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CPR/Resuscitation
Is two-dimensional echocardiography better than electrocardiography for predicting patient outcomes after cardiac arrest?
Dong Ki Kim, Yong Soo Cho, Joochan Kim, Byung Kook Lee, Dong Hun Lee, Eujene Jung, Jeong Mi Moon, Byeong Jo Chun
Acute Crit Care. 2021;36(1):37-45.   Published online December 21, 2020
DOI: https://doi.org/10.4266/acc.2020.00773
  • 4,709 View
  • 160 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
Coronary artery stenosis increases hospital mortality and leads to poor neurological recovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannot fully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determine whether regional wall motion abnormality (RWMA), as observed by two-dimensional echocardiography (2DE), predicted patient survival outcomes with greater accuracy than did ST segment elevation (STE) on ECG in CA patients who underwent coronary angiography (CAG) after return of spontaneous circulation.
Methods
This was a retrospective observational study of adult patients with CA of presumed cardiac etiology who underwent CAG at a single tertiary care hospital. We investigated whether RWMA observed on 2DE predicted patient outcomes more accurately than did STE observed on ECG. The primary outcome was incidence of hospital mortality. The secondary outcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6 months after discharge and significant coronary artery stenosis on CAG.
Results
Among the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariable analysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjusting the total arrest time for survival outcomes, were significant only for STE (OR, 0.40; 95% CI, 0.17–0.94). The presence of RWMA was not a significant factor.
Conclusions
While STE predicted survival outcomes in adult CA patients, RWMA did not. The decision to perform CAG after CA should include ECG under existing guidelines. The use of RWMA has limited benefits in treatment of this population.

Citations

Citations to this article as recorded by  
  • Just the Facts: Management of return of spontaneous circulation after out-of-hospital cardiac arrest
    Hashim Kareemi, Ariel Hendin, Christian Vaillancourt
    Canadian Journal of Emergency Medicine.2023; 25(7): 580.     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
  • 8,688 View
  • 114 Download
AbstractAbstract 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.
Case Reports
Cardiology
Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient
Hyun-Jung Lee, Hack-Lyoung Kim, Doyeon Hwang, Chan-Soon Park, Jae-Sung Lim, Eungyu Kang, Joo-Hee Zo
Korean J Crit Care Med. 2016;31(1):39-43.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.39
  • 5,337 View
  • 74 Download
  • 2 Crossref
AbstractAbstract PDF
The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.

Citations

Citations to this article as recorded by  
  • Spontaneous ventricular thrombosis in patients with inflammatory bowel disease
    Stella Pak, Juan Linares, Yan Yatsynovich, David Cha, Dexter Nye, Diana Kaminski, Jillian Costello
    Cardiology in the Young.2018; 28(3): 351.     CrossRef
  • Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction
    Dong Wook Lee, Ju Hee Ha, Jun Ho Kim, Ki Beom Park, Jae Joon Lee, Han Il Choi, Jin Hee Kim
    Journal of Lipid and Atherosclerosis.2016; 5(2): 163.     CrossRef
Detection of Pulmonary Artery Catheter Knotting by Transesophageal Echocardiography: A Case Report
Eun Soo Kim, Seung Hoon Baek, Kyu Youn Jung, Jae En Kim
Korean J Crit Care Med. 2011;26(2):98-100.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.98
  • 2,371 View
  • 10 Download
  • 1 Crossref
AbstractAbstract PDF
Placement of a pulmonary artery catheter is associated with various complications, including catheter knotting. Fluoroscopy can be used to visualize and confirm catheter knotting. Transesophageal echocardiography is readily available to detect knot formation in the operating room or intensive care unit. We present a case in which pulmonary artery catheter knotting was detected by transesophageal echocardiography. This method may be useful in the operating room or in the intensive care unit to identify the presence and location of catheter knotting.

Citations

Citations to this article as recorded by  
  • Knotting of Pulmonary Artery Catheter During Tricuspid Valve Surgery - A Case Report -
    Kyung Chen Lee, Wol Seon Jung, Yong Beom Kim, Ji Yeon Lee
    Korean Journal of Critical Care Medicine.2012; 27(1): 45.     CrossRef
Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report
So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na
Korean J Crit Care Med. 2010;25(2):89-92.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.89
  • 2,514 View
  • 18 Download
  • 1 Crossref
AbstractAbstract PDF
The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

Citations

Citations to this article as recorded by  
  • Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
    Eun Young Kim, Ji Hyun Kim
    The Korean Journal of Critical Care Medicine.2016; 31(3): 236.     CrossRef

ACC : Acute and Critical Care