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Cardiology
Clinical implications of pleural effusion following left ventricular assist device implantation
So-Min Lim, Ah-Ram Kim, Junho Hyun, Sang-Eun Lee, Pil-Je Kang, Sung-Ho Jung, Min-Seok Kim
Acute Crit Care. 2024;39(1):169-178.   Published online January 17, 2024
DOI: https://doi.org/10.4266/acc.2023.01102
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AbstractAbstract PDF
Background
Studies on the association between pleural effusion (PE) and left ventricular assist devices (LVADs) are limited. This study aimed to examine the characteristics and the clinical impact of PE following LVAD implantation. Methods: This study is a prospective analysis of patients who underwent LVAD implantation from June 2015 to December 2022. We investigated the prognostic impact of therapeutic drainage (TD) on clinical outcomes. We also compared the characteristics and clinical outcomes between early and late PE and examined the factors related to the development of late PE. Results: A total of 71 patients was analyzed. The TD group (n=45) had a longer ward stay (days; median [interquartile range]: 31.0 [23.0–46.0] vs. 21.0 [16.0–34.0], P=0.006) and total hospital stay (47.0 [36.0–82.0] vs. 31.0 [22.0–48.0], P=0.002) compared to the no TD group (n=26). Early PE was mostly exudate, left-sided, and neutrophil-dominant even though predominance of lymphocytes was the most common finding in late PE. Patients with late PE had a higher rate of reintubation within 14 days (31.8% vs. 4.1%, P=0.004) and longer hospital stays than those without late PE (67.0 [43.0–104.0] vs. 36.0 [28.0–48.0], P<0.001). Subgroup analysis indicated that female sex, low body mass index, cardiac resynchronization therapy, and hypoalbuminemia were associated with late PE. Conclusions: Compared to patients not undergoing TD, those undergoing TD had a longer hospital stay but not a higher 90-day mortality. Patients with late PE had poor clinical outcomes. Therefore, the correction of risk factors, like hypoalbuminemia, may be required.

Citations

Citations to this article as recorded by  
  • Nuances of pleural effusion after left ventricular assist devices implantation: insights from therapeutic drainage and preoperative predictors
    Huijin Lee, Jeehoon Kang
    Acute and Critical Care.2024; 39(1): 192.     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
  • 4,152 View
  • 199 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

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  • 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
Review Article
Pulmonary
Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages
Vorakamol Phoophiboon, Monvasi Pachinburavan, Nicha Ruamsap, Natthawan Sanguanwong, Nattapong Jaimchariyatam
Acute Crit Care. 2021;36(4):286-293.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00458
  • 6,801 View
  • 444 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDF
The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

Citations

Citations to this article as recorded by  
  • Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension
    Qian Zhang, Fang Zhu, Guocheng Shi, Chen Hu, Weituo Zhang, Puzhen Huang, Chunfeng Zhu, Hong Gu, Dong Yang, Qiangqiang Li, Yonghua Niu, Hao Chen, Ruixiang Ma, Ziyi Pan, Huixian Miao, Xin Zhang, Genxia Li, Yabing Tang, Guyuan Qiao, Yichen Yan, Zhongqun Zhu,
    Circulation.2023; 147(7): 549.     CrossRef
  • Pregnancy in Patients with Pulmonary Arterial Hypertension in Light of New ESC Guidelines on Pulmonary Hypertension
    Karolina Barańska-Pawełczak, Celina Wojciechowska, Wojciech Jacheć
    International Journal of Environmental Research and Public Health.2023; 20(5): 4625.     CrossRef
  • Pregnancy in Severe Pulmonary Hypertension: A Case Report and Literature Analysis
    一人 王
    Advances in Clinical Medicine.2023; 13(10): 16433.     CrossRef
  • Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal‐fetal outcome in late pregnancy
    Yuan Yuan Xing, Yanping Ruan, Huai Qin, Lei Zhao, Qing Zhao, Yun Wei, Jie Chen, Xiaohai Ma
    Echocardiography.2023; 40(12): 1339.     CrossRef
  • Clinical Analysis in 82 Pregnant Women with the Severity of Pulmonary Hypertension
    安芬 李
    Advances in Clinical Medicine.2023; 13(11): 18492.     CrossRef
Original Article
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
  • 5,140 View
  • 163 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
Review Article
Basic science and research
Sepsis-induced cardiac dysfunction: a review of pathophysiology
Reverien Habimana, Insu Choi, Hwa Jin Cho, Dowan Kim, Kyoseon Lee, Inseok Jeong
Acute Crit Care. 2020;35(2):57-66.   Published online May 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00248
  • 14,188 View
  • 937 Download
  • 44 Web of Science
  • 48 Crossref
AbstractAbstract PDF
It is well known that cardiac dysfunction in sepsis is associated with significantly increased mortality. The pathophysiology of sepsis-induced cardiac dysfunction can be summarized as involving impaired myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Impaired blood flow to the myocardium is associated with microvascular dysfunction, impaired endothelium, and ventriculo-arterial uncoupling. The mechanisms behind direct myocardial depression consist of downregulation of β-adrenoceptors and several myocardial suppressants (such as cytokine and nitric oxide). Recent research has highlighted that mitochondrial dysfunction, which results in energy depletion, is a major factor in sepsis-induced cardiac dysfunction. Therefore, the authors summarize the pathophysiological process of cardiac dysfunction in sepsis based on the results of recent studies.

Citations

Citations to this article as recorded by  
  • Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology
    Sophie M. Duignan, Satyan Lakshminrusimha, Kathryn Armstrong, Willem P. de Boode, Afif El-Khuffash, Orla Franklin, Eleanor J. Molloy, Willem P. de Boode, Franz B. Plötz, Tobias Strunk, Marina Degtyareva, Helmut Küster, Eric Giannoni, Joseph M. Bliss, H. R
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    Azar Hosseini, Mohaddeseh Sadat Alavi, Mitra Ghane Nikookar Toos, Tannaz Jamialahmadi, Amirhossein Sahebkar
    Journal of Agriculture and Food Research.2024; 15: 101034.     CrossRef
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    Andia Taghdiri
    International Journal of Arrhythmia.2024;[Epub]     CrossRef
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    Nutnicha Yolsiriwat, Surat Tongyoo
    Clinical Critical Care.2024;[Epub]     CrossRef
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    Bei Chen, Ya-Fei Li, Zhang Fang, Wen-Yi Cai, Zhi-Qiang Tian, Dianfu Li, Ze-Mu Wang
    Heliyon.2024; 10(5): e27163.     CrossRef
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    Amol Singam
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    Richard C. Cabot, Eric S. Rosenberg, David M. Dudzinski, Meridale V. Baggett, Kathy M. Tran, Dennis C. Sgroi, Jo-Anne O. Shepard, Emily K. McDonald, Tara Corpuz, Zaven Sargsyan, Sunita D. Srivastava, Virginia A. Triant, Brian B. Ghoshhajra
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  • Melatonin: A potential protective multifaceted force for sepsis-induced cardiomyopathy
    Eman Casper, Lamia El Wakeel, Nagwa Sabri, Ramy Khorshid, Sarah F. Fahmy
    Life Sciences.2024; 346: 122611.     CrossRef
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    Daniele Orso, Nicola Federici, Cristina Lio, Filippo Mearelli, Tiziana Bove
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    Keigo Sato, Akihiro Naito, Taichi Shiratori, Masahiro Yamamoto, Kenichi Shimane, Manabu Mikami, Mariko Senda, Haruki Kume, Motofumi Suzuki
    IJU Case Reports.2023; 6(1): 26.     CrossRef
  • Jujuboside A attenuates sepsis-induced cardiomyopathy by inhibiting inflammation and regulating autophagy
    Zi Wang, Danrui Xiao, Qingqi Ji, Yanjie Li, Zhaohua Cai, Liang Fang, Huanhuan Huo, Guo Zhou, Xiangming Yan, Linghong Shen, Ben He
    European Journal of Pharmacology.2023; 947: 175451.     CrossRef
  • Mitochondrial transplantation protects against sepsis-induced myocardial dysfunction by modulating mitochondrial biogenesis and fission/fusion and inflammatory response
    Behnaz Mokhtari, Masoud Hamidi, Reza Badalzadeh, Ata Mahmoodpoor
    Molecular Biology Reports.2023; 50(3): 2147.     CrossRef
  • Therapeutic potentials of stem cell–derived exosomes in cardiovascular diseases
    Saiprahalad Mani, Narasimman Gurusamy, Thennavan Ulaganathan, Autumn J Paluck, Satish Ramalingam, Johnson Rajasingh
    Experimental Biology and Medicine.2023; 248(5): 434.     CrossRef
  • CLINICAL, MOLECULAR, AND EXOSOMAL MECHANISMS OF CARDIAC AND BRAIN DYSFUNCTION IN SEPSIS
    Daniel C. Morris, Zheng Gang Zhang, Anja K. Jaehne, Jing Zhang, Emanuel P. Rivers
    Shock.2023; 59(2): 173.     CrossRef
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    Gemma Barber, Jelena Tanic, Aleksandra Leligdowicz
    Current Opinion in Lipidology.2023; 34(2): 70.     CrossRef
  • Extracellular Histone-Induced Protein Kinase C Alpha Activation and Troponin Phosphorylation Is a Potential Mechanism of Cardiac Contractility Depression in Sepsis
    Simon T. Abrams, Yasir Alhamdi, Min Zi, Fengmei Guo, Min Du, Guozheng Wang, Elizabeth J. Cartwright, Cheng-Hock Toh
    International Journal of Molecular Sciences.2023; 24(4): 3225.     CrossRef
  • Septic cardiomyopathy: A narrative review
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    Revista Portuguesa de Cardiologia.2023; 42(5): 471.     CrossRef
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  • Role of Pellino-1 in Inflammation and Cardioprotection following Severe Sepsis: A Novel Mechanism in a Murine Severe Sepsis Model †
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  • Decoding molecular signature on heart of septic mice with distinct left ventricular ejection fraction
    Lina Zhang, Desheng Qi, Milin Peng, Binbin Meng, Xinrun Wang, Xiaolei Zhang, Zhihong Zuo, Li Li, Zhanwen Wang, Wenxuan Zou, Zhonghua Hu, Zhaoxin Qian
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  • Role of toll-like receptor-mediated pyroptosis in sepsis-induced cardiomyopathy
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  • Understanding yellow fever-associated myocardial injury: an autopsy study
    Fernando Rabioglio Giugni, Vera Demarchi Aiello, Caroline Silverio Faria, Shahab Zaki Pour, Marielton dos Passos Cunha, Melina Valdo Giugni, Henrique Trombini Pinesi, Felipe Lourenço Ledesma, Carolina Esteves Morais, Yeh-Li Ho, Jaques Sztajnbok, Sandra de
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  • The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement
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  • Deep-learning model for screening sepsis using electrocardiography
    Joon-myoung Kwon, Ye Rang Lee, Min-Seung Jung, Yoon-Ji Lee, Yong-Yeon Jo, Da-Young Kang, Soo Youn Lee, Yong-Hyeon Cho, Jae-Hyun Shin, Jang-Hyeon Ban, Kyung-Hee Kim
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Original Articles
Rapid response system
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
Acute Crit Care. 2020;35(2):77-86.   Published online May 13, 2020
DOI: https://doi.org/10.4266/acc.2019.00661
  • 6,350 View
  • 212 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

Citations

Citations to this article as recorded by  
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Thoracic Surgery
How small is enough for the left heart decompression cannula during extracorporeal membrane oxygenation?
Sua Kim, Jin Seok Kim, Jae Seung Shin, Hong Ju Shin
Acute Crit Care. 2019;34(4):263-268.   Published online November 29, 2019
DOI: https://doi.org/10.4266/acc.2019.00577
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AbstractAbstract PDF
Background
Left ventricular (LV) distension is a recognizable problem accompanied by subsequent complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression has been established, and no minimal flow requirement has been designated. Thus, we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression during VA-ECMO in adult patients.
Methods
Left heart decompression was performed when severe pulmonary edema was detected on chest radiography or when no generation of pulse pressure followed severe LV dysfunction in patients receiving VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath into the left atrium via the femoral vein. The sheath was connected to the venous catheter used for ECMO. The catheter was maintained during VA-ECMO.
Results
The left heart decompression procedure was performed in seven of 35 patients who received VA-ECMO between February 2017 and June 2018. Three patients had acute myocardial infarction; three, fulminant myocarditis; and one, dilated cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an increase in pulse pressure of >20 mm Hg within 24 hours from the left heart decompression procedure. All seven patients were successfully weaned from VA-ECMO. No complications related to the left heart decompression procedure occurred.
Conclusions
An 8-Fr sheath may be a possible option for left heart decompression in adult patients with LV distension under VA-ECMO who are expecting recovery of LV function.

Citations

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    Enzo Lüsebrink, Leonhard Binzenhöfer, Antonia Kellnar, Christoph Müller, Clemens Scherer, Benedikt Schrage, Dominik Joskowiak, Tobias Petzold, Daniel Braun, Stefan Brunner, Sven Peterss, Jörg Hausleiter, Sebastian Zimmer, Frank Born, Dirk Westermann, Holg
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    Chengfen Yin, Lei Xu
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    Beong Ki Kim, Jeong In Hong, Jinwook Hwang, Hong Ju Shin
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    Ah‐Ram Kim, Hanbit Park, Sang‐Eun Lee, Jung‐Min Ahn, Duk‐Woo Park, Seung‐Whan Lee, Jae‐Joong Kim, Seung‐Jung Park, Jung Ae Hong, Pil‐Je Kang, Sung‐Ho Jung, Min‐Seok Kim
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CPR/Resuscitation
Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards
Chul Park
Acute Crit Care. 2019;34(3):212-218.   Published online August 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00598
Correction in: Acute Crit Care 2020;35(3):228
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AbstractAbstract PDF
Background
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
Methods
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
Results
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
Conclusions
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.

Citations

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Case Report
Pulmonary
Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation
Dong Kyu Oh, Tae Sun Shim, Kyung-Wook Jo, Seung-Il Park, Dong Kwan Kim, Sehoon Choi, Geun Dong Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong
Acute Crit Care. 2020;35(2):117-121.   Published online April 8, 2019
DOI: https://doi.org/10.4266/acc.2018.00416
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AbstractAbstract PDF
Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.

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Original Article
CPR/Resuscitation
Comparison between Gel Pad Cooling Device and Water Blanket during Target Temperature Management in Cardiac Arrest Patients
Yoon Sun Jung, Kyung Su Kim, Gil Joon Suh, Jun-Hwi Cho
Acute Crit Care. 2018;33(4):246-251.   Published online November 30, 2018
DOI: https://doi.org/10.4266/acc.2018.00192
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  • 5 Web of Science
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AbstractAbstract PDFSupplementary Material
Background
Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM.
Methods
We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature (<34°C) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from 33°C was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from 33°C during the maintenance period. If the selected temperature was not between 32°C and 34°C, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods.
Results
A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, 35.7°C vs. WB, 35.6°C; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from 33°C during the maintenance period was 0.19°C (95% confidence interval [CI], 0.17°C to 0.21°C) in the GP group and 0.76°C (95% CI, 0.71°C to 0.80°C) in the WB group. GP significantly decreased this difference by 0.59°C (95% CI, 0.44°C to 0.75°C; P<0.001).
Conclusions
The GP was superior to the WB for strict temperature control during TTM.

Citations

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Case Report
CPR/Resuscitation
Acute aortic dissection developed after cardiopulmonary resuscitation: transesophageal echocardiographic observations and proposed mechanism of injury
Dong Keon Lee, Kyung Sik Kang, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang
Acute Crit Care. 2019;34(3):228-231.   Published online April 26, 2018
DOI: https://doi.org/10.4266/acc.2015.00633
  • 7,716 View
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  • 7 Web of Science
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AbstractAbstract PDFSupplementary Material
There has been no report about aortic dissection due to cardiopulmonary resuscitation (CPR). We present here a case of acute aortic dissection as a rare complication of CPR and propose the potential mechanism of injury on the basis of transesophageal echocardiographic observations. A 54-year-old man presented with cardiac arrest after choking and received 19 minutes of CPR in the emergency department. Transesophageal echocardiography (TEE) during CPR revealed a focal separation of the intimal layer at the descending thoracic aorta without evidence of aortic dissection. After restoration of spontaneous circulation, hemorrhagic cardiac tamponade developed. Follow-up TEE to investigate the cause of cardiac tamponade revealed aortic dissection of the descending thoracic aorta. Hemorrhagic cardiac tamponade was thought to be caused by myocardial hemorrhage from CPR.

Citations

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  • Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair
    Aniekeme S Etuk, Olanrewaju F Adeniran , Bernard I Nkwocha, Nformbuh Asangmbeng, Mina Jacob
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Original Articles
Cardiology/Emergency
Five-year Experience of Extracorporeal Life Support in Emergency Physicians
Yong Soo Cho, Kyoung Hwan Song, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Dong Hun Lee, Sung Min Lee
Korean J Crit Care Med. 2017;32(1):52-59.   Published online February 28, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00885
  • 7,202 View
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AbstractAbstract PDF
Background
This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians.
Methods
We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications.
Results
Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest.
Conclusions
The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Citations

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  • Extracorporeal cardiopulmonary resuscitation location, coronary angiography and survival in out-of-hospital cardiac arrest
    Yoonjic Kim, Jeong Ho Park, Sun Young Lee, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin
    The American Journal of Emergency Medicine.2023; 64: 142.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry
    Yeongho Choi, Jeong Ho Park, Joo Jeong, Yu Jin Kim, Kyoung Jun Song, Sang Do Shin
    Critical Care.2023;[Epub]     CrossRef
  • Time from arrest to extracorporeal cardiopulmonary resuscitation and survival after out‐of‐hospital cardiac arrest
    Jeong Ho Park, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, Ki Jeong Hong
    Emergency Medicine Australasia.2019; 31(6): 1073.     CrossRef
  • Pre-hospital extra-corporeal cardiopulmonary resuscitation
    Ben Singer, Joshua C. Reynolds, David J. Lockey, Ben O’Brien
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2018;[Epub]     CrossRef
Thoracic Surgery
Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses
Tae Sik Kim, Jong Hyun Lee, Chan-Young Na
Korean J Crit Care Med. 2016;31(2):101-110.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.101
  • 10,568 View
  • 195 Download
  • 2 Crossref
AbstractAbstract PDF
Background:
We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations.
Methods
From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery.
Results
The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups.
Conclusions
Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Citations

Citations to this article as recorded by  
  • Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond
    Matti Jubouri, Fatemeh Hedayat, Sakina Abrar, Sophie L. Mellor, Louise J. Brown, Amer Harky
    Coronary Artery Disease.2022; 33(1): 52.     CrossRef
  • Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study
    Keum Young So, Sang Hun Kim
    Medical Biological Science and Engineering.2022; 5(1): 6.     CrossRef
Case Reports
Cardiology/Thoracic Surgery
Extracorporeal Membrane Oxygenation for 67 Days as a Bridge to Heart Transplantation in a Postcardiotomy Patient with Failing Heart and Mediastinitis
Hyoung Woo Chang, Yang Hyun Cho, Suhyun Cho, Kiick Sung, Pyo Won Park
Korean J Crit Care Med. 2015;30(4):295-298.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.295
  • 4,474 View
  • 56 Download
AbstractAbstract PDF
We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation
Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong
Korean J Crit Care Med. 2015;30(2):132-134.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.132
  • 7,647 View
  • 96 Download
  • 5 Crossref
AbstractAbstract PDF
Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

Citations to this article as recorded by  
  • Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
    Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
    Transfusion and Apheresis Science.2022; 61(2): 103408.     CrossRef
  • Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
    Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
    Frontiers in Pediatrics.2021;[Epub]     CrossRef
  • Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
    Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
    PLOS ONE.2020; 15(3): e0229724.     CrossRef
  • Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
    Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
    Chonnam Medical Journal.2017; 53(2): 110.     CrossRef
  • Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
    Yoon Hee Kim
    The Korean Journal of Critical Care Medicine.2015; 30(3): 139.     CrossRef

ACC : Acute and Critical Care