Sleeve gastrectomy is safe and effective in patients with left ventricular assist devices (LVADs) and morbid obesity to improve candidacy for transplantation and increase survival rates. Literature describing warfarin anticoagulation in this population is limited. A single-center, propensity score-matched, retrospective cohort study was conducted to determine if sleeve gastrectomy in LVAD-implanted patients has an effect on warfarin dose requirements in the outpatient setting. Patients were eligible for inclusion if they were 18 years of age or older, underwent LVAD implant at the study center, and were discharged from the hospital on warfarin therapy. They must have at least 8 weeks of available follow-up data post-discharge. Propensity matching was utilized to identify a non-sleeve gastrectomy LVAD-only patients for comparison. A total of 96 LVAD-only patients and 48 LVAD plus sleeve gastrectomy patients were included in the final analysis. Outpatient warfarin requirements increased from baseline over time in both groups, with no significant differences between groups except at month 12, with a mean total weekly dose of 38.1 ± 21.4 mg in the LVAD only group and 46.8 ± 18.6 mg in the LVAD with sleeve gastrectomy group ( p = 0.05). The sleeve gastrectomy group had a significantly lower warfarin doses per kilogram of body weight until month 6 post-discharge. The percent time in therapeutic range was significantly lower in the SG group at the 8 week, 3 month, and 6 month interval time point. There were no significant differences in the incidence of bleeding or thromboembolic events.

BACKGROUND:Acute pulmonary edema is a life-threatening condition commonly occurring as a result of acute decompensated heart failure. The current pulmonary edema guidelines recommend initiating IV NTG at 5 μg/min and titrating by 5 μg every 3 to 5 min to reduce systolic blood pressure (SBP) by 25 % within the first hour of arrival to the emergency department (ED). Current studies do not determine if the dose of IV NTG has an impact on the time to oxygen weaning. The purpose of this study is to evaluate and analyze clinical outcomes associated with oxygenation status in patients treated with either low dose or high dose IV NTG for the management of SCAPE. METHODS:This was a retrospective, single center, cohort study including adult patients who arrived to the ED with the diagnosis of pulmonary edema in the setting of a hypertensive crisis. Patients were categorized into two groups: low dose IV NTG < 100 μg/min (n = 248) and high dose IV NTG ≥ 100 μg/min (n = 193). The primary outcome was the time from initiation of IV NTG to oxygen weaning. Secondary outcomes included incidence of SBP reduction by 25 % (+/- 5 %) within 60 min of initiation of IV NTG, incidence of hypotension (SBP ≤ 90 mmHg or an acute drop >30 %), hypotension requiring vasopressors, improvement/worsening of respiratory status, rate of intensive care unit (ICU) admission, and ICU length of stay. RESULTS:This study included 441 patients who received IV NTG. Patients in the high dose group (≥100 μg/min), had a median time from initiation of infusion to oxygen weaning of 2.7 h as compared to 3.3 h in the low dose group (<100 μg/min) (p = 0.01). Patients in the low dose group had a lower likelihood of obtaining an SBP reduction by 25 % (+/- 5 %) within 60 min when compared to the high dose group (RR 0.64, 95 % CI 0.52 to 0.79). Hypotension was more common in the low dose group when compared to the high dose group (RR 1.29, 95 % CI 1.02 to 1.62). There were no significant differences in incidence of hypotension requiring vasopressors, worsening respiratory status, and ICU length of stay between the two groups. CONCLUSIONS:High dose IV NTG results in an earlier weaning of oxygen when compared to low dose IV NTG. High dose IV NTG was associated with a higher likelihood of obtaining initial SBP goals without concern for an increased risk of hypotension when compared to low dose IV NTG.

ABSTRACT:Loop diuretics are a fundamental cornerstone in management of hypervolemia encountered in acute decompensated heart failure. There is variation in the literature describing relative potency of loop diuretic agents, and there are very limited available data specific to the heart failure population. In this retrospective cohort study, we aimed to compare the urine output response between intravenous furosemide and bumetanide in patients with acute decompensated heart failure. Patients were eligible for inclusion if they were admitted between July 1, 2021, and June 30, 2022, with acute decompensated heart failure and received intravenous bumetanide or furosemide within 48 hours of admission. Propensity matching was used to determine comparison groups. The primary outcome was total urine output for 24 hours after initiation of the diuretic regimen. A total of 120 patients (60 in each group) were matched after exclusion criteria were applied. The total urine output was similar between groups. The bumetanide group did demonstrate a greater urine output: furosemide-equivalent response (52 ± 46 mL/mg vs. 33 ± 25 mL/mg; P = 0.007). Based on our analysis, similar urine output may be achieved with either intravenous bumetanide or furosemide in acute decompensated heart failure; however, a higher dose of furosemide may be required than what has been previously established as an equivalent dose to bumetanide to achieve a similar diuretic effect. These results should warrant further investigation to better establish dose-response relationships with loop diuretics in acute decompensated heart failure.

BACKGROUND While renin-angiotensin system (RAS) inhibitors have a longstanding history in blood pressure control, their suitability as first-line in-patient treatment may be limited due to prolonged half-life and kidney failure concerns.METHODS Using a cohort design, we assessed the impact of RAS inhibitors, either alone or in combination with beta-blockers, on mortality, while exploring interactions, including those related to end-stage renal disease and serum creatinine levels. Eligible subjects were Acute Ischemic Stroke (AIS) patients aged 18 or older with specific subtypes who received in-patient antihypertensive treatment. The primary outcome was mortality rates. Statistical analyses included cross-sectional and longitudinal approaches, employing generalized linear models, G-computation, and discrete-time survival analysis over a 20-day follow-up period.RESULTS In our study of 3,058 AIS patients, those using RAS inhibitors had significantly lower in-hospital mortality (2.2%) compared to non-users (12.1%), resulting in a relative risk (RR) of 0.18 (95% CI: 0.12-0.26). Further analysis using G-computation revealed a marked reduction in mortality risk associated with RAS inhibitors (0.0281 vs. 0.0913, risk difference [RD] of 6.31% or 0.0631, 95% CI: 0.046-0.079). Subgroup analysis demonstrated notable benefits, with individuals having creatinine levels below and above 1.3 mg/dl exhibiting statistically significant RD (RD -0.0510 vs. -0.0895), and a significant difference in paired comparison (-0.0385 or 3.85%, CI 0.023-0.054). Additionally, longitudinal analysis confirmed a consistent daily reduction of 0.93% in mortality risk associated with the intake of RAS inhibitors.CONCLUSIONS RAS inhibitors are associated with a significant reduction in in-hospital mortality in AIS patients, suggesting potential clinical benefits in improving patient outcomes. Graphical Abstract

The purpose of this study is to compare the incidence of contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) in patients on sodium-glucose cotransporter-2 (SGLT-2) inhibitors prior to the procedure with a matched cohort of patients not receiving sodium-glucose cotransporter-2 inhibitor therapy. In this retrospective observational study, patients were eligible for inclusion if they underwent PCI at any of the included study centers within the study time period. Patients were assigned to either the SGLT-2 inhibitor group or control group depending on the documentation of receiving any SGLT-2 inhibitors within 24 h prior to PCI. Propensity matching was utilized to determine the final subjects to include for comparison. The primary outcome was the incidence of CIN. A total of 192 patients (96 in each group) were matched after exclusion criteria were applied. The incidence of contrast-induced nephropathy was similar between groups, occurring in 8 (8.3

Introduction: 4-F PCC is administered for reversal of factor Xa inhibitor-associated coagulopathy despite a lack of quality evidence demonstrating hemostatic efficacy. The aim of this study was to evaluate the hemostatic efficacy of 4-F PCC in intracerebral hemorrhage patients who received factor Xa inhibitors versus warfarin.Materials and Methods: This was a multi-center, retrospective, observational cohort study at a large healthcare system. Patients taking warfarin received 4-F PCC 25-50 units/kg based on the presenting INR, while patients taking a factor Xa inhibitor received 35 units/kg. The primary outcome was the percentage of patients with good or excellent hemostatic efficacy as assessed by modified Sarode scale, with neurologic outcomes assessed as a secondary endpoint. Patients were included in the primary outcome population if they had a repeat CT scan within 24 h.Results: One hundred fifty-seven patients were included in the primary outcome population; [warfarin (n = 76), factor Xa inhibitors (n = 81)]. Hemostatic efficacy was 83 % in the warfarin group versus 75 % in the factor Xa inhibitor group (p = 0.24). The hemostatic efficacy risk difference between the groups was 7.6 % (95 % CI 5.1 %, 20.2 %). Good neurologic outcome (mRS 0-2) at discharge was 17 % in warfarin patients versus 12 % in the factor Xa inhibitor patients (p = 0.40).Conclusions: There was no significant difference in hemostatic efficacy or clinical outcomes between patients taking warfarin or a factor Xa inhibitor following reversal with 4-F PCC. This study provides further support that 4-F PCC can be used for the reversal of factor Xa inhibitor-associated coagulopathy.

Extracorporeal life support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to assist circulation in patients with severe cardiogenic shock or cardiac arrest. The vasoactive-inotropic score (VIS) is a standardized calculation of vasoactive medication support which uses coefficients for each medication that converts them to an equivalent value. The purpose of this study was to assess the VIS as an early prognostication tool for survival to decannulation patients on adult VA-ECMO support. This was a single-center, observational cohort study of adult patients who received VA-ECMO support compared based on their survival to decannulation. The primary endpoint was the VIS at hour 24 postcannulation. Among the 265 patients included in this study, 140 patients (52.8%) survived to decannulation of VA-ECMO. At 24 hours postcannulation, a lower VIS was observed in the group that survived decannulation (6.5 ± 7.5 vs. 12.3 ± 16.9; p < 0.001). Multivariate analysis performed also demonstrates an association between 24-hour VIS and survival to decannulation (odds ratio 0.95; 95% confidence interval, 0.91–0.95). This study suggests that the 24-hour VIS may be an early prognostic indicator in patients on VA-ECMO patients. http://links.lww.com/ASAIO/B39

Background Acute ischemic stroke (AIS) is a major health challenge, often resulting in long-term disability and death. This study assesses the impact of renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) on AIS patient mortality compared to non-RAS antihypertensive medications. Methods This retrospective cohort study, conducted at Memorial Hermann–Texas Medical Center in Houston, Texas, from August 31, 2017, to August 31, 2022, examined AIS patient mortality. We used a cohort design, evaluating the effects of RAS inhibitors, either alone or in combination with beta-blockers (BBs), while exploring interactions, including those related to end-stage renal disease (ESRD) and serum creatinine levels. Eligible subjects included AIS patients aged 18 or older with specific AIS subtypes who received in-patient antihypertensive treatment. Missing data were addressed using imputation, followed by Inverse Probability of Treatment Weighting (IPTW) to achieve covariate balance. Our primary outcome was mortality rates. Statistical analyses involved cross-sectional and longitudinal approaches, including generalized linear models, G-computation, and discrete time survival analysis over a 20-day follow-up period. Results In our study of 3058 AIS patients, those using RAS inhibitors had significantly lower in-hospital mortality (2.2%) compared to non-users (12.1%), resulting in a relative risk (RR) of 0.18 (95% CI 0.12-0.26). Further analysis using G-computation revealed a marked reduction in mortality risk associated with RAS inhibitors (Risk 0.0281 vs. 0.0913, Risk Difference (RD) of 6.31% or 0.0631, 95% CI 0.046-0.079). Subgroup analysis demonstrated notable benefits, with individuals having creatinine levels below and above 1.3 mg/dL exhibiting statistically significant RD (RD −0.0510 vs. −0.0895), and a significant difference in paired comparison (−0.0385 or 3.85%, CI 0.023-0.054). Additionally, longitudinal analysis confirmed a consistent daily reduction of 0.93% in mortality risk associated with the intake of RAS inhibitors. Conclusion RAS inhibitors are associated with a significant reduction in in-hospital mortality in AIS patients, suggesting potential clinical benefits in improving patient outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N/A ### Funding Statement None ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has been approved by the Committee for the Protection of Human Subjects (the UTHSC-H IRB) under protocol HSC-MH-23-0749. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes We acknowledge and confirm that all data and materials referred to in this manuscript are available upon request.

Introduction: Guidelines support acute systolic blood pressure (SBP) lowering in intracerebral hemorrhage (ICH) if SBP is between 150 and 220 mmHg to improve outcomes. Recommendations for SBP >220 mm Hg are less clear. A proposed risk is failure of cerebral autoregulation, leading to brain ischemia and poor outcomes. Methods: A single center, retrospective cohort study of adult ICH patients from July 2017 to 2021. Patients from outside of the hospital system, in-hospital ICH, pregnant, or a prisoner were excluded. The primary outcome was incidence of cerebral ischemia in patients with SBP >220 mmHg (high) vs. 150-219 mmHg (low), assessed through percent SBP lowering and evaluation of radiographic imaging during admission. Secondary outcomes included poor neurologic status with mRS of 4 to 6 at discharge. Results: Of the 393 patients included, median (IQR) premorbid mRS was 0 in both groups, median (IQR) NIHSS was high; 16 (8, 23) vs. low; 13 (5, 19), p < 0.01. The median (IQR) presenting SBP was high; 236 (225, 246) mmHg vs. low; 180 (166, 197) mmHg. SBP goal was achieved in the first 24 hours in high; 86% vs. low; 77%, p = 0.09. Median (IQR) change in SBP 12 hours after arrival was high; -98 (-112, -83) mmHg vs. low; -47 (-62, -25) mmHg (p < 0.01) with a percent change in 12 hour SBP of 41% vs. 25%, p < 0.01. Significance persisted at 18 and 24 hours after arrival. Both groups had a mean (SD) of 7 (4) radiographic images obtained during admission. The median (IQR) time to detection of ischemia was high; 2.8 (1.4, 5.7) days vs. low; 3.1 (1.2, 6.6) days, p = 0.6. Presence of ischemic insults did not differ in the regression model based on presenting SBP groups [HR 0.57 (0.25, 1.3) p = 0.81] or percent change in SBP > or < 25% at 24 hours [HR 0.83 (0.41, 1.69) p = 0.61]. Poor neurologic outcome at discharge was present in high; 82% vs. low; 69% of patients (p = 0.07). Higher admission ICH score (p < 0.01) and NIHSS (p < 0.01) was associated with a poor outcome in the regression model. Conclusions: These results suggest there was no difference in the development of ischemic changes based on presenting SBP or percent change in the SBP. Poor neurologic outcome was associated with higher NIHSS and ICH score on admission in the analysis. These results will need to be confirmed in a randomized study.

After the initiation of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for hemodynamic support, patients often require vasopressor and inotropic medications to support their blood pressure and cardiac contractility. The vasoactive-inotropic score (VIS) is a standardized calculation of vasopressor and inotrope equivalence, which uses coefficients for each medication to calculate a total value. This study evaluated the association between the 30-day survival of patients receiving V-A ECMO support and the VIS calculated 24 h after ECMO cannulation (VIS24). This was a single-center, retrospective, observational cohort study. The median VIS24 of the entire cohort was 6.0, and was determined as a cutoff for comparison. Patients with a VIS24 < 6.0 were assigned to a group, and those with a VIS24 ≥ 6.0 were assigned to a second group. Patients with a VIS24 < 6.0 had higher 30-day survival than those with a VIS24 ≥ 6.0 (54.5% vs 41.4%; p = 0.03). The group with a VIS24 < 6.0 also had significantly improved survival to decannulation of ECMO support; however, there was no difference in the survival to hospital discharge. We conducted a secondary analysis of quartiles and determined that individuals with a VIS24 > 11.4 had the lowest survival in the cohort. This finding may help identify patients with the lowest probability of 30-day survival in those receiving V-A ECMO for hemodynamic support.

Chan, Hannah; Harman, Emily; Gulbis, Brian; Underbrink, Kristen; Savitz, Sean; Jiang, Xiaoqian; Zhang, Kai; Allison, Teresa Author Information

Harman, Emily; Chan, Hannah; Gulbis, Brian; Savitz, Sean; Silos, Christin; Underbrink, Kristen; Allison, Teresa Author Information

Introduction: Four Factor Prothrombin Complex Concentrate (4F-PCC) is indicated for reversal of warfarin-induced coagulopathy. In small cohort studies, 4F-PCC has similar hemostatic efficacy rates reversing non-vitamin K anticoagulants (NOACs). There are no comparison studies evaluating 4F-PCC for the reversal of warfarin versus NOACs in the setting of intracerebral hemorrhage (ICH). Methods: A multicenter retrospective cohort study was conducted between 2013-2020 at a comprehensive stroke system in ICH patients who received 4F-PCC for the reversal of warfarin or a NOAC. Patients were included if they were adults with an acute ICH, anticoagulant regimen of warfarin (INR 1.3 or greater) or NOAC, and 2 head CT scans within 24 hours to determine hemostatic efficacy. Hemostatic efficacy was evaluated by the Sarode scale. The chi square and t-test were used as appropriate for demographic and clinical data, with multivariable regression analysis conducted in a forward stepwise manner, retaining variables with significance less than 0.05. Results: One hundred fifty-seven patients were included (baseline characteristics in Table 1). There was no statistically significant difference in effective hemostasis observed between warfarin and NOAC patients (83% vs 75%, p=0.33). Similarly, multivariable analysis did not demonstrate a significant difference in effective hemostasis (OR 0.55, 95% CI: 0.2-1.3, p=0.2). However, due to wide 95% confidence intervals, we cannot exclude a key treatment effect from PCC. After controlling for baseline characteristics, patients treated with NOACs had 53% lower odds of a good clinical outcome compared to those treated with warfarin (Figure 1; OR 0.47, 95% CI: 0.2-1.3, p=0.13). Conclusions: In conclusion, there was no statistically significant difference in hemostatic efficacy or clinical outcomes between warfarin and NOAC patients following reversal with 4F-PCC.

Acute ischemic stroke (AIS) patients often experience an extended length of stay (LOS) due to multiple factors, including blood pressure management (BPM). The aim of this quality improvement project was to assess the impact of BPM on LOS in AIS patients. This was a retrospective review of 99 AIS patients randomly selected at a comprehensive stroke center from January to June 2020. The primary outcome was the percentage of patients with LOS observed/expected (O/E) ratio ≥ 0.8. Factors associated with delayed hospital discharge (DHD) were evaluated. Chi-square, student t-test, and Mann-Whitney U test were used as appropriate for analysis. Patients had a mean (SD) age of 65 (14) years, median (IQR) NIHSS 7 (4, 15), HTN history (67%), and were African American (40%), Caucasian (32%), or Other (28%). Table 1 shows types of strokes. Twenty-three (23%) patients received tPA. Forty-five (45%) patients had a LOS O/E ratio of ≥ 0.8. Reasons for DHD included BPM (38%), medical management (33%), stroke management (25%), and disposition (4%). Patients with DHD had an initial mean (SD) SBP of 164 (32) mmHg compared to 161 (33) mmHg in patients with no DHD, p=0.603. Figure 1 shows mean SBP trends. Patients with DHD had a median (IQR) of 2 (0, 3) home BP medications compared to 1 (0, 2) in patients with no DHD, p=0.040. Nine patients (20%) with DHD compared to 7 patients (13%) with no DHD were initiated on a nicardipine drip upon admission, p = 0.416. Oral therapy was initiated on median (IQR) hospital day 2.5 (2, 3) in DHD patients vs. 3 (2, 3) in patients with no DHD, p = 0.951. Median (IQR) number of BP medications on discharge was 2 (1, 2) in DHD patients vs. 1 (0, 2) in patients with no DHD, p=0.170. Reasons for elevated BP included delayed therapy initiation (12%), medication titration (59%), and titration intolerability (29%). Blood pressure management in this cohort was one of the most significant factors in delaying discharge. Protocols should focus on better and faster BPM as a means of reducing length of stay.

Gastrointestinal (GI) bleeding is a common complication following the placement of continuous-flow left ventricular assist devices (LVADs) in patients with advanced heart failure. Secondary events arising as a result of GI bleeding have not been well-described. Furthermore, attribution of these events to bleeding is complicated by the interruption or de-intensification of antithrombotic therapy, while bleeding is controlled. The purpose of this study was to assess the incidence of pump thrombosis and ischemic stroke in patients with LVADs who experience GI bleeding, while on support. This was a single-center, retrospective, observational cohort study of consecutive patients with LVADs implanted from January 2012 to June 2018. Patients were assigned to comparator groups based on whether they experienced GI bleeding while on LVAD support. The primary endpoint assessed was the composite of pump thrombosis or ischemic stroke. Secondary endpoints assessed included incidence of pump thrombosis or ischemic stroke. A total of 250 patients were included after screening for exclusion criteria, 101 (40.4%) in the GI bleeding group, and 149 (59.6%) in the non-bleeding group. The incidence of pump thrombosis or ischemic stroke was not significantly greater in patients experiencing GI bleeding [23 (22.8%) vs. 21 (14.1%); P = .09]; however, the incidence of ischemic stroke alone was significantly greater [17 (16.8%) vs. 10 (6.7%); P = .01]. We conclude that GI bleeding in LVAD patients may be associated with a greater risk of ischemic stroke.

Introduction: Atrial fibrillation and atrial flutter are common supraventricular arrhythmias in patients who present to the emergency department. Under the American Heart Association guidelines, dilTIAZem is the calcium channel blocker frequently used by many practitioners for rate control. Currently, institution-specific data have identified that many patients receiving dilTIAZem for atrial fibrillation or atrial flutter are given initial doses that exceed the recommended dose by more than 10%, resulting in hypotension in some patients. Methods: ED personnel were surveyed to determine their current knowledge of appropriate intravenous dilTIAZem dosing and methods of prescribing intravenous dilTIAZem to determine the causes of higher dosing. Based on the baseline data, an intervention of adding a text alert when withdrawing diITIAZem from the automated medication dispensing cabinet was implemented. Results: Following the intervention, 29 patients received intravenous dilTIAZem for rate control of atrial fibrillation or flutter with rapid ventricular response. For the primary outcome, the incidence of high-dose dilTIAZem decreased by 19% (P = 0.03). There was no change in the secondary outcome of a reduction in hypotension (P= 0.3). Discussion: The interventions of education and medication alerts resulted in a significant increase in the percentage of patients receiving appropriate doses of diITIAZem and a nonsignificant decrease in the incidence of hypotension. This process-oriented intervention resulted in an improvement in appropriate dilTIAZem doses at our site. Rate control was not statistically significantly different between the 2 groups. Long-term sustainability of this intervention requires further study.

Objective: The aim of this study was to determine whether clevidipine (CLEV) achieved faster blood pressure control compared to nicardipine (NIC) in patients presenting with either an acute ischemic stroke (AIS) or a spontaneous intracerebral hemorrhage (ICH). Methods: This was a retrospective, observational, cohort study conducted in patients with AIS or ICH admitted to the emergency department of a Comprehensive Stroke Center from November 2011 to June 2013 who received CLEV or NIC continuous infusion for acute blood pressure management. Results: The study included 210 patients: 70 in the CLEV group and 140 in the NIC group. There was no difference in mean time (standard deviation [SD]) from initiation of the infusion to goal systolic blood pressure (SBP), CLEV: 50 (83) minutes versus NIC: 74 (103) minutes, P = .101. Comparison of the 2 agents within diagnosis showed no difference. Hypotension developed in 5 (7.1%) CLEV patients versus 14 (10%) NIC patients (P = .003). There was no difference in the percentage change at 2 hours; CLEV: −20% (16%) versus NIC: −16% (16%), P = .058. Mean (SD) time to alteplase administration from admission was 56 (22) minutes in the CLEV group versus 59 (25) minutes in the NIC group (P = .684). Conclusions: There was no difference in the mean time from initiation of the infusion to the SBP goal between agents or in the secondary outcomes. Due to the lack of differences observed, each agent should be considered based on the patient care needs of the institution.

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Background: Sudden cardiac death (SCD) is a major cause of mortality in the United States, and in-hospital mortality for successfully resuscitated patients remains high. Our hospital is a level one cardiovascular center in a major metropolitan area and receives the majority of SCD patients in the region. The purpose of this study was to evaluate whether SCD patients who undergo cardiac catheterization demonstrated significantly improved survival or neurological outcomes. Methods: 205 consecutive SCD patients admitted to our hospital from 2004 –2007 were evaluated. Using Chi-squared univariate analyses, we compared patients that underwent cardiac catheterization versus those that did not. We also performed a subanalysis comparing patients that underwent cardiac catheterization within three hours of hospital arrival versus those that underwent cardiac catheterization after the initial three-hour period. Primary endpoints included survival and neurological outcome (using the previously validated CPC score). ...