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Original Articles
Pediatrics
Development of a deep learning model for predicting critical events in a pediatric intensive care unit
In Kyung Lee, Bongjin Lee, June Dong Park
Acute Crit Care. 2024;39(1):186-191.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.01424
Correction in: Acute Crit Care 2024;39(2):330
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  • 90 Download
AbstractAbstract PDF
Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality. Methods: This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing. Results: Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000). Conclusions: The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.
Pediatrics
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute Crit Care. 2023;38(4):498-506.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01354
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  • 49 Download
AbstractAbstract PDFSupplementary Material
Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.
Nursing
Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan
Mohammad Tayseer Al- Betar, Rami Masa'deh, Shaher H. Hamaideh, Fatma Refaat Ahmed, Hajar Bakkali, Mohannad Eid AbuRuz
Acute Crit Care. 2023;38(3):333-342.   Published online August 30, 2023
DOI: https://doi.org/10.4266/acc.2023.00052
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AbstractAbstract PDF
Background
Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients’ quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients’ QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA.
Methods
One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews.
Results
There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension.
Conclusions
After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.
CPR/Resuscitation
Lower limb muscle matters in patients with hypoxic brain injury following out-of-hospital cardiac arrest
Dong-Hyun Jang, Seung Min Park, Dong Keon Lee, Dong Won Kim, Chang Woo Im, You Hwan Jo, Kui Ja Lee
Acute Crit Care. 2023;38(1):104-112.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01389
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AbstractAbstract PDFSupplementary Material
Background
There are conflicting results regarding the association between body mass index and the prognosis of cardiac arrest patients. We investigated the association of the composition and distribution of muscle and fat with neurologic outcomes at hospital discharge in successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. Methods: This prospective, single-centre, observational study involved adult OHCA patients, conducted between April 2019 and June 2021. The ratio of total skeletal muscle, upper limb muscle, lower limb muscle, and total fat to body weight was measured using InBody S10, a bioimpedance analyser, after achieving the return of spontaneous circulation. Restricted cubic spline curves with four knots were used to examine the relationship between total skeletal muscle, upper limb muscle, and lower limb muscle relative to total body weight and neurologic outcome at discharge. Multivariable logistic regression analysis was performed to assess an independent association. Results: A total of 66 patients were enrolled in the study. The proportion of total muscle and lower limb muscle positively correlated with the possibility of having a good neurologic outcome. The proportion of lower limb muscle showed an independent association in the multivariable analysis (adjusted odds ratio, 2.29; 95% confidence interval, 1.06–13.98), and its optimal cut-off value calculated through receiver operating characteristic curve analysis was 23.1%, which can predict a good neurological outcome. Conclusions: A higher proportion of lower limb muscle to body weight was independently associated with the probability of having a good neurologic outcome in OHCA patients.
Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
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  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
Pediatrics
Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients
Dmytro Dmytriiev, Mykola Melnychenko, Oleksandr Dobrovanov, Oleksandr Nazarchuk, Marian Vidiscak
Acute Crit Care. 2022;37(4):636-643.   Published online October 19, 2022
DOI: https://doi.org/10.4266/acc.2022.00297
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AbstractAbstract PDF
Background
The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators. Methods: The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI). Results: Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO. Conclusions: In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions,

Citations

Citations to this article as recorded by  
  • Trends in the dynamics of morbidity and mortality from hypertension in the Republic of Kazakhstan from 2010 to 2019
    Yeldos Makhambetchin, Aigerim Yessembekova, Ardak Nurbakyttana, Aza Galayeva, Saparkul Arinova
    Polski Merkuriusz Lekarski.2024; 52(1): 95.     CrossRef
  • Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure
    Jun-Jun Wang, Zhong Zhou, Li-Ying Zhang
    World Journal of Clinical Cases.2023; 11(26): 6040.     CrossRef
CPR/Resuscitation
Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest
Hui Hwan Kim, Ji Ho Lee, Dong Hun Lee, Byung Kook Lee
Acute Crit Care. 2022;37(4):601-609.   Published online August 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00542
  • 2,570 View
  • 120 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality. Methods: The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients’ 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality. Results: Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027–1.244) and 72 hours (OR, 1.241; 95% CI, 1.059–1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489–0.673), 0.622 (95% CI, 0.528–0.710), 0.706 (95% CI, 0.615–0.786), and 0.762 (95% CI, 0.675–0.835), respectively. Conclusions: CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

Citations

Citations to this article as recorded by  
  • The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest
    Ji Ho Lee, Dong Hun Lee, Byung Kook Lee, Seok Jin Ryu
    World Journal of Emergency Medicine.2024; 15(3): 223.     CrossRef
  • Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development
    Asser M. J. Seppä, Markus B. Skrifvars, Pirkka T. Pekkarinen
    Acta Anaesthesiologica Scandinavica.2023; 67(9): 1273.     CrossRef
  • Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome
    Ju Hee Yoon, Woo Sung Choi, Yong Su Lim, Jae Ho Jang
    Journal of Clinical Medicine.2023; 12(14): 4568.     CrossRef
  • C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram
    Xin Zhou, Shouzhi Fu, Yisi Wu, Zhenhui Guo, Wankang Dian, Huibin Sun, Youxia Liao
    Scientific Reports.2023;[Epub]     CrossRef
Pediatrics
Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country
Sidra Ishaque, Saleem Akhtar, Asma Akbar Ladak, Russell Seth Martins, Muhammad Kamran Younis Memon, Alisha Raza Kazmi, Fatima Mahmood, Anwar ul Haque
Acute Crit Care. 2022;37(2):217-223.   Published online February 3, 2022
DOI: https://doi.org/10.4266/acc.2020.00990
  • 4,263 View
  • 201 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan. Methods: A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected. Results: Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker. Conclusions: More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.

Citations

Citations to this article as recorded by  
  • Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients
    Ketut Putu Yasa, Arinda Agung Katritama, I. Komang Adhi Parama Harta, I. Wayan Sudarma
    Journal of Arrhythmia.2024; 40(2): 356.     CrossRef
  • Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals
    Diane H. Brown, Xiao Zhang, Awni M. Al-Subu, Nicholas H. Von Bergen
    Journal of Intensive Care Medicine.2023; 38(9): 809.     CrossRef
Case Reports
CPR/Resuscitation
Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation
SungJoon Park, Jung-Youn Kim, Young-Duck Cho, Eusun Lee, Bosun Shim, Young-Hoon Yoon
Acute Crit Care. 2021;36(1):67-69.   Published online October 21, 2020
DOI: https://doi.org/10.4266/acc.2020.00122
  • 4,601 View
  • 132 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
In cardiac arrest, if the initial rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, the survival rates are high and good neurologic outcomes are expected. However, the mortality rate increases when refractory ventricular fibrillation (RVF) occurs. We report a case of RVF that was successfully resuscitated with double sequence defibrillation (DSD). A 51-year-old man visited the emergency department with chest pain. The initial electrocardiography showed markedly elevated ST-segment on V1–V5 leads, and VF arrest occurred. Although 10 defibrillations were administered over 20 minutes, there was no response. Two rounds of DSD were performed by placing additional pads on the patient’s anterior-posterior areas and sequentially applying the maximum energy setting. The patient returned to spontaneous circulation and was discharged with cerebral performance category 1 after 14 days of hospital admission. Therefore, DSD could be an option for treatment and termination of RVF.

Citations

Citations to this article as recorded by  
  • Keep shocking: Double sequential defibrillation for refractory ventricular fibrillation
    Ahmed Kamal Mohamed, Mohamed Shakaib Nayaz, Ali Nawaz, Carl B Kapadia
    The American Journal of Emergency Medicine.2023; 63: 178.e5.     CrossRef
Cardiology
A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium
Jong Wook Beom, Yeekyoung Ko, Ki Yung Boo, Jae-Geun Lee, Joon Hyouk Choi, Seung-Jae Joo, Ji Hwan Moon, Su Wan Kim, Song-Yi Kim
Acute Crit Care. 2021;36(1):70-74.   Published online October 12, 2020
DOI: https://doi.org/10.4266/acc.2020.00234
  • 9,986 View
  • 179 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is lifethreatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

Citations

Citations to this article as recorded by  
  • A Rare Case of Primary Purulent Pericarditis Caused by Streptococcus constellatus
    Medeinė Kapačinskaitė, Dovilė Gabartaitė, Agnė Šatrauskienė, Ieva Sakaitė, Vytė Valerija Maneikienė, Aleksejus Zorinas, Vilius Janušauskas
    Medicina.2023; 59(1): 159.     CrossRef
  • The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding
    Magdalena Pilarczyk-Zurek, Izabela Sitkiewicz, Joanna Koziel
    Frontiers in Microbiology.2022;[Epub]     CrossRef
  • The effects of pneumopericardium during epicardial catheter ablation after dry pericardiocentesis on patients with ventricular arrhythmia
    Qingyong Chen, Bosen Yang, Zhenggang Lai, Wen Yue, Qing Yang
    Journal of Interventional Cardiac Electrophysiology.2022; 66(2): 373.     CrossRef
Review Articles
CPR/Resuscitation
Role of extracorporeal cardiopulmonary resuscitation in adults
Hongsun Kim, Yang Hyun Cho
Acute Crit Care. 2020;35(1):1-9.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2020.00080
  • 9,823 View
  • 367 Download
  • 21 Web of Science
  • 23 Crossref
AbstractAbstract PDF
Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10–20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

Citations

Citations to this article as recorded by  
  • Impact of independent early stage extracorporeal cardiopulmonary resuscitation in the emergency department following the establishment of an extracorporeal life support team
    Zhan-Xiao Liu, Ya Yang, Huan-Huan Song, Wei Liu, Peng Sun, Cai-Wei Lin
    Heliyon.2024; 10(1): e23411.     CrossRef
  • Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies
    Christopher Jer Wei Low, Ryan Ruiyang Ling, Michele Petrova Xin Ling Lau, Nigel Sheng Hui Liu, Melissa Tan, Chuen Seng Tan, Shir Lynn Lim, Bram Rochwerg, Alain Combes, Daniel Brodie, Kiran Shekar, Susanna Price, Graeme MacLaren, Kollengode Ramanathan
    Intensive Care Medicine.2024;[Epub]     CrossRef
  • What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study
    Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
    International Journal of Emergency Medicine.2024;[Epub]     CrossRef
  • Clinician Perspectives on Cannulation for Extracorporeal Cardiopulmonary Resuscitation: A Mixed Methods Analysis
    Devindi Wanigasekara, Vincent A. Pellegrino, Aidan JC. Burrell, Nyein Aung, Shaun D. Gregory
    ASAIO Journal.2023; 69(3): 332.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis
    Christopher Jer Wei Low, Kollengode Ramanathan, Ryan Ruiyang Ling, Maxz Jian Chen Ho, Ying Chen, Roberto Lorusso, Graeme MacLaren, Kiran Shekar, Daniel Brodie
    The Lancet Respiratory Medicine.2023; 11(10): 883.     CrossRef
  • Anticoagulation strategies in patients with extracorporeal membrane oxygenation: A network meta‐analysis and systematic review
    Jiale Chen, Guoquan Chen, Wenyi Zhao, Wenxing Peng
    Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2023; 43(10): 1084.     CrossRef
  • Prophylactic antibiotic treatment for preventing nosocomial infection in extracorporeal membrane oxygenation–resuscitated circulatory arrest patients
    Lan-Pin Kuo, Yi-Chen Wang, Po-Lin Chen, Wei-Hung Lin, Wei-Ming Wang, Chao-Jung Shih, Pei-Ni Yang, Yu-Ning Hu, Chih-Hsin Hsu, Jun-Neng Roan, Meng-Ta Tsai
    JTCVS Open.2023; 16: 582.     CrossRef
  • Lethal abdominal compartment syndrome after extracorporeal cardiopulmonary resuscitation in a patient with out-of-hospital cardiac arrest: a case report
    Gun Jik Kim, Kyoung Hoon Lim, Tak-hyuk Oh, Hyun-Joo Lee, Deokbi Hwang, Hanna Jung
    International Journal of Emergency Medicine.2023;[Epub]     CrossRef
  • How effective is extracorporeal life support for patients with out-of-hospital cardiac arrest initiated at the emergency department? A systematic review and meta-analysis
    Wachira Wongtanasarasin, Sarunsorn Krintratun, Witina Techasatian, Daniel K. Nishijima, Gaetano Santulli
    PLOS ONE.2023; 18(11): e0289054.     CrossRef
  • Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study
    Georg Trummer, Christoph Benk, Jan-Steffen Pooth, Tobias Wengenmayer, Alexander Supady, Dawid L. Staudacher, Domagoj Damjanovic, Dirk Lunz, Clemens Wiest, Hug Aubin, Artur Lichtenberg, Martin W. Dünser, Johannes Szasz, Dinis Dos Reis Miranda, Robert J. va
    Journal of Clinical Medicine.2023; 13(1): 56.     CrossRef
  • Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program
    Maciej Sip, Mateusz Puslecki, Marek Dabrowski, Tomasz Klosiewicz, Radoslaw Zalewski, Marcin Ligowski, Ewa Goszczynska, Christopher Paprocki, Marek Grygier, Maciej Lesiak, Marek Jemielity, Bartłomiej Perek
    Perfusion.2022; 37(1): 46.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: first results and outcomes of a newly established ECPR program in a large population area
    Ilija Djordjevic, Christopher Gaisendrees, Christoph Adler, Kaveh Eghbalzadeh, Simon Braumann, Borko Ivanov, Julia Merkle, Antje-Christin Deppe, Elmar Kuhn, Robert Stangl, Alex Lechleuthner, Christian Miller, Roman Pfister, Navid Mader, Stephan Baldus, An
    Perfusion.2022; 37(3): 249.     CrossRef
  • Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients
    Christopher Gaisendrees, Ilija Djordjevic, Anton Sabashnikov, Christopher Adler, Kaveh Eghbalzadeh, Borko Ivanov, Sebastian Walter, Georg Schlachtenberger, Julia Merkle‐Storms, Stephen Gerfer, Henning Carstens, Antje‐Christin Deppe, Elmar Kuhn, Thorsten W
    Artificial Organs.2022; 46(3): 451.     CrossRef
  • Vascular complications based on mode of extracorporeal membrane oxygenation
    Juliet Blakeslee-Carter, Connie Shao, Ryan LaGrone, Irina Gonzalez-Sigler, Danielle C. Sutzko, Benjamin Pearce, Kyle Eudailey, Emily Spangler, Adam W. Beck, Graeme E. McFarland
    Journal of Vascular Surgery.2022; 75(6): 2037.     CrossRef
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CPR/Resuscitation
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute Crit Care. 2019;34(3):173-178.   Published online August 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00654
  • 33,883 View
  • 2,161 Download
  • 30 Web of Science
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AbstractAbstract PDF
Post-cardiac arrest syndrome is a complex and critical issue in resuscitated patients undergone cardiac arrest. Ischemic-reperfusion injury occurs in multiple organs due to the return of spontaneous circulation. Bundle of management practicies are required for post-cardiac arrest care. Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease. Vasopressors such as norepinephrine and dobutamine are the first-line treatment for shock. Maintainance of oxyhemoglobin saturation greater than 94% but less than 100% is recommended to avoid fatality. Target temperature therapeutic hypothermia helps to resuscitated patients. Strict temperature control is required and is maintained with the help of cooling devices and monitoring the core temperature. Montorings include electrocardiogram, oxymetry, capnography, and electroencephalography (EEG) along with blood pressue, temprature, and vital signs. Seizure should be treated if EEG shows evidence of seizure or epileptiform activity. Clinical neurologic examination and magnetic resonance imaging are considered to predict neurological outcome. Glycemic control and metabolic management are favorable for a good neurological outcome. Recovery from acute kidney injury is essential for survival and a good neurological outcome.

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Case Reports
Thoracic Surgery
Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery
Sue Hyun Kim, Ho Young Hwang, Min Jung Kim, Kyu Joo Park, Ki-Bong Kim
Acute Crit Care. 2020;35(3):213-217.   Published online April 19, 2019
DOI: https://doi.org/10.4266/acc.2018.00423
  • 10,183 View
  • 205 Download
  • 5 Web of Science
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AbstractAbstract PDF
Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but fatal complication. Early diagnosis and intervention can be lifesaving. We report two cases of patients who underwent early diagnostic laparoscopy for suspicious AMI after cardiac surgery and demonstrated favorable outcomes. An 83-year-old male with severe left ventricular dysfunction underwent off-pump coronary artery bypass grafting. Severe ileus with gaseous distension of the small bowel was developed on the 3rd postoperative day and computed tomographic angiography (CTA) showed pneumatosis intestinalis of small bowel suggestive of AMI. An immediate bedside laparoscopy was performed and it showed preserved perfusion of small bowel. He recovered without complication under supportive medical management. Another 69-year-old male who underwent aortic valve replacement complained of whole abdominal tenderness with severe distension on the 3rd postoperative day. The CTA found segmental non-enhancing bowel wall with air bubbles suggestive of AMI with possible microperforation. A diagnostic laparoscopy demonstrated small-bowel infarction with pus-like fluid collection in the peritoneal cavity. The operation was converted to laparotomy and complete resection of ischemic segments of small bowel was done. He recovered well without any other complications and discharged home on the 35th postoperative day.

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Cardiology
Two women presenting aborted sudden cardiac arrest as the first event of mitral valve disease
Sua Kim, Jae Min Shim, Seong-Mi Park
Acute Crit Care. 2019;34(4):289-293.   Published online November 13, 2018
DOI: https://doi.org/10.4266/acc.2017.00570
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AbstractAbstract PDF
Mitral valve prolapse (MVP) is a relatively common valvular heart disease and is known to have a benign course. However, a certain subtype of MVP has a pathologic prognosis and can be accompanied by malignant cardiac arrhythmia causing sudden cardiac arrest, which can be characterized by bileaflet mitral valvular thickening and prolapse and frequent premature ventricular ectopic activity upon electrocardiography. Herein, we present two patients with bileaflet mitral prolapse who survived aborted sudden cardiac arrest. These cases show a precise MVP diagnosis that may prevent a devastating life event with the unique MVP subtype.

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Review Article
Rapid response system
Deep Learning in the Medical Domain: Predicting Cardiac Arrest Using Deep Learning
Youngnam Lee, Joon-myoung Kwon, Yeha Lee, Hyunho Park, Hugh Cho, Jinsik Park
Acute Crit Care. 2018;33(3):117-120.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00290
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  • 533 Download
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  • 19 Crossref
AbstractAbstract PDF
With the wider adoption of electronic health records, the rapid response team initially believed that mortalities could be significantly reduced but due to low accuracy and false alarms, the healthcare system is currently fraught with many challenges. Rule-based methods (e.g., Modified Early Warning Score) and machine learning (e.g., random forest) were proposed as a solution but not effective. In this article, we introduce the DeepEWS (Deep learning based Early Warning Score), which is based on a novel deep learning algorithm. Relative to the standard of care and current solutions in the marketplace, there is high accuracy, and in the clinical setting even when we consider the number of alarms, the accuracy levels are superior.

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ACC : Acute and Critical Care