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Funding Acknowledgements Type of funding sources: None. Background Since its proposal, Vasoactive Inotropic Score (VIS) was applied in different setting of acute critical care (e.g. pediatric population or post-cardiac surgery). It reflects the pharmacological support of the cardiovascular system and higher VIS values in the first 24 hours from ICU admission predict worse outcomes, both in pediatric and adult population. Few data are available regarding patients admitted for an Out of Hospital Cardiac Arrest (OHCA). The aim of this work is to investigate the prognostic role of VIS score in this population. Methods We enrolled 171 consecutive patients who were resuscitated after an OHCA and admitted to ICU at our center from September 2017 to April 2021. VIS score on admission was available for 144 patients. We divided the population in two groups (high vs low VIS score) according to VIS score median values. For every patient neurological outcome at discharge and survival at one year were available. Results Median VIS score was 10 so we considered low values ≤ 10 (group 1) and high values > 10 (group 2). There were 73 patients in low VIS group (Group 1) and 71 in high VIS group (Group 2). No differences were found in the two groups regarding sex (75% males vs 74%, p=0.88), age [64 (49-70) vs 61 (52-74), p=0.5], SAPS II score at admission [63.61 (53-70) vs 65.46 (61-86), p=0.54], shockable rhythm as first rhythm (60.2% vs 51.51%, p=0.3) and number of shocks delivered [median value 1 (0-13) vs 1 (0-14), p=0.84]. On the contrary, patients with lower VIS values had a shorter arrest duration [26 mins (19-40) vs 41 mins (27-74), p=0.0002] and less adrenaline delivered [2 mg (0-6) vs 3 mg (0 -12), p=0.0012]. Moreover, patients with lower VIS score values on admission showed a better neurological outcome (defined as a CPC < 2) at ICU discharge (44% vs 21%, p=0.08). In addition, patients in group 1 showed a lower mortality rate as compared to group 2 [60% (44/73) vs 76% (54/71),p=0.0048]. Conclusion in adult patients resuscitated from an out-of-hospital cardiac arrest and admitted to an ICU, lower values of VIS score were associated with higher survival at 1 year. Moreover patients with low VIS showed better neurological outcome at ICU discharge. This could be explained by the fact that VIS express the need for cardiovascular support and is lower in patients with a more stable hemodynamic status after OHCA, reflecting a less compromised clinical condition.

Funding Acknowledgements Type of funding sources: None. Background Global hypoperfusion causes tissue hypoxia, resulting in overproduction of lactate because of impaired mitochondrial oxidation, causing lactic acidosis (LA). Base excess (BE) is defined as the amount of acid or base required to return the pH to 7.4 in the setting of a normal Paco2 and is therefore related to the degree of acid production following injury. Purpose Our hypothesis was that lactate levels, BE levels and occurrence of LA on admission could help in early risk stratification in patients admitted to the ICU after an out-of-hospital cardiac arrest (OHCA). Methods we enrolled 171 consecutive patients resuscitated from an OHCA and admitted to ICU at our center from September 2017 to April 2021. Blood gas analysis on admission was available for 140 patients [77%male, mean age 60 (18-90) years, 54% with first shockable rhythm, median number of shocks delivered 1 (0-14), median dose of adrenaline administered 3 mg (0-12), 26% received amiodarone, median cardiac arrest duration 38 min (IQR 22-74 min)]. Patients with low lactate levels were compared with patients with high lactate levels (cutoff 2 mmol/l as per standard practice), patients with low BE levels were compared with patients with high BE levels (cutoff -8.5 mmol/l, median value) and patients with LA were compared with patients without LA (defined as pH 2mmol/). Survival with good neurological outcome (CPC 1-2) at ICU discharge and 30-day survival were investigated for each group with chi-squared test. Then, one-year survival was investigated for each group with Kaplan-Meier analysis. Results Patients with low BE (< -8.5 mmol/l) had a significantly lower survival with good neurological outcome at ICU discharge (p=0.0017), lower survival at 30 days (p < 0.0001) and 365 days (p - 8.5 mmol/l). Low lactate levels (< 2 mmol/L) were associated with higher survival with good neurological outcome at ICU discharge (p< 0.0001), higher survival at 30 days (p < 0.0001) and 365 days (p = 0.0002) compared to higher lactate levels (> 2 mmol/l). The occurrence of LA on admission was significantly associated with lower survival with good neurological outcome at ICU discharge (p=0.001), lower 30-days survival (p=0.001) and 365-days survival (p Conclusion high blood lactate levels, low base excess and lactic acidosis predict short-term and long-term survival in patients admitted to the ICU after an OHCA. These results could help clinician in the identification of populations with different risk profile with the first blood gas analysis obtained at ICU admission.

Introduction Ventricular fibrillation (VF) Amplitude Spectral Area (AMSA) is a well-established predictor of successful defibrillation and return of spontaneous circulation (ROSC). Attending to the limited evidence on the topic, gender seems to affect AMSA, and higher values have been reported in females. The aim of this work was to investigate the effect of gender in AMSA values for patients suffering out-of-hospital cardiac arrest (OHCA). Methods We enrolled 4619 consecutive OHCA patients from January 2015 to December 2020 in the LombardiaCare Registry. We considered only those subjects with attempted cardio-pulmonary resuscitation (697 patients) and at least one shock delivered. A total of 250 patients were considered (40 F/ 210 M) with 830 shocks (100 F/ 730 M). AMSA values were computed for the ventricular fibrillation in the 2-s pre-shock interval of the ECG recorded by the Corpuls3 defibrillator (Corpuls, Kaufering, Germany). Results Female patients were older than male [median (IQR): 70.5 (62–72) vs 67 (55–75) years, p=0.01], with cardiac arrest more frequently at home (84% vs 76%, p=0.003), fewer shocks [2 (1–4) vs 4 (2–7), p=0.004] and higher percentage of success (53% vs 40%, p=0.009). On the contrary, cardiac arrest duration [ 58.7 (31–69) vs 57.6 (41.4–77.3) min, p=0.366] and the rate of ROSC (32% vs 33%, p=0.88) were similar in both groups. Higher AMSA values were found in female patients [10.3 Hz-mV (6.6–13.5) vs 7.9 Hz-mV (5.2–12.1), p=0.0007]. At a multivariable analysis, after correction for witnessed status, bystanders CPR, amiodarone administration, age and call-to shock time, male sex was found to be independently associated with the probability of having low values of AMSA, below the median value of 8.3 Hz-mV [OR 2.15 (95% CI1.35–3.43), p=0.001]. Despite gender stratification ROC curve analysis confirmed AMSA as a predictor of shock success [AUC-F: 0.75 (95% CI 0.65–0.83), p Conclusion Female sex is related to higher AMSA values. As AMSA reflects the energetical status and the ATP levels in the myocardial cells during cardiac arrest, this difference may be due to lower incidence and lower severity of cardiac ischemic disease in women. AMSA remains a valid predictor of both shock success and ROSC for female and male patients. Further investigations are needed to support and comprehend these conclusions. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Background and purpose Permanent pacemaker implantation (PPMi) is needed in about 5% of patients following heart transplant (HTx) primarily due to sinus node dysfunction (SND), which commonly occurs in an early phase, or to atrio-ventricular block (ABV), which is common later on. Currently, data on rate of ventricular pacing (VP) is lacking and little is known on long-term outcomes after PPMi. Methods This was a retrospective, monocentric study. Among 1123 patients treated with HTx, all with biatrial technique, from november 1985 to march 2019 at our institution, 61 (5.4%) patients needed PPMi. PM parameters, clinical and echocardiographic data were collected at 1 month and at 1-3-5-10 years follow-up. The primary aim was to analyse the percentage of right ventricular pacing in the overall population and in subgroups stratified by the timing of PPMi and by pacing indication. Secondary endpoints were to analyze long-term outcomes according to the percentage of ventricular pacing and to the type of implanted PM (single vs. dual chamber). Results Among patients treated with PPMi (68.9% single-chamber), 62.2% were implanted for SND and 36% for AVB. Early PPMi (< 3 months after HTx), occurred in 34.4% of patients, mainly due to SND, while late PPMi (> 3 months after HTx) occurred in 65,6% with an equal distribution between SND and AVB. Median follow-up time from HTx was 140 months and 82 months from PPMi. Overall mean rate of VP was 21%. Rate of VP was higher in patients implanted early rather than late after HTx, both at 1 month (91% vs 2%, P = 0,002) and at 1 year after the procedure (43 vs 1, P = 0,037). Patients with AVB had a greater rate of VP compared to those implanted for SND, irrespective of timing of implantation and these findings were still present at 3 and 5 years follow-up (62 vs 1%, P = 0,011 at 3 years and 80 vs 6%, P = 0,002 at 5 years). VP declined progressively after PPM implantation. No differences were observed in terms of 10-years mortality between early vs late PPMi, dual vs single-chamber and mean VP > 21% vs ≤ 21%. Conclusions Patients treated with PPMi after HTx show on average low percentage of VP over long-term follow-up. AV block indication and early implantation are associated with a higher percentage of VP. The rate of VP, the timing of PPMi and the use of single vs dual chamber PM do not affect overall prognosis or left ventricular systolic function. Our data may justify implantation of a single-chamber PPM, which bears less complications and procedural time, in the majority of HTx patients needing PPMi.