Teresa May, DO
Pulmonologist, Faculty Scientist
Maine Medical Center, United States
Disclosure information not submitted.
Richard Riker, MD
Professor of Medicine
Maine Medical Center, United States
Disclosure information not submitted.
David Gagnon, BCCCP, PharmD, FCCM
Clinical Pharmacist - Critical Care
Maine Medical Center, United States
Disclosure information not submitted.
Sergey Ryzhov, MD, PhD
Faculty Scientist II, Co-Director, Myocardial Biology & Heart Failure Research Lab
Maine Medical Center Research Institute, United States
Disclosure information not submitted.
Joanne deKay, n/a
Research Associate III -- Bench
Maine Medical Center Research Institute, United States
Disclosure information not submitted.
Lee Lucas, PhD
Epidemiologist
Maine Medical Center Research Institute, United States
Disclosure information not submitted.
Jonathan Rud, MD
Resident Physician
Maine Medical Center, United States
Disclosure information not submitted.
Deanna Williams
Data Visualization Analayst
Maine Medical Center Research Institute, United States
Disclosure information not submitted.
Christine Lord, RB
Clinical Research Coordinator
Maine Medical Center, United States
Disclosure information not submitted.
Sarah Bockian, RN
Clinical Research Coordinator
Maine Medical Center, United States
Disclosure information not submitted.
Ashley Eldridge, RN
Clinical Research Coordinator
Maine Medical Center, United States
Disclosure information not submitted.
Meghan Searight, BS
Clinical Research Coordinator
Maine Medical Center, United States
Disclosure information not submitted.
David Seder, MD
Chief of Critical Care Services
Maine Medical Center, United States
Disclosure information not submitted.
Title: Evaluation of Clinical and Molecular Phenotypes in Urban and Rural Cardiac Arrest in Maine
INTRODUCTION/HYPOTHESIS: Urban and rural cardiac arrest (CA) events have different characteristics in terms of location, EMS response distance, and time to tertiary care center. We hypothesized that urban and rural patients presenting to a tertiary care center in Maine might have distinct clinical and molecular phenotypes related to these geographic differences.
Methods: We retrospectively evaluated the rurality of patients hospitalized after CA enrolled in a registry and an observational study of immune function. We assorted patients by rurality using Rural-Urban Commuting Areas (RUCA) and compared the clinical and molecular characteristics of patients in urban, large rural, and small rural/isolated geographic regions. Categories were compared using parametric or nonparametric tests as appropriate in R, and a linear regression model including age, initial heart rhythm, witnessed arrest, ischemic time, and rurality was run to identify the independent contribution of rurality to long-term outcome.
Results: Of 99 patients, 78 had molecular data available. Mean age was 60 ± 15, 78% were male, 60% had an initial shockable rhythm, with 18 (11, 25) minutes median ischemic time. Patient demographics and comorbidities were similar between patients with and without molecular data, and between the urban and rural cohorts. When differences between urban (n=58), large rural (n=22), and small rural (n=19) patients were analyzed, rural arrests tended toward being more frequently witnessed, and to have longer ischemic times (P=NS); small rural and isolated patients tended to less often have an initial shockable rhythm (P=NS). Rural patients had higher total WBC and higher neutrophil to lymphocyte ratio on admission and at 48 hours; these differences had resolved by 72 hours. Outcomes, neuron specific enolase levels, and other molecular markers of inflammation including TNF-a, CD73, MCP1, and CCL23 did not differ between the three cohorts. The linear regression model did not identify rurality as an independent predictor of outcome.
Conclusions: In a small group of post-resuscitation patients at a single center, we did not identify a clear rural phenotype at the clinical or molecular level.