Acute and Critical Care

Erratum

Cardiology
Erratum: Moderate to Severe Left Ventricular Ejection Fraction Related to Short-term Mortality of Patients with Post-cardiac Arrest Syndrome after Out-of-Hospital Cardiac Arrest: Kyoung Jeen Min, Jin Joo Kim, In Cheol Hwang, Jae Hyuk Woo, Yong Su Lim, Hyuk Jun Yang, Keun Lee; Korean J Crit Care Med. 2017;32(1):88-88. Published online February 28, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00570.e01; Corrects: Acute Crit Care 2016;31(4):342

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Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study
Maria Trepa, Samuel Bastos, Marta Fontes-Oliveira, Ricardo Costa, André Dias-Frias, André Luz, Vasco Dias, Mário Santos, Severo Torres
The Journal of Critical Care Medicine.2020; 6(1): 41. CrossRef

Original Articles

Cardiology/Emergency
Moderate to Severe Left Ventricular Ejection Fraction Related to Short-term Mortality of Patients with Post-cardiac Arrest Syndrome after Out-of-Hospital Cardiac Arrest: Kyoung Jeen Min, Jin Joo Kim, In Cheol Hwang, Jae Hyuk Woo, Yong Su Lim, Hyuk Jun Yang, Keun Lee; Korean J Crit Care Med. 2016;31(4):342-350. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00570; Correction in: Acute Crit Care 2017;32(1):88

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Abstract PDF: Background
The aim of this study was to investigate the relationships between left ventricular ejection fraction (LVEF) and mortality and neurologic outcomes with post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA).
Methods
Patients with PCAS after OHCA admitted to the intensive care unit between January 2014 and December 2015 were analyzed retrospectively.
Results
A total of 104 patients were enrolled in this study. The mean age was 54.4 ± 15.3 years, and 75 of the patients were male (72.1%). Arrest with a cardiac origin was found in 55 (52.9%). LVEF < 45%, 45-55%, and > 55% was measured in 39 (37.5%), 18 (17.3%), and 47 (45.2%) of patients, respectively. In multivariate analysis, severe LV dysfunction (LVEF < 45%) was significantly related to 7-day mortality (odds ratio 3.02, 95% Confidence Interval 1.01-9.0, p-value 0.047).
Conclusions
In this study, moderate to severe LVEF within 48 hours after return of spontaneous circulation was significantly related to 7-day short-term mortality in patients with PCAS after OHCA. Clinicians should actively treat myocardial dysfunction, and further studies are needed.

Emergency/Neurology
Brain Magnetic Resonance Imaging in Patients with Favorable Outcomes after Out-of-Hospital Cardiac Arrest: Many Have Encephalopathy Even with a Good Cerebral Performance Category Score: Woo Sung Choi, Jin Joo Kim, Hyuk Jun Yang; Korean J Crit Care Med. 2015;30(4):265-271. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.265

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Abstract PDF: Background
The aim of this study was to retrospectively evaluate and analyze the brain magnetic resonance imaging (B-MRI) findings of patients with a favorable neurological outcome following cerebral performance category (CPC) after out-of-hospital cardiac arrest (OHCA) at single university hospital emergency center.
Methods
Patients with return of spontaneous circulation (> 24 h) after OHCA who were older than 16 years of age and who had been admitted to the emergency intensive care unit (EICU) for over a 57-month period between July 2007 and March 2012 and survived with a favorable neurological outcome were enrolled. B-MRI was taken after recovery of their mental status.
Results
Fifty-two patients among the 305 admitted patients had a good CPC, and 33 patients’ B-MRI were analyzed (CPC 1: 26 patients, CPC 2: 7 patients). Among these, 18 (54.5%) patients had a normal finding on B-MRI. On the other hand, ischemia/infarction/microangiopathy compatible with hypoxic-ischemic encephalopathy (HIE) were found on various brain areas including subcortical white matter (7/13), cerebral cortex, central semiovlae, basal ganglia, putamen, periventricular white matter, and cerebellum.
Conclusions
Survivors with a favorable neurological outcome from OHCA showed HIE on B-MRI, especially all of the patients with a CPC 2. More detail neurologic category including brain imaging would be needed to categorize patients with favorable outcome after OHCA.

Pulmonary
The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department: Jong Won Kim, Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, In Cheol Hwang, Sang Hyun Han; Korean J Crit Care Med. 2015;30(4):258-264. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.258

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Abstract PDF

Background
Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department.
Methods
From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined.
Results
Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35–4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01–1.08), leukopenia (OR, 3.63; 95% CI, 1.48–8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41–4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30–6.38).
Conclusions
A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.

Citations

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Neurology/Emergency
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Sung Joon Kim, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang; Korean J Crit Care Med. 2014;29(4):288-296. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.288

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Abstract PDF

BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Citations

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Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study
Yaacov Hasin, Yigal Helviz, Sharon Einav
Internal and Emergency Medicine.2024; 19(1): 159. CrossRef

Implementation of Therapeutic Hypothermia after Pediatric Out-of Hospital Cardiac Arrest in One Tertiary Emergency Center: Woo Jin Kim, Jin Joo Kim, Jae Ho Jang, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee; Korean J Crit Care Med. 2013;28(1):25-32.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.25

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Abstract PDF

BACKGROUND
Cardiac arrest in infants and children is rare than adults yet, it is critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proved through many studies however, there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-of hospital cardiac arrest.
METHODS
Infants and children (1 to 17 years old), who were admitted to our emergency intensive care units following the return of spontaneous circulation after out-of hospital cardiac arrest from Jan 2008 to Apr 2012, were included in this study. Basal patients' characteristics and variables about therapeutic hypothermia were analyzed.
RESULTS
A total of seventy-six patients visited our emergency center after a pediatric cardiac arrest during the study period. Among this, sixty-three patients received pediatric advanced life support, twenty one patients were admitted to intensive care units and nine patients received therapeutic hypothermia. Overall, the survival discharge was 7.9% (5 of 63). Among the admitted patients, 3 patients (14.3%) had a good Cerebral Performance Category (CPC). Two patients received endovascular cooling and seven patients received surface cooling. The mean time from the induction of therapeutic hypothermia to reaching the temperature with in the therapeutic range was 193.9 minutes. There were no critical adverse events during induction, maintenance and the rewarming period of therapeutic hypothermia.
CONCLUSIONS
Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established in order to be used widely in pediatric intensive care units. Further, larger studies are needed on the subject of pediatric therapeutic hypothermia.

Citations

Citations to this article as recorded by

Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report
Jae Yun Ahn, Mi Jin Lee, Hyun Kim, Han Deok Yoon, Hye Young Jang
Journal of Korean Medical Science.2015; 30(9): 1354. CrossRef

The Frequency of Defibrillation Related to the Survival Rate and Neurological Outcome in Patients Surviving from Out-of-hospital Cardiac Arrest: Sung Yeol Hyun, Jae Ho Jang, Jin Joo Kim, Hyuk Jun Yang, Woo Jin Kim; Korean J Crit Care Med. 2012;27(4):263-268.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.263

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Abstract PDF

BACKGROUND
Early defibrillation is the treatment of choice in out-of-hospital cardiac arrests (OHCA) with initial shockable rhythms. However, the relationship between the frequency of defibrillation and neurological outcome was not clear. In this study, the frequency of defibrillation and other factors related to neurological outcome were investigated.
METHODS
Records of 255 adult patients, who were admitted to the hospital after resuscitation from OHCA between November 2008 and March 2012, were retrospectively reviewed. 6 months after the return of spontaneous circulation, patients were divided into two groups based on the cerebral performance category (CPC) score for neurologic prognosis. The frequency of defibrillation during resuscitation and other variables were analyzed between the two groups.
RESULTS
In the study group, initial rhythm was divided into two groups, non shockable rhythm (200, 78.4%) and shockable rhythm (55, 21.6%). The frequency of 1-7 defibrillations was significantly associated with good neurological outcome (OR 3.05, 95% CI 1.328-6.850). In addition, shockable initial rhythm (OR 4.520, 95% CI 1.953-10.459), arrest caused cardiac origin (OR 2.945, 95% CI 1.334-6.500), time to BLS (OR 1.139, 95% CI 1.033-1.256) and lower APACHII score (OR 1.095, 95% CI 1.026-1.169), which were associated with good neurological outcomes, independently.
CONCLUSIONS
In those patients who survived from OHCA, adequate defibrillation was important to improve the neurological outcome, whether the initial rhythm was shockable or not. Frequency of 1-7 times defibrillation was associated with good neurological outcome.

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The Factors Influencing Survival of Out-of-hospital Cardiac Arrest with Cardiac Etiology
Su-Yeon Jeong, Chul-Woung Kim, Sung-Ok Hong
Journal of the Korea Academia-Industrial cooperation Society.2016; 17(2): 560. CrossRef

Men Associated with Good Prognosis after Return of Spontaneous Circulation after Out-of Hospital Cardiac Arrest: a Retrospective Study in One Emergency Center: Se Jong Oh, Jin Joo Kim, Sung Youn Hwang, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee; Korean J Crit Care Med. 2012;27(1):24-28.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.24

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Abstract PDF: BACKGROUND
The aim of this study was to analyze the gender factors associated with good or bad prognosis after return of spontaneous circulation after out-of hospital cardiac arrest.
METHODS
The patients admitted to the intensive care unit after successful resuscitation after out-of hospital cardiac arrest were retrospectively identified and evaluated. Thirty days mortality after admission, and neurologic outcome at 6 months after hospital discharge (cerebral performance category [CPC]) were evaluated.
RESULTS
One hundred forty-two patients were evaluated in this study; there were 101 males (71.1%). The median age was 52 years old (43-63). Thirty days after admission, 85 patients (59.9%) survived, 40 patients had a good neurologic outcome (CPC 1-2). The factors associated 30 days mortality were cause of arrest (non-cardiac, p = 0.03), lactate in emergency department (p = 0.05) and the factors associated with good neurologic outcome were males (p = 0.007), young age (p = 0.01), body weight and height (p = 0.001), cause of death (cardiac, p = 0.000). Alcohols and smoking were not associated with mortality and neurologic outcome. In multiple logistic regression analysis, men had a 8-fold increased good neurologic outcome (CPC 1-2) (odds ratio [OR] 8.038, 95% Confidence Interval [CI] 1.079-59.903). Other factors associated with good neurologic outcome were cardiac cause of death (OR 5.523, 95% CI 1.562-19.533) and young age (OR 1.055, 95% CI 1.009-1.103).
CONCLUSIONS
Men had a good neurologic outcome after return of spontaneous circulation after out-of hospital cardiac arrest in one emergency center. Other additional factors including gonadal hormones should be evaluated.

VAP (Ventilator-associated Pneumonia) in Patients with Pulmonary Contusion: Jong Hyun Jeong, Sung Youl Hyun, Jin Joo Kim, Jae Hyuk Kim, Yong Su Lim, Jin Seong Cho, Sung Yeon Hwang, Hyuk Jun Yang; Korean J Crit Care Med. 2010;25(4):224-229.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.224

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Abstract PDF: BACKGROUND
This study was conducted to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia in patients with pulmonary contusion.
METHODS
The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. A retrospective analysis was conducted on thoracic injury patients admitted between Jan 2007 and Dec 2009. Among 122 patients investigated, 30 patients were excluded. Patient data included basal characteristics and information related to development of ventilator-associated pneumonia and ultimate mortality. Statistical methods included the Chi-square test and the Mann-Whitney test. Study data were stored and processed using Microsoft Office Excel 2007 & SPSS 18.0 for Windows.
RESULTS
Ventilator-associated pneumonia developed in 46 patients (50%). The patients with ventilator-associated pneumonia were more likely to have a longer duration of hospitalization, longer length of ICU stay, longer duration of mechanical ventilation, a low initial GCS, a higher APACHE II score, and were more likely to require emergency intubation or tracheostomy. Factors associated with mortality included longer duration of hospitalization, longer duration of mechanical ventilation, low intial GCS and the need for dialysis.
CONCLUSIONS
Ventilator-associated pneumonia in the patients with pulmonary contusion was not relevant to mortality, but was relevant to longer hospitalization, length of ICU stay and duration of mechanical ventilation.

The Clinical Features of Patients with Deep Neck Infections Who Were Admitted to the Intensive Care Unit in a Single Emergency Center: Jin Joo Kim, Sung Youl Hyun, Jung Kwon Kim, Yong Su Lim, Jong Hwan Shin, Jin Seong Cho, Ji Ho Ryu, Gun Lee; Korean J Crit Care Med. 2008;23(2):96-101.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.96

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Abstract PDF

BACKGROUND
Deep neck infections are a life-threatening disease that spread to the neck spaces and the mediastinum via neck fascial planes. In spite of using antibiotics, the mortality of deep neck infections is still high. The aim of our study was to analyze the factors related to mortality and morbidity of patients with deep neck infection who were admitted to the intensive care unit.
METHODS
This is a retrospective study of patients with deep neck infections who were admitted to the intensive care unit over a 2 year period between June 2006 and May 2008. The various factors related to mortality and morbidity were analyzed.
RESULTS
Twenty-four patients were included over 2 years. The median age was 58 years. Eighteen patients (75%) were males and six patients were females. Ten patients (41.7%) had underlying diabetes mellitus. The median white blood cell count and C-reactive protein (CRP) were 14,000/mm3 and 24.1 mg/dl, respectively. The most common cause of deep neck infection was of dental origin (62.5%) and the most common complication was mediastinitis (37.5%). The factors related to mortality were underlying diabetes mellitus, pO2, CRP, sequential organ failure assessment (SOFA) score, gas-forming score (GAS), and complications due to mediastinitis.
CONCLUSIONS
It is useful to measure several factors in patients with deep neck infections. The patients with underlying diabetes mellitus, increased CRP, a GAS score of 2, and complications to mediastinitis have a high mortality rate, so active surgical and medical management should be performed.

Citations

Citations to this article as recorded by

Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
Anesthesia and Pain Medicine.2019; 14(3): 347. CrossRef

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