Acute and Critical Care

Original Articles

CPR/Resuscitation
Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry: June-sung Kim, Hannah Park, Won Young Kim; Acute Crit Care. 2026;41(2):356-363. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.002225

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Abstract PDF Supplementary Material: Background
Mechanical chest compression devices are increasingly used during cardiopulmonary resuscitation, particularly in the prehospital setting, where maintaining high-quality manual chest compressions is challenging. In this study, we aimed to determine whether prehospital exposure to mechanical chest compression is independently associated with increased risk of compression-related chest trauma among out-of-hospital cardiac arrest (OHCA) survivors. Methods: We retrospectively analyzed patients from our prospective OHCA registry who achieved sustained return of spontaneous circulation and underwent chest computed tomography (CT) between March 2019 and June 2023. Chest trauma was identified on imaging and categorized as rib fractures, lung contusion, pneumothorax, pneumomediastinum, hematoma, sternal fracture, or hemothorax. Multivariate logistic regression was performed to identify factors associated with chest trauma. Results: Among 634 included patients, 614 (97%) underwent chest CT, and 277 (45.1%) had evidence of chest trauma. Patients with chest trauma were more likely to be female, be older, have lower body mass index, undergo longer resuscitation, and receive prehospital mechanical chest compression. Rib fractures were the most common injury, followed by sternal fracture. Multivariate analysis showed that the use of mechanical compression in the prehospital setting was an independent risk factor for compression-related chest trauma (adjusted odds ratio, 2.33; 95% CI, 1.45– 3.74). Conclusions: Exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma among OHCA survivors.

CPR/Resuscitation
Prognostic value of initial hemoglobin levels for neurological outcomes in patients with out-of-hospital cardiac arrest in South Korea: Jihun Keum, Kyung Hun Yoo, Yongil Cho, Tae Ho Lim, Hyunggoo Kang, Jaehoon Oh, Byuk Sung Ko, Juncheol Lee; Received October 21, 2025 Accepted March 2, 2026 Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.005075 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
Previous studies suggest that lower hemoglobin (Hb) levels are associated with adverse outcomes after out-of-hospital cardiac arrest (OHCA). However, most of these were limited by small sample sizes and single-center designs. We aimed to evaluate the association between initial Hb levels and clinical outcomes after OHCA using a large multicenter registry.
Methods
This retrospective observational study analyzed prospectively collected multicenter registry data. Hb levels measured at emergency department arrival were analyzed as continuous variables with restricted cubic spline (RCS) models, which flexibly characterize dose–response relationships with unfavorable neurological outcomes and in-hospital mortality. Generalized estimating equations with a logit link were used to account for within-hospital clustering and to adjust for clinically relevant covariates.
Results
Lower Hb levels were independently associated with higher adjusted odds of unfavorable neurological outcomes and in-hospital mortality. RCS analyses showed a statistically significant overall association between Hb levels and both outcomes after multivariable adjustment (overall P<0.001). The adjusted odds of adverse outcomes increased progressively with decreasing Hb levels. Cluster-adjusted analyses using generalized estimating equations yielded consistent results.
Conclusions
Initial Hb levels were independently associated with neurological outcomes and in-hospital mortality after OHCA. Modeling Hb as a continuous variable showed a graded association across the Hb spectrum. These findings highlight the prognostic relevance of baseline Hb levels.

Review Article

Pediatrics
From scores to signals: evolution and innovations in pediatric early warning systems: Wonjin Jang, Bongjin Lee; Acute Crit Care. 2026;41(2):252-261. Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.004475

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Abstract PDF: Early identification of clinical deterioration in hospitalized children is essential to improve outcomes and prevent critical events. Over the past two decades, structured approaches such as pediatric early warning scores and rapid response systems have provided a framework for systematic risk detection in general wards. More recently, artificial intelligence and continuous monitoring technologies have begun to transform this field, offering the potential for more timely and accurate recognition of subtle changes in patient status. Despite these advances, challenges remain before seamless integration of these technologies into routine clinical decision-making can be achieved. This review explores the evolution of pediatric early warning systems and examines how emerging innovations may shape the future of predictive monitoring and clinical decision support in pediatric care.

Original Articles

Epidemiology
The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea: Ho Kyung Sung, Jeehye Lee, Min-hwan Oh, Jin Young Kim, Young Kyun Choi, Jae Young Moon; Acute Crit Care. 2026;41(2):270-281. Published online April 15, 2026; DOI: https://doi.org/10.4266/acc.004225

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Abstract PDF Supplementary Material: Background
In Korea, intensive care units (ICUs) are defined mainly by administrative categories, which do not reflect functional capability. This study examined the relationship between hospital capacity and functional performance by analyzing nationwide patterns of volume, capability, and institutional variation. Methods: We analyzed adult emergency department-to-ICU admissions in 378 hospitals from 2016 to 2023. Admission and life-support intervention (LSI) volumes were measured; organ-supportive therapies such as mechanical ventilation and renal replacement therapy were considered LSIs, and the LSI rate (LSI admissions/total admissions) was used as a proxy for functional capability. Generalized additive models assessed non-linear relationships with bed capacity, and residual-based analysis was used to classify hospitals into functional phenotypes. Results: Critical care delivery was highly concentrated; the top 8% of hospitals provided 50% of LSIs. Admission and LSI volumes increased with hospital size but plateaued beyond approximately 1,300 beds, while the LSI rate continued to rise until approximately 1,700 beds. Hospitals of similar size showed wide variation in both volume and capability. Based on residuals, 42.4% of hospitals formed a central reference group, while others were classified as high-volume/high-capability (13.7%), low-volume/high-capability (15.0%), low-volume/low-capability (12.0%), or high-volume/low-capability (16.9%). Conclusions: The relationship between structural capacity and functional performance in Korean ICUs is complex and non-linear. Hospital size alone is insufficient to predict emergency critical care delivery, underscoring the importance of operational models alongside structural resources. These findings provide a foundation for capability-based ICU stratification to guide resource allocation and strengthen system resilience.

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

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Abstract PDF Supplementary Material

Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Citations

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Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study
Jeehye Lee, Ho Kyung Sung, Min-hwan Oh, Jin Young Kim, KyoungHo Kim, Jae Young Moon
Acute and Critical Care.2026; 41(2): 282. CrossRef

CPR/Resuscitation
Initial arterial pH predicts survival of out-of-hospital cardiac arrest in South Korea: Daun Jeong, Sang Do Shin, Tae Gun Shin, Gun Tak Lee, Jong Eun Park, Sung Yeon Hwang, Jin-Ho Choi; Acute Crit Care. 2025;40(3):444-451. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.001050

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Abstract PDF Supplementary Material

Background
Arterial pH reflects both metabolic and respiratory distress in cardiac arrest and has prognostic implications. However, it was excluded from the 2024 update of the Utstein out-of-hospital cardiac arrest (OHCA) registry template. We investigated the rationale for including arterial pH into models predicting clinical outcomes. Methods: Data were sourced from the Korean Cardiac Arrest Research Consortium, a nationwide OHCA registry (NCT03222999). Prediction models were constructed using logistic regression, random forest, and eXtreme Gradient Boosting frameworks. Each framework included three model types: pH, low-flow time, and combined models. Then the area under the receiver operating characteristic curve (AUROC) of each predicting model was compared. The primary outcome was 30- day death or neurologically unfavorable status (cerebral performance category ≥3). Results: Among the 15,765 patients analyzed, 92.2% experienced death or unfavorable neurological outcomes. The predicting performance of the models including pH (AUROC, 0.92–0.94) were comparable to the models including low-flow time in all frameworks (0.93–0.94) (all P>0.05). Inclusion of pH into low-flow time models consistently showed higher AUROCs than individual models in all frameworks (AUROC, 0.93–0.95; all P<0.05). Conclusions: The predicting performance of models including arterial pH was comparable to models including low-flow time, and addition of arterial pH into low-flow time models could increase the performance of the models. Key Words: blood pH; hydrogen-ion con

Citations

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Comparison of Traumatic and Non-Traumatic Cardiopulmonary Arrest Patients
Kenan Çalışkan, Necmi Baykan
Journal of Anatolian Medical Research.2026; 11(1): 12. CrossRef

Epidemiology
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea: Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park; Acute Crit Care. 2025;40(2):160-170. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004968

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