Neurological Outcome Research Articles

Silencing of SH3BP2 Inhibits Microglia Activation Via the JAK/STAT Signaling in Spinal Cord Injury Models.

The purpose of our study was to investigate the expression of SH3 domain-binding protein 2 (SH3BP2) in spinal cord injury (SCI) rats and lipopolysaccharide (LPS)-induced microglia, and explored its impact as well as potential mechanism. We examined the level of SH3BP2 in SCI rats using GEO data, immunofluorescence co-staining, qRT-PCR and western blotting. Next, we constructed a rat model with SH3BP2 silencing by injecting LV-shSH3BP2 into the injury site of SCI rats, and then evaluated its neurological outcome, functional recovery, M1 polarization and neuroinflammation by Basso-Beattie-Bresnahan (BBB) score, inclined plane test, Nissl staining and hematoxylin-eosin (H&E). The SH3BP2-related signaling pathway was predicted by KEGG analysis in GSE45006 dataset. BV2 microglial cells and primary microglia were incubated with LPS, and then measured its activation and inflammation by qRT-PCR, western blotting and immunofluorescence. Further complement experiments were performed to explore the molecular mechanisms of SH3BP2. The expression of SH3BP2 was increased in the spinal dorsal horn tissues of SCI rats and LPS-induced microglia. Silencing of SH3BP2 improved neurological outcomes and functional recovery, attenuated neuroinflammation and microglia polarization in SCI rats. Additionally, the JAK/STAT pathway was regulated by SH3BP2. Silencing of SH3BP2 inhibited LPS-induced microglia inflammation and activation, decreased the phosphorylation levels of JAK and STAT. Silencing of SH3BP2 attenuated SCI by regulating the JAK/STAT pathway to inhibit the activation of microglia.

Total Antioxidant Status in Critically Ill Patients with Traumatic Brain Injury and Secondary Organ Failure—A Systematic Review

Introduction: The available literature indicates that oxidant–antioxidant imbalance plays a significant role in the pathophysiology of traumatic brain injury and the subsequent secondary organ dysfunctions. However, there is a lack of studies summarizing the knowledge in this area, and no clear guidelines exist regarding the use of biomarkers of oxidative stress as diagnostics tools. Methods: The present work aims to provide a systematic review of the literature on the use of total antioxidant capacity (TAC) assays in predicting the outcomes of traumatic brain injury (TBI). A literature search was conducted up to 1 September 2024, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, using the PubMed and Scopus databases. Based on the inclusion criteria, 24 studies were used for the final review. Results: Promising data indicate that TAC assays are useful in predicting 30-day mortality and neurological outcomes. Moreover, they correlate with radiological findings on CT scans in brain injury and the clinical classifications of injuries, as well as the parameters of organ failure. Conclusions: Total antioxidant capacity assays can be used to assess the extent of brain damage and prognosticate general vital functions. Future experiments should include long-term randomized clinical trials on larger populations of TBI patients.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study.

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes. This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD. The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121). Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

Defining neonatal status epilepticus: A scoping review from the ILAE neonatal task force.

To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden. The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were abstracted regarding: (1) article characteristics (author identification, publication year, journal name, digital object identifier, title, objective, and study design); (2) cohort characteristics (sample size, gestational age, seizure etiology); (3) definition of SE and/or seizure burden; and (4) the method used to identify and classify SE, including routine EEG (EEG), continuous EEG monitoring (cEEG), amplitude-integrated EEG (aEEG), or clinical features. The scoping review yielded 44 articles containing a definition of neonatal SE. Studies mainly included infants with hypoxic-ischemic encephalopathy or neonates considered at risk for seizures. SE identification and classification most often relied on cEEG. The majority of studies based the definition of SE on seizure duration, including summed duration of seizures comprising ≥50% of any 1-h epoch, recurrent seizures for >50% of the total recording time, or either electrographic seizures lasting >30 min and/or repeated electrographic seizures totaling >50% in any 1-h period. Seizure burden was reported in 20 studies, and the most commonly used approach assessed total seizure burden, defined as total duration of EEG seizures in minutes. Sixteen studies assessed the relationship between seizure burden and outcomes, and most identified a significant association between higher seizure burden and unfavorable outcomes. This scoping review demonstrates a substantial variation in neonatal SE definitions across the literature. The most common definitions were based around a 30-min seizure duration criterion, but evidence was insufficient to support that 30 min was a cutoff defining prolonged seizures or that seizures exceeding this burden were more likely to be pharmacoresistant or associated with worse outcomes. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE. Prolonged seizures are a neurologic emergency, if untreated, can lead to permanent injury or death. In adults and children, seizures lasting longer than 30 min are believed to cause brain damage. However, it is not clear if this definition can be applied to neonates. The International League Against Epilepsy Neonatal Taskforce performed a scoping literature review which identified 44 articles containing a definition of neonatal status epilepticus. In this article, the authors reviewed the current used definitions for prolonged seizures in neonates to establish a relationship between seizure duration and neurological outcome. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE.

Unreactive alpha or alpha-theta coma electroencephalogram patterns with favorable neurologic outcomes: a report of three cases and literature review

Unreactive alpha or alpha-theta coma electroencephalogram patterns with favorable neurologic outcomes: a report of three cases and literature review

Abstract Su904: The association between base excess on arrival at the hospital and neurological outcome of adult out-hospital cardiac arrest: observational study

Background: The relationship between base-excess (BE) values, which take into account the time interval from cardiac arrest to blood test, and neurological outcome after out-of-hospital cardiac arrest (OHCA) is not well understood. The purpose of this study was to evaluate the association between BE on arrival at the hospital and neurological outcomes in OHCA patients. Methods: The CRITICAL study, a prospective, multicenter observational study in Osaka, Japan, registered consecutive OHCA patients who were transported to 16 participating critical care centers from 2012 to 2021. We included adult patients aged 18 years with witnessed OHCA whose BE values on hospital arrival was available, and divided patients into quartiles based on BE values of initial blood test on arrival at the hospital: Q1 (BE ≤ −21.1 mmol/L), Q2 (−21.1 < BE ≤ −15.7 mmol/L), Q3 (−15.7 < BE ≤ −10.4 mmol/L), and Q4 (BE > −10.4 mmol/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. Results: A total of 23,854 patients were registered, and 6,066 of them were eligible for analyses. Neurologically favorable outcome was the lowest in the Q1 group (3.2% [49/1,528]), followed by the Q2 (4.7% [70/1,493]), Q3 (9.8% [148/1,515]), and Q4 (23.5% [359/1,530]) group. In the multivariable logistic regression analysis, the adjusted odds ratio of Q1 compared with Q4 for one-month favorable neurological outcome was 0.13 (95% CI 0.090–0.18). The proportion of one-month favorable neurological outcome decreased progressively across decreasing quartiles (p for trend < 0.001). In subgroup analysis, there was an interaction between presence of return of spontaneous circulation (ROSC) before blood test and neurological outcome (p for interaction < 0.001). The neurological outcome worsened as the BE values decreased among those who achieved ROSC before the blood test (p for trend < 0.001), but not in those without ROSC (p for trend = 0.078). There was not a significant interaction between BE values without ROSC before blood test and time from witness to blood test (p for interaction = 0.501). Conclusions: We demonstrated that lower BE values at hospital arrival were associated with worse neurological outcome. The BE values may be one of the effective prognostic indications for neurological outcome, especially in OHCA patients with ROSC before hospital arrival.

Abstract Sa1101: Association Between Changes in Hypoxic-Ischemic Brain Injury and Neurological Outcomes in Cardiac Arrest Survivors.

Aim: Quantitative analysis of hypoxic-ischemic brain injury (HIBI) using apparent diffusion coefficient (ADC) values from brain magnetic resonance imaging (MRI) is used to predict poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Our study aimed to determine the association between changes in HIBI and neurological outcomes in OHCA survivors using two types of MRI. Methods: This observational study used data collected prospectively from a tertiary academic hospital. The study included adult comatose OHCA survivors who underwent targeted temperature management (TTM) and brain MRI within 6 hours (first) and 72–96 hours (second) using the same MR scanner. We analyzed the neurological outcomes based on brain volumes below a specific ADC value using 10-step intervals within the range of 200–1200 × 10 -6 mm 2 /s for the first and second MRIs. ADC-R(x) represents the proportion of total brain volume occupied by voxels, with ADC values ranging from 200 × 10 -6 mm 2 /s to each threshold. Additionally, ADC(x) represents the proportion of total brain volume occupied by voxels that are “threshold - 10” at each threshold. Poor neurological outcomes were categorized as cerebral performance levels 3–5, observed 6 months after OHCA. Results: Overall, 122 patients (25% female) were included in the analysis, of whom 61 (50%) showed poor neurological outcomes. Higher ADC-R(x) were observed in the poor neurological outcome group on both the first and second MRI scans at all ADC intervals (all P < 0.05) (Figure 1). In the Good Neurological Outcome group, the ADC-R values ranged between 370 and 940, with the second MRI value being smaller than that of the first (right shift, P < 0.05). In contrast, the Poor Neurological Outcome group showed ADC-R values ranging between 340 and 1190, with the second MRI value being higher than that of the first (left shift, P < 0.05) (Figure 2). The difference in ADC(x) between the second and first MRI based on neurological outcome showed a positive change in ADC below 620 for a poor neurological outcome and a positive change in ADC above 740 for a good neurological outcome (Figure 3). Conclusions: In this cohort study, we observed that the initial HIBI that occurred during OHCA worsened or returned to normal depending on the neurological outcome after TTM. Prospective multicenter studies are required to generalize our findings.

Abstract Su1204: Impact of Hypothermia vs. Normothermia Temperature Management Based on Body Temperature at Hospital Arrival on 30-Day Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients: A Nationwide, Retrospective Study in Japan

Introduction: Temperature management (TM) to prevent fever is crucial to mitigate neurological deterioration post-cardiac arrest. Whether hypothermic TM (h-TM) is superior or equal to normothermic TM (n-TM) after out-of-hospital cardiac arrest (OHCA) is debatable, prompting ongoing effects to identify patients who might benefit more from h-TM. We hypothesized that effect of TM would differ based on body temperature at hospital arrival. Aim: Explore which post-cardiac arrest patient subsets might benefit from h-TM by stratifying them based on body temperature at hospital arrival. Methods: This retrospective, observational study used data from the OHCA registry in Japan. Patients 18 years and older who experienced OHCA due to medical cause and received TM in the intensive care unit were included. Primary outcome measure was 30-day favorable neurological outcomes, defined as a Cerebral Performance Category score of 1 or 2. Patients were stratified into groups based on body temperature at hospital arrival: normothermia (36.0-38.0°C), hypothermia (<36.0°C), and hyperthermia (>38.0°C). Effect of TM post-cardiac arrest (h-TM [32-34°C] or n-TM [35-36°C]) was evaluated in each stratified group. Univariable and multivariable logistic regression analysis was used for comparison. Adjusted odds ratio (OR) for favorable neurological outcome with h-TM was calculated using n-TM as a reference. Hyperthermia was excluded from multivariable analyses due to small sample size. Results: We analyzed 3,044 patients, 1,273 in the normothermia group, 1,747 in the hypothermia group, and 24 in the hyperthermia group. Numbers of patients with favorable neurological outcomes were as follows: 530/1,273 (41.6%) in the normothermia group, 584/1,747 (33.4%) in the hypothermia group, and 4/24 (16.7%) in the hyperthermia group. There were no differences in favorable 30-day neurological outcomes between h-TM and n-TM in any stratified group in the univariable analysis: normothermia (h-TM 323/785 [41.2%] vs. n-TM 207/488 [42.4%], p=0.66); hypothermia (411/1,185 [34.7%] vs. 173/562 [30.8%], p=0.11); hyperthermia (3/13 [23.1%] vs. 1/11 [9.1%], p=0.59). Multivariable analysis also showed no differences: normothermia (OR: 0.96, 95% CI: 0.72-1.26), hypothermia (OR: 1.10, 95% CI: 0.85-1.42). Conclusion: TM (h-TM vs. n-TM) did not significantly affect 30-day neurological outcomes, regardless of initial temperature at hospital arrival.

Abstract Sa1108: The Aberrant Autophagy-Apoptosis regulation Mediates the Severe Neurological Dysfunction after Cardiac Arrest in Diabetic Mice

Background: Patients with diabetes have lower survival and worse neurological outcome after cardiopulmonary resuscitation (CPR) compared with non-diabetes. Previous studies have mentioned the aberrant autophagy in diabetic mice. However, whether this abnormal autophagy exacerbates neuronal apoptosis and neurological outcome in diabetic mice remains unclear. Methods: Patients were divided into non-diabetic cardiac arrest (CA) patients and diabetic CA patients, and the survival and neurological outcomes at discharge and day 28 after ROSC were compared between these two groups. Diabetic mice were fed with high fat diet (HFD), and CA model was established by inducing ventricular fibrillation electrically. The neurological prognosis was assessed by open field test (OPT), novel object recognition (NOR) and Y-maze. Neuronal apoptosis and autophagy were evaluated by immunofluorescence and western blotting, including TUNEL, cleaved caspase 3, LC3B, p62 and beclin1. Results: Compared with non-diabetic patients, the survival at discharge and at day 28 after ROSC are significantly lower in IHCA patients with diabetes. Meanwhile, the neurological deficits at discharge and at day 28 after ROSC are much severer in diabetic-CA patients. In addition, the lower survival and worse neurological function have been discovered, and the cognition impairment is more significant after ROSC in HFD mice. Neuronal apoptosis is severer in HFD mice. In ND mice, the activated autophagy has been revealed after CA-CPR-ROSC, however, autophagy can not be activated after ROSC in HFD mice since the baseline autophagy is at a higher level when compared with ND mice. Neuronal apoptosis is exacerbated after autophagy inhibition by 3-MA in ND mice, while after autophagy activation by rapamycin in HFD mice, apoptosis is attenuated after ROSC. Conclusion: Diabetes is the risk factor for neurological outcome in IHCA patients. The aberrant autophagy regulation in cortex neurons contributes to the severe apoptosis and neurological deficits after ROSC in diabetic mice.

Abstract 4137905: The association between prehospital epinephrine administration and short-term outcomes in patients with shockable out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: a propensity matched analysis

Background: In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome. Aim: To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR. Methods: This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district. Results: Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of <10% for all variables (329 matched pairs). The proportion of patients with prehospital ROSC was significantly higher in those who received prehospital epinephrine than those who did not (36 [8%] vs 31 [5%]; adjusted odds ratio [OR] after propensity score-matching, 1.96 [95% CI 1.05-3.67], p=0.03). The proportion of patients with favorable neurological outcome at 30 days was not significantly lower in those who received prehospital epinephrine than those who did not (34 [8%] vs 78 [13%]; adjusted OR after propensity score-matching, 0.78 [95% CI 0.45-1.37], p=0.39). Conclusion: In patients with shockable OHCA and ECPR, prehospital epinephrine administration was significantly associated with increased ROSC before hospital arrival and not significantly with decreased favorable neurological outcome at 30 days.

Abstract Su901: Association of Hemoglobin and Partial Pressure of Oxygen in Arterial Blood on Survival and Neurologic Outcomes in In-Hospital Cardiac Arrest Patients

Background: Lower hemoglobin levels have been associated with poor outcomes in patients with out-of-hospital cardiac arrests. Pre-arrest hemoglobin (within 24 hours) and its association with outcomes and PaO2 in in-hospital cardiac arrest (IHCA) remains unknown. We aimed to evaluate the association of pre-arrest hemoglobin levels with survival and neurologic outcomes, and intra-arrest PaO2 levels in adults with IHCA. Methods: The study population included adults with IHCA undergoing resuscitation at an academic tertiary medical center from 2011-2019. Hemoglobin levels were obtained within 24 hours prior to arrest, and PaO2 levels were obtained intra-arrest via arterial blood gas samples. Patients were classified based upon three pre-arrest hemoglobin (Hgb) levels: Hgb < 8.5, Hgb 8.5-10.5, Hgb > 10.5. Return of spontaneous circulation (ROSC), survival to discharge, favorable neurological outcome (defined as a Glasgow Outcome Score of 4-5), and association with PaO2 served as outcomes of interest. Results: Of the 799 patients studied, 493 patients had pre-arrest hemoglobin data and 164 had intra-arrest PaO2 data. Of those patients that had pre-arrest hemoglobin data, 145 (29.4%) had Hgb < 8.5, 178 (36.1%) had Hgb 8.5-10.5, 170 (34.5%) had Hgb >10.5. Charlson Comorbidity Score was similar across each hemoglobin group. Most patients had PEA/Asystole as the initial rhythm at onset of cardiac arrest, and the number was similar across each hemoglobin group. Mean intra-arrest PaO2 was higher in the Hgb < 8.5 group. Compared to Hgb < 8.5, higher hemoglobin levels were associated with higher rates of ROSC in both univariate (Hgb < 8.5: 46.9% vs. Hgb 8.5-10.5: 59.6% vs. Hgb > 10.5: 62.9%, p = 0.012) and multivariate (Hgb 8.5-10.5: OR 1.51, 95% CI 0.96-2.39; Hgb > 10.5: OR 1.75, 95% CI 1.10-2.79) analyses. Higher hemoglobin levels were associated with higher rates of favorable neurologic outcome in the univariate analysis only (Hgb < 8.5: 10.5% vs. Hgb 8.5-10.5: 11.8% vs. Hgb > 10.5: 19.4%, p = 0.043). There was no significant correlation between pre-arrest hemoglobin and intra-arrest PaO2. Conclusions: In this contemporary registry of adults with IHCA, higher hemoglobin values were associated with higher rates of ROSC. There may be an association between higher hemoglobin levels and favorable neurologic outcome. There was no association between pre-arrest hemoglobin and intra-arrest PaO2.

Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study.

: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri-cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. DERR1-10.2196/58780.

Resection of Calcified and Giant Thoracic Disc Herniation Through Bilateral Postero-Lateral Approach and 360° Cord Release: A Technical Note

Background/Objectives: Surgical treatment of thoracic disc herniation (TDH) is risky and technically demanding due to its proximity to the spinal cord and the high possibility of the TDH being calcified (up to 40%), making the resection even more complex. Calcified TDH may be resected from an anterior via thoracotomy/thoracoscopy, lateral extra-cavitary, or a postero-lateral approach. Here, we present our experience in managing such pathology with an original technique Methods: This original technique, used successfully in more than 40 patients, is introduced, with a precise description of the surgical anatomy and the surgical steps to take. Indications for surgical management and neurological outcomes are also analyzed. This surgical approach consisted of transverso-pediculectomy, most often bilaterally, partial vertebral body drilling, 360° release of the cord, and short fixation. Results: A total of 44 patients were collected, with a mean age of 52.4 ± 11.7 years. Seven patients (15.9%) had complete calcifications, and thirty-one had partial calcifications (70.5%), while the remaining six did not have signs of calcifications. There were only 4 intraoperative complications (2 dural tears and 2 loss of evoked potentials). The TDH could be resected in total for 39 patients (88.6%) and partially, according to the “floating” technique, in 5 patients (11.4%). In the postoperative follow-up, all of the patients except two (presenting with sensory aggravation) reported an improvement in neurological conditions leading to an overall risk of neurological aggravation of 4.5%. Conclusions: The bilateral postero-lateral approach provides a large decompression of the cord (360°) and gives safe access to the TDH, even calcified, permitting high rates of total resection. It also prevents any prejudicial pressure on the spinal cord, reducing the risk of severe postoperative deficits and permitting optimal instrumentation (pedicle screw-based) of the spinal segment. The surgical sequence to resect the bony structures around the spinal cord is of great importance.

Abstract Su1202: The utility of post cardiac arrest temperature control protocol according to the severity of hypoxic encephalopathy based on amplitude-integrated electroencephalography findings

Introduction: The TTM2 trial showed that active fever prevention below 37.5°C and hypothermia at 33°C had similar outcomes in out-of-hospital post cardiac arrest patients. However, the patients in the trial had mild hypoxic encephalopathy, and the effects of hypothermia may vary with its severity. We previously reported that amplitude-integrated electroencephalography (aEEG) findings after the return of spontaneous circulation can be used to categorize the severity of hypoxic encephalopathy (Crit Care. 2018;22:226). In September 2022, we adopted a new temperature control protocol wherein the target temperature was set based on aEEG findings. This study examined changes in outcomes before and after implementing this new protocol. Methods: We assessed out-of-hospital cardiac arrest patients who received post cardiac arrest care in our emergency intensive care unit between March 2021 and February 2024. We divided the patients into two groups: before (B) and after (A) the introduction of the new protocol. We classified the patients into categories 1 (C1) to 4 (C4) based on the severity of hypoxic encephalopathy (Figure 1). All patients in group B were treated with hypothermia at 34°C. In group A, patients in C1 were treated with active fever prevention, and those in C2–C4 received hypothermia at 34°C (Figure 2). Primary outcome was favorable neurological outcomes (cerebral performance categories of 1 or 2) at hospital discharge. Secondary outcome was the duration of mechanical ventilation. Results: A total of 160 patients were included. The median age was 62 years and 105 (66%) patients had cardiac etiology. Fifty-five (34%) patients underwent extracorporeal cardiopulmonary resuscitation. The median cardiac arrest time was 29 min. Groups B and A comprised 57 and 103 patients, respectively. C1 category comprised 20 and 28 patients in groups B and A, respectively. The rate of favorable neurological outcomes was 35% in both B and A groups (p=1.00). Regarding C1 patients, the rates were 90% and 86% in B and A groups (p=1.00). Median duration of mechanical ventilation was 5 and 3 days in group B and A, respectively (p=0.11). Conclusion: Neurological outcomes before and after introducing the new protocol were similar. Management of patients with mild hypoxic encephalopathy can be simplified with active fever prevention. A temperature control protocol based on the severity of hypoxic encephalopathy using aEEG findings is feasible for emergency physicians.

Abstract Su804: Use of Machine Learning Models to Predict Neurologically Intact Survival for Advanced Age Adults Following Out-of-hospital Cardiac Arrest

Background: We recently published a multivariable logistic regression model that successfully predicted neurologic outcomes in advanced age adults (≥ 65 years old) who achieve return of spontaneous circulation following out-of-hospital cardiac arrest (OHCA). Prior to externally validating this model, we sought to compare the predictive performance of our logistic regression model against common machine learning (ML) algorithms using the same dataset. Methods: We performed a retrospective observational analysis of the Cardiac Arrest Registry to Enhance Survival database from 2013-2021. All non-traumatic OHCA occurring in adults (≥65 years) who survived to hospital admission were included. The primary outcome measure was neurologically intact survival defined as a cerebral performance category (CPC) score of 1 or 2 at hospital discharge. Our original logistic regression model was compared to Boosted Trees and Decision Tree ML algorithms and assessed using accuracy, Area Under the Receiver Operating Characteristic Curve (AUC-ROC) and Area Under the Precision-Recall Curve (AUC-PR). The model variables included age, gender, race/ethnicity, location, witnessed status, who initiated cardiopulmonary resuscitation, whether an automated external defibrillator was applied prior to emergency medical services arrival, and first monitored rhythm. Results: A total of 83,561 OHCA were included. Median age was 75 years (IQR 69-82), 58.9% were male, 53% were White, 67% experienced an OHCA at home, 52% were witnessed by a bystander, 44% received bystander CPR, and 34% were found in shockable rhythm. Neurologically intact survival (CPC 1 or 2) occurred in 23% of patients. The logistic regression model had an accuracy of 79.6%, AUC-PR 0.542, and AUC-ROC of 0.774. The Boosted Trees model had an accuracy of 79.2%, AUC-PR 0.555, and AUC-ROC of 0.774. The Decision Tree Model had an accuracy of 79.3%, AUC-PR 0.490, and AUC-ROC of 0.717. Conclusion: Boosted Trees and Decision Tree ML models performed comparably to the logistic regression model in predicting favorable versus unfavorable neurological outcomes following successful resuscitation from OHCA in advanced-age adults. Given their similar performance, logistic regression may be preferred for its simplicity and interpretability over alternative ML models. Future efforts to improve and ultimately externally validate the model are warranted.

Abstract Sa1105: The Effect of a Combination of Neuroprotective Medications on Post-Cardiac Arrest Survival

Introduction: Reperfusion injury after cardiac arrest (CA) leads to poor survival and neurological outcomes. We hypothesized that a combination of pharmacologic neuroprotection therapies administered 24-72 hours post-CA [“combination therapy”] that target key steps in reperfusion injury; 1) excitotoxicity (Magnesium, Memantine, Perampanel, Minocycline), 2) mitochondrial dysfunction (Thiamine, Coenzyme Q10), 3) oxidative stress (Vitamin C, Vitamin E), and 4) inflammation (Hydrocortisone), would improve survival. AIMS: We compared survival between subjects with combination therapy and those without. Methods: A retrospective analysis of post-CA patients (01/01/2019 - 06/01/2023) was conducted as part of a quality improvement project. Inclusion: in-hospital CA, age ≥ 18 years, non-COVID, ≥ 5 min CPR, sustained ROSC (≥ 20 min). Exclusion: out-of-hospital CA. Combination therapy was at the discretion of the provider and given in addition to current post-CA standard critical care: targeted temperature management (TTM) (32-36°C), glucose (target 140 mg/dL), PaO2 (target 100 mmHg), PaCO2 (target 40 mmHg), and MAP (target 80 - 100 mmHg). Survival was assessed at hospital discharge. Results: Among 196 subjects, 146 received combination therapy (study group) and 50 did not (control group). Demographic variables (age, race, ethnicity) and intra-cardiac arrest variables (initial rhythm, CPR duration, and hospital site) were not statistically different between groups. Post-CA variables (mean PaCO2, PaO2, and glucose) were not statistically different between groups. MAP was 76 (69, 83) for study group and 65 (46, 72) for control group ( P = <0.001). Lowest temperature in study group was 34.8°C vs. 35.9°C in control group ( P = 0.034). Survival at hospital discharge was 33% for study group and 14% for control group ( P = 0.01). There were no known safety concerns or adverse events. Conclusions: The administration of a combination of neuroprotective medications that target key pathways in reperfusion injury appears to be feasible and safe, and may improve survival beyond current post-CA standard critical care. A future randomized controlled trial that includes the assessment of neurological outcomes is warranted.

Abstract 4137065: Efficacy and Safety of Extracorporeal CPR in Out-of-Hospital Cardiac Arrest Survival and Neurological Integrity: a Meta-Analysis of Randomized Controlled Trials

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a significant public health challenge, with conventional cardiopulmonary resuscitation (CPR) often yielding limited success. Extracorporeal CPR (eCPR) has emerged as a potential adjunctive therapy to improve outcomes in OHCA patients. Purpose: To evaluate the efficacy and safety of eCPR compared to conventional CPR in OHCA. Methods: A comprehensive search of Cochrane CENTRAL, PubMed, Ovid Medline, and Web of Science databases was conducted independently until November 10, 2023. Randomized controlled trials (RCTs) comparing eCPR with conventional CPR in OHCA were included. Primary efficacy outcome was defined as survival to hospital discharge, while primary safety outcome was assessed for bleeding events. Summary effect measures of the primary outcomes were obtained by pooling the data with an inverse variance–weighted random-effects model. A sensitivity analysis was performed regarding whether the conclusions reached might differ substantially if a single study was omitted. Statistical analyses were performed with “meta” package in R (version 4.3.2) and Revman 5.4. Results: Four unique RCTs involving 435 patients were included in the analysis. ECCPR was associated with a significantly higher rate of survival at 1 month with good neurological outcome (Risk Ratio [RR] 1.55, 95% Confidence Interval (CI) 1.06 to 2.27, I 2 : 0%) but comparable at survival to hospital discharge (RR 1.10, 95% CI 0.16 to 7.30, I 2 : 47%) compared to conventional CPR. Furthermore, no significant differences were observed between eCPR and conventional CPR groups in survival rates at 3 months (RR 1,33, 95% CI 0.92 to 1.94, I 2 : 64%), survival at 6 months with good neurological outcome (RR 1.39, 95% CI 0.97 to 1.99, I 2 : 0%), and survival at 6 months (RR 2.79, 95% CI 0.33 to 23.28, I 2 : 63%). eCPR demonstrated a statistically significant elevation in bleeding events compared to conventional CPR (RR 4.25, 95% CI 2.37 to 7.64, I 2 : 0%). Sensitivity analysis revealed that none of the studies significantly influenced the pooled risk estimate to any great extent. Conclusion: eCPR shows beneficial results in improving short-term survival and neurological outcomes at 1-month post-OHCA. However, it is associated with an elevated risk of bleeding when compared to conventional CPR. Further investigations are imperative to delineate the specific patient populations that stand to gain the most benefit from ECPR intervention.

Abstract Su1207: Influence of Duration of Device-based Fever Prevention on Inflammation, Vasopressor Usage, and Oxygen Consumption after Cardiac Arrest - a Substudy of a Randomized Controlled Trial

Background: In the post-resuscitation phase, cardiac arrest patients develop a systemic inflammatory response and fever is likely if not actively treated. The Blood Pressure and Oxygenation Targets after Out-of-hospital Cardiac Arrest (BOX) trial, randomized patients to a total duration of device-based fever prevention for 36 or 72 hours. The trial found no differences in mortality or neurologic outcome. Use of device-based fever prevention for a shorter or longer duration could however result in clinically relevant differences in the magnitude of inflammation, vasopressor usage, and oxygen consumption. Aim: To assess the effect of a shorter or longer duration of device-based fever prevention on inflammation, vasopressor usage, and oxygen consumption in the intervention period from 36 to 72 hours. Methods: The BOX trail [NCT03141099] randomized comatose resuscitated out-of-hospital cardiac arrest (OHCA) patients to three different treatment targets in the post-resuscitation phase: mean arterial blood pressure target of 63 or 77mmHg; oxygenation targets of 68-75 or 98-105 mmHg; and duration of device-based fever prevention in comatose patients for a total of 36 or 72 hours. Endpoints at 48 and 72 hours: leukocytes; CRP; vasoactive-inotropic score (VIS); systemic oxygen consumption determined by use of Fick’s principle. Analyses were performed both on the total BOX population, and for a sensitivity analysis, selectively on patients still comatose at 72 hours (i.e., not awake or dead) as these had the most exposure to the intervention. Results: The total population consists of 789 patients, with 393 and 396 randomized to a total duration of device-based fever prevention for 36 and 72 hours respectively. For the analysis of patients still comatose at 72 hours, 122 and 148 were available for analysis in the 36-hour and 72-hour group respectively. There were no differences between the 36- and 72-hour group for leukocytes, CRP, VIS, or oxygen consumption during the intervention period from 36 until 72 hours, neither for the total population (Figure 1, all p>0.05) or the cohort of patients still comatose at 72 hours (Figure 2, all p>0.05). Conclusions: There were no group differences for patients randomized to device-based fever prevention for 36 or 72 hours with respect to the magnitude of inflammation, vasopressor usage, or oxygen consumption. These findings were consistent for the cohort as a whole, and when examining those with most exposure to the intervention.

A neurosurgical nursing training system based on 3D printing models: practice and exploration of precision medicine.

In recent years, the concept of precision medicine has gradually permeated the field of nursing, presenting new challenges for neurosurgical nursing staff. Traditional teaching methods often struggle to adequately convey complex anatomical knowledge and nursing skills, thereby affecting the learning outcomes and clinical decision-making abilities of nurses. As an innovative educational tool, three-dimensional (3D) printing technology has demonstrated significant potential in medical education in recent years. Therefore, this project aims to explore the advantages and feasibility of using 3D printed models as a novel teaching tool in neurosurgical nursing. The study involved 80 nursing personnel who participated in the neurosurgical rotation training at Shaoxing People's Hospital from 2022 to 2023. The control group (40 individuals) used only traditional teaching tools such as textbooks, multimedia courseware, and laboratory equipment for theoretical and practical training based on the curriculum. The experimental group (40 individuals) incorporated a 3D printing model database as an innovative teaching tool on the basis of traditional teaching methods, and used patient-specific 3D printed models for precise nursing training. After the training, both groups were assessed for theoretical and practical abilities, professional values, job satisfaction, and the prognosis of intracranial aneurysm patients they cared for. The experimental group demonstrated superior scores in theoretical and practical abilities, professional values, and job satisfaction compared to the control group. During the training period, patients with intracranial aneurysms receiving precision nursing care from the experimental group showed better quality of life and neurological functional outcomes compared to the control group. The nursing training system based on 3D printing models can enhance the learning efficiency and nursing work satisfaction of nursing personnel. It may have a positive impact on the professional values of nursing personnel, thereby laying a solid foundation for providing high-quality, precise nursing services in the field of neurosurgery in the future.

Abstract 4113573: Long Noncoding RNAs to Predict COVID-19 Neuro-Cardio-Vascular Outcomes

Introduction/Background: Cardiovascular and neurological diseases develop in a significant proportion of COVID-19 patients. Minimally invasive tools to predict outcome after SARS-CoV-2 infection would enable personalized healthcare, potentially easing the disease burden. We showed that blood levels of the long noncoding RNA lymphoid enhancer-binding factor-1 antisense 1 (LEF1-AS1) predict COVID-19 in-hospital mortality. Hypothesis: LEF1-AS1 is associated with long-term clinical outcomes of COVID-19. Aim: Test the capacity of LEF1-AS1 to predict neuro-cardio-vascular outcomes post-SARS-CoV-2 infection. Methods/Approach: We enrolled 104 primo-infected COVID-19 patients aged 18+ recruited from April to December 2020 in the PrediCOVID national cohort for which 12-month follow-up data were available (Ethics Committee approvals 202003/07 and 202310/02-SU-202003/07). Whole blood samples were collected at baseline and expression levels of LEF1-AS1 were assessed by quantitative PCR. Results/Data: Of the 104 patients, 35 had at least one neurological symptom and one cardiovascular symptom at month 12. Levels of LEF1-AS1 at baseline were lower (p=0.019) in patients who developed neurological and cardiovascular symptoms as compared to patients who did not. Lower LEF1-AS1 was associated with symptoms development with an odds ratio of 0.48 (95% CI 0.28-0.83) from logistic regression model adjusted for age, sex, comorbidities and disease severity at baseline. Addition of LEF1-AS1 to a clinical model including age, sex, comorbidities and baseline severity yielded an incremental predictive value as attested by an increased AUC from 0.79 to 0.83 (likelihood ratio test p=0.005), a net reclassification index of 0.54 (p=0.007) and an integrated discrimination improvement of 0.08 (p=0.009). Conclusion: Blood levels of LEF1-AS1 predict 12-month neurological and cardiovascular outcomes of COVID-19 patients. This needs to be validated in larger populations.