1
|
Bayramoğlu A, Tekin E, Kurt E, Kaşali K, Kurt N. The role of blood nitric oxide level in predicting return of spontaneous circulation: a prospective case-control study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240155. [PMID: 39230143 PMCID: PMC11370741 DOI: 10.1590/1806-9282.20240155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/19/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE The aim of this study was to investigate whether there is a difference in serum nitric oxide levels between patients who return spontaneously after cardiopulmonary resuscitation and those who do not. We also examined the potential of using serum nitric oxide levels as a marker to make an accurate decision about patient survival. METHODS We included 100 consecutive patients who were brought to the emergency clinic due to cardiac arrest. Blood samples were taken from these patients at admission, 30 min after admission, and when resuscitation was terminated. RESULTS We found that there was a significant difference in NO1 and NO3 values between the group of patients who did not return after cardiopulmonary resuscitation and the group in which spontaneous circulation returned. The NO1 value was significant in the receiver operating characteristic (ROC) analysis, while the NO3 value was not. A higher NO1 value provided a higher rate of survival. CONCLUSION Our findings suggest that nitric oxide may be a useful parameter to support the decision about patient survival. A higher NO1 value is associated with a better prognosis and survival rate. Therefore, serum nitric oxide levels may be a suitable indicator to support the decision-making process regarding patient survival.
Collapse
Affiliation(s)
- Atıf Bayramoğlu
- Alanya Alaaddin Keykubat University, Faculty of Medical, Department of Emergency – Alanya, Turkey
| | - Erdal Tekin
- Atatürk University, Faculty of Medicine, Department of Emergency Medicine – Erzurum, Turkey
| | - Engin Kurt
- Mengücek Gazi Training and Research Hospital – Erzincan, Turkey
| | - Kamber Kaşali
- Atatürk University, Faculty of Medicine, Department of Medical Statistics – Erzurum, Turkey
| | - Nezahat Kurt
- Erzincan Binali Yıldırım University, Faculty of Medicine, Department of Biochemistry – Erzincan, Turkey
| |
Collapse
|
2
|
Ahn S, Jung S, Park JH, Cho H, Moon S, Lee S. Artificial intelligence for predicting shockable rhythm during cardiopulmonary resuscitation: In-hospital setting. Resuscitation 2024; 202:110325. [PMID: 39029581 DOI: 10.1016/j.resuscitation.2024.110325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
AIM OF THE STUDY This study aimed to develop an artificial intelligence (AI) model capable of predicting shockable rhythms from electrocardiograms (ECGs) with compression artifacts using real-world data from emergency department (ED) settings. Additionally, we aimed to explore the black box nature of AI models, providing explainability. METHODS This study is retrospective, observational study using a prospectively collected database. Adult patients who presented to the ED with cardiac arrest or experienced cardiac arrest in the ED between September 2021 and February 2024 were included. ECGs with a compression artifact of 5 s before every rhythm check were used for analysis. The AI model was designed based on convolutional neural networks. The ECG data were assigned into training, validation, and testing sets on a per-patient basis to ensure that ECGs from the same patient did not appear in multiple sets. Gradient-weighted class activation mapping was employed to demonstrate AI explainability. RESULTS A total of 1,889 ECGs with compression artifacts from 172 patients were used. The area under the receiver operating characteristic curve (AUROC) for shockable rhythm prediction was 0.8672 (95% confidence interval [CI]: 0.8161-0.9122). The AUROCs for manual and mechanical compression were 0.8771 (95% CI: 0.8054-0.9408) and 0.8466 (95% CI: 0.7630-0.9138), respectively. CONCLUSION This study was the first to accurately predict shockable rhythms during compression using an AI model trained with actual patient ECGs recorded during resuscitation. Furthermore, we demonstrated the explainability of the AI. This model can minimize interruption of cardiopulmonary resuscitation and potentially lead to improved outcomes.
Collapse
Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea
| | - Sumin Jung
- Core Research & Development Center, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, 15355 Ansan-si, Republic of Korea.
| |
Collapse
|
3
|
Mouawad YA, El Ters F, Mina C, Richa K, Salameh P, Nakhle R. Assessment of Point-of-Care Ultrasound (POCUS) Knowledge Among Lebanese Medical Residents. Cureus 2024; 16:e69205. [PMID: 39268028 PMCID: PMC11392010 DOI: 10.7759/cureus.69205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2024] [Indexed: 09/15/2024] Open
Abstract
Over the past few years, point-of-care ultrasound (POCUS) has emerged as a critical diagnostic tool in emergency medicine, providing real-time imaging at the bedside. This study aims to assess POCUS knowledge and competency among medical residents in Lebanon, identify possible gaps and deficiencies in their training, and recommend guidelines for further improvement of the curriculum in Lebanese medical schools and residency programs. Our study reveals that 58.3% (N=119) of resident doctors from multiple specialties in Lebanon have only basic knowledge about POCUS, 19.6% (N=40) have no knowledge, and only 21.6% (N=44) have sufficient knowledge to perform diagnostic studies on a routine basis. Lebanese medical residents currently possess suboptimal POCUS knowledge and proficiency due to disparities in training and educational obstacles. To address this, residency programs should focus on standardized POCUS training, simulation-based learning, and faculty development. This approach will help ensure residents gain the necessary skills to use POCUS effectively in clinical practice.
Collapse
Affiliation(s)
- Yara A Mouawad
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Fadi El Ters
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Christeen Mina
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Khalil Richa
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| | - Pascale Salameh
- Primary Care and Population Health, University of Nicosia Medical School, Nicosia, CYP
- Public Health, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie (INSPECT-LB), Beirut, LBN
- Faculty of Pharmacy, Lebanese University, Beirut, LBN
- School of Medicine, Lebanese American University, Beirut, LBN
| | - Ramzi Nakhle
- Emergency Department, Lebanese American University Medical Center, Beirut, LBN
| |
Collapse
|
4
|
Abuguyan F, Almasry NW, Alzahrani AA. Barriers to Point-of-Care Ultrasound Utilization Among Emergency Medicine Residents in Riyadh, Saudi Arabia. Cureus 2024; 16:e65765. [PMID: 39211663 PMCID: PMC11361400 DOI: 10.7759/cureus.65765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency medicine (EM). This study aimed to identify barriers to POCUS utilization among EM residents in the Riyadh region. MATERIALS AND METHODS An observational cross-sectional study was conducted among 116 EM residents from various training centers in Riyadh. Data were collected through self-administered questionnaires assessing demographics, ultrasound (US) training, perceived barriers, and facilitators to POCUS usage. Statistical analysis included descriptive statistics, multiple response dichotomy analysis, and multivariable linear regression. RESULTS The majority of residents had completed US training and recognized the importance of POCUS in emergency settings. However, significant barriers were identified, including time constraints and logistical challenges. Multivariable regression analysis revealed associations between residents' training status, beliefs in incentives, anticipated POCUS use, and perceived barriers. CONCLUSION This study highlights the importance of addressing barriers to POCUS integration into residency programs. Efforts should focus on optimizing training, addressing workflow challenges, and enhancing residents' confidence in POCUS utilization. Targeted interventions tailored to specific clinical contexts may facilitate greater acceptance and integration of POCUS into routine practice.
Collapse
Affiliation(s)
- Fahad Abuguyan
- Emergency Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | - Naief W Almasry
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
| | - Ali A Alzahrani
- Emergency Medicine, King Khalid University Hospital, Riyadh, SAU
| |
Collapse
|
5
|
Park SY, Choi B, Kim SH. Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients. BMC Emerg Med 2024; 24:79. [PMID: 38710999 DOI: 10.1186/s12873-024-00998-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND This study compared out-of-hospital cardiac arrest (OHCA) patient outcomes based on intravenous (IV) access and prehospital epinephrine use. METHODS A retrospective study in Ulsan, South Korea, from January 2017 to December 2022, analyzed adult nontraumatic OHCA cases. Patients were grouped: Group 1 (no IV attempts), Group 2 (failed IV access), Group 3 (successful IV access without epinephrine), and Group 4 (successful IV access with epinephrine), with comparisons using logistic regression analysis. RESULTS Among 2,656 patients, Group 4 had significantly lower survival to hospital discharge (adjusted OR 0.520, 95% CI 0.346-0.782, p = 0.002) and favorable neurological outcomes (adjusted OR 0.292, 95% CI 0.140-0.611, p = 0.001) than Group 1. Groups 2 and 3 showed insignificant survival to hospital discharge (adjusted OR 0.814, 95% CI 0.566-1.171, p = 0.268) and (adjusted OR 1.069, 95% CI 0.810-1.412, p = 0.636) and favorable neurological outcomes (adjusted OR 0.585, 95% CI 0.299-1.144, p = 0.117) and (adjusted OR 1.075, 95% CI 0.689-1.677, p = 0.751). In the shockable rhythm group, Group 3 had better survival to hospital discharge (adjusted OR 1.700, 95% CI 1.044-2.770, p = 0.033). CONCLUSIONS Successful IV access with epinephrine showed worse outcomes in both rhythm groups than no IV attempts. Outcomes for failed IV and successful IV access without epinephrine were inconclusive. Importantly, successful IV access without epinephrine showed favorable survival to hospital discharge in the shockable rhythm group, warranting further research into IV access for fluid resuscitation in shockable rhythm OHCA patients.
Collapse
Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Republic of Korea
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 25, Daehakbyeongwon-ro, Ulsan, Dong-gu, 44033, Republic of Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 25, Daehakbyeongwon-ro, Ulsan, Dong-gu, 44033, Republic of Korea.
| |
Collapse
|
6
|
Choi MJ, Kim KJ. Effects of team-based mixed reality simulation program in emergency situations. PLoS One 2024; 19:e0299832. [PMID: 38422080 PMCID: PMC10903827 DOI: 10.1371/journal.pone.0299832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This study aimed to demonstrate the effectiveness of a team-based mixed reality simulation program about emergencies. METHOD A nonequivalent control group pretest-posttest design was utilized. We recruited 32 nurses for the experimental group and 32 for the control group, resulting in a total of 61 nurses ultimately included as subjects for analysis. This mixed reality program is designed to facilitate responses in cardiopulmonary resuscitation situations simultaneously using four HoloLens. With shared content visible to all four trainees, the participants could engage in simulation while freely communicating. The experimental group engaged in cardiopulmonary resuscitation emergency simulation while wearing the HoloLens, while the control group was provided with written CPR materials. RESULTS There were significant increases in the experimental group's critical thinking (p < .001), learning transfer motivation (p = .006), communication confidence (p = .033), and learning immersion (p < .001) compared to the control group. CONCLUSION The program developed in this study presents an effective educational strategy that can enhance nurses' emergency competencies and leverage the practicality of mixed reality.
Collapse
Affiliation(s)
- Moon-Ji Choi
- Department of Nursing, Kyungil University, Gyeongsan, South Korea
| | - Kyeng-Jin Kim
- College of Nursing, Kyungpook National University, Daegu, South Korea
| |
Collapse
|
7
|
Suh GJ, Kim T, Kim KS, Kwon WY, Kim H, Park H, Wang G, Park J, Hur S, Sim J, Kim K, Lee JC, Shin DA, Cho WS, Kim BJ, Kwon S, Lee YJ. A remote-controlled automatic chest compression device capable of moving compression position during CPR: A pilot study in a mannequin and a swine model of cardiac arrest. PLoS One 2024; 19:e0297057. [PMID: 38241416 PMCID: PMC10798619 DOI: 10.1371/journal.pone.0297057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/24/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Recently, we developed a chest compression device that can move the chest compression position without interruption during CPR and be remotely controlled to minimize rescuer exposure to infectious diseases. The purpose of this study was to compare its performance with conventional mechanical CPR device in a mannequin and a swine model of cardiac arrest. MATERIALS AND METHODS A prototype of a remote-controlled automatic chest compression device (ROSCER) that can change the chest compression position without interruption during CPR was developed, and its performance was compared with LUCAS 3 in a mannequin and a swine model of cardiac arrest. In a swine model of cardiac arrest, 16 male pigs were randomly assigned into the two groups, ROSCER CPR (n = 8) and LUCAS 3 CPR (n = 8), respectively. During 5 minutes of CPR, hemodynamic parameters including aortic pressure, right atrial pressure, coronary perfusion pressure, common carotid blood flow, and end-tidal carbon dioxide partial pressure were measured. RESULTS In the compression performance test using a mannequin, compression depth, compression time, decompression time, and plateau time were almost equal between ROSCER and LUCAS 3. In a swine model of cardiac arrest, coronary perfusion pressure showed no difference between the two groups (p = 0.409). Systolic aortic pressure and carotid blood flow were higher in the LUCAS 3 group than in the ROSCER group during 5 minutes of CPR (p < 0.001, p = 0.008, respectively). End-tidal CO2 level of the ROSCER group was initially lower than that of the LUCAS 3 group, but was higher over time (p = 0.022). A Kaplan-Meier survival analysis for ROSC also showed no difference between the two groups (p = 0.46). CONCLUSION The prototype of a remote-controlled automated chest compression device can move the chest compression position without interruption during CPR. In a mannequin and a swine model of cardiac arrest, the device showed no inferior performance to a conventional mechanical CPR device.
Collapse
Affiliation(s)
- Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Taegyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hayoung Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesu Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gaonsorae Wang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeheung Park
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Sungmoon Hur
- Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Jaehoon Sim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | | | - Jung Chan Lee
- Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering and Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Ah Shin
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Woo Sang Cho
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Byung Jun Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Soyoon Kwon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Ye Ji Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Roh Y, Ahn GJ, Lee JH, Jung WJ, Kim S, Im HY, Lee Y, Im D, Lim J, Hwang SO, Cha K. Hemodynamic Effect of Repeated Epinephrine Doses Decreases With Cardiopulmonary Resuscitation Cycle Progression. J Am Heart Assoc 2024; 13:e030776. [PMID: 38156546 PMCID: PMC10863801 DOI: 10.1161/jaha.123.030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Epinephrine is administered to increase coronary perfusion pressure during advanced life support and promote short-term survival. Recent cardiopulmonary resuscitation (CPR) guidelines recommend an epinephrine dosing interval of 3 to 5 minutes during resuscitation; however, scientific evidence supporting this recommendation is lacking. Therefore, we aimed to investigate the hemodynamic effects of repeated epinephrine doses during CPR by monitoring augmented blood pressure after its administration in a swine model of cardiac arrest. METHODS AND RESULTS A secondary analysis of data from a published study was performed using a swine cardiac arrest model. The epinephrine dose was fixed at 1 mg, and the first dose of epinephrine was administered after no-flow and low-flow times of 2 minutes and 8 minutes, respectively, and subsequently administered every 4 minutes. Four cycles of dosing intervals were defined because a previous study was terminated 26 minutes after the induction of ventricular fibrillation. Augmented blood pressures and corresponding timelines were determined. Augmented blood pressure trends following cycles and the epinephrine effect duration were also monitored. Among the 140 CPR cycles, the augmented blood pressure after epinephrine administration was the highest during the first cycle of CPR and decreased gradually with further cycle repetitions. The epinephrine effect duration did not differ between repeated cycles. The maximum blood pressure was achieved 78 to 97 seconds after epinephrine administration. CONCLUSIONS Hemodynamic augmentation with repeated epinephrine administration during CPR decreased with cycle progression. Further studies are required to develop an epinephrine administration strategy to maintain its hemodynamic effects during prolonged resuscitation.
Collapse
Affiliation(s)
- Young‐Il Roh
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Gyo Jin Ahn
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Jung Hun Lee
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Woo Jin Jung
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Soyeong Kim
- Korea Health Industry Development InstituteCheongjuRepublic of Korea
| | - Hyeon Young Im
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Yujin Lee
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Dahye Im
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Jihye Lim
- National Health Big Data Clinical Research InstituteYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Sung Oh Hwang
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| | - Kyoung‐Chul Cha
- Department of Emergency MedicineYonsei University Wonju College of MedicineWonjuRepublic of Korea
- Research Institute of Resuscitation ScienceYonsei University Wonju College of MedicineWonjuRepublic of Korea
| |
Collapse
|
9
|
Ahn S, Jin BY, Cho H, Moon S, Cho YD, Park JH. Association of prehospital advanced airway and epinephrine with survival in patients with out-of-hospital cardiac arrest. Sci Rep 2023; 13:17836. [PMID: 37857787 PMCID: PMC10587122 DOI: 10.1038/s41598-023-44991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
Survival benefits of prehospital advanced airway and epinephrine in out-of-hospital cardiac arrest (OHCA) patients are controversial, but few studies evaluated this together. This study evaluated association of prehospital advanced airway and epinephrine with survival outcomes in OHCA patients. This was observational study using a prospective multicentre KoCARC registry. Adult OHCA patients between October 2015 and December 2021 were included. The variables of interest were prehospital managements, which was classified into basic life support (BLS)-only, BLS + advanced airway, and BLS + advanced airway + epinephrine. In total, 8217 patients were included in analysis. Survival to discharge and good neurological outcomes were lowest in the BLS + advanced airway + epinephrine group (22.1% in BLS-only vs 13.2% in BLS + advanced airway vs 7.5% in BLS + advanced airway + epinephrine, P < 0.001 and 17.1% in BLS-only vs 9.2% in BLS + advanced airway vs 4.3% in BLS + advanced airway + epinephrine, P < 0.001, respectively). BLS + advanced airway + epinephrine group was less likely to survive to discharge and have good neurological outcomes (aOR 0.39, 95% CI 0.28-0.55, P < 0.001 and aOR 0.33, 95% CI 0.21-0.51, P < 0.001, respectively) than BLS-only group after adjusting for potential confounders. In prehospital settings with intermediate EMS providers and prehospital advanced airway insertion is performed followed by epinephrine administration, prehospital management with BLS + advanced airway + epinephrine in OHCA patients was associated with lower survival to discharge rate compared to BLS-only.
Collapse
Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Bo-Yeong Jin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Young-Duck Cho
- Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| |
Collapse
|
10
|
Jung WJ, Roh YI, Im H, Lee Y, Im D, Cha KC, Hwang SO. Efficacy of Cardiopulmonary Resuscitation Using Automatic Compression-Defibrillation Apparatus: An Animal Study and A Manikin-Based Simulation Study. J Clin Med 2023; 12:5333. [PMID: 37629377 PMCID: PMC10455516 DOI: 10.3390/jcm12165333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chest compression and defibrillation are essential components of cardiac arrest treatment. Mechanical chest compression devices (MCCD) and automated external defibrillators (AED) are used separately in clinical practice. We developed an automated compression-defibrillation apparatus (ACDA) that performs mechanical chest compression and automated defibrillation. We investigated the performance of cardiopulmonary resuscitation (CPR) with automatic CPR (A-CPR) compared to that with MCCD and AED (conventional CPR: C-CPR). METHODS Pigs were randomized into A-CPR or C-CPR groups: The A-CPR group received CPR+ACDA, and the C-CPR group received CPR+MCCD+AED. Hemodynamic parameters, outcomes, and time variables were measured. During a simulation study, healthcare providers performed a basic life support scenario for manikins with an ACDA, MCCD, and AED, and time variables and chest compression parameters were measured. RESULTS The animals showed no significant in hemodynamic effects, including aortic pressures, coronary perfusion pressure, carotid blood flow, and end-tidal CO2, and resuscitation outcomes between the two groups. In both animal and simulation studies, the time to defibrillation, time to chest compression, and hands-off time were significantly shorter in the A-CPR group than those in the C-CPR group. CONCLUSIONS CPR using ACDA showed similar hemodynamic effects and resuscitation outcomes as CPR using AED and MCCD separately, with the advantages of a reduction in the time to compression, time to defibrillation, and hands-off time.
Collapse
Affiliation(s)
- Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Young-Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Hyeonyoung Im
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Yujin Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Dahye Im
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea; (W.J.J.); (Y.-I.R.); (H.I.); (Y.L.); (D.I.)
- Research Institute of Resuscitation Science, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| |
Collapse
|
11
|
Woo JH, Lim YS, Cho JS, Yang HJ, Jang JH, Choi JY, Choi WS. Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. J Clin Med 2023; 12:5040. [PMID: 37568442 PMCID: PMC10420180 DOI: 10.3390/jcm12155040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline. METHODS A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality. RESULTS Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time p = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater (p = 0.044 and p = 0.024, respectively) and the incidence of hyperchloremia was lower (p < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes. CONCLUSION Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients.
Collapse
Affiliation(s)
| | - Yong Su Lim
- Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea; (J.-H.W.)
| | | | | | | | | | | |
Collapse
|
12
|
Kim TY, Kim S, Han SI, Hwang SO, Jung WJ, Roh YI, Cha KC. Gastric Inflation in Prehospital Cardiopulmonary Resuscitation: Aspiration Pneumonia and Resuscitation Outcomes. Rev Cardiovasc Med 2023; 24:198. [PMID: 39077027 PMCID: PMC11266457 DOI: 10.31083/j.rcm2407198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/31/2024] Open
Abstract
Background Gastric inflation (GI) can induce gastric regurgitation and subsequent aspiration pneumonia, which can prolong intensive care unit stay. However, it has not been verified in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the incidence of GI during prehospital resuscitation and its effect on aspiration pneumonia and resuscitation outcomes in patients with out-of-hospital cardiac arrest. Methods This was a multicenter, retrospective, observational study. Patients with non-traumatic OHCA aged > 19 years who had been admitted to the emergency department were enrolled. Patients who received mouth-to-mouth ventilation during bystander cardiopulmonary resuscitation (CPR) were excluded from the evaluation owing to the possibility of GI following bystander CPR. Patients who experienced cardiac arrest during transportation to the hospital who were treated by the emergency medical service (EMS) personnel, and those with a nasogastric tube at the time of chest or abdominal radiography were also excluded. Radiologists independently reviewed plain chest or abdominal radiographs immediately after resuscitation to identify GI. Chest computed tomography performed within 24 h after return of spontaneous circulation was also reviewed to identify aspiration pneumonia. Results Of 499 patients included in our analysis, GI occurred in approximately 57% during the prehospital resuscitation process, and its frequency was higher in a bag-valve mask ventilation group (n = 70, 69.3%) than in the chest compression-only cardiopulmonary resuscitation (n = 31, 55.4%), supraglottic airway (n = 180, 53.9%), and endotracheal intubation groups (n = 3, 37.5%) (p = 0.031). GI was inversely associated with initial shockable rhythm (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.30-0.94). Aspiration pneumonia was not associated with GI. Survival to hospital discharge and favorable neurologic outcomes were not associated with GI during prehospital resuscitation. Conclusions GI in patients with OHCA was not associated with the use of different airway management techniques.
Collapse
Affiliation(s)
- Tae Youn Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 10326 Goyang, Republic of Korea
| | - Soyeong Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| | - Sang Il Han
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 26426 Wonju, Republic of Korea
| |
Collapse
|
13
|
Lee SH, Shin H, Cho Y, Oh J, Choi HJ. Arterial Blood Gas Analysis for Survival Prediction in Pediatric Patients with Out-of-Hospital Cardiac Arrest. J Pers Med 2023; 13:1061. [PMID: 37511675 PMCID: PMC10381305 DOI: 10.3390/jpm13071061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Arterial blood gas analysis (ABGA) is one of the few tests performed during cardiopulmonary resuscitation (CPR). There have been some studies on the prediction of survival outcomes in adult out-of-hospital cardiac arrest (OHCA) patients during CPR using ABGA results. However, in pediatric OHCA patients, the prognosis of survival outcome based on ABGA results during CPR remains unclear. We retrospectively analyzed prospectively collected data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry, a multicenter OHCA registry of Republic of Korea. We analyzed 108 pediatric (age < 19 years) OHCA patients between October 2015 and June 2022. Using multivariable logistic regression, an adjusted odds ratio (aOR) was obtained to validate the ABGA results of survival to hospital admission and survival to discharge. The variables associated with survival to hospital admission were non-comorbidities (aOR 3.03, 95% confidence interval (CI) 1.22-7.53, p = 0.017) and PaO2 > 45.750 mmHg (aOR 2.69, 95% CI 1.13-6.42, p = 0.026). There was no variable that was statistically significant association with survival to discharge. PaO2 > 47.750 mmHg and non-comorbidities may serve as an independent prognostic factor for survival to hospital admission in pediatric OHCA patients. However, the number of cases analyzed in our study was relatively small, and there have been few studies investigating the association between ABGA results during CPR and the survival outcome of pediatric OHCA patients. Therefore, further large-scale studies are needed.
Collapse
Affiliation(s)
| | - Hyungoo Shin
- Correspondence: (H.S.); (Y.C.); Tel.: +82-2-2290-9829 (Y.C.)
| | - Yongil Cho
- Correspondence: (H.S.); (Y.C.); Tel.: +82-2-2290-9829 (Y.C.)
| | | | | | | |
Collapse
|
14
|
Ko BS, Kim YJ, Han KS, Jo YH, Shin J, Park I, Kang H, Lim TH, Hwang SO, Kim WY. Association between the number of prehospital defibrillation attempts and a sustained return of spontaneous circulation: a retrospective, multicentre, registry-based study. Emerg Med J 2023; 40:424-430. [PMID: 37024298 DOI: 10.1136/emermed-2021-212091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Currently, there is no consensus on the number of defibrillation attempts that should be made before transfer to a hospital in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the association between the number of defibrillations and a sustained prehospital return of spontaneous circulation (ROSC). METHODS A retrospective analysis of a multicentre, prospectively collected, registry-based study in Republic of Korea was conducted for OHCA patients with prehospital defibrillation. The primary outcome was sustained prehospital ROSC, and the secondary outcome was a good neurological outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Cumulative incidence of sustained prehospital ROSC and good neurological outcome according to number of defibrillations were examined. Multivariable logistic regression analysis was used to examine whether the number of defibrillations was independently associated with the outcomes. RESULTS Excluding 172 patients with missing data, a total of 1983 OHCA patients who received prehospital defibrillation were included. The median time from arrest to first defibrillation was 10 (IQR 7-15) min. The numbers of patients with sustained prehospital ROSC and good neurological outcome were 738 (37%) and 549 (28%), respectively. Sustained ROSC rates decreased as the number of defibrillation attempts increased from the first to the sixth (16%, 9%, 5%, 3%, 2% and 1%, respectively). The cumulative sustained ROSC rate, and good neurological outcome rate from initial defibrillation to sixth defibrillation were 16%, 25%, 30%, 34%, 36%, 36% and 11%, 18%, 22%, 25%, 26%, 27%, respectively. With adjustment for clinical characteristics and time to defibrillation, a higher number of defibrillations was independently associated with a lower chance of a sustained ROSC (OR 0.81, 95% CI 0.76 to 0.86) and a lower chance of good neurological outcome (OR 0.86, 95% CI 0.80 to 0.92). CONCLUSIONS We observed no significant increase in ROSC after five defibrillations, and no absolute increase in ROSC after seven defibrillations. These data provide a starting point for determination of the optimal defibrillation strategy prior to consideration for prehospital extracorporeal cardiopulmonary resuscitation (ECPR) or conveyance to a hospital with an ECPR capability. TRIAL REGISTRATION NUMBER NCT03222999.
Collapse
Affiliation(s)
- Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
| | - Kap Su Han
- Emergency Medicine, Korea University College of Medicine and School of Medicine, Seoul, The Republic of Korea
| | - You Hwan Jo
- Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
| | - JongHwan Shin
- Emergency Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seodaemun-gu, The Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - S O Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, The Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
| |
Collapse
|
15
|
Hong SI, Kim YJ, Kim YJ, Kim WY. Pre-arrest comorbidity burden and the future risk of out-of-hospital cardiac arrest in Korean adults. Heart 2023; 109:542-547. [PMID: 36598057 DOI: 10.1136/heartjnl-2022-321650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the impact of pre-arrest comorbidities on future out-of-hospital cardiac arrest (OHCA) development using a nationwide dataset. METHODS This population-based, matched case-control study used the national health insurance claims data relevant to OHCA in South Korea from January 2009 to December 2018. Case patients were randomly matched to controls by age, sex and date of cardiac arrest. Controls were defined as patients who did not experience OHCA based on claim codes in national health screening data. The comorbidity burden was assessed using the Charlson Comorbidity Index (CCI). RESULTS A total of 191 370 OHCA patients were matched to 347 568 controls. The mean CCI in the case group was 3.76, which was significantly higher than that in the control group (1.75, p<0.001). Overall, OHCA was 1.35 (95% CI 1.34 to 1.35) times more likely to occur with every 1 point increase in the CCI. All other comorbidities constituting the CCI were associated with the OHCA risk (p<0.001). Patients with CCI ≥3 presented an OR of 3.71 (95% CI 3.67 to 3.76) for the risk of OHCA occurrence. This association was more pronounced in patients aged <70 years than in those aged ≥70 years (OR (95% CI) 16.07 (15.48 to 16.68) vs 6.50 (6.33 to 6.68)). CONCLUSION A high burden of pre-arrest comorbidity was associated with a higher risk of OHCA development, which was more pronounced in patients with less advanced age.
Collapse
Affiliation(s)
- Seok-In Hong
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, The Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, The Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, The Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, The Republic of Korea
| |
Collapse
|
16
|
Choi Y, Park JH, Jeong J, Kim YJ, Song KJ, Shin SD. Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry. Crit Care 2023; 27:87. [PMID: 36879338 PMCID: PMC9990293 DOI: 10.1186/s13054-023-04384-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND There is inconclusive evidence regarding the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients. We aimed to evaluate the association between ECPR and neurologic recovery in OHCA patients using time-dependent propensity score matching analysis. METHODS Using a nationwide OHCA registry, adult medical OHCA patients who underwent CPR at the emergency department between 2013 and 2020 were included. The primary outcome was a good neurological recovery at discharge. Time-dependent propensity score matching was used to match patients who received ECPR to those at risk for ECPR within the same time interval. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated, and stratified analysis by the timing of ECPR was also performed. RESULTS Among 118,391 eligible patients, 484 received ECPR. After 1:4 time-dependent propensity score matching, 458 patients in the ECPR group and 1832 patients in the no ECPR group were included in the matched cohort. In the matched cohort, ECPR was not associated with good neurological recovery (10.3% in ECPR and 6.9% in no ECPR; RR [95% CI] 1.28 [0.85-1.93]). In the stratified analyses according to the timing of matching, ECPR with a pump-on within 45 min after emergency department arrival was associated with favourable neurological outcomes (RR [95% CI] 2.51 [1.33-4.75] in 1-30 min, 1.81 [1.11-2.93] in 31-45 min, 1.07 (0.56-2.04) in 46-60 min, and 0.45 (0.11-1.91) in over 60 min). CONCLUSIONS ECPR itself was not associated with good neurological recovery, but early ECPR was positively associated with good neurological recovery. Research on how to perform ECPR at an early stage and clinical trials to evaluate the effect of ECPR is warranted.
Collapse
Affiliation(s)
- Yeongho Choi
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Jeong Ho Park
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea. .,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. .,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.,Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| |
Collapse
|
17
|
Hwang SO, Jung WJ, Roh YI, Cha KC. Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation. Clin Exp Emerg Med 2022; 9:271-280. [PMID: 36475353 PMCID: PMC9834834 DOI: 10.15441/ceem.22.399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Determining the cause of cardiac arrest (CA) and the heart status during CA is crucial for its treatment. Transesophageal echocardiography (TEE) is an imaging method that facilitates close observation of the heart without interfering with cardiopulmonary resuscitation (CPR). Intra-arrest TEE is a point-of-care ultrasound technique that is used during CPR. Intra-arrest TEE is performed to diagnose the cause of CA, determine the presence of cardiac contraction, evaluate the quality of CPR, assist with catheter insertion, and explore the mechanism of blood flow during CPR. The common causes of CA diagnosed using intra-arrest TEE include cardiac tamponade, aortic dissection, pulmonary embolism, and intracardiac thrombus, which can be observed on a few simple image planes at the mid-esophageal and upper esophageal positions. To operate an intra-arrest TEE program, it is necessary to secure a physician who is capable of performing TEE, provide appropriate training, establish implementation protocols, and prepare a plan in collaboration with the CPR team.
Collapse
Affiliation(s)
- Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea,Correspondence to: Sung Oh Hwang Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea E-mail:
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young-Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
18
|
Pyo Y, Chung TN. Effect of corticosteroid administration on cardiac arrest: a systematic review and network meta-analysis of the timing of administration. Clin Exp Emerg Med 2022; 9:286-295. [PMID: 36239078 PMCID: PMC9834831 DOI: 10.15441/ceem.22.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/21/2023] Open
Abstract
Corticosteroids may have a beneficial effect on the outcome of cardiac arrest (CA); however, it is not known whether the timing of corticosteroid use affects the outcome. We performed a systematic review and network meta-analysis to compare the efficacy of corticosteroid administration according to the timing. A favorable final outcome, as the primary study outcome, was defined as a combination of survival with good neurologic outcome and survival for 1 year. The secondary outcome was survival to discharge. Nine clinical studies were included. Corticosteroids administered during cardiopulmonary resuscitation (CPR; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.11-1.51) and post-CA (OR, 1.47; 95% CI, 1.30-1.66) had a positive effect on the favorable final outcome compared to the control protocol (no corticosteroid administration), while those used prior to CA had a negative effect. Corticosteroids administered post-CA had a positive effect on survival to discharge compared to the control protocol (OR, 1.82; 95% CI, 1.02-3.27), while those used prior to CA and during CPR had no significant effect. Post-CA was evaluated to be the best administration timing for both outcomes. In conclusion, the timing of corticosteroid administration may be an important factor for the prognosis of CA. Corticosteroids administration post-CA and during CPR may have beneficial effects on CA outcomes.
Collapse
Affiliation(s)
- Youngchan Pyo
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Tae Nyoung Chung
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
19
|
Oh DK, Kim JS, Ryoo SM, Kim YJ, Kim SM, Hong SI, Chae B, Kim WY. Augmented-Medication CardioPulmonary Resuscitation (AMCPR) trial: a study protocol for a randomized controlled trial. Clin Exp Emerg Med 2022; 9:361-366. [PMID: 36318879 PMCID: PMC9834824 DOI: 10.15441/ceem.22.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Clinical trials on demodynamic-directed cardiopulmonary resuscitation have been limited. The aim of this study is to investigate whether Augmented-Medication CardioPulmonary Resuscitation (AMCPR) would improve the odds of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest. Methods This is a double-blind, single-center, randomized placebo-controlled trial that will be conducted in the emergency department of a tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adult patients with nontraumatic, nonshockable, out-of-hospital cardiac arrest who have an initial diastolic blood pressure above 20 mmHg will be randomly assigned to two groups of 74 patients (a 1:1 ratio). Patients will receive an intravenous dose of 40 IU of vasopressin with epinephrine, or a placebo with epinephrine. The primary endpoint is a sustained ROSC (over 20 minutes). Secondary endpoints are enhanced diastolic blood pressure, end-tidal carbon dioxide levels, acidosis, and lactate levels during resuscitation. Discussion AMCPR is a trial about tailored medication for select patients during resuscitation. This is the first randomized control trial to identify patients who would benefit from vasopressin for achieving ROSC. This study will provide evidence about the effect of administration of vasopressin with epinephrine to increase ROSC rate. Trial registration ClinicalTrials.gov identifier: NCT03191240. Registered on June 19, 2017.
Collapse
Affiliation(s)
- Dong Kun Oh
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - June-sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok In Hong
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bora Chae
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence to: Won Young Kim Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail:
| |
Collapse
|
20
|
Perkins EJ, Begley JL, Brewster FM, Hanegbi ND, Ilancheran AA, Brewster DJ. The use of video laryngoscopy outside the operating room: A systematic review. PLoS One 2022; 17:e0276420. [PMID: 36264980 PMCID: PMC9584394 DOI: 10.1371/journal.pone.0276420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
This study aimed to describe how video laryngoscopy is used outside the operating room within the hospital setting. Specifically, we aimed to summarise the evidence for the use of video laryngoscopy outside the operating room, and detail how it appears in current clinical practice guidelines. A literature search was conducted across two databases (MEDLINE and Embase), and all articles underwent screening for relevance to our aims and pre-determined exclusion criteria. Our results include 14 clinical practice guidelines, 12 interventional studies, 38 observational studies. Our results show that video laryngoscopy is likely to improve glottic view and decrease the incidence of oesophageal intubations; however, it remains unclear as to how this contributes to first-pass success, overall intubation success and clinical outcomes such as mortality outside the operating room. Furthermore, our results indicate that the appearance of video laryngoscopy in clinical practice guidelines has increased in recent years, and particularly through the COVID-19 pandemic. Current COVID-19 airway management guidelines unanimously introduce video laryngoscopy as a first-line (rather than rescue) device.
Collapse
Affiliation(s)
| | - Jonathan L. Begley
- Alfred Health, Melbourne, VIC, Australia
- Intensive Care Unit, Cabrini Hospital, Malvern, VIC, Australia
| | - Fiona M. Brewster
- Department of Anaesthesia, Royal Women’s Hospital, Parkville, VIC, Australia
| | | | | | - David J. Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Oh J, Cha KC, Lee JH, Park S, Kim DH, Lee BK, Park JS, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE, Hwang SO. Erratum to “2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support”. Clin Exp Emerg Med 2022; 9:162-163. [PMID: 35843620 PMCID: PMC9288876 DOI: 10.15441/ceem.21.023.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|