest during interfacility transport. We included 572 OHCA patients transported from an outside ED to our facility. Median dwell time was 113 (IQR=85-159) minutes. Measured in 30min epochs, increasing dwell time was not associated with in-hospital mortality, 24-h mortality, cause of death and initial pH, but was associated with lower 24-h SOFA score (p=0.01) and lower initial lactate (p=0.03). Rearrest during transport was rare (n=29, 5%). Dwell time was associated with lower probability of rearrest during transport (OR=0.847, (95% CI 0.68-1.01), p=0.07). Dwell time was not associated with in-hospital mortality. Rapid transport may be associated with risk of rearrest. Prospective data are needed to clarify optimal patient stabilization and transport strategies.

The Willingness of Bystander to Perform CPR to the Patient with Out of Hospital Cardiac Arrest During the Pandemic Covid 19: A Literature Review

Cardiac arrest is one of the emergency cases that requires immediate treatment. The Out of the Hospital Cardiac Arrest (OHCA) can happen anytime and everywhere with or without any sign. During a pandemic, OHCA often occurs at home and the patient have been found by family members as witness. unfortunately, based on the data The survival rate for patients with OHCA during the pandemic has decreased. There are several factors that cause this to happen, one of which is a decrease in bystander in performing CPR on patients. Bystander's willingness to perform CPR plays an important role in the chain of survival of patients with OHCA which affects patient outcomes. Based on this, a study was conducted on the willingness of bystander to perform CPR to the patient with out of hospital cardiac arrest (OHCA) during the pandemic covid 19. This research method is a literature review sourced from research journals conducted in 2019 to 2021 about the willingness of bystanders to perform CPR during the pandemic. The results seven journals that have been analysed show that most of the bystanders are willing to perform CPR with various conditions including Perform hands only CPR and if Personal Protective Equipment (PPE) is Avalaible. There are several conditions that cause the CPR bystander not to be willing to perform CPR, such as the fear of being infected, the absence of PPE and the victim is a stranger or unfamiliar person for bystander. Conclusion the willingness of bystanders to perform CPR on OHCA victims during the pandemic is still high, bystander perform hands only CPR and using PPE during the intervention.

Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study

BackgroundLittle is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm.MethodsWe retrospectively analysed data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW).ResultsIn the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76–3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19–4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83–2.36; OR 1.87, 95% CI 1.01–3.47 among the initial shockable and non-shockable patients, respectively).ConclusionWe suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.

Development and validation of the SARICA score to predict survival after return of spontaneous circulation in out of hospital cardiac arrest using an interpretable machine learning framework

BackgroundAccurate and timely prognostication of patients with out-of-hospital cardiac arrest (OHCA) who achieved the return of spontaneous circulation (ROSC) is crucial in clinical decision-making, resource allocation, and communications with next-of-kins. We aimed to develop the Survival After ROSC in Cardiac Arrest (SARICA), a practical clinical decision tool to predict survival in OHCA patients who attained ROSC. MethodsWe utilized real-world Singapore data from the population-based Pan-Asian Resuscitation Outcomes Study between 2010–2018. We excluded patients without ROSC. The dataset was segmented into training (60%), validation (20%) and testing (20%) cohorts. The primary endpoint was survival (to 30-days or hospital discharge). AutoScore, an interpretable machine-learning based clinical score generation algorithm, was used to develop SARICA. Candidate factors were chosen based on objective demographic and clinical factors commonly available at the time of admission. Performance of SARICA was evaluated based on receiver-operating curve (ROC) analyses. Results5970 patients were included, of which 855 (14.3%) survived. A three-variable model was determined to be most parsimonious. Prehospital ROSC, age, and initial heart rhythm were identified for inclusion via random forest selection. Finally, SARICA consisted of these 3 variables and ranged from 0 to 10 points, achieving an area under the ROC (AUC) of 0.87 (95% confidence interval: 0.84–0.90) within the testing cohort. ConclusionWe developed and internally validated the SARICA score to accurately predict survival of OHCA patients with ROSC at the time of admission. SARICA is clinically practical and developed using an interpretable machine-learning framework. SARICA has unknown generalizability pending external validation studies.

Abstract 8941: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has few evidence about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim in this study is to assess the effectiveness and safety of resuscitation strategies using MCC versus resuscitation strategies using standard manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions at our hospital. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device (LUCAS® Lund University Cardiac Arrest System, USA) during the resuscitation. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR, and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups (manual group 42.8% vs MCC group 50.1% p=0.13). However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated for cardiac arrest or refractory cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (manual group 26.8% vs MCC group 39.1% p=0.014). Conclusions: This study showed that mechanical chest compression in cardiac arrest and cardiogenic shock increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.

Abstract 13811: Cognitive and Psychological Outcomes of Patients 6 Months After Cardiac Arrest or Intensive Care Stay

Background: The neuropsychological and cognitive consequences of an ICU stay can cause a large burden on many patients. In this study, we assessed the outcomes of a group of patients attending a newly set up, multi-disciplinary outpatient clinic focused on assessing neuropsychological and cognitive outcomes following a significant (&gt;72 hours) ICU stay, and compared patients whose ICU was post-OHCA (out of hospital cardiac arrest), and those non-OHCA. Methods: Between 2016 and 2019, 152 patients were assessed within the Care after REsuscitation (CARE) / ICU follow up clinic, 6 months following hospital discharge, using the SF-36, HADS, PTSS-14 and MoCA. The OHCA group were compared to other non-OHCA, ICU patients (&gt;72 hour stay). Results: No significant differences (p&lt;0.05) were found between the groups outcomes, however we found that 6 months post-discharge, the non-OHCA group experience significantly more pain, are older, and required a longer length of stay (p&lt;0.05). However, we found compared to normative data of the SF-36, over half of the OHCA group (on 6 out of the 8 subscales) and the non-OHCA (on 7 out of the 8) were below population norms, especially Role-Physical (66.7% OHCA and 71.6% non-OHCA) and Energy/ fatigue (66.7% OHCA and 61.4% non-OHCA). Anxiety was observed in 33.3% of the OHCA group, and 35.2% of the non-OHCA group had an abnormal total HADS score. PTSD was seen in 12.7% of the OHCA group and 10.2% of the non-OHCA group. Cognitive impairment was observed in 61.9% of OHCA and 59.1% of non-OHCA patients. Age and hospital length of stay had no significant effect on outcomes on our OHCA population, however females had significantly worse health related quality of life (HRQoL) on 6 out of the 8 subscales (p&lt;0.05). Conclusion: Despite the OHCA and non-OHCA groups having no significant difference between their outcomes, there is a great disease burden upon many individuals following ICU stay, with many experiencing poor HRQoL, mood disorders, PTSD and cognitive impairment. The factors contributing to poor outcome following both ICU related illness and cardiac arrest should be further studied. The creation and validation of new assessment tools is imperative to ensure we fully appreciate the extent of the morbidity in this group to improve care for all ICU patients.

Abstract 11817: The Effect of Time to Treatment With Antiarrhythmic Drugs on Return of Spontaneous Circulation in Shock Refractory Out-of-Hospital Cardiac Arrest: A Secondary Analysis of the ALPS Randomized Controlled Trial

Purpose: The effects of amiodarone and lidocaine on the return of spontaneous circulation (ROSC), relative to time to treatment in out of hospital cardiac arrest (OHCA) patients is unknown. We conducted a post-hoc analysis of the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo (ROC ALPS) randomized trial examining the association of time to treatment with ROSC at emergency department (ED) arrival. Method: In the ROC ALPS trial, adults with non-traumatic OHCA with initial VF/pVT after ≥ 1 shock were randomized to receive amiodarone, lidocaine or placebo. We used logistic regression to examine the association of time to treatment (911 call to study drug administration interval) with ROSC at ED arrival. Results: Overall, 1112 (36.7%) patients had ROSC at ED arrival. Time to treatment data were available for 2994 (99%) of the patients. The proportion of patients with ROSC at ED arrival decreased as time to drug administration increased, in amiodarone (OR 0.92, 95% CI 0.90-0.94 per min increase), lidocaine (OR 0.95, 95% CI: 0.93-0.96) and placebo (OR 0.95, 95% CI: 0.93-0.96) arms. The odds of ROSC at ED in the amiodarone group (versus placebo) changed in relation to the time of drug administration (OR 0.96, 95% CI: 0.93-0.99). With short times to drug administration, ROSC was higher in amiodarone versus placebo recipients, whereas ROSC was higher with placebo at later times. Comparing lidocaine to placebo, ROSC rate increased at all times (OR 1.29, 95% CI: 1.07-1.59); there was no time to drug administration effect (OR 1.00, 95% CI: 0.97-1.03). Among all patients, survival at hospital discharge was 21.0%, 24.4%, and 23.7% for placebo, amiodarone and lidocaine respectively. Conclusion: Amiodarone’s efficacy in restoring ROSC declined with longer duration of arrest, potentially due to its adverse hemodynamic effects. Overall, amiodarone and lidocaine had similar effects on mortality; in this study, ROSC at ED arrival trend did not reflect the overall survival rate

Abstract 11336: Experience with an Institutional Guideline on Extracorporeal Cardiopulmonary Resuscitation for Refractory in Hospital and Out of Hospital Cardiac Arrest

Aim: To compare survival rates in patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR) before and after implementation of an action card.The primary outcome was survival to discharge, and secondary outcomes were low-flow time and rate of cerebral complications. Methods: Retrospective evaluation of 37 patients treated with ECPR for refractory cardiac arrest. Information was obtained through medical records. Patients were categorized into two groups - before (BA) and after (AA) introduction of an action card. The card entailed inclusion and exclusion criteria used to evaluate the benefit of ECPR for any individual patient. Results: There were no statistically significant differences in baseline characteristics between the groups.After the introduction of the action card, survival to discharge increased from 6.7 % to 18.2 % suggesting a trend toward improved survival, despite this finding being statistically insignificant (p = 0.629).Low-flow time was reduced from 100 (12-195) minutes to 66 (30-195) minutes and the upper extreme was reduced from 195 to 153 minutes, but this was not statistically significant (p = 0.334).Cerebral factors contributed to significantly fewer deaths in AA compared with BA (p = 0.0022). Conclusion: There was no statistically significant improvement in survival rates nor a reduction in low-flow time after the implementation of an action card for the use of ECPR in patients with refractory CA. However, cerebral causes factored in fewer deaths and several patients survived despite meeting potential exclusion criteria outlined in local and international guidelines.

Abstract 10868: Risk Factors and Long-Term Outcomes of Cardiogenic Shock in Young Patients with Myocardial Infarction - The Mass General Brigham Young-MI Registry

Introduction: Cardiogenic shock complicating acute myocardial infarction (CS-AMI) is associated with high morbidity and mortality, yet data among younger individuals are limited. Methods: Retrospective cohort study of consecutive AMI patients aged 18-50 years admitted to 2 tertiary care academic centers from 2000-2016. CS was determined by physician review of electronic health records (EHR) using the SCAI CS classification system. Baseline characteristics, treatment and outcomes including all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF) were adjudicated by physicians using EHR and death records. Mahalanobis distance matching was used to define a comparator group in the non-CS cohort. Results: The study included 2097 AMI patients (mean age 44 ± 5.1 years, 74% white, 81% male), with CS-AMI identified in 148 (7%) patients. There were no significant differences in age, sex or race between groups, although CS-AMI patients were more likely to have public or no insurance (p=0.02). Independent factors associated with CS-AMI included female sex, STEMI at presentation, out of hospital cardiac arrest, left main coronary disease, diabetes and peripheral artery disease. Over a median follow up of 11.2 years, compared to 461 matched non-CS-AMI patients and controlling for relevant covariates, CS-AMI patients had significantly higher ACM (aHR 2.84, p&lt;0.001), CVM (aHR 4.09, p&lt;0.001), and 1-year HHF (aHR 6.18, p=0.001) (Figure 1). In landmark analyses, CS-AMI patients who survived to discharge continued to have significantly higher risk of CVM (aHR 2.76, p=0.016) compared with matched non-CS AMI patients. All results were similar in the full cohort comparison. Conclusion: Cardiogenic shock is infrequent amongst young AMI patients, but associated with substantially higher overall and post-discharge mortality, and 1-year heart failure hospitalizations after AMI compared to those without cardiogenic shock.

Abstract 13916: The Obesity Paradox in ST-elevation Myocardial Infarction

Introduction: In patients with known cardiovascular disease (CVD), body mass index (BMI)-defined obesity has been found to be protective against all-cause mortality and CVD events, commonly known as the “obesity paradox”. However, the role of BMI in STEMI outcomes remains poorly understood. Methods: The Midwest STEMI Consortium database of 15,039 consecutive STEMI activations between January 2010 and December 2020 consists of four regional STEMI centers. Using data from two centers with complete follow-up available, Minneapolis Heart Institute and The Christ Hospital, we examined differences by BMI groups defined as normal (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ) in baseline characteristics, treatment, in-hospital death and 1-year MACE and mortality risk. Results: Among 4,682 patients (22% normal BMI, 36% overweight and 42% obese), obese patients were significantly younger but had higher rates of hypertension, diabetes, dyslipidemia, and were taking more cardiac medications prior to admission. Systolic and diastolic blood pressures, heart rate, and creatinine were highest in the obese subgroup. Obese patients had a higher rate of out of hospital cardiac arrest (9.2% vs. 9.6% vs. 12%, p=0.02) and a trend towards higher in-hospital death (5.7% vs. 4.7% vs. 6.4%, p=0.08). Overweight and obese patients had a lower risk of 1-year mortality (4.6% vs. 2.6% vs. 2.9%) and a trend towards lower 1-year MACE events (7.6% vs. 5.5% vs. 5.9%) compared to normal BMI patients (Figure). Discussion: Among individuals presenting with STEMI, despite more risk factors, higher rates of out of hospital cardiac arrest and a trend towards higher in-hospital death, overweight and obese patients had lower 1-year mortality consistent with the obesity paradox. Further research is needed to understand the obesity paradox in STEMI patients.

Abstract 11045: Pre-Hospital Airway for Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Study

Introduction: This study investigated whether use of pre-hospital advanced airway management (AAM) is associated with improved survival of adults with out-of hospital cardiac arrest (OHCA) compared to conventional bag-valve-mask ventilation (BVM). Method: The study subjects were derived from Korean Cardiac Arrest Research Consortium (KoCARC), a multi-center OHCA registry of Korea. Patients who underwent AAM or BVM using supraglottic airway, oropharyngeal airway, or endotracheal intubation were compared. The differences in baseline clinical characteristics were adjusted using propensity scoring matching (PSM) or inverse probability of treatment weighting (IPTW). The primary outcome was 30-day survival with neurologically favorable status of cerebral performance category ≤2. The outcome was also compared according to the duration of low-flow time. Results: Of 9,616 patients enrolled, (median age = 71, male sex = 65%) there were 7,583 AAM and 2,033 BVM patients. The unadjusted survival to with neurologically favorable status was lower in AAM compared to BVM (HR = 1.27, 95% confidence interval (CI) = 1.20 - 1.34, p&lt;0.001). However, there was no significant difference of survival to with neurologically favorable status between AAM and BVM after PSM or ITPW-adjusted comparisons (p&gt;0.05, all). This finding was consistent irrespective of duration of low-flow time. Conclusion: In this nationwide real-world data of out-of hospital cardiac arrest study, prehospital advanced airway management compared to bag-and-mask ventilation did not result in an improved clinical outcome at 30 days.

Abstract 13847: Sex-Differences by Body Mass Index After ST-Elevation Myocardial Infarction

Introduction: There are significant differences in body composition by sex; however, differences by sex on the association of BMI with cardiovascular outcomes after STEMI remains poorly understood. Methods: The Midwest STEMI Consortium consists of 15,039 consecutive STEMI activations. 4,682 patients with 1-year follow-up were included to examine sex-differences in characteristics, treatment, in-hospital and 1-year MACE and mortality risk by BMI groups: normal (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ). Results: Among 4,682 patients, 30% were women and 70% were men. Among women, 28% had normal BMI, 30% were overweight, and 42% obese. In normal BMI patients women were significantly older, had higher rates of HTN, lower rates of smokers, lower peak troponin, and longer door-to-balloon times compared to men. Women had lower risk of 30-day MACE (1.1% vs. 3%, p=0.045) but there were no sex-differences in 1-year MACE or mortality. Among overweight patients, women were significantly older, had higher rates of HTN and diabetes, and lower rates of smokers. Bleeding complication was more common in women (38% vs. 32%, p=0.03) as was cardiogenic shock pre-PCI (13% vs. 8.8%, p=0.02) but no sex-differences were seen in 1-year MACE or mortality. Among obese patients, women were significantly older and had higher rates of HTN, diabetes and stroke. Women had lower rates of out of hospital cardiac arrest (8.8% vs. 13%, p=0.005) and more bleeding complication (39% vs. 33%, p=0.025). Women had higher risk of 30-day death (2% vs. 0.8%, p=0.02), 1-year stroke (2.4% vs. 0.7%, p=0.004), and 1-year MACE and mortality (Figure). Discussion: Among STEMI patients, we found that obese women were at increased risk of MACE and mortality. Interestingly, there were no differences in MACE or mortality between men and women of normal and overweight BMI ranges, suggesting the importance of BMI when risk stratifying patients, particularly women, that warrants further research.

Abstract 10020: Worse Outcomes of Out-of-Hospital Cardiac Arrest in COVID-19 versus Non-COVID-19: A Systematic Review and Meta Analysis

Introduction: A surge in incidence of out-of-hospital cardiac arrest (OHCA) has been reported during COVID-19 outbreak in certain countries. However, limited data exists on a comparison of outcomes among COVID-19 positive OHCA patients vs. non- COVID-19 OHCA patients. Therefore, we aimed to perform a meta-analysis comparing characteristics and outcome of COVID-19 OHCA vs COVID-19 negative OHCA patients. Methods: We reviewed PubMed/Medline, SCOPUS, and EMBASE until April 2021 using relevant keywords COVID-19, SARS-CoV-2, “out of hospital cardiac arrest” or OHCA to identify studies that included outcomes data on OHCA with COVID-19 positive and negative status. Random-effects models were obtained to perform a meta-analysis. I 2 statistics was used for heterogeneity. Results: Of 5789 OHCA patients included from 6 studies, patients who were COVID-19 positive comprised of 61.46% males while COVID-19 negative patients included 63.37% of males (p=0.2). COVID-19 OHCA patients were younger (Mean±SD, 68.94±17.93 vs 70.23±17.93, p=0.03) compared to COVID-19 negative patients. Incidence of OHCA at home/private address was higher (OR=1.92, 95%CI:1.52-2.43), while shockable rhythm (OR=0.34, 95%-CI:0.24-0.46) and use of AED (OR=0.77, 95%CI 0.61-0.97) were less frequently noted in COVID-19 patients (p&lt;0.0001). As shown in Fig. 1 , return of spontaneous circulation did not differ significantly (OR=1.01, 95%CI:0.85-1.20, p&lt;0.92); however, survival to admission (OR=0.64, 95%CI:0.48-0.86, p&lt;0.01), and survival to discharge (OR=0.28, 95%CI:0.13-0.59, p&lt;0.01) were significantly lower in COVID-19 OHCA admissions compared to non-COVID-19 OHCA admissions. Conclusions: This meta-analysis demonstrated that the SARS-CoV-2 infection in OHCA patients was associated with poorer outcomes as compared to COVID-19 negative OHCA admissions. Future studies are warranted to assess long-term residual effects of COVID-19 on OHCA risk and outcomes.

Abstract 12639: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). Hypothesis: Gender-based disparities in the modifiable and non-modifiable OHCA characteristics and outcomes are significant between rural and urban settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value&lt;.001). Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.

Abstract 13213: The Prognostic Role of Serum Neutrophil Gelatinase Associated Lipocalin in Out of Hospital Cardiac Arrest Patients Who Underwent Targeted Temperature Management

This study investigated the prognostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). The study included 85 comatose adult patients with OHCA who underwent TTM between May 2018 and December 2020. Serum NGAL and neuron-specific enolase (NSE) were measured at 24-h intervals until 72 h after return of spontaneous circulation (ROSC). The primary outcome was neurological status at 3 months after OHCA. Forty-nine patients (57.6%) had a poor neurological outcome; NGAL levels at all time points measured were significantly higher in these patients than in those with a good outcome (p&lt;0.01). NGAL showed lower maximal sensitivity (95% CI) under a false-positive rate of 0% for the primary outcome compared with NSE (18.2% [95% CI 8.2-32.7] vs. 66.7% [95% CI 50.5-80.4]). Combination of NGAL with NSE at 48 h showed the highest sensitivity (69.1% [95% CI 52.9-82.4]) and had the highest AUC (0.91 [95% CI 0.81-0.96]) for a poor outcome. The prognostic performance of NGAL alone was inadequate at all time points. However, NGAL obtained at 24 and 48 h after ROSC showed improved sensitivity when combined with NSE. NGAL should be considered as an additional biomarker to improve accuracy for prognostication in these patients.