Acute and Critical Care

Original Articles

Epidemiology
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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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.

Citations

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Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: implicaciones para la práctica y la toma de decisiones en enfermería
Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
Prohominum.2025; 7(2): 209. CrossRef

Epidemiology
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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Abstract PDF Supplementary 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.

Citations

Citations to this article as recorded by

Impact of an independent pediatric rapid response team on pediatric patient safety
Jin Hwan Lyu, Soo Keun Lee, Min Joo Kang, Sumin Lee, Mireu Park, Soo Yeon Kim, Kyung Won Kim, Jong Deok Kim
Archives of Pediatric Critical Care.2024; 2(2): 91. CrossRef

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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Abstract PDF Supplementary 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.

Epidemiology
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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Abstract PDF Supplementary 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

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Implementation of the bedside paediatric early warning system, its sustainability in clinical practice and patient outcomes: a quality improvement initiative
Ruqiah Ali AlZaher, Syed Jamil, Iris Murabi, Eidah Ahmari
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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
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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
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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

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

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Abstract PDF Supplementary 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.

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Association of the blood urea nitrogen to serum albumin ratio and 28-day all-cause mortality in patients with cardiac arrest: a retrospective cohort study using the MIMIC-IV database
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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

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Abstract 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.

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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

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Abstract 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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Neurochemical Research.2025;[Epub] CrossRef
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Eduardo Amaya Rocha, Zenia Claros Coca, Gironella Duveyska Flores Muñoz
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Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani
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Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar‐Areshtanab, Neda Gilani
Nursing Open.2023; 10(11): 7215. CrossRef
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Susan E. Smith, Brooke Barlow, Liana Ha, SeongEun Emily Park, Trisha N. Branan
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Case Report

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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Abstract 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.

Citations

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Mitral annular disjunction identified peripartum: A case highlighting key features of a recently classified syndrome
Monique Doran, Gemma Reemst, Kenny Ng, Courtney Shaw, Paul Stoodley
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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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Abstract 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.

Citations

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Internal and External Validation of a Deep Learning-Based Early Warning System of Cardiac Arrest with Variable-Length and Irregularly Measured Time Series Data
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Resuscitation Plus.2025; 24: 100973. CrossRef
External Validation of Deep Learning-Based Cardiac Arrest Risk Management System for Predicting In-Hospital Cardiac Arrest in Patients Admitted to General Wards Based on Rapid Response System Operating and Nonoperating Periods: A Single-Center Study
Kyung-Jae Cho, Kwan Hyung Kim, Jaewoo Choi, Dongjoon Yoo, Jeongmin Kim
Critical Care Medicine.2024; 52(3): e110. CrossRef
New Innovations to Address Sudden Cardiac Arrest
Christine P Shen, Sanjeev P Bhavnani, John D Rogers
US Cardiology Review.2024;[Epub] CrossRef
Development of deep learning algorithm for detecting dyskalemia based on electrocardiogram
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Hung Viet Nguyen, Haewon Byeon
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Multimedia Tools and Applications.2023; 83(14): 42955. CrossRef
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Hansol Chang, Ji Woong Kim, Weon Jung, Sejin Heo, Se Uk Lee, Taerim Kim, Sung Yeon Hwang, Sang Do Shin, Won Chul Cha, Marcus Ong
Scientific Reports.2023;[Epub] CrossRef
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Smart Health.2022; 25: 100294. CrossRef
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Arom Choi, Min Joung Kim, Ji Min Sung, Sunhee Kim, Jayoung Lee, Heejung Hyun, Hyeon Chang Kim, Ji Hoon Kim, Hyuk-Jae Chang
Journal of Cardiovascular Development and Disease.2022; 9(12): 430. CrossRef
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Peng Ran, Kun Dong, Xu Liu, Jing Wang
SSRN Electronic Journal .2022;[Epub] CrossRef
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Alberto Nogales, Álvaro J. García-Tejedor, Diana Monge, Juan Serrano Vara, Cristina Antón
Artificial Intelligence in Medicine.2021; 112: 102020. CrossRef
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Samaneh Layeghian Javan, Mohammad Mehdi Sepehri
Artificial Intelligence in Medicine.2021; 117: 102099. CrossRef
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Arom Choi, Min Joung Kim, Ji Min Sung, Sunhee Kim, Jayong Lee, Heejung Hyun, Ji Hoon Kim, Hyuk-Jae Chang
JMIR Medical Informatics.2021;[Epub] CrossRef
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Kuan-Han Wu, Fu-Jen Cheng, Hsiang-Ling Tai, Jui-Cheng Wang, Yii-Ting Huang, Chih-Min Su, Yun-Nan Chang
PeerJ.2021; 9: e11988. CrossRef
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Bohdan B Khomtchouk, Diem-Trang Tran, Kasra A Vand, Matthew Might, Or Gozani, Themistocles L Assimes
Briefings in Bioinformatics.2020; 21(6): 2031. CrossRef
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Acute and Critical Care.2019; 34(2): 108. CrossRef

Original Articles

CPR/Resuscitation
APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management: Sang-Il Kim, Youn-Jung Kim, You-Jin Lee, Seung Mok Ryoo, Chang Hwan Sohn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Won Young Kim; Acute Crit Care. 2018;33(2):83-88. Published online May 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00514

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Abstract PDF

Background
This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM).
Methods
Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study.
Results
Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014).
Conclusions
In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.

Citations

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Prediction performance of scoring systems after out-of-hospital cardiac arrest: A systematic review and meta-analysis
Boldizsár Kiss, Rita Nagy, Tamás Kói, Andrea Harnos, István Ferenc Édes, Pál Ábrahám, Henriette Mészáros, Péter Hegyi, Endre Zima, Jignesh K. Patel
PLOS ONE.2024; 19(2): e0293704. CrossRef
Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks
Wei-Ting Chiu, Chen-Chih Chung, Chien-Hua Huang, Yu-san Chien, Chih-Hsin Hsu, Cheng-Hsueh Wu, Chen-Hsu Wang, Hung-Wen Chiu, Lung Chan
Journal of the Formosan Medical Association.2022; 121(2): 490. CrossRef
Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management
Szu-Yi Chou, Oluwaseun Adebayo Bamodu, Wei-Ting Chiu, Chien-Tai Hong, Lung Chan, Chen-Chih Chung
Scientific Reports.2022;[Epub] CrossRef
Novel Approaches to Risk Stratification of In-Hospital Cardiac Arrest
Jason J. Yang, Xiao Hu, Noel G. Boyle, Duc H. Do
Current Cardiovascular Risk Reports.2021;[Epub] CrossRef

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.

Citations

Citations to this article as recorded by

Post cardiac arrest left ventricular ejection fraction associated with survival to discharge
Kanjit Leungsuwan, Kory R. Heier, Olivia Henderson, Karam Ayoub, Talal Alnabelsi, Emily Slade, Vedant A. Gupta
Resuscitation Plus.2024; 19: 100737. CrossRef

Case Report

Obstetric/Emergency
Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage: Kwang Ho Lee, Seong Jin Choi, Yeong Gwan Jeon, Raing Kyu Kim, Dae Ja Um; Korean J Crit Care Med. 2016;31(4):359-363. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00325

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Abstract PDF

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

Citations

Citations to this article as recorded by

Persephin as a diagnostic marker of acute brain injury in critically ill newborns: a clinical trial
A. A. Zadvornov, E. V. Grigoriev
Fundamental and Clinical Medicine.2021; 6(3): 15. CrossRef

Original Article

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.

Case Report

Cardiology
Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction: Dong Hyun Lee, Seul Lee, Hyo Jin Jung, Soo Jin Kim, Jeong Min Seo, Jae Hyuk Choi, Jong Sung Park; Korean J Crit Care Med. 2014;29(4):331-335. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.331

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Abstract PDF: A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.

Original Articles

Hematology/Emergency
Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest: Seongtak Kim, Jinseong Cho, Yongsu Lim, Jinjoo Kim, Hyukjun Yang, Gun Lee; Korean J Crit Care Med. 2014;29(4):313-319. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.313

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Abstract PDF: BACKGROUND
The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated.
METHODS
Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%).
RESULTS
A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time.
CONCLUSIONS
RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.

Neurology/Emergency
Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Hyung Seok Kim, Ho Sung Jung, Yong Su Lim, Jae Hyug Woo, Jae Ho Jang, Jee Yong Jang, Hyuk Jun Yang; Korean J Crit Care Med. 2014;29(4):304-312. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.304

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Abstract PDF

BACKGROUND
The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH).
METHODS
We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes.
RESULTS
A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively.
CONCLUSIONS
Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

Citations

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The first national survey on practices of neurological prognostication after cardiac arrest in China, still a lot to do
Lanfang Du, Kang Zheng, Lu Feng, Yu Cao, Zhendong Niu, Zhenju Song, Zhi Liu, Xiaowei Liu, Xudong Xiang, Qidi Zhou, Hui Xiong, Fengying Chen, Guoqiang Zhang, Qingbian Ma
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Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

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.

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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

Efficacies of Somatosensory Evoked Potential and Diffusion-Weighted Magnetic Resonance Imaging as Predictors of Prognosis for Patients Experiencing Coma after Cardiac Arrest: Sang Hee Chae, Soo Hyun Kim, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2013;28(4):300-308.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.300

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Abstract PDF

BACKGROUND
The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest.
METHODS
Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests.
RESULTS
Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%.
CONCLUSIONS
The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.

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The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients
Xiao-Hua Zhang, Tao Gu, Xuan-Wei Liu, Ping Han, Hui-Lan Lv, Yu-Long Wang, Peng Xiao
Frontiers in Neuroscience.2021;[Epub] 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.

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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

Case Report

Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support: A Case Report: Jeehoon Kang, In Chang Hwang, Chang Hwan Yoon; Korean J Crit Care Med. 2012;27(4):269-273.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.269

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Abstract PDF: The ergonovine provocation test is often used in diagnosing variant angina. Most patients with an ergonovine-induced coronary artery spasm respond promptly to intracoronary nitroglycerin administration within 3 to 5 minutes. However, in a few patients ergonovine results in serious cardiovascular complications due to intractable coronary artery spasm. We report a case of a severe and medically intractable coronary spasm induced by ergonovine, followed by cardiac arrest. Aided by percutaneous cardiopulmonary support (PCPS) and mechanical ventilation, the patient could survive after four days of hospitalization despite a recurrent vasospasm. Recovery was largely attributed to full supportive care and the use of PCPS.

Original Articles

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

Effect of Hydrogel Pad and Conventional Method on the Induction Time of Therapeutic Hypothermia in Patients with Out-of-Hospital Cardiac Arrest: Ga Young Chung, Tae Rim Lee, Dae Jong Choi, Sung Su Lee, Mun Ju Kang, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Yeon Kwon Jeong; Korean J Crit Care Med. 2012;27(4):218-223.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.218

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Abstract PDF: BACKGROUND
Therapeutic hypothermia has been recommended as a standard treatment of cardiac arrest patients after return of spontaneous circulation. There are various methods to drop patient's core body temperature below 33.5degrees C. We compared the cooling rate of the conventional cooling method using cold saline bladder irrigation with the commercial hydrogel pad in out-of-hospital cardiac arrest (OHCA) patients.
METHODS
We collected data retrospectively from the Samsung Medical Center hypothermia database. The conventional method group was cooled with IV infusion of 2,000 ml of 4degrees C cold saline and cold saline bladder irrigation. Patients in the hydrogel pad group had their body temperature lowered with the Artic Sun(R) after receiving 2,000 ml of 4degrees C cold saline intravenously. The induction time was defined as time from cold saline infusion to the esophageal core temperature below 33.5degrees C. The esophageal temperature probe insertion to the target temperature time (ET to target BT time) was defined as the time from the esophageal probe insertion to the core temperature below 33.5degrees C. We compared these times and cooling rates between the two groups.
RESULTS
Eighty one patients were enrolled. Fifty seven patients were included in the hydrogel pad group and 24 patients were in the conventional group. There were no statistical differences of baseline characteristics between the two groups. The induction time of the conventional group (138 min., IQR 98-295) was shorter than that of the hydrogel pad group (190 min., IQR 140-250). The ET to target BT time of the conventional group (106 min., IQR 68-249) was shorter than that of the hydrogel pad group (163 min., IQR 108-222). The cooling rate of the conventional group (0.93degrees C/hr., IQR 0.58-2.08) was lower than that of the hydrogel pad group (1.05degrees C/hr., IQR 0.74-1.96). However, there were no statistical differences in the induction time, the ET to target BT time and the cooling rate between the two groups.
CONCLUSIONS
There was no significant statistical difference of the cooling rate of the hydrogel pad and conventional method on the induction time of therapeutic hypothermia in Patients with OHCA. The conventional cooling method can be used as an effective and efficient way to lower OHCA patient's core body temperature during the induction phase of therapeutic hypothermia.

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.

A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage: Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong; Korean J Crit Care Med. 2011;26(3):151-156.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.151

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Abstract PDF: BACKGROUND
Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage.
METHODS
We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan.
RESULTS
Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome.
CONCLUSIONS
Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.

Clinical Characteristics of Acute Brain Swelling in Patients Successfully Resuscitated from Non-traumatic Out-of-hospital Cardiac Arrest: Wonhyun Ryu, Young Joo Lee, Eun Jung Park, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2010;25(4):219-223.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.219

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Abstract PDF

BACKGROUND
The number of cardiac arrest patients who are resuscitated has increased with the development of emergency medical services. Brain swelling is often found in these patients, following return of spontaneous circulation. This study identifies risk factors for brain swelling, describes it's frequency, analyzes the effect of brain swelling on neurological outcome, and compares the results with other studies.
METHODS
A retrospective analysis had been conducted on cardiac arrest patients who visited the emergency room at a university hospital during a 24 month period since 2007. Thirty-seven successfully resuscitated patients were divided into 2 groups based on computed tomography findings; these groups consisted of 14 patients with brain swelling and 23 patients without brain swelling. Comparative studies were conducted on post-lab findings and several additional factors.
RESULTS
The 14 patients with brain swelling were significantly younger and showed a higher clinical performance category score than patients without brain swelling. Initial serum lactic acid levels showed good correlation with brain swelling.
CONCLUSIONS
An urgent CT should be conducted and aggressive treatment pursued when brain swelling is suspected, after consideration of various prognostic factors.

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Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?
Erik G. Hayman, Akil P. Patel, W. Taylor Kimberly, Kevin N. Sheth, J. Marc Simard
Neurocritical Care.2018; 28(3): 276. CrossRef
Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology
Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Yong Hun Jung, Wook Jin Choi, Soo Hyun Kim, Chun Sung Youn, In Soo Cho, Dong Hun Lee
Resuscitation.2015; 96: 46. CrossRef

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