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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
  • 5,122 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
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
  • 6,333 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  
  • Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration
    Bryan D. Steitz, Allison B. McCoy, Thomas J. Reese, Siru Liu, Liza Weavind, Kipp Shipley, Elise Russo, Adam Wright
    Journal of General Internal Medicine.2024; 39(1): 27.     CrossRef
  • Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review
    Qiuxia Zhang, Khuan Lee, Zawiah Mansor, Iskasymar Ismail, Yi Guo, Qiao Xiao, Poh Ying Lim
    Heart & Lung.2024; 63: 51.     CrossRef
  • Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
    Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
    Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef
  • The associations between rapid response systems and their components with patient outcomes: A scoping review
    Rebecca J. Piasecki, Cheryl R. Dennison Himmelfarb, Kelly T. Gleason, Rachel M. Justice, Elizabeth A. Hunt
    International Journal of Nursing Studies Advances.2023; 5: 100134.     CrossRef
  • Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
    Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
    Acute and Critical Care.2022; 37(2): 237.     CrossRef
  • Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance
    Juliana Vanessa Rincón-López, Diego Larrotta-Castillo, Kelly Estrada-Orozco, Hernando Gaitán-Duarte
    Revista Colombiana de Obstetricia y Ginecología.2021; 72(2): 171.     CrossRef
  • Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
    Sang Hyuk Kim, Ji Young Hong, Youlim Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
    Mi-Jung Yoon, Jin-Hee Park
    Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491.     CrossRef
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
  • 6,837 View
  • 151 Download
  • 10 Web of Science
  • 10 Crossref
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

Citations to this article as recorded by  
  • Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis
    Ting-Hao Yang, Shih-Chieh Shao, Yi-Chih Lee, Chien-Han Hsiao, Chieh-Ching Yen
    Biomedical Journal.2023; : 100656.     CrossRef
  • Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA)
    Mehdi Torabi, Ghazal Soleimani Mahani, Moghaddameh Mirzaee
    International Journal of Emergency Medicine.2023;[Epub]     CrossRef
  • Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial
    Cédric Gil-Jardiné, Patricia Jabre, Frederic Adnet, Thomas Nicol, Patrick Ecollan, Bertrand Guihard, Cyril Ferdynus, Valery Bocquet, Xavier Combes
    Internal and Emergency Medicine.2022; 17(2): 611.     CrossRef
  • Risk factors associated with peri-intubation cardiac arrest in the emergency department
    Ting-Hao Yang, Kuan-Fu Chen, Shi-Ying Gao, Chih-Chuan Lin
    The American Journal of Emergency Medicine.2022; 58: 229.     CrossRef
  • Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
    I-Wen Chen, Yu-Yu Li, Kuo-Chuan Hung, Ying-Jen Chang, Jen-Yin Chen, Ming-Chung Lin, Kuei-Fen Wang, Chien-Ming Lin, Ping-Wen Huang, Cheuk-Kwan Sun
    Medicine.2022; 101(33): e30032.     CrossRef
  • Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review
    Rohit S. Loomba, Riddhi Patel, Elizabeth Kunnel, Enrique G. Villarreal, Juan S. Farias, Saul Flores
    Journal of Pediatric Intensive Care.2022;[Epub]     CrossRef
  • Comparison of Suction Rates Between a Standard Yankauer, a Commercial Large-Bore Suction Device, and a Makeshift Large-Bore Suction Device
    Dhimitri A. Nikolla, Briana King, Andrew Heslin, Jestin N. Carlson
    The Journal of Emergency Medicine.2021; 61(3): 265.     CrossRef
  • Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies
    Kunal Karamchandani, Jonathan Wheelwright, Ae Lim Yang, Nathaniel D. Westphal, Ashish K. Khanna, Sheila N. Myatra
    Anesthesia & Analgesia.2021; 133(3): 648.     CrossRef
  • Further Validation of a Novel Acute Myocardial Infarction Risk Stratification (nARS) System for Patients with Acute Myocardial Infarction
    Shinnosuke Sawano, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
    International Heart Journal.2020; 61(3): 463.     CrossRef
  • Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards
    Chul Park
    Acute and Critical Care.2020; 35(3): 228.     CrossRef
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
  • 6,022 View
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  • 5 Web of Science
  • 6 Crossref
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

Citations to this article as recorded by  
  • Efficacy and safety of the Arctic Sun device for hypoxic-ischemic encephalopathy in adult patients following cardiopulmonary resuscitation: A systematic review and meta-analysis
    SaurabhC Sharda, MandipSingh Bhatia, RohitR Jakhotia, Ashish Behera, Atul Saroch, AshokKumar Pannu, HMohan Kumar
    Brain Circulation.2023; 9(3): 185.     CrossRef
  • Factors influencing deviation from target temperature during targeted temperature management in postcardiac arrest patients
    Kanae Ochiai, Yasuhiro Otomo
    Open Heart.2023; 10(2): e002459.     CrossRef
  • Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C
    Seok Jin Ryu, Dong Hun Lee, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Jung Soo Park, Jin Hong Min, Dong Ki Kim
    Therapeutic Hypothermia and Temperature Management.2022; 12(2): 74.     CrossRef
  • Comparison of hydrogel pad and water-circulating blanket cooling methods for targeted temperature management: A propensity score-matched analysis from a prospective multicentre registry
    Kyoung Tak Keum, Yong Hwan Kim, Jun Ho Lee, Seong Jun Ahn, Seong Youn Hwang, Joo Suk Oh, Su Jin Kim, Soo Hyun Kim, Kyung Woon Jeung
    Resuscitation.2021; 169: 78.     CrossRef
  • Use of a Servo-Controlled Cooling Gel Pad System to Regulate Body Temperature in Critically Ill Children
    Gema Pérez, Gema Manrique, Julia García, Sara de la Mata, Débora Sanz, Jesús López-Herce
    Pediatric Critical Care Medicine.2020; 21(12): e1094.     CrossRef
  • Management of post-cardiac arrest syndrome
    Youngjoon Kang
    Acute and Critical Care.2019; 34(3): 173.     CrossRef
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
  • 7,692 View
  • 153 Download
  • 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

Citations to this article as recorded by  
  • 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
    Cureus.2023;[Epub]     CrossRef
  • Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement
    Jan Naar, Dagmar Vondrakova, Andreas Kruger, Marek Janotka, Iva Zemanova, Martin Syrucek, Petr Neuzil, Petr Ostadal
    Journal of Clinical Medicine.2023; 12(16): 5318.     CrossRef
  • Blunt Thoracic Aortic Injury and Contemporary Management Strategy
    Ranjan Dahal, Yogesh Acharya, Alan H. Tyroch, Debabrata Mukherjee
    Angiology.2022; 73(6): 497.     CrossRef
  • Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients
    Dong-Hyun Jang, Dong Keon Lee, You Hwan Jo, Seung Min Park, Young Taeck Oh, Chang Woo Im
    Resuscitation.2022; 179: 277.     CrossRef
  • Blunt traumatic aortic dissection death by falling: an autopsy case report
    Gentaro Yamasaki, Marie Sugimoto, Takeshi Kondo, Motonori Takahashi, Mai Morichika, Azumi Kuse, Kanako Nakagawa, Yasuhiro Ueno, Migiwa Asano
    Forensic Science, Medicine and Pathology.2022; 19(3): 388.     CrossRef
  • Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation
    Sung Oh Hwang, Woo Jin Jung, Young-Il Roh, Kyoung-Chul Cha
    Clinical and Experimental Emergency Medicine.2022; 9(4): 271.     CrossRef
  • Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes
    Woo Jin Jung, Kyoung-Chul Cha, Yong Won Kim, Yoon Seop Kim, Young-Il Roh, Sun Ju Kim, Hye Sim Kim, Sung Oh Hwang
    Resuscitation.2020; 154: 31.     CrossRef
  • Aortic Rupture as a Complication of Cardiopulmonary Resuscitation
    Prashanth Venkatesh, Edward J. Schenck
    JACC: Case Reports.2020; 2(8): 1150.     CrossRef
Original Article
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
  • 7,195 View
  • 154 Download
  • 4 Web of Science
  • 4 Crossref
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

Citations to this article as recorded by  
  • 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
Case Report
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
  • 7,635 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
Original Articles
Cardiology/Pediatric
Effectiveness of Bradycardia as a Single Parameter in the Pediatric Acute Response System
Yu Hyeon Choi, Hyeon Seung Lee, Bong Jin Lee, Dong In Suh, June Dong Park
Korean J Crit Care Med. 2014;29(4):297-303.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.297
  • 4,314 View
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  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS.
METHODS
This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate.
RESULTS
Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01).
CONCLUSIONS
Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.

Citations

Citations to this article as recorded by  
  • Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children
    Lia Kim, Kyoung Sung Yun, June Dong Park, Bongjin Lee
    Children.2023; 10(1): 167.     CrossRef
  • 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 and Critical Care.2023; 38(4): 498.     CrossRef
  • Pediatric triage modifications based on vital signs: a nationwide study
    Bongjin Lee, June Dong Park, Young Ho Kwak, Do Kyun Kim
    Clinical and Experimental Emergency Medicine.2022; 9(3): 224.     CrossRef
Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest
Sei Jong Bae, Byung Kook Lee, Ki Tae Kim, Kyung Woon Jeung, Hyoung Youn Lee, Yong Hun Jung, Geo Sung Lee, Sun Pyo Kim, Seung Joon Lee
Korean J Crit Care Med. 2013;28(1):33-40.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.33
  • 2,339 View
  • 22 Download
AbstractAbstract PDF
BACKGROUND
If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest.
METHODS
A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups.
RESULTS
Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%).
CONCLUSIONS
The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.
The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon
Korean J Crit Care Med. 2012;27(4):255-262.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.255
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BACKGROUND
The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH.
METHODS
The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality.
RESULTS
One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622-42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003-1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0-228.0) mg/dl, 128.0 (102.0-165.0) mg/dl, and 105.0 (87.5-129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180-309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133-242) mg/dl of the maximal median blood glucose value during the cooling phase (p < 0.001).
CONCLUSIONS
High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.

ACC : Acute and Critical Care