National Follow-up Survey of Preventable Trauma Death Rate in Korea

Background@#The preventable trauma death rate survey is a basic tool for the quality management of trauma treatment because it is a method that can intuitively evaluate the level of national trauma treatment. We conducted this study as a national biennial follow-up survey project and report the results of the review of the 2019 trauma death data in Korea. @*Methods@#From January 1, 2019 to December 31, 2019, of a total of 8,482 trauma deaths throughout the country, 1,692 were sampled from 279 emergency medical institutions in Korea. All cases were evaluated for preventability of death and opportunities for improvement using a multidisciplinary panel review approach. @*Results@#The preventable trauma death rate was estimated to be 15.7%. Of these, 3.1% were judged definitive preventable deaths, and 12.7% were potentially preventable deaths. The odds ratio for preventable traumatic death was 2.56 times higher in transferred patients compared to that of patients who visited the final hospital directly. The group that died 1 hour after the accident had a statistically significantly higher probability of preventable death than that of the group that died within 1 hour after the accident. @*Conclusion@#The preventable trauma death rate for trauma deaths in 2019 was 15.7%, which was 4.2%p lower than that in 2017. To improve the quality of trauma treatment, the transfer of severe trauma patients to trauma centers should be more focused.

Therapeutic effects of stiripentol against ischemia-reperfusion injury in gerbils focusing on cognitive deficit, neuronal death, astrocyte damage and blood brain barrier leakage in the hippocampus

Stiripentol is an anti-epileptic drug for the treating of refractory status epilepticus. It has been reported that stiripentol can attenuate seizure severity and reduce seizure-induced neuronal damage in animal models of epilepsy. The objective of the present study was to investigate effects of post-treatment with stiripentol on cognitive deficit and neuronal damage in the cornu ammonis 1 (CA1) region of the hippocampus proper following transient ischemia in the forebrain of gerbils. To evaluate ischemia-induced cognitive impairments, passive avoidance test and 8-arm radial maze test were performed. It was found that post-treatment with stiripentol at 20 mg/kg, but not 10 or 15 mg/kg, reduced ischemia-induced memory impairment. Transient ischemia-induced neuronal death in the CA1 region was also significantly attenuated only by 20 mg/kg stiripentol treatment after transient ischemia. In addition, 20 mg/kg stiripentol treatment significantly decreased ischemia-induced astrocyte damage and immunoglobulin G leakage. In brief, stiripentol treatment after transient ischemia ameliorated transient ischemia-induced cognitive impairment in gerbils, showing that pyramidal neurons were protected and astrocyte damage and blood brain barrier leakage were significantly attenuated in the hippocampus. Results of this study suggest stiripentol can be developed as a candidate of therapeutic drug for ischemic stroke.

The outcomes of pesticide poisoning in accordance with toxicity grade: is the slightly hazardous toxicity not harmful?

Objective@#Emergency physicians frequently encounter suicidal attempt patients. Some of the patients are intoxicated with the pesticides. Unlike medical drugs, finding out detailed information in terms of human toxicity is not easy. In Korea, there is the crop protection substance guidebook, and the toxicity grade is noted in that book. However, little is known about the patients’ characteristics and outcomes with slightly hazardous substances. @*Methods@#This is a retrospective, single-center study. The study duration was 2 years. We investigated the pesticideintoxicated patients who visited our emergency department. The patients were divided according to toxicity grades, including slightly hazardous, moderately hazardous, highly hazardous and extremely hazardous. Initial vital signs, mental status, laboratory values, therapeutic modalities and therapeutic outcomes were investigated. @*Results@#Among a total of 472 patients, 110 (23.3%) were pesticide-intoxicated patients. Intensive care unit (ICU) admission rate and mortality rate were higher, and ICU admission duration was longer in the pesticide-intoxicated patients. The deterioration of initial arterial blood gas values (41.2%), hypokalemia or hyperkalemia (32.4%), acute kidney injury (17.6%), troponin elevation (8.8%), and rhabdomyolysis (3.4%) were noted in the slightly hazardous group. Continuous renal replacement therapy, endotracheal intubation and vasopressor use were performed in some of them. The seizure, shock and cardiac arrest were also developed. More than half of patients (52.9%) were admitted to the ICU. @*Conclusion@#Significant limitation of relying on the toxicity grade was noted. In the low-grade toxicity pesticide group, some patients were deteriorated. Therefore, caution is needed when treating pesticide intoxication patients.

The characteristics of the transported patients from the scene by helicopter emergency medical services in Korea: a single center study

Objective@#The helicopter emergency medical service (HEMS) is operated in Korea for seriously ill patients or time-sensitive conditions such as major trauma, acute coronary syndrome, and acute stroke. The patients are transported directly from the scene of the incident or from other hospitals. However, little is known about the characteristics of these patients. @*Methods@#This was a retrospective, single-center study. The study period was from 2016 to 2020. The helicopter was available during the daytime. We compared the flight distances, flight duration, and admission rate between those transferred from the scene of the incident and those transferred from the hospitals. We investigated the discharge or transfer rate from the emergency department and the precise reasons for the same. @*Results@#Of a total of 1,345 patients, 70 (5.2%) were transported directly from the scene of the incident. Of these, 23 (32.9% of patients from the scene) were transported from islands. The most frequent request calls were made by emergency medical services. Of the patients, 27.1% of those from the scene were discharged from the emergency department or transferred to another hospital. The discharge or transfer rate was higher in the scene-transported group (27.1% vs. 8.2%, P<0.001). @*Conclusion@#The discharge or transfer rate of patients transported from the scene was high. In some cases, unexpected negative effects may occur during the use of the HEMS and hence the crew must weigh the risk vs. benefit of helicopter transportation.

Best practice guideline for patients requiring discharge against medical advice from emergency department

Discharge against medical advice remains a problematic issue worldwide because it may not only lead to adverse medical outcomes for the patients but also medicolegal problems for emergency physicians. Recently, there have been cases in Korea in which a patient in the emergency room, who had been discharged from hospital without following medical instructions, filed a lawsuit against the hospital and emergency medical staff for their responsibility for their worsening disease since discharge. The court acknowledged the responsibility of the medical staff. To minimize the legal risk and reach the optimal ethical standard for these patients, this paper suggests the best practice guideline for the emergency physicians for patients who request discharge against medical advice from the emergency department in Korea.

Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

Introduction and characteristics of helicopter emergency medical services

Helicopter emergency medical services (HEMS) are a part of air medical services. The transportation of patients using helicopters or airplanes is a core element of the air medical services. HEMS have developed from militarybased transportation, which used helicopters on the battlefield. HEMS have played an important role in properly transporting critical patients before the golden time elapses. The optimal strategies for the operation of HEMS at any emergency medical system are dependent on the characteristics of the regional emergency medical system, diversitiy of HEMS organizations, and the legal background of each country. Therefore, every participant, including the government, medical personnel, and HEMS organizations, should concentrate their efforts toward the establishment of HEMS. Other than the factors related to patients, the key element in facilitating the establishment of HEMS is the safety of the flight and crew members.

Visual Outcomes after Bilateral Implantation of an Extended Depth of Focus Intraocular Lens: A Multicenter Study

Purpose@#To evaluate visual performance after bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL). @*Methods@#This multicenter, prospective, observational study included 100 patients who underwent bilateral cataract surgery with a toric or non-toric EDOF IOL (Tecnis Symfony), and 96 patients completed the final assessment at 4 to 6 months. Binocular corrected distance visual acuity and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA), spectacle independence, visual symptoms, and patient satisfaction were evaluated. @*Results@#Mean decimal visual acuity results showed a binocular corrected distance visual acuity of 1.10 ± 0.18, UDVA of 1.04 ± 0.17, UIVA of 0.96 ± 0.16, and UNVA of 0.68 ± 0.18. Binocular UDVA and UIVA were 0.8 (decimal) or better in 98% and 94% of patients, respectively. Binocular UNVA was 0.63 (decimal) or better in 76% of patients. Overall, 76% of the patients achieved spectacle independence across all distances, and more than 85% reported no or mild dysphotoptic phenomena. On a scale of 0 to 10, the median patient satisfaction score was 9 for far, 9.5 for intermediate, and 8 for near vision. @*Conclusions@#The Symfony EDOF IOL provided excellent distance, intermediate visual outcome, and functional near visual acuity. The visual results were associated with prominent levels of spectacle independence and patient satisfaction.

Analysis of the cardiopulmonary resuscitation-related complications based on computed tomography

Objective@#High-quality cardiopulmonary resuscitation (CPR) needs to be provided to cardiac arrest victims. The chest compression at a 5-6 cm depth and 100-120 beats per minute are recommended according to the 2015 CPR guidelines. The physical forces to the patient’s chest wall cause inevitable complications. This study analyzed the CPR-related complications based on computed tomography (CT). @*Methods@#This was a retrospective, single-center study. The study period was from 2009 to 2019. The cardiac arrest victims received the CPR in or out-of-hospital. After the return of spontaneous circulation, CTs were performed on some survivors. The complications detected on CTs were reviewed, and the types and frequencies of complications, age, sex, arrest location, CPR duration, the survival discharge were investigated. @*Results@#Among 1,357 cardiac arrest patients during the study period, 368 patients were enrolled. The average age was 64.2, and 66.3% were male. The average CPR duration was 24.6 minutes. The most frequent complication was rib fracture (73.6%). Lung contusion (41.3%), hemothorax (22.0%), sternal fracture (19.3%), and retrosternal hemorrhage (13.6%) were also detected. Those with rib fractures, sternal fractures, and retrosternal hemorrhage were older (P<0.001). Those with rib fractures, lung contusion, hemothorax received longer CPR (P=0.032, P=0.003, and P=0.041). Low survival discharge rates were observed in patients with rib fractures, sternal fractures, and pneumothorax (P=0.002, P=0.014, and P=0.016). @*Conclusion@#The rib fracture, sternal fracture, and retrosternal hemorrhage were frequent in older patients. Those with rib fractures, lung contusion, or hemothorax received the longer CPR. The survival discharge rates were low in the rib fracture, sternal fracture, pneumothorax patients.

Analysis of the treatment-time reduction of ST elevation myocardial infarction patients transferred by helicopter-based emergency medical services in Korea

Objective@#ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy, and the first medical contact (FMC) to percutaneous coronary intervention (PCI) time within 120 minutes is recommended. Therefore, early recognition and rapid transportation of STEMI patients to the PCI-capable hospital are important. This study analyzed the time reduction effect of STEMI patients who were transferred by a helicopter. @*Methods@#This was a retrospective, single-center study. The study period was from 2016 to 2017. An air ambulance was available based on the 24-hour PCI capable hospital. This study selected STEMI patients who were transferred from other hospitals in six regions. The transfer distances, time factors, and treatment outcomes in those transferred by helicopter and those transferred by ambulance were compared. @*Results@#Among 88 STEMI patients from six regions, 38 (43.2%) and 50 (56.8%) were transferred by helicopter and ambulance, respectively. The average transfer distances were longer in the helicopter-transfer group (92.7 km vs. 82.4 km, P=0.004). The transfer time, call-to-lab time, door-to-balloon time, and FMC-to-PCI time were shorter in the helicopter-transfer group. The proportion of FMC-to-PCI within 120 minutes was higher in the helicopter-transfer group (40.5% vs. 11.4%, P=0.002). @*Conclusion@#Helicopter-transfer reduced the FMC-to-PCI time, including the transfer time and call-to-lab time. Therefore, a higher proportion of time-targeted treatment was achieved.

Analysis of the cardiopulmonary resuscitation-related complications based on computed tomography

Objective@#High-quality cardiopulmonary resuscitation (CPR) needs to be provided to cardiac arrest victims. The chest compression at a 5-6 cm depth and 100-120 beats per minute are recommended according to the 2015 CPR guidelines. The physical forces to the patient’s chest wall cause inevitable complications. This study analyzed the CPR-related complications based on computed tomography (CT). @*Methods@#This was a retrospective, single-center study. The study period was from 2009 to 2019. The cardiac arrest victims received the CPR in or out-of-hospital. After the return of spontaneous circulation, CTs were performed on some survivors. The complications detected on CTs were reviewed, and the types and frequencies of complications, age, sex, arrest location, CPR duration, the survival discharge were investigated. @*Results@#Among 1,357 cardiac arrest patients during the study period, 368 patients were enrolled. The average age was 64.2, and 66.3% were male. The average CPR duration was 24.6 minutes. The most frequent complication was rib fracture (73.6%). Lung contusion (41.3%), hemothorax (22.0%), sternal fracture (19.3%), and retrosternal hemorrhage (13.6%) were also detected. Those with rib fractures, sternal fractures, and retrosternal hemorrhage were older (P<0.001). Those with rib fractures, lung contusion, hemothorax received longer CPR (P=0.032, P=0.003, and P=0.041). Low survival discharge rates were observed in patients with rib fractures, sternal fractures, and pneumothorax (P=0.002, P=0.014, and P=0.016). @*Conclusion@#The rib fracture, sternal fracture, and retrosternal hemorrhage were frequent in older patients. Those with rib fractures, lung contusion, or hemothorax received the longer CPR. The survival discharge rates were low in the rib fracture, sternal fracture, pneumothorax patients.

Analysis of the treatment-time reduction of ST elevation myocardial infarction patients transferred by helicopter-based emergency medical services in Korea

Objective@#ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy, and the first medical contact (FMC) to percutaneous coronary intervention (PCI) time within 120 minutes is recommended. Therefore, early recognition and rapid transportation of STEMI patients to the PCI-capable hospital are important. This study analyzed the time reduction effect of STEMI patients who were transferred by a helicopter. @*Methods@#This was a retrospective, single-center study. The study period was from 2016 to 2017. An air ambulance was available based on the 24-hour PCI capable hospital. This study selected STEMI patients who were transferred from other hospitals in six regions. The transfer distances, time factors, and treatment outcomes in those transferred by helicopter and those transferred by ambulance were compared. @*Results@#Among 88 STEMI patients from six regions, 38 (43.2%) and 50 (56.8%) were transferred by helicopter and ambulance, respectively. The average transfer distances were longer in the helicopter-transfer group (92.7 km vs. 82.4 km, P=0.004). The transfer time, call-to-lab time, door-to-balloon time, and FMC-to-PCI time were shorter in the helicopter-transfer group. The proportion of FMC-to-PCI within 120 minutes was higher in the helicopter-transfer group (40.5% vs. 11.4%, P=0.002). @*Conclusion@#Helicopter-transfer reduced the FMC-to-PCI time, including the transfer time and call-to-lab time. Therefore, a higher proportion of time-targeted treatment was achieved.

The comparisons of prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests

OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.

Inter-rater agreement of Korean Triage and Acuity Scale between emergency physicians and nurses

OBJECTIVE: The Korean Triage and Acuity Scale (KTAS) has been used in all emergency departments (EDs) since 2016. Medical personnel can provide the treatment priority based on the KTAS levels. The inter-rater agreement with KTAS has not been reported, even though most triage assignments are performed by nurses in Korea. This study was aimed to verify the agreement of triage levels between emergency physicians (EPs) and nurses with KTAS. METHODS: This was a prospective, single-center study of an academic tertiary medical center. If the patient visits the ED, the triage nurse and EP meet the patients together. The nurse performed the history taking and physical examinations including vital signs measurements then recorded the KTAS levels. The EP did not interfere with the nurse's decision. The EP also decided the KTAS levels. The designated codes and levels were compared. The EP recorded the detailed reasons for the disagreement if there was discrepancy. RESULTS: Comparisons were performed with 928 patients. The number of patients in each KTAS level was 95 (10.2%) in level I, 263 (28.3%) in level II, 348 (37.5%) in level III, 144 (15.5%) in level IV, and 78 (8.4%) in level V. The overall agreement was 761 (82%), and the Kappa coefficient was 0.691. The errors of history taking were most frequent (131, 78.4%). Insufficient understanding of the disease pathophysiology, inaccurate neurological examinations, and errors that did not consider the vital signs except for the blood pressure were encountered in 12 (7.2%). CONCLUSION: The agreement rate was high between EPs and nurses using KTAS (K=0.691, substantial agreement).

The efficacy of modified focused assessment with sonography for trauma: a pilot study

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is used routinely for evaluating patients with major trauma. After a primary survey, the existence of hemoperitoneum or hemopericardium must be searched using FAST. Traditionally, hemopericardium can be assessed through the subcostal approach with the curved probe for the abdomen. On the other hand, satisfactory images (four chamber view) are difficult to obtain with this approach. METHODS: This was a prospective, single-center pilot study of an academic tertiary medical center. When FAST is performed on the patients, traditional FAST (subcostal approach with the curved probe) is generally conducted. During a FAST examination, the time consumed, numeric rating scale (NRS) for pain, and success rate of satisfactory images are recorded. After the traditional FAST was used, we used the curved probe like echo probe. The curved probe was positioned beside the left nipple with the probe marker opposite-sided (modified FAST) like the parasternal long-axis view of echocardiography. Finally, the existence of hemopericardium is confirmed using an echo probe. In this study, the consumed time, NRS, and success rate of satisfactory images were compared. RESULTS: The consumed time was shorter (57.4 vs. 71.2 seconds, P<0.001) and the pain score was lower (0.1 vs. 1.8, P<0.001) with the modified FAST compared to the traditional FAST. Satisfactory images were obtained in 23 cases (51%) with traditional FAST, whereas satisfactory images were obtained in 37 cases (82%) using modified FAST. CONCLUSION: Mvodified FAST is more accurate for the detection of hemopericardium than traditional FAST. The pain is less severe and the time consumed is shorter.

Oculomotor nerve palsy associated with internal carotid artery: case reports

Oculomotor nerve palsy limits the specific direction eyeball movement, and represents diplopia, mydriasis, and ptosis. The vascular-associated etiologies of oculomotor nerve palsy are the microvascular ischemia due to hypertension or diabetes, or compression of the nerve by the aneurysm. For the aneurysm, if not treated properly, it may result in mortality or severe neurological impairment. Thorough history taking, physical examinations, and proper imaging modality are needed to make an accurate diagnosis. A 76-year-old female with decreased mentality and anisocoria presented at our emergency department. An 83-year-old female presented with right ptosis and lateral-side deviated of the right eyeball. No definite lesion was noted on the initial non-contrast brain computed tomography (CT) and magnetic resonance imaging diffusion. An aneurysm was detected on CT angiography taken several hours later in the former patient. For the latter patient, a giant aneurysm was detected on magnetic resonance angiography that had been performed at another hospital 4 days earlier. These two patients underwent transfemoral cerebral angiography with coiling. They were discharged with no neurological sequelae.

Similar Operative Outcomes between the da Vinci Xi® and da Vinci Si® Systems in Robotic Gastrectomy for Gastric Cancer

PURPOSE: The robotic system for surgery was introduced to gastric cancer surgery in the early 2000s to overcome the shortcomings of laparoscopic surgery. The more recently introduced da Vinci Xi® system offers benefits allowing four-quadrant access, greater range of motion, and easier docking through an overhead boom rotation with laser targeting. We aimed to identify whether the Xi® system provides actual advantages over the Si® system in gastrectomy for gastric cancer by comparing the operative outcomes. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent robotic gastrectomy as treatment for gastric cancer from March 2016 to March 2017. Patients' demographic data, perioperative information, and operative and pathological outcomes were collected and analyzed. RESULTS: A total of 109 patients were included in the Xi® group and 179 in the Si® group. Demographic characteristics were similar in both groups. The mean operative time was 229.9 minutes in the Xi® group and 223.7 minutes in the Si® group. The mean estimated blood loss was 72.7 mL in the Xi® group and 62.1 mL in the Si® group. No patient in the Xi® group was converted to open or laparoscopy, while 3 patients in the Si® group were converted, 2 to open surgery and 1 to laparoscopy, this difference was not statistically significant. Bowel function was resumed 3 days after surgery, while soft diet was initiated 4 days after surgery. CONCLUSIONS: We found no difference in surgical outcomes after robotic gastrectomy for gastric cancer between the da Vinci Xi® and da Vinci Si® procedures.

A Carbon Monoxide Poisoning Case in Which Hyperbaric Oxygen Therapy Was Not Possible Due to Iatrogenic Pneumothorax after Unnecessary Central Catheterization

Hyperbaric oxygen therapy (HBOT) is used to treat carbon monoxide (CO) poisoning. However, untreated pneumothorax is an absolute contraindication for HBOT. More caution is needed with regard to monoplace hyperbaric chambers, as patient monitoring and life-saving procedures are impossible inside these chambers. Central catheterization is frequently used for various conditions, but unnecessary catheterization must be avoided because of the risk of infection and mechanical complications. Herein, we describe a case of CO poisoning in which iatrogenic pneumothorax developed after unnecessary subclavian central catheterization. The patient did not need to be catheterized, and HBOT could not be performed because of the pneumothorax. Hence, this case reminds us of basic—but nonetheless important—principles of catheterization.

Single Ventilation during Cardiopulmonary Resuscitation Results in Better Neurological Outcomes in a Porcine Model of Cardiac Arrest

PURPOSE: Recent basic life support (BLS) guidelines recommend a 30:2 compression-to-ventilation ratio (CV2) or chest compression-only cardiopulmonary resuscitation (CC); however, there are inevitable risks of interruption of high-quality cardiopulmonary resuscitation (CPR) in CV2 and hypoxemia in CC. In this study, we compared the short-term outcomes among CC, CV2, and 30:1 CV ratio (CV1). MATERIALS AND METHODS: In total, 42 pigs were randomly assigned to CC, CV1, or CV2 groups. After induction of ventricular fibrillation (VF), we observed pigs for 2 minutes without any intervention. Thereafter, BLS was started according to the assigned method and performed for 8 minutes. Defibrillation was performed after BLS and repeated every 2 minutes, followed by rhythm analysis. Advanced cardiac life support, including continuous chest compression with ventilation every 6 seconds and intravenous injection of 1 mg epinephrine every 4 minutes, was performed until the return of spontaneous circulation (ROSC) or 22 minutes after VF induction. Hemodynamic parameters and arterial blood gas profiles were compared among groups. ROSC, 24-hour survival, and neurologic outcomes were evaluated at 24 hours. RESULTS: The hemodynamic parameters during CPR did not differ among the study groups. Partial pressure of oxygen in arterial blood and arterial oxygen saturation were lowest in the CC group, compared to those in the other groups, during the BLS period (p=0.002 and p < 0.001, respectively). The CV1 groups showed a significantly higher rate of favorable neurologic outcome (swine CPC 1 or 2) than the other groups (p=0.044). CONCLUSION: CPR with CV1 could promote better neurologic outcome than CV2 and CC.

Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite

OBJECTIVE: Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis. METHODS: This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite. RESULTS: Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P < 0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P < 0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724. CONCLUSION: DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.