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1.
Resuscitation ; 187: 109761, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36898602

RESUMO

BACKGROUND: This study evaluated the association between the extent of diffusion restriction on brain diffusion-weighted imaging (DWI) and neurological outcomes in patients who underwent targeted temperature management (TTM) after an out-of-hospital cardiac arrest (OHCA). METHODS: Patients who underwent brain magnetic resonance imaging within 10 days of OHCA between 2012 and 2021 were analysed. The extent of diffusion restriction was described according to the modified DWI Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS). The 35 predefined brain regions were assigned a score if diffuse signal changes were concordantly present in DWI scans and apparent diffusion coefficient maps. The primary outcome was an unfavourable neurological outcome at 6 months. The sensitivity, specificity, and receiver operating characteristic (ROC) curves for the measured parameters were analysed. Cut-off values were determined to predict the primary outcome. The predictive cut-off DWI-ASPECTS was internally validated using five-fold cross-validation. RESULTS: Of the 301 patients, 108 (35.9%) had 6-month favourable neurological outcomes. Patients with unfavourable outcomes had higher whole-brain DWI-ASPECTS (median, 31 [26-33] vs. 0 [0-1], P < 0.001) than those with favourable outcomes. The area under the ROC curve (AUROC) of whole-brain DWI-ASPECTS was 0.957 (95% confidence interval [CI] 0.928-0.977). A cut-off value of ≥8 for unfavourable neurological outcomes had specificity and sensitivity of 100% (95% CI 96.6-100) and 89.6% (95% CI 84.4-93.6), respectively. The mean AUROC was 0.956. CONCLUSION: More extensive diffusion restriction on DWI-ASPECTS in patients with OHCA who underwent TTM was associated with 6-month unfavourable neurological outcomes. Running title: Diffusion restriction and neurological outcomes after cardiac arrest.


Assuntos
Parada Cardíaca Extra-Hospitalar , Acidente Vascular Cerebral , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico por imagem , Parada Cardíaca Extra-Hospitalar/terapia , Parada Cardíaca Extra-Hospitalar/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética
2.
ASAIO J ; 69(2): 191-197, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36716072

RESUMO

This study compared the effects of extracorporeal cardiopulmonary resuscitation (ECPR) using propensity-score matching (PSM) analyses. A nationwide registry of out-of-hospital cardiac arrest (OHCA) patients in Korea between 2013 and 2016 was used. Patients with OHCA aged ≥15 years with cardiac etiology and resuscitation time >30 minutes were enrolled. Resuscitation-related variables before the initiation of ECPR were included. Two PSM analyses were performed separately, with and without post-ECPR variables. The primary outcome (PO) was a favorable neurologic outcome at hospital discharge. The rate of PO was 8.1% (13/161) in the ECPR group and 1.5% (247/16,489) in the conventional CPR (CCPR) group. In the matched cohort with post-ECPR variables, there was no significant difference in the rate of PO between the ECPR and CCPR groups (7.9% vs. 7.9%; p = 0.982). In the matched cohort without post-ECPR variables, the rate of PO was higher in the ECPR group than that in the CCPR group (8.3% vs. 3.6%; p = 0.012). PSM analysis without post-ECPR variables compared outcomes of all patients experiencing OHCA and treated with ECPR versus CCPR, which showed better neurologic outcomes for ECPR. PSM analysis with post-ECPR variables compared outcomes between ECPR survivors and CCPR survivors, which exhibited similar neurologic outcomes.


Assuntos
Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Parada Cardíaca Extra-Hospitalar , Humanos , Reanimação Cardiopulmonar/efeitos adversos , Resultado do Tratamento , Oxigenação por Membrana Extracorpórea/efeitos adversos , Parada Cardíaca Extra-Hospitalar/terapia , Fatores de Tempo , Estudos Retrospectivos
3.
J Clin Med ; 11(16)2022 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-36013063

RESUMO

Background: Glyphosate herbicide (GH) is widely used worldwide. It has a higher fatality rate than expected. GH-poisoned cases are increasingly reported. Acute kidney injury in poisoned patients is one of several predictors of GH mortality. The aim of this study was to determine whether estimated glomerular filtration rate (eGFR) could predict kidney injury in GH intoxication. Methods: This was a retrospective study conducted at the emergency department (ED) of a single hospital between January 2004 and December 2021. A total of 434 patients presented with GH intoxication via oral ingestion, and 424 were enrolled. Their demographic characteristics, laboratory variables, complications, and mortality were analyzed to determine clinical predictors associated with GH-induced mortality using a logistic regression analysis. The relationship between GH intoxication and eGFR was determined based on the results of dominance analysis. Additionally, the comparison of creatinine and eGFR was performed through receiver operating characteristic (ROC) curves. Results: A total of 424 GH-poisoned patients were enrolled. Of them, 43 (10.1%) died. In the multivariable analysis, initial GCS (OR: 0.874; 95% CI: 0.765−0.998, p = 0.047), albumin (OR: 0.874; 95% CI: 0.765−0.998, p = 0.027), pH (OR: 0.002; 95% CI: 0.000−0.037, p < 0.001), QTc interval (OR: 1.018; 95% CI: 1.007−1.029, p = 0.001), and eGFR (OR: 0.969; 95% CI: 0.95−0.989, p = 0.003) were independent factors for predicting in-hospital mortality. In the dominance analysis of the relative importance of the predictive factors, pH accounted for the largest proportion at 35.8%, followed by QTc (20.0%), GCS (17.3%), eGFR (17.0%), and albumin (9.9%). Additionally, eGFR had a larger area under the ROC curve (0.846; 95% CI, 0.809−0.879) than that of creatinine (0.811; 95% CI, 0.771−0.848, p = 0.033). Conclusion: In sum, eGFR, considered a surrogate of renal function, was a useful prognostic factor for mortality in glyphosate herbicide-poisoned patients.

4.
Prehosp Disaster Med ; : 1-6, 2022 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-35293304

RESUMO

This paper provides a field report on a fire that broke out on January 26, 2018 at Sejong Hospital in Miryang, South Korea, engendering the establishment of a committee to investigate the hospital fire response. This field report analyzes the disaster medical response. The official records of the disaster response from each institution were examined. On-site surveys were conducted through interviews with government officials and other health care workers regarding communication during the disaster response without using a separate questionnaire. All medical records were abstracted from hospital charts. There were 192 casualties: 47 victims died, seven were seriously injured, and 121 suffered minor injuries. Emergency Medical Services (EMS) arrived three minutes after the fire started, while news of the fire reached the National Emergency Medicine Operation Center based in Seoul in 12 minutes. The first disaster medical assistance team (DMAT) was dispatched 63 minutes after the National Emergency Medicine Operation Center was notified. The disaster response was generally conducted in accordance with disaster medical support manuals; however, these response manuals need to be improved. Close cooperation among various institutions, including nearby community public health centers, hospitals, fire departments, and DMATs, is necessary. The response manuals should be revised for back-up institutions, as the relevant information is currently incomplete.

5.
Acad Emerg Med ; 29(6): 729-735, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35064724

RESUMO

OBJECTIVES: The relationship between cooling time (CT) variables and neurological outcomes is controversial. We evaluated the relationship between CT and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). METHODS: We conducted a multicenter, prospective, and registry-based study of OHCA survivors treated with TTM. CT was defined as the time from restoration of spontaneous circulation to achievement of the target temperature. The primary outcome was a favorable neurological outcome at 6 months. Multilevel logistic regression analysis was performed to test the relationship between CT and the primary outcome. RESULTS: Overall, the favorable neurological outcome rates at 6 months were 29.8% in 937 patients. When CT was stratified into categories of 0-3, 3.1-6, 6.1-9, 9.1-12, and >12 h, according to 3-h intervals, the primary outcome rates were 8.2%, 22.7%, 35.5%, 44.7%, and 44.5%, respectively (p < 0.001). Significant differences were not found in multilevel logistic regression analysis; the adjusted odds ratios (95% confidence interval) of each category for the primary outcome compared to the 0-3-h group were 0.81 (0.32 to 2.04), 0.77 (0.30 to 2.01), 1.26 (0.43 to 3.68), and 1.06 (0.37 to 3.06). CONCLUSIONS: We did not find a relationship between CT and neurological outcomes at 6 months.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Reanimação Cardiopulmonar/efeitos adversos , Humanos , Hipotermia Induzida/efeitos adversos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Sistema de Registros
6.
Resuscitation ; 169: 78-85, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34678333

RESUMO

BACKGROUND: Various methods have been used to control body temperature in targeted temperature management (TTM), but few studies have compared specific subtypes of surface cooling systems. The aim of this study was to compare the efficiencies and neurological outcomes between hydrogels pad and water-circulating blanket cooling methods. METHODS: We conducted a multicentre, prospective, registry-based study of out-of-hospital cardiac arrest patients treated with TTM between 2015 and 2018. We compared the neurological outcomes, efficacies for cooling, and adverse events between patients who received TTM using a hydrogel pad and water-circulating blanket cooling. Patients were one-to-one matched using propensity scores to adjust for differences in the baseline characteristics of each cooling method. The primary outcome was a favourable neurological outcome at 6 months. RESULTS: We included 1,132 patients in the analysis, 870 of whom underwent hydrogel pad cooling, and the remaining 262 underwent water-circulating blanket cooling. In the unmatched cohort, a greater number of adverse events occurred in the water-circulating blanket group. The favourable neurologic outcome rates at 6 months were similar between the hydrogel pad group and the water circulating blanket group (30.2% vs. 29.8%, p = 0.939). In the propensity-matched cohort, which included 184 pairs, the rates of adverse events between the two groups were similar. The similarity of favourable neurologic outcome rates at 6 months between the two groups persisted (28.8% vs. 29.9%, p = 0.819). CONCLUSION: Neurological outcomes and adverse events between the hydrogel pad cooling and water-circulating blanket cooling groups were similar.


Assuntos
Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Temperatura Corporal , Humanos , Hidrogéis , Parada Cardíaca Extra-Hospitalar/terapia , Pontuação de Propensão , Estudos Prospectivos , Sistema de Registros , Temperatura , Água
7.
Sci Rep ; 11(1): 15067, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34302037

RESUMO

This study aimed to investigate the efficacy of the combination of neuron-specific enolase (NSE) measurement and initial neurological examination in predicting the neurological outcomes of patients with cardiac arrest (CA) by retrospectively analyzing data from the Korean Hypothermia Network prospective registry. NSE levels were recorded at 48 and 72 h after CA. The initial Full Outline of UnResponsiveness (FOUR) and Glasgow Coma Scale (GCS) scores were recorded. These variables were categorized using the scorecard method. The primary endpoint was poor neurological outcomes at 6 months. Of the 475 patients, 171 (36%) had good neurological outcomes at 6 months. The areas under the curve (AUCs) of the categorized NSE levels at 72 h, GCS score, and FOUR score were 0.889, 0.722, and 0.779, respectively. The AUCs of the combinations of categorized NSE levels at 72 h with categorized GCS scores and FOUR score were 0.910 and 0.912, respectively. Each combination was significantly higher than the AUC value of the categorized NSE level at 72 h alone (with GCS: p = 0.015; with FOUR: p = 0.026). Combining NSE measurement and initial neurological examination improved the prediction of neurological outcomes.


Assuntos
Parada Cardíaca/patologia , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico/métodos , Fosfopiruvato Hidratase/isolamento & purificação , Feminino , Escala de Coma de Glasgow , Parada Cardíaca/complicações , Parada Cardíaca/genética , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/patologia , Fosfopiruvato Hidratase/genética , Valor Preditivo dos Testes , Prognóstico
8.
J Korean Med Sci ; 35(16): e108, 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32329257

RESUMO

BACKGROUND: Patients who achieve a return of spontaneous circulation (ROSC) with prolonged cardiac arrest have been recognized to have a poor prognosis. This might lead to reluctance in the provision of post-resuscitation care. Hence, we evaluated the impact of cardiac arrest time on neurologic outcomes in out-of-hospital cardiac arrest (OHCA) patients. METHODS: This cross-sectional study used a hospital-based nationwide registry of OHCAs in Korea between 2012 and 2016. All witnessed OHCA patients aged ≥ 15 years and treated with targeted temperature management were included. We collected the time from collapse to sustained ROSC, which was defined as the downtime. The primary outcome was a favorable neurological outcome at hospital discharge. A multiple logistic regression analysis was conducted to determine independent factors for primary outcome in patients with downtime > 30 minutes. RESULTS: Overall, neurologically favorable outcome rates were 30.5% in 1,963 patients. When the downtime was stratified into categories of 0-10, 11-20, 21-30, 31-40, 41-50, 51-60, and > 60 minutes according to 10-minute intervals, neurologically favorable outcome rates were 58.2%, 52.3%, 37.3%, 24.6%, 14.1%, 17.4%, and 16.7%, respectively (P < 0.001). In patients with downtime > 30 minutes, age 51-70 years (odds ratio [OR], 5.35; 95% confidence interval [CI], 2.50-11.49), age ≤ 50 years (OR, 13.16; 95% CI, 6.06-28.57), shockable rhythm (OR, 3.92; 95% CI, 2.71-5.68), bystander resuscitation (OR, 1.80; 95% CI, 1.27-2.55), cardiac cause (OR, 3.50; 95% CI, 1.69-7.25), percutaneous coronary intervention (OR, 1.82; 95% CI, 1.18-2.81), and downtime ≤ 40 minutes (OR, 2.02; 95% CI, 1.42-2.88) were associated with favorable neurological outcomes. CONCLUSION: In patients with prolonged downtime, predicting favorable neurologic outcome may be multifactorial. The cutoff value for downtime is not the only determining factor to provide post-resuscitation care.


Assuntos
Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Adulto , Idoso , Reanimação Cardiopulmonar , Estudos Transversais , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/patologia , Intervenção Coronária Percutânea , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Sci Rep ; 10(1): 1921, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024899

RESUMO

We evaluated the applicability of the neck and sternal notch (SN) as anatomical landmarks for paediatric chest compression (CC) depth using chest computed tomography. The external anteroposterior diameter (EAPD) of the neck and chest at the SN level, mid-point between two landmarks (mid-landmark), and EAPD of the chest at the lower half of the sternum (EDLH) were measured. To estimate the depths of the landmarks from a virtual point at the same height as the position for CC, we calculated the differences between the EAPDs of the neck, SN, mid-landmark, and EDLH. We analysed the relationship between the depths of the landmarks and one-third EDLH using Bland-Altman plots. In all, 506 paediatric patients aged 1-9 years were enrolled. The depths of the neck, SN, and mid-landmark were 53.7 ± 10.0, 37.8 ± 8.5, and 45.8 ± 9.0 mm, respectively. The mean one-third EDLH was 46.8 ± 7.0 mm. The means of the differences between the depths of the neck and one-third EDLH, depths of the SN and one-third EDLH, and depths of the mid-landmark and one-third EDLH were 9.0, -6.9, and 1.0 mm, respectively. The SN and neck are inappropriate landmarks to guide compression depth in paediatric CPR.


Assuntos
Pontos de Referência Anatômicos , Reanimação Cardiopulmonar/métodos , Insuficiência Respiratória/terapia , Fatores Etários , Reanimação Cardiopulmonar/normas , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pescoço/anatomia & histologia , Pescoço/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Pressão , Estudos Retrospectivos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Tórax/anatomia & histologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
J Korean Med Sci ; 34(14): e114, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30977315

RESUMO

BACKGROUND: The 5-level triage tool, the Korean Triage and Acuity Scale (KTAS), was developed based on the Canadian Triage and Acuity Scale and has been used for triage in all emergency medical institutions in Korea since 2016. This study evaluated the association between the decrease in level number and the change in its relative importance for disposition in the emergency department (ED). METHODS: Using the registry of the National Emergency Department Information System (NEDIS) ver. 3.1, data regarding consecutive emergency patients from March 2017 to October 2017 were reviewed retrospectively. Reconfiguring KTAS levels, a total of 15 multinomial logistic regression models (KTAS_0 to KTAS_14), including the KTAS, its variants, and covariates were constructed to determine significant factors affecting ED disposition. The relative importance of each model was obtained using a dominance analysis. RESULTS: A total of 79,771 patients were included in the analysis. In the model KTAS_0, the KTAS and 8 covariates were found to be significantly related to ED disposition. The KTAS and the decision maker of each ED visit, whether it was the physician or others, had the largest relative importance, 34.8% and 31.4%, respectively (P < 0.001). In other models of KTAS variants, including 4-level, 3-level and 2-level, the rates of the KTAS decreased to 31.8% (interquartile range [IQR], 28.9-34.2), 26.4% (IQR, 23.2-31.0), and 18.7% (IQR, 7.5-24.9), respectively (P = 0.016). On the other hand, the rates for covariates tended to be larger for smaller triage levels and so there was a significant interaction effect between the KTAS and the covariates according to the triage level (P < 0.001). CONCLUSION: The 5-level triage tool, the KTAS, had the largest relative importance among the predictors affecting ED disposition only at its original level. Therefore, it is recommended that no attempt should be made to reduce the number of levels in the triage tool.


Assuntos
Serviço Hospitalar de Emergência , Triagem/métodos , Adulto , Idoso , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Pessoa de Meia-Idade , Sistema de Registros , República da Coreia , Estudos Retrospectivos
11.
PLoS One ; 14(3): e0212025, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822313

RESUMO

PURPOSE: We aimed to examine the utility of the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) score as early prognostic predictors of short-term outcomes in patients with carbon monoxide (CO) poisoning. We hypothesized that both the PSS and the SOFA score would be useful prognostic tools. METHODS: This was retrospective observational study of patients with CO poisoning who presented to the emergency department and were admitted for more than 24 hours. We calculated PSS, the initial SOFA score, a second (2nd) SOFA score, and a 24-hour delta SOFA score. The primary outcome was reported as the cerebral performance category (CPC) scale score at discharge. We classified those with CPC 1-2 as the good outcome group and those with CPC 3-5 as the poor outcome group. RESULTS: This study included 192 patients: 174 (90.6%) belonged to the good outcome group, whereas 18 (9.4%) belonged to the poor outcome group. The PSS (1.00 [0.00, 1.00] vs 3.00 [3.00, 3.00], p < 0.001), initial SOFA (1.00 [0.00, 2.00] vs 4.00 [3.25, 6.00], p < 0.001), 2nd SOFA score (0.00 [0.00, 1.00] vs 4.00 [3.00, 7.00], p < 0.001), and 24-hour delta SOFA score (-1.00 [-1.00, 0.00] vs 0.00 [-1.00, 1.00], p = 0.047) of the good outcome group were significantly higher than those of the poor outcome group. The areas under the receiver operating characteristic curve for PSS and the initial SOFA and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944-0.993), 0.945 (95% CI 0.903-0.973), and 0.978 (95% CI 0.947-0.994), respectively. CONCLUSION: The PSS, initial SOFA score, and 2nd SOFA score predict acute poor outcome accurately in patients with CO poisoning.


Assuntos
Intoxicação por Monóxido de Carbono/mortalidade , Monóxido de Carbono/toxicidade , Escores de Disfunção Orgânica , APACHE , Adulto , Área Sob a Curva , Monóxido de Carbono/metabolismo , Serviço Hospitalar de Emergência , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
12.
Medicine (Baltimore) ; 97(37): e12256, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30212960

RESUMO

Lateral neck radiography is often used as a screening tool in emergency departments for suspected acute epiglottitis. The qualitative radiographic signs have been mainly used. The aim of this study was to evaluate the accuracy of objective radiographic parameters to aid diagnosis of acute epiglottitis.Patients who were diagnosed with acute epiglottitis from January 2006 to December 2016 were included in this case-control study. Control subjects with normal lateral neck radiograph findings were included at a 1:4 ratio during the same period. The clinical findings of the patients were assessed from electronic medical records and radiographs were interpreted by a board-certified radiologist and a board-certified emergency medicine physician. The widths of the 3rd cervical vertebral body, epiglottis base (EWB), epiglottis tip (EWT), aryepiglottic fold (AFW), and hypopharynx, as well as the dimensions of the retropharyngeal and retrotracheal soft tissues, were retrospectively measured. The sensitivity, specificity, and receiver operating characteristic (ROC) curves were analyzed for the measured parameters, and cutoff values were determined to predict acute epiglottitis. The predictive cutoff values of radiologic parameters were evaluated using 5-fold cross-validation.A total 260 epiglottitis patients and 1166 controls were included in the study. In the ROC curve analysis, the EWB had an area under the ROC curve (AUROC) of 0.99 for a cutoff value of 5.02 mm (sensitivity, 96.2%; specificity, 98.2%). The EWT had an AUROC of 0.97 for a cutoff value of 4.84 mm (sensitivity, 91.2%; specificity, 97.3%). The AFW had an AUROC of 0.88 for a cutoff value of 6.59 mm (sensitivity, 86.5%; specificity, 78.8%). The 5-fold cross-validation achieved AUROCs of 0.97 for EWB, 0.94 for EWT, and 0.83 for AFW.The objective radiographic parameters in lateral neck radiography may be useful in diagnosing acute epiglottitis. Further prospective studies may be warranted to evaluate the diagnostic performance in actual clinical practice.


Assuntos
Epiglotite/diagnóstico por imagem , Epiglotite/patologia , Doença Aguda , Adulto , Idoso , Estudos de Casos e Controles , Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Hipofaringe/anatomia & histologia , Hipofaringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Valores de Referência , Estudos Retrospectivos
13.
Pediatr Crit Care Med ; 19(1): e1-e6, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29135701

RESUMO

OBJECTIVE: The 2015 American Heart Association guidelines recommended pediatric rescue chest compressions of at least one-third the anteroposterior diameter of the chest, which equates to approximately 5 cm. This study evaluated the appropriateness of these two types by comparing their safeties in chest compression depth simulated by CT. DESIGN: Retrospective study with data analysis conducted from January 2005 to June 2015 SETTING:: Regional emergency center in South Korea. PATIENTS: Three hundred forty-nine pediatric patients 1-9 years old who had a chest CT scan. INTERVENTIONS: Simulation of chest compression depths by CT. MEASUREMENTS AND MAIN RESULTS: Internal and external anteroposterior diameter of the chest and residual internal anteroposterior diameter after simulation were measured from CT scans. The safe cutoff levels were differently applied according to age. One-third external anteroposterior diameters were compared with an upper limit of chest compression depth recommended for adults. Primary outcomes were the rates of overcompression to evaluate safety. Overcompression was defined as a negative value of residual internal anteroposterior diameter-age-specific cutoff level. Using a compression of 5-cm depth simulated by chest CT, 16% of all children (55/349) were affected by overcompression. Those 1-3 years old were affected more than those 4-9 years old (p < 0.001). Upon one-third compression of chest anteroposterior depth, only one subject (0.3%) was affected by overcompression. Rate of one-third external anteroposterior diameter greater than 6 cm in children 8 and 9 years old was 16.1% and 33.3%, respectively. CONCLUSIONS: A chest compression depth of one-third anteroposterior might be more appropriate than the 5-cm depth chest compression for younger Korean children. But, one-third anteroposterior depth chest compression might induce deep compressions greater than an upper limit of compression depth for adults in older Korean children.


Assuntos
Massagem Cardíaca/métodos , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , American Heart Association , Criança , Pré-Escolar , Simulação por Computador , Feminino , Massagem Cardíaca/efeitos adversos , Massagem Cardíaca/normas , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , República da Coreia , Estudos Retrospectivos , Estados Unidos
14.
Crit Care ; 21(1): 322, 2017 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-29268775

RESUMO

BACKGROUND: When an out-of-hospital cardiac arrest (OHCA) patient receives cardiopulmonary resuscitation (CPR) in the emergency department (ED), blood laboratory test results can be obtained by using point-of-care testing during CPR. In the present study, the relationship between blood laboratory test results during CPR and outcomes of OHCA patients was investigated. METHODS: This study was a multicenter retrospective analysis of prospective registered data that included 2716 OHCA patients. Data from the EDs of three university hospitals in different areas were collected from January 2009 to December 2014. Univariate and multivariable analyses were conducted to elucidate the factors associated with survival to discharge and neurological outcomes. A final analysis was conducted by including patients who had no prehospital return of spontaneous circulation and those who underwent rapid blood laboratory examination during CPR. RESULTS: Overall, 2229 OHCA patients were included in the final analysis. Among them, the rate of survival to discharge and a good Cerebral Performance Categories Scale score were 14% and 4.4%, respectively. The pH level was independently related to survival to hospital discharge (adjusted OR 6.287, 95% CI 2.601-15.197; p < 0.001) and good neurological recovery (adjusted OR 15.395, 95% CI 3.439-68.911; p < 0.001). None of the neurologically intact patients had low pH levels (< 6.8) or excessive potassium levels (> 8.5 mEq/L) during CPR. CONCLUSIONS: Among the blood laboratory test results during CPR of OHCA patients, pH and potassium levels were observed as independent factors associated with survival to hospital discharge, and pH level was considered as an independent factor related to neurological recovery.


Assuntos
Concentração de Íons de Hidrogênio , Parada Cardíaca Extra-Hospitalar/induzido quimicamente , Idoso , Gasometria/métodos , Gasometria/estatística & dados numéricos , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Imediatos , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo
15.
Hum Exp Toxicol ; 36(5): 431-437, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27387349

RESUMO

OBJECTIVE: This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. MATERIAL AND METHODS: The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. RESULTS: A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. CONCLUSION: The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.


Assuntos
APACHE , Herbicidas/intoxicação , Escores de Disfunção Orgânica , Paraquat/intoxicação , Escore Fisiológico Agudo Simplificado , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
16.
Am J Emerg Med ; 34(12): 2326-2330, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27727067

RESUMO

OBJECTIVE: The general incidence of intracranial hemorrhage (ICH) as a cause of out-of-hospital cardiac arrest (OHCA) remains unclear, although the incidence of subarachnoid hemorrhage has been determined to be 4% to 18%. The main objectives of our study were to describe the incidence of ICH in OHCA and the different laboratory findings between ICH and non-ICH groups. METHODS: A retrospective cohort study using the prospective OHCA registry was conducted at three university hospitals in Korea. All cases of OHCA that occurred over a period of 6 years, from January 2009 to December 2014, were examined. Pre-hospital and in-hospital variables and laboratory data taken during CPR were examined in order to compare the ICH and non-ICH groups. RESULTS: A total of 2716 patients with OHCA were registered in the database. Among the 804 patients included in the final analysis, ICH was the cause of cardiac arrest in 92 patients (11.4%). Of those with ICH, 79 (86%) patients also had subarachnoid hemorrhage. No patient had a good neurological outcome in the ICH group. There were statistically significant differences in gender, age, pre-hospital return of spontaneous circulation, survival to hospital discharge, good neurologic outcomes, serum sodium, potassium, glucose, Pco2, and Po2 during CPR between the ICH and non-ICH groups. In multivariate analysis, gender, age, potassium, glucose and Po2 levels differed significantly between the two groups. CONCLUSIONS: OHCA patients with confirmed ICH were identified in about 11% of cases after return of spontaneous circulation. Gender, age, higher glucose, and lower potassium and Po2 levels during CPR were associated with ICH.


Assuntos
Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/etiologia , Fatores Etários , Idoso , Glicemia/metabolismo , Reanimação Cardiopulmonar , Feminino , Humanos , Incidência , Hemorragias Intracranianas/sangue , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Oxigênio/sangue , Pressão Parcial , Potássio/sangue , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/epidemiologia , Taxa de Sobrevida
17.
Basic Clin Pharmacol Toxicol ; 119(6): 604-610, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27224736

RESUMO

An increasing number of suicide attempts involve the ingestion of glyphosate surfactant; hence, clinical toxicologists may encounter severe cases of glyphosate surfactant intoxication. In several other clinical conditions, serum lactate is used to predict outcome. We investigated the relationship between lactate levels and 30-day mortality from glyphosate surfactant poisoning. This retrospective analysis involved 232 patients who were admitted to the emergency department after acute glyphosate surfactant poisoning between January 2004 and June 2014. We used a receiver operating characteristic (ROC) curve to define the optimal cut-off point for lactate levels. A Kaplan-Meier 30-day survival curve was then analysed in terms of the defined cut-off level. We used multi-variate Cox proportional hazards regression analysis to determine the risk factors for 30-day mortality. Of the 232 patients, 29 died, yielding a case fatality rate of 12.5%. Lactate was significantly higher in non-survivors (6.5 ± 3.1 mmol/L) than in survivors (3.3 ± 2.2 mmol/L; p < 0.001), and elevated lactate was significantly associated with 30-day mortality. The area under the ROC curve of lactate levels was 0.836 [95% confidence interval (CI): 0.716-0.869]. Lactate levels higher than 4.7 mmol/L were associated with increased mortality in multi-variable analysis (hazard ratio: 3.2; 95% CI: 1.1-8.7). Besides lactate, age >59 years, corrected QT interval >495 ms and potassium >5.5 mmol/L were independent risk factors for 30-day mortality. Lactate is an independent predictor of 30-day mortality in patients with glyphosate surfactant poisoning. Early measurement of lactate levels may be a simple and practical way to assess the severity of intoxication.


Assuntos
Glicina/análogos & derivados , Herbicidas/toxicidade , Ácido Láctico/sangue , Intoxicação por Organofosfatos/sangue , Testes Imediatos , Tensoativos/toxicidade , Centros Médicos Acadêmicos , Biomarcadores/sangue , Estudos de Coortes , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Glicina/toxicidade , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação por Organofosfatos/diagnóstico , Intoxicação por Organofosfatos/mortalidade , Intoxicação por Organofosfatos/terapia , Prognóstico , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Tentativa de Suicídio , Análise de Sobrevida , Glifosato
18.
J Korean Med Sci ; 30(9): 1347-53, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26339178

RESUMO

The change of compressing personnel will inevitably accompany hands off time when cardiopulmonary resuscitation (CPR) is performed by two or more rescuers. The present study assessed whether changing compression by a second rescuer located on the opposite side (OS) of the first rescuer can reduce hands-off time compared to CPR on the same side (SS) when CPR is performed by two rescuers. The scenario of this randomized, controlled, parallel simulation study was compression-only CPR by two laypersons in a pre-hospital situation. Considering sex ratio, 64 participants were matched up in 32 teams equally divided into two gender groups, i.e. , homogenous or heterogeneous. Each team was finally allocated to one of two study groups according to the position of changing compression (SS or OS). Every team performed chest compression for 8 min and 10 sec, with chest compression changed every 2 min. The primary endpoint was cumulative hands-off time. Cumulative hands-off time of the SS group was about 2 sec longer than the OS group, and was significant (6.6 ± 2.6 sec vs. 4.5 ± 1.5 sec, P = 0.005). The range of hands off time of the SS group was wider than for the OS group. The mean hands-off times of each rescuer turn significantly shortened with increasing number of turns (P = 0.005). A subgroup analysis in which cumulative hands-off time was divided into three subgroups in 5-sec intervals revealed that about 70% of the SS group was included in subgroups with delayed hands-off time ≥ 5 sec, with only 25% of the OS group included in these subgroups (P = 0.033). Changing compression at the OS of each rescuer reduced hands-off time compared to the SS in prehospital hands-only CPR provided by two bystanders.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca/prevenção & controle , Massagem Cardíaca/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Reanimação Cardiopulmonar/métodos , Feminino , Parada Cardíaca/epidemiologia , Massagem Cardíaca/métodos , Humanos , Masculino , República da Coreia/epidemiologia , Resultado do Tratamento , Adulto Jovem
19.
Am J Emerg Med ; 33(5): 691-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25800412

RESUMO

INTRODUCTION: This study was designed to compare the performances of 4 airway devices in achieving successful ventilation. METHODS: A randomized crossover trial was conducted to evaluate 4 airway devices: laryngeal mask airway (LMA), i-gel (iGEL), PENTAX Airway Scope (AWS), and Macintosh laryngoscope (MCL). Thirty-eight unskilled rescuers performed intubation on a manikin during chest compressions in normal and difficult airway scenarios. The time to ventilation, intubation success rate, and difficulty of intubation were measured. RESULTS: The time to ventilation of the airway devices in the normal scenario had a median value of 8.8 seconds (interquartile range, 7.3-10.5 seconds) for iGEL, 16.1 seconds (13.9-19.3 seconds) for LMA, 30.6 seconds (24.6-37.6 seconds) for AWS, and 35.0 seconds (29.5-45.9 seconds) for MCL. In the difficult airway scenario, the respective time to ventilation was 8.6 seconds (7.8-10.0 seconds), 15.3 seconds (14.3-20.2 seconds), 29.4 seconds (25.7-36.3 seconds) and 59.0 seconds (46.1-103.3 seconds). The success rates were 100% and 100% for LMA, 100% and 100% for iGEL, 97.4% and 94.7% for AWS, and 78.9% and 47.4% for MCL in the normal and difficult airway scenarios. The difficulties of intubation expressed as numerical rating scale were 2.0 and 2.0 (median values) for LMA, 1.0 and 2.0 for iGEL, 3.0 and 3.0 for AWS, and 4.0 and 5.0 for MCL in the normal and difficult airway scenarios, respectively. CONCLUSION: With novice intubators who were unfamiliar with the airway devices, the LMA, iGEL, and AWS were superior to the MCL for establishing an airway without interruption of chest compressions in a manikin study. Intubation with the iGEL was faster and easier than with the other airway devices.


Assuntos
Medicina de Emergência/educação , Intubação Intratraqueal/instrumentação , Manequins , Competência Clínica , Estudos Cross-Over , Feminino , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
20.
Scand J Trauma Resusc Emerg Med ; 22: 59, 2014 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-25348723

RESUMO

OBJECTIVE: We aimed to compare rescuer fatigue and cardiopulmonary resuscitation (CPR) quality between standard 30:2 CPR (ST-CPR) and chest compression only CPR (CO-CPR) performed for 8 minutes on a realistic manikin by following the 2010 CPR guidelines. METHODS: All 36 volunteers (laypersons; 18 men and 18 women) were randomized to ST-CPR or CO-CPR at first, and then each CPR technique was performed for 8 minutes with a 3-hour rest interval. We measured the mean blood pressure (MBP) of the volunteers before and after performing each CPR technique, and continuously monitored the heart rate (HR) of the volunteers during each CPR technique using the MRx monitor. CPR quality measures included the depth of chest compression (CC) and the number of adequate CCs per minute. RESULTS: The adequate CC rate significantly differed between the 2 groups after 2 minutes, with it being higher in the ST-CPR group than in the CO-CPR group. Additionally, the adequate CC rate significantly differed between the 2 groups during 8 minutes for male volunteers (p =0.012). The number of adequate CCs was higher in the ST-CPR group than in the CO-CPR group after 3 minutes (p =0.001). The change in MBP before and after performing CPR did not differ between the 2 groups. However, the change in HR during 8 minutes of CPR was higher in the CO-CPR group than in the ST-CPR group (p =0.007). CONCLUSIONS: The rate and number of adequate CCs were significantly lower with the CO-CPR than with the ST-CPR after 2 and 6 minutes, respectively, and performer fatigue was higher with the CO-CPR than with the ST-CPR during 8 minutes of CPR.


Assuntos
Reanimação Cardiopulmonar/métodos , Fidelidade a Diretrizes , Parada Cardíaca/terapia , Massagem Cardíaca/métodos , Manequins , Adolescente , Estudos Cross-Over , Feminino , Seguimentos , Humanos , Masculino , Pressão , Estudos Prospectivos , Fatores de Tempo
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