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Original Article
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
  • 136 View
  • 4 Download
AbstractAbstract PDFSupplementary 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 ratios, 2.33; 95% CI, 1.45–3.74).
Conclusion
Exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma among OHCA survivors.
Review Article
Trauma
Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review
Junsik Kwon, Byung Hee Kang
Acute Crit Care. 2026;41(1):47-57.   Published online January 20, 2026
DOI: https://doi.org/10.4266/acc.003525
  • 5,271 View
  • 634 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Hemorrhage remains a leading cause of preventable death in trauma, emphasizing the importance of early bleeding control. In addition to mechanical hemostasis, effective management of trauma-induced coagulopathy (TIC) plays a critical role in improving outcomes. TIC is a multifactorial condition with diverse phenotypes, involving complex pathophysiology. These variations complicate early diagnosis and targeted treatment. In the prehospital setting, phenotype-based management is not feasible; thus, empirical strategies have been adopted. Administration of tranexamic acid and prehospital whole blood transfusion have shown clinical benefit in selected trauma populations. Upon hospital arrival, fixed-ratio massive transfusion protocols and whole blood resuscitation provide broad support for coagulopathic states and have proven effective in reducing early mortality. However, these approaches may not fully account for individual variation in coagulation profiles. Viscoelastic assays allow real-time evaluation of coagulation status and offer the potential for individualized, goal-directed therapy. While some studies suggest improved outcomes with viscoelastic-guided resuscitation, evidence of clear superiority over conventional methods remains limited. Further research is needed to determine the optimal resuscitation strategy and integrate both empirical and precision-based approaches in TIC management.

Citations

Citations to this article as recorded by  
  • Management of trauma‐induced coagulopathy in the perioperative setting: What is the role of anesthesia?
    Angela M. Mitchell, Brennah C. O'Connell, Valerie G. Sams
    Transfusion.2026;[Epub]     CrossRef
Original Articles
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
  • 3,450 View
  • 68 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary 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

Citations to this article as recorded by  
  • Comparison of Traumatic and Non-Traumatic Cardiopulmonary Arrest Patients
    Kenan Çalışkan, Necmi Baykan
    Journal of Anatolian Medical Research.2026; 11(1): 12.     CrossRef
Epidemiology
Development of a deep learning model for predicting critical events in a pediatric intensive care unit
In Kyung Lee, Bongjin Lee, June Dong Park
Acute Crit Care. 2024;39(1):186-191.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.01424
Correction in: Acute Crit Care 2024;39(2):330
  • 7,120 View
  • 199 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality.
Methods
This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing.
Results
Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000).
Conclusions
The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.

Citations

Citations to this article as recorded by  
  • Clinical Applications of Data Science and Machine Learning in the Pediatric Cardiac Intensive Care Unit
    Fabio Savorgnan, Pranathi Pilla, Joshua Prabhu, Saul Flores, Rohit S. Loomba, Sebastian Acosta
    Pediatric Cardiology.2026;[Epub]     CrossRef
  • Prediction of Adverse Events in Single Ventricle Physiology Infants Using Artificial Intelligence Tools
    Min Yu, Lucas Saenz Gaitan, Alejandro Lopez Magallon, Craig Futterman, Fang Jin, Marius George Linguraru, Syed Muhammad Anwar, Ricardo Munoz
    Critical Care Explorations.2026; 8(2): e1381.     CrossRef
  • Artificial Intelligence in Predicting Mortality Risk for Critically Ill Children in Pediatric Intensive Care Units: A Systematic Review
    Seyedeh Narjes Ahmadizadeh, Hasan Shamsi, Neda Izadi, Ali Dabbagh, Moein Ebrahimi, Marzieh Shahrabi, Fariba Shabani
    Health Science Reports.2026;[Epub]     CrossRef
  • Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: implicaciones para la práctica y la toma de decisiones en enfermería
    Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
    Prohominum.2025; 7(2): 209.     CrossRef
  • Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: Implicaciones para la práctica y la toma de decisiones en enfermería
    Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
    Más Vita.2025; 7(2): 58.     CrossRef
CPR/Resuscitation
Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea
Yun Im Lee, Ryoung-Eun Ko, Soo Jin Na, Jeong-Am Ryu, Yang Hyun Cho, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh
Acute Crit Care. 2023;38(2):190-199.   Published online May 25, 2023
DOI: https://doi.org/10.4266/acc.2022.01438
  • 6,254 View
  • 120 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known.
Methods
Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia.
Results
During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ.
Conclusions
In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

Citations

Citations to this article as recorded by  
  • Post-resuscitation care after adult extracorporeal cardiopulmonary resuscitation: A scoping review
    Tommaso Scquizzato, Gioia Moscoloni, Alexander Supady, Darryl Abrams, Fabio Silvio Taccone, Claudio Sandroni, Jason Bartos, Natalie Kruit, Arianna Gazzato, Alex Rosenberg, Jae-Seung Jung, Steven Ling, Aidan Burrell, Mark Dennis, Anna Mara Scandroglio
    Resuscitation.2025; 217: 110880.     CrossRef
  • Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study
    Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
    Intensive and Critical Care Nursing.2024; 83: 103674.     CrossRef
  • What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study
    Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
    International Journal of Emergency Medicine.2024;[Epub]     CrossRef
  • Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest and in-hospital cardiac arrest with return of spontaneous circulation: be careful when comparing apples to oranges
    Hwa Jin Cho, In Seok Jeong, Jan Bělohlávek
    Acute and Critical Care.2023; 38(2): 242.     CrossRef
CPR/Resuscitation
Percent fluid overload for prediction of fluid de-escalation in critically ill patients in Saudi Arabia: a prospective observational study
Reham A. Alharbi, Namareq F. Aldardeer, Emily L. G. Heaphy, Ahmad H. Alabbasi, Amjad M. Albuqami, Hassan Hawa
Acute Crit Care. 2023;38(2):209-216.   Published online May 16, 2023
DOI: https://doi.org/10.4266/acc.2022.01550
  • 8,665 View
  • 189 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
Percent fluid overload greater than 5% is associated with increased mortality. The appropriate time for fluid deresuscitation depends on the patient's radiological and clinical findings. This study aimed to assess the applicability of percent fluid overload calculations for evaluating the need for fluid deresuscitation in critically ill patients.
Methods
This was a single-center, prospective, observational study of critically ill adult patients requiring intravenous fluid administration. The study's primary outcome was median percent fluid accumulation on the day of fluid deresuscitation or intensive care unit (ICU) discharge, whichever came first.
Results
A total of 388 patients was screened between August 1, 2021, and April 30, 2022. Of these, 100 with a mean age of 59.8±16.2 years were included for analysis. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15.4±8.0. Sixty-one patients (61.0%) required fluid deresuscitation during their ICU stay, while 39 (39.0%) did not. Median percent fluid accumulation on the day of deresuscitation or ICU discharge was 4.5% (interquartile range [IQR], 1.7%–9.1%) and 5.2% (IQR, 2.9%–7.7%) in patients requiring deresuscitation and those who did not, respectively. Hospital mortality occurred in 25 (40.9%) of patients with deresuscitation and six (15.3%) patients who did not require it (P=0.007).
Conclusions
The percent fluid accumulation on the day of fluid deresuscitation or ICU discharge was not statistically different between patients who required fluid deresuscitation and those who did not. A larger sample size is needed to confirm these findings.

Citations

Citations to this article as recorded by  
  • THE RELATIONSHIP BETWEEN FLUID BALANCE AND FLUID MANAGEMENT STRATEGIES WITH MORTALITY AND CLINICAL OUTCOMES IN ICU: A SYSTEMATIC REVIEW
    Arda Tri Wahyuningsih
    Indonesian Journal of Anesthesiology and Critical Care Medicine.2026; 1(2): 53.     CrossRef
CPR/Resuscitation
Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable?
Mohammad Reza Zarkesh, Raheleh Moradi, Azam Orooji
Acute Crit Care. 2022;37(3):438-453.   Published online August 29, 2022
DOI: https://doi.org/10.4266/acc.2021.01501
  • 25,711 View
  • 195 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Anticipating the need for at-birth cardiopulmonary resuscitation (CPR) in neonates is very important and complex. Timely identification and rapid CPR for neonates in the delivery room significantly reduce mortality and other neurological disabilities. The aim of this study was to create a prediction system for identifying the need for at-birth CPR in neonates based on Machine Learning (ML) algorithms.
Methods
In this study, 3,882 neonatal medical records were retrospectively reviewed. A total of 60 risk factors was extracted, and five ML algorithms of J48, Naïve Bayesian, multilayer perceptron, support vector machine (SVM), and random forest were compared to predict the need for at-birth CPR in neonates. Two types of resuscitation were considered: basic and advanced CPR. Using five feature selection algorithms, features were ranked based on importance, and important risk factors were identified using the ML algorithms.
Results
To predict the need for at-birth CPR in neonates, SVM using all risk factors reached 88.43% accuracy and F-measure of 88.4%, while J48 using only the four first important features reached 90.89% accuracy and F-measure of 90.9%. The most important risk factors were gestational age, delivery type, presentation, and mother’s addiction.
Conclusions
The proposed system can be useful in predicting the need for CPR in neonates in the delivery room.

Citations

Citations to this article as recorded by  
  • Anticipating the Need for Advanced Resuscitation in Newborns: A 10-Year Retrospective Case-Control Study
    Maria Sousa Dias, Mariana Meneses, Monica Calado Araujo, Joana Moreno, Ana Azevedo, Sara Peixoto, Claudia Ferraz
    Pediatric Oncall.2025;[Epub]     CrossRef
  • Predicting the Need for Cardiopulmonary Resuscitation in Preterm Infants in the Delivery Room Using Machine Learning Models: Analysis of a Korean Neonatal Network Database
    Hyun Ho Kim
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
    Henry C. Lee, Marya L. Strand, Emer Finan, Jessica Illuzzi, Beena D. Kamath-Rayne, Vishal Kapadia, Melissa Mahgoub, Susan Niermeyer, Stephen M. Schexnayder, Georg M. Schmölzer, Jessica Weglarz, Amanda L. Williams, Gary M. Weiner, Myra Wyckoff, Nicole K. Y
    Circulation.2025;[Epub]     CrossRef
Ethics
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 Crit Care. 2022;37(2):237-246.   Published online February 24, 2022
DOI: https://doi.org/10.4266/acc.2021.01095
  • 8,312 View
  • 223 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Background
The Life-Sustaining Treatment (LST) Decisions Act allows withholding and withdrawal of LST, including cardiopulmonary resuscitation (CPR). In the present study, the incidence of CPR before and after implementation of the Act was compared.
Methods
This was a retrospective review involving hospitalized patients who underwent CPR at a single center between February 2016 and January 2020 (pre-implementation period, February 2016 to January 2018; post-implementation period, February 2018 to January 2020). The primary outcome was monthly incidence of CPR per 1,000 admissions. The secondary outcomes were duration of CPR, return of spontaneous circulation (ROSC) rate, 24-hour survival rate, and survival-to-discharge rate. The study outcomes were compared before and after implementation of the Act.
Results
A total of 867 patients who underwent CPR was included in the analysis. The incidence of CPR per 1,000 admissions showed no significant difference before and after implementation of the Act (3.02±0.68 vs. 2.81±0.75, P=0.255). The ROSC rate (67.20±0.11 vs. 70.99±0.12, P=0.008) and survival to discharge rate (20.24±0.09 vs. 22.40±0.12, P=0.029) were higher after implementation of the Act than before implementation.
Conclusions
The incidence of CPR did not significantly change for 2 years after implementation of the Act. Further studies are needed to assess the changes in trends in the decisions of CPR and other LSTs in real-world practice.

Citations

Citations to this article as recorded by  
  • Impact of the Life-Sustaining Treatment Decision Act on the Incidence and Outcomes of In-Hospital Cardiopulmonary Resuscitation
    Tak Kyu Oh, In-Ae Song
    Critical Care Medicine.2026;[Epub]     CrossRef
  • Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
    Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
    BMC Palliative Care.2024;[Epub]     CrossRef
  • For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act
    Hye Yoon Park, Min Sun Kim, Shin Hye Yoo, Jung Lee, In Gyu Song, So Yeon Jeon, Eun Kyung Choi
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions—The Experience of a Single Children’s Hospital
    Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim
    Healthcare.2024; 12(21): 2156.     CrossRef
  • Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
    Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
    BMC Medical Ethics.2023;[Epub]     CrossRef
  • Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
    In-Ae Song
    Acute and Critical Care.2022; 37(2): 256.     CrossRef
  • Effect of life-sustaining treatment decision law on pediatric in-hospital cardiopulmonary resuscitation rate: A Korean population-based study
    Jaeyoung Choi, Ah Young Choi, Esther Park, Meong Hi Son, Joongbum Cho
    Resuscitation.2022; 180: 38.     CrossRef
Rapid response system
Analysis of avoidable cardiopulmonary resuscitation incidents with a part-time rapid response system in place
Jun Yeun Cho, Dong Seon Lee, Yun Young Choi, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Acute Crit Care. 2021;36(2):109-117.   Published online April 16, 2021
DOI: https://doi.org/10.4266/acc.2020.01095
  • 8,688 View
  • 180 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
Although a rapid response system (RRS) can reduce the incidence of cardiopulmonary resuscitation (CPR) in general wards, avoidable CPR cases still occur. This study aimed to investigate the incidence and causes of avoidable CPR.
Methods
We retrospectively reviewed the medical records of all adult patients who received CPR between April 2013 and March 2016 (35 months) at a tertiary teaching hospital where a part-time RRS was introduced in October 2012. Four experts reviewed all of the CPR cases and determined whether each event was avoidable.
Results
A total of 192 CPR cases were identified, and the incidence of CPR was 0.190 per 1,000 patient admissions. Of these, 56 (29.2%) were considered potentially avoidable, with the most common cause being doctor error (n=32, 57.1%), followed by delayed do-not-resuscitate (DNR) placement (n=12, 21.4%) and procedural complications (n=5, 8.9%). The percentage of avoidable CPR was significantly lower in the RRS operating time group than in the RRS non-operating time group (20.7% vs. 35.5%; P=0.026). Among 44 avoidable CPR events (excluding cases related to DNR issues), the rapid response team intervened in only three cases (6.8%), and most of the avoidable CPR cases (65.9%) occurred during the non-operating time.
Conclusions
A significant number of avoidable CPR events occurred with a well-functioning, part-time RRS in place. However, RRS operation does appear to lower the occurrence of avoidable CPR. Thus, it is necessary to extend RRS operation time and modify RRS activation criteria. Moreover, policy and cultural changes are needed prior to implementing a full-time RRS.

Citations

Citations to this article as recorded by  
  • The effect of nurses' perceptions and satisfaction with hospital rapid response teams on burnout related to emergency situations in Korea: a cross-sectional study
    Bumin Kim, Nahyun Kim
    Journal of Korean Biological Nursing Science.2025; 27(2): 234.     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
  • A Review of the Commercially Available ECG Detection and Transmission Systems—The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest
    Michał Lewandowski
    Micromachines.2021; 12(12): 1489.     CrossRef
Review Article
Trauma
Damage control strategy in bleeding trauma patients
Maru Kim, Hangjoo Cho
Acute Crit Care. 2020;35(4):237-241.   Published online November 30, 2020
DOI: https://doi.org/10.4266/acc.2020.00941
  • 15,309 View
  • 454 Download
  • 5 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Hemorrhagic shock is a main cause of death in severe trauma patients. Bleeding trauma patients have coagulopathy on admission, which may even be aggravated by incorrectly directed resuscitation. The damage control strategy is a very urgent and essential aspect of management considering the acute coagulopathy of trauma and the physiological status of bleeding trauma patients. This strategy has gained popularity over the past several years. Patients in extremis cannot withstand prolonged definitive surgical repair. Therefore, an abbreviated operation, referred to as damage control surgery (DCS), is needed. In addition to DCS, the likelihood of survival should be maximized for patients in extremis by providing appropriate critical care, including permissive hypotension, hemostatic resuscitation, minimization of crystalloid use, early use of tranexamic acid, and avoidance of hypothermia and hypocalcemia. This review presents an overview of the evolving strategy of damage control in bleeding trauma patients.

Citations

Citations to this article as recorded by  
  • The Concept of “Damage Control Resuscitation”: Scoping-Review
    I. V. Sbitnev, A. R. Rasskazov, M. A. Petrushin, V. A. Reva
    Russian Sklifosovsky Journal "Emergency Medical Care".2026; 14(4): 763.     CrossRef
  • Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review
    Junsik Kwon, Byung Hee Kang
    Acute and Critical Care.2026; 41(1): 47.     CrossRef
  • Massive Transfusion Protocols in Orthopaedic Trauma: Lessons from the Battlefield
    Vishnu Senthil, Mainak Roy
    Apollo Medicine.2026;[Epub]     CrossRef
  • Management of Penetrating Thoracoabdominal Trauma in a Resource-Limited Setting: A Case Report
    Zac W Riggenbach, Brooklyn Williams, Jonathan Lutgens, Abigail Kelly, Alexander Malloy
    Cureus.2026;[Epub]     CrossRef
  • Evidence‑based Updates in Trauma Care: Global Progress From the 2000s to 2025
    Mohamed S. A. Mohamed
    Journal of Acute Care and Resuscitation.2026; 3(1): 3.     CrossRef
  • A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation
    David Silveira Marinho, Denise Menezes Brunetta, Luciana Maria de Barros Carlos, Luany Elvira Mesquita Carvalho, Jessica Silva Miranda
    Brazilian Journal of Anesthesiology (English Edition).2025; 75(2): 844583.     CrossRef
  • Targeting Inflammation After Hemorrhagic Shock as a Molecular and Experimental Journey to Improve Outcomes: A Review
    Kenneth Meza Monge, Astrid Ardon-Lopez, Akshay Pratap, Juan-Pablo Idrovo
    Cureus.2025;[Epub]     CrossRef
  • Comprehensive meta-analysis of emergency trauma outcomes: trends, interventions, and survival rates
    Aiming Li, Qiaoyan Feng, Ye Zhao, Xianhuan Zhang, Weijie Jiang
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Hypovolemic shock in adults. Guidelines of the All-Russian Public Organization “Federation of Anesthesiologists and Reanimatologists”
    Igor B. Zabolotskikh, E. V. Grigoryev, V. S. Afonchikov, A. Yu. Bulanov, S. V. Grigoryev, A. N. Kuzovlev, V. V. Kuzkov, R. E. Lakhin, K. M. Lebedinskii, O. V. Orlova, E. V. Roitman, S. V. Sinkov, N. P. Shen, A. V. Schegolev
    Annals of Critical Care.2024; (4): 7.     CrossRef
  • Navigating Hemorrhagic Shock: Biomarkers, Therapies, and Challenges in Clinical Care
    Kenneth Meza Monge, Caleb Rosa, Christopher Sublette, Akshay Pratap, Elizabeth J. Kovacs, Juan-Pablo Idrovo
    Biomedicines.2024; 12(12): 2864.     CrossRef
  • Current Approaches to the Treatment of Traumatic Shock (Review)
    D. A. Ostapchenko, A. I. Gutnikov, L. A. Davydova
    General Reanimatology.2021; 17(4): 65.     CrossRef
Original Articles
Ethics
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute Crit Care. 2020;35(3):179-188.   Published online August 10, 2020
DOI: https://doi.org/10.4266/acc.2020.00136
  • 17,292 View
  • 320 Download
  • 15 Web of Science
  • 17 Crossref
AbstractAbstract PDF
Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

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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
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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.

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    Julien Amour, Paul Balendraud, Jacques Boddaert, Pierre Bouzat, Laure Champ-Rigot, Olivier Clovet, Judith Cohen-Bittan, Isabelle Constant, Charles Court, Sabine Drevet, Christophe Hulet, Eric Jeziorski, Olivier Joannes-Boyau, Hélène Kovacsik, Morgan Le Gu
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    Akiko Ogawa, Yoko Tsuchiya, Ikue Sakemi, Nobuo Kutsuna
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    Bumin Kim, Nahyun Kim
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Pediatric
Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit
Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim
Acute Crit Care. 2020;35(2):87-92.   Published online May 12, 2020
DOI: https://doi.org/10.4266/acc.2019.00752
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AbstractAbstract PDF
Background
There are few studies on the effect of intensivist staffing in pediatric intensive care units (PICUs) in Korea. We aimed to evaluate the effect of pediatric intensivist staffing on treatment outcomes in a Korean hospital PICU.
Methods
We analyzed two time periods according to pediatric intensivist staffing: period 1, between November 2015 to January 2017 (no intensivist staffing, n=97) and period 2, between February 2017 to February 2018 (intensivists staffing, n=135).
Results
Median age at admission was 5.4 years (range, 0.7–10.3 years) in period 1 and 3.6 years (0.2–5.1 years) in period 2 (P=0.013). The bed occupancy rate decreased in period 2 (75%; 73%–88%) compared to period 1 (89%; 81%–94%; P=0.015). However, the monthly bed turnover rate increased in period 2 (2.2%; 1.9%–2.7%) compared to period 1 (1.5%, 1.1%– 1.7%; P=0.005). In both periods, patients with chronic neurologic illness were the most common. Patients with cardiovascular problems were more prevalent in period 2 than period 1 (P=0.008). Daytime admission occurred more frequently in period 2 than period 1 (63% vs. 39%, P<0.001). The length of PICU stay, parameters related with mechanical ventilation and tracheostomy, and pediatric Sequential Organ Failure Assessment score were not different between periods. Sudden cardiopulmonary resuscitations occurred in two cases during period 1, but no case occurred during period 2.
Conclusions
Pediatric intensivist staffing in the PICU may affect efficient ICU operations.

Citations

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    Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
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CPR/Resuscitation
Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation
Athanasios Chalkias, Anastasios Koutsovasilis, Eleni Laou, Apostolos Papalois, Theodoros Xanthos
Acute Crit Care. 2020;35(2):93-101.   Published online April 20, 2020
DOI: https://doi.org/10.4266/acc.2019.00773
  • 10,759 View
  • 180 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Background
Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient’s volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf’s association with vasopressor-free resuscitation.
Methods
Ten healthy Landrace/Large-White piglets aged 10–12 weeks with average weight 20±1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5–7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤4 mm Hg. No vasopressors were used.
Results
The mean volume of blood removed was 860±20 ml (blood loss, ~61%) and the bleeding time was 43.2±2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09±1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5–7.5 seconds and 3.72±0.23 mm Hg at 55– 57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1±1.7 minutes and mean administered volume being 394±20 ml.
Conclusions
For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.

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Review Article
CPR/Resuscitation
Role of extracorporeal cardiopulmonary resuscitation in adults
Hongsun Kim, Yang Hyun Cho
Acute Crit Care. 2020;35(1):1-9.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2020.00080
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AbstractAbstract PDF
Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10–20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

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Original Article
Rapid response system
Effect of a rapid response system on code rates and in-hospital mortality in medical wards
Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
Acute Crit Care. 2019;34(4):246-254.   Published online November 29, 2019
DOI: https://doi.org/10.4266/acc.2019.00668
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AbstractAbstract PDF
Background
To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards.
Methods
This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups.
Results
There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024).
Conclusions
Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

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Review Article
CPR/Resuscitation
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute Crit Care. 2019;34(3):173-178.   Published online August 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00654
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AbstractAbstract PDF
Post-cardiac arrest syndrome is a complex and critical issue in resuscitated patients undergone cardiac arrest. Ischemic-reperfusion injury occurs in multiple organs due to the return of spontaneous circulation. Bundle of management practicies are required for post-cardiac arrest care. Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease. Vasopressors such as norepinephrine and dobutamine are the first-line treatment for shock. Maintainance of oxyhemoglobin saturation greater than 94% but less than 100% is recommended to avoid fatality. Target temperature therapeutic hypothermia helps to resuscitated patients. Strict temperature control is required and is maintained with the help of cooling devices and monitoring the core temperature. Montorings include electrocardiogram, oxymetry, capnography, and electroencephalography (EEG) along with blood pressue, temprature, and vital signs. Seizure should be treated if EEG shows evidence of seizure or epileptiform activity. Clinical neurologic examination and magnetic resonance imaging are considered to predict neurological outcome. Glycemic control and metabolic management are favorable for a good neurological outcome. Recovery from acute kidney injury is essential for survival and a good neurological outcome.

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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
  • 11,819 View
  • 174 Download
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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.

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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
  • 9,950 View
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  • 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

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    Yoonjic Kim, Jeong Ho Park, Sun Young Lee, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin
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Review Article
Surgery
Management of Critical Burn Injuries: Recent Developments
David J. Dries, John J. Marini
Korean J Crit Care Med. 2017;32(1):9-21.   Published online February 17, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00969
  • 31,875 View
  • 1,620 Download
  • 9 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries.
Methods
A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association.
Results
The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems.
Conclusion
Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

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Case Report
Thoracic surgery
Aortic Dissection in a Survivor after Cardiopulmonary Resuscitation
Jeong-Sun Lee, Suk-Kyung Hong
Korean J Crit Care Med. 2017;32(2):218-222.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00416
  • 11,704 View
  • 154 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDF
We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 min, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography (TTE). Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.

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    Eduardo Saadi Neto, Ronna L. Campbell, Autumn Brogan, Fernanda Bellolio, Aidan F. Mullan, Danielle Gerberi, Nguyen Ba Cuong, Alexander S. Finch
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Review Article
Cardiology/Surgery/Basic Science and Research
The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation
Neil J Glassford, Rinaldo Bellomo
Korean J Crit Care Med. 2016;31(4):276-299.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00934
  • 27,764 View
  • 625 Download
  • 23 Crossref
AbstractAbstract PDF
Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

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Original Article
Ethics
Effect of Timing of Do-Not-Resuscitate Orders on the Clinical Outcome of Critically Ill Patients
Moon Seong Baek, Younsuck Koh, Sang-Bum Hong, Chae-Man Lim, Jin Won Huh
Korean J Crit Care Med. 2016;31(3):229-235.   Published online August 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00178
  • 15,362 View
  • 166 Download
  • 12 Crossref
AbstractAbstract PDF
Background
Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU.
Methods
We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission.
Results
Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001).
Conclusions
Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.

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  • The Authors Reply
    Jeong Uk Lim, Jongmin Lee, Jick Hwan Ha, Hyeon Hui Kang, Sang Haak Lee, Hwa Sik Moon
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Case Report
Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?
Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee
Korean J Crit Care Med. 2016;31(1):63-67.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.63
  • 15,787 View
  • 65 Download
AbstractAbstract PDF
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Original Articles
Pulmonary
The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study
Hong Joon Ahn, Kun Dong Kim, Won Joon Jeong, Jun Wan Lee, In Sool Yoo, Seung Ryu
Korean J Crit Care Med. 2015;30(2):89-94.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.89
  • 10,375 View
  • 175 Download
  • 7 Crossref
AbstractAbstract PDF
BACKGROUND
We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Background: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Methods: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (Plimit). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (Ppeak) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a Ppeak of ≤ 50 cmH2O. Results: In Model 1, Vt and Ppeak were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and Ppeak levels were 17%, and the Ppeak adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and Ppeak levels were 85%; the Ppeak adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of Plimit. Conclusions: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

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  • Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression
    Jung Wan Kim, Jin Woong Lee, Seung Ryu, Jung Soo Park, InSool Yoo, Yong Chul Cho, Hong Joon Ahn
    World Journal of Emergency Medicine.2020; 11(2): 97.     CrossRef
  • Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function
    Tillmann Speer, Wolfgang Dersch, Björn Kleine, Christian Neuhaus, Clemens Kill
    Advances in Therapy.2017; 34(10): 2333.     CrossRef
Neurology/Emergency
Acute Physiologic and Chronic Health Examination II and Sequential Organ Failure Assessment Scores for Predicting Outcomes of Out-of-Hospital Cardiac Arrest Patients Treated with Therapeutic Hypothermia
Sung Joon Kim, Yong Su Lim, Jin Seong Cho, Jin Joo Kim, Won Bin Park, Hyuk Jun Yang
Korean J Crit Care Med. 2014;29(4):288-296.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.288
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AbstractAbstract PDF
BACKGROUND
The aim of this study was to assess the relationship between acute physiologic and chronic health examination (APACHE) II and sequential organ failure assessment (SOFA) scores and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia (TH).
METHODS
Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between January 2010 and December 2012 were retrospectively evaluated. We captured all components of the APACHE II and SOFA scores over the first 48 hours after intensive care unit (ICU) admission (0 h). The primary outcome measure was in-hospital mortality and the secondary outcome measure was neurologic outcomes at the time of hospital discharge. Receiver-operating characteristic and logistic regression analysis were used to determine the predictability of outcomes with serial APACHE II and SOFA scores.
RESULTS
A total of 138 patients were enrolled in this study. The area under the curve (AUC) for APACHE II scores at 0 h for predicting in-hospital mortality and poor neurologic outcomes (cerebral performance category: 3-5) was more than 0.7, and for SOFA scores from 0 h to 48 h the AUC was less than 0.7. Odds ratios used to determine associations between APACHE II scores from 0 h to 48 h and in-hospital mortality were 1.12 (95% confidence interval [CI], 1.03-1.23), 1.13 (95% CI, 1.04-1.23), and 1.18 (95% CI, 1.07-1.30).
CONCLUSIONS
APACHE II, but not SOFA score, at the time of ICU admission is a modest predictor of in-hospital mortality and poor neurologic outcomes at the time of hospital discharge for patients who have undergone TH after return of spontaneous circulation following OHCA.

Citations

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  • Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study
    Yaacov Hasin, Yigal Helviz, Sharon Einav
    Internal and Emergency Medicine.2024; 19(1): 159.     CrossRef
Case Report
Cardiology/Neurology
Intracranial Hemorrhage Identified in the Early Stage after Applying Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation
Yong Hwan Kim, Kyoung Yul Lee, Seong Youn Hwang
Korean J Crit Care Med. 2014;29(3):197-200.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.197
  • 6,931 View
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AbstractAbstract PDF
Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation, but neurologic complications may develop. Cardiac arrest is a fairly common complication following severe intracranial hemorrhage; this complication is encountered both out-of-hospital and in-hospital with variable frequency. To prevent cerebral complications, to detect the cause of cardiac arrest, and to guide further treatment, early neuroimaging study is needed. Herein, we report a case of intracranial hemorrhage identified after extracorporeal cardiopulmonary resuscitation, in which the cause of the hemorrhage was not clear.
Original Article
Emergency
Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation
Yong Oh Kim, Hyun Soo Park
Korean J Crit Care Med. 2014;29(3):172-176.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.172
  • 13,335 View
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  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR.
METHODS
This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR.
RESULTS
During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC.
CONCLUSIONS
During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Citations

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  • Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults
    Hyun Seok Chai, Young-Min Kim, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Ji Han Lee
    SAGE Open Medicine.2023;[Epub]     CrossRef
  • Femoral venous oxygen saturation obtained during CPR predicts successful resuscitation in a pig model
    Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
    The American Journal of Emergency Medicine.2015; 33(7): 941.     CrossRef
Case Report
Emergency/Liver
Liver Laceration with Hemoperitoneum after Cardiopulmonary Resuscitation
Jin Wi, Dongho Shin
Korean J Crit Care Med. 2014;29(2):141-143.   Published online May 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.2.141
  • 11,386 View
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  • 4 Crossref
AbstractAbstract PDF
It is well known that external chest compression during cardiopulmonary resuscitation is frequently associated with various complications. These complications predominantly involve trauma to the heart, lungs, and chest wall, whereas cases involving intra-abdominal injury are much less frequent. The present report describes a rare case of a female patient with severe hemoperitoneum associated with liver injury after cardiopulmonary resuscitation. Although emergent angiography and embolization of the hepatic artery were performed and transfusion of various kinds of blood products was done continuously, the patient expired the next day.

Citations

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  • A rare case of spontaneous hemoperitoneum in a bone marrow transplant recipient on VV-ECMO
    Patrick Donabedian, Amir M. Emtiazjoo, Mindaugus Rackauskas, Philip Efron, Cynthia Gries, Melissa Burger, Letitia Bible, Victoria Reams, Marc O. Maybauer, Biplab K. Saha
    The American Journal of the Medical Sciences.2025; 369(2): 296.     CrossRef
  • Major liver trauma post-mechanical cardiopulmonary resuscitation—the first reported case of survival with normal cardiovascular and neurological outcome
    P Sharma, C Hernandez-Caballero
    Oxford Medical Case Reports.2020;[Epub]     CrossRef
  • Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation
    Song-I Lee
    Kosin Medical Journal.2020; 35(2): 156.     CrossRef
  • ICD lead extraction: Not a benign procedure. External chest compression: Not a benign manoeuvre
    Federico Sertic, Paolo Bosco, Antonella Ferrara, Patrick Heck, Yasir Abu-Omar
    JRSM Cardiovascular Disease.2017;[Epub]     CrossRef
Original Articles
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
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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 Frequency of Defibrillation Related to the Survival Rate and Neurological Outcome in Patients Surviving from Out-of-hospital Cardiac Arrest
Sung Yeol Hyun, Jae Ho Jang, Jin Joo Kim, Hyuk Jun Yang, Woo Jin Kim
Korean J Crit Care Med. 2012;27(4):263-268.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.263
  • 5,294 View
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AbstractAbstract PDF
BACKGROUND
Early defibrillation is the treatment of choice in out-of-hospital cardiac arrests (OHCA) with initial shockable rhythms. However, the relationship between the frequency of defibrillation and neurological outcome was not clear. In this study, the frequency of defibrillation and other factors related to neurological outcome were investigated.
METHODS
Records of 255 adult patients, who were admitted to the hospital after resuscitation from OHCA between November 2008 and March 2012, were retrospectively reviewed. 6 months after the return of spontaneous circulation, patients were divided into two groups based on the cerebral performance category (CPC) score for neurologic prognosis. The frequency of defibrillation during resuscitation and other variables were analyzed between the two groups.
RESULTS
In the study group, initial rhythm was divided into two groups, non shockable rhythm (200, 78.4%) and shockable rhythm (55, 21.6%). The frequency of 1-7 defibrillations was significantly associated with good neurological outcome (OR 3.05, 95% CI 1.328-6.850). In addition, shockable initial rhythm (OR 4.520, 95% CI 1.953-10.459), arrest caused cardiac origin (OR 2.945, 95% CI 1.334-6.500), time to BLS (OR 1.139, 95% CI 1.033-1.256) and lower APACHII score (OR 1.095, 95% CI 1.026-1.169), which were associated with good neurological outcomes, independently.
CONCLUSIONS
In those patients who survived from OHCA, adequate defibrillation was important to improve the neurological outcome, whether the initial rhythm was shockable or not. Frequency of 1-7 times defibrillation was associated with good neurological outcome.

Citations

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  • The Factors Influencing Survival of Out-of-hospital Cardiac Arrest with Cardiac Etiology
    Su-Yeon Jeong, Chul-Woung Kim, Sung-Ok Hong
    Journal of the Korea Academia-Industrial cooperation Society.2016; 17(2): 560.     CrossRef
Assessment and Training of Teamwork and Leadership for Critical Care Nurses: A Pilot Study
Hyun Jin Kim, Sang Mo Je, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee
Korean J Crit Care Med. 2012;27(2):75-81.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.75
  • 3,661 View
  • 49 Download
AbstractAbstract PDF
BACKGROUND
Teamwork and leadership training have been shown to improve subsequent resuscitation performance in a variety of clinical situations. Critical care nurses, in addition to those who may be part of resuscitation team leaders and members, have also the need for such training. This study examines the teamwork and leadership skills of critical care nurses and their perceptions of the need for teamwork and leadership training.
METHODS
We developed a pilot, interactive 3-hour teamwork, and the leadership training program based on the objectives and teaching methods of the Advanced Life Support (ACLS) course. Participants completed a 1-hour lecture, and discussion for team roles and obstacles, 30 min of script-based role play in resuscitation team training, and finally, a 2-hour simulation-based team training program. Before the completion of the course, participants were anonymously surveyed on the perceived educational value of the teamwork and leadership program. Expert raters reviewed videos of simulated resuscitation events in the course, and scored each video by two existing checklist for the team dynamic.
RESULTS
Fifty-one nurses voluntarily participated and six videotaped simulation were rated by an expert rater. Most of the students believed the course was delivered at an appropriate level for them, and that it is a necessary training in their continuing professional education. The video rated average scores were from 68.5 to 72.9 according to the checklists.
CONCLUSIONS
Critical care nurses can learn teamwork and leadership skills from appropriately designed programs, and believe it is a necessity in their training.
Effect of Cardiac Arrest Team Training Using Script on the Quality of Simulated Resuscitation
Mao Lung Sun, Hyun Jong Kim, Sung Phil Chung, Hahn Shick Lee, Wen Joen Chang
Korean J Crit Care Med. 2012;27(1):5-9.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.5
  • 3,522 View
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AbstractAbstract PDF
BACKGROUND
The purpose of this study was to compare the quality of simulated resuscitation between the conventional simulation training group and the script based training group.
METHODS
This was a retrospective analysis of video clips from a previous study of cardiopulmonary resuscitation (CPR) team simulation training. A total of eighty-four video clips were analyzed. Each video clip belonged to either the conventional group or the script group, of either pre-training or post-training. One of the authors analyzed all the video clips. The qualities of resuscitation team plays were compared in terms of the hands-on compression time, the interval to meaningful measures and the number of utterances of the team leader and members.
RESULTS
The hands-on time of the conventional group improved after training whereas that of the script group deteriorated (22.2 vs -7.0 sec, p = 0.009). The time to defibrillation also improved in the conventional group whereas that of the script group deteriorated (-24.0 vs 33.0 sec, p = 0.002). There were no differences in the utterances of team leaders and members between groups and between pre- and post-training.
CONCLUSIONS
This study suggested that the effect of script-based training on quality of CPR was less useful than that of conventional training using simulation and debriefing. Therefore, CPR team training using a script alone should not be recommended.
Adequacy of Epinephrine Administration during Advanced Cardiovascular Life Support in terms of Dosing and Intervals between Doses
Seung Joon Lee, Byung Kook Lee, Kyung Woon Jeung, Hyoung Youn Lee, Tag Heo, Yong Il Min, Jong Geun Yun, Jae Hoon Lim
Korean J Crit Care Med. 2011;26(2):69-77.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.69
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AbstractAbstract PDF
BACKGROUND
Consensus guidelines clearly define how epinephrine is administered during cardiopulmonary resuscitation (CPR). In South Korea, it is not known whether epinephrine is administered in accordance with the current advanced cardiovascular life support (ACLS) guidelines during actual practice. We sought to investigate adherence to ACLS guidelines during actual CPR in terms of the dose of epinephrine and the interval between doses.
METHODS
A retrospective review of medical records was performed on 394 adult cardiac arrest patients who received CPR at an emergency room. Data including the duration of CPR, the dose of epinephrine, and the interval between doses was collected from CPR records.
RESULTS
Standard-dose epinephrine (1 mg) was used in 166 of 394 patients (42.1%). In 58.8% of patients, the average between-dose interval was within the 3-5 min recommended in the guidelines, whereas it was shorter than 3 min in 31.4% of patients. As a whole, epinephrine was administered in accordance with the current ACLS guidelines in only 96 of 394 patients (24.4%). Logistic regression analysis revealed the duration of CPR to be an independent factor affecting the use of standard-dose epinephrine and the adequate between-dose interval.
CONCLUSIONS
Epinephrine was not administered according to the ACLS guideline in most patients. A national multi-center study is required to determine whether the poor adherence to the ACLS guideline is a widespread problem. In addition, efforts to improve adherence to the ACLS guideline are required.

Citations

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  • Reply to letter “Improving ROSC with high dose of epinephrine. Are we really?”
    Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min
    Resuscitation.2012; 83(3): e73.     CrossRef
A Simulation Study for Quality of Chest Compression Provided by Health Personnel
Jun Mo Yeo, Min Hong Choa, Sang Won Chung, In Byung Kim, Ji Hoon Kang, Kyung Wuk Kim, Jai Woog Ko
Korean J Crit Care Med. 2011;26(2):64-68.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.64
  • 3,839 View
  • 38 Download
  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Effective chest compression may improve the return of spontaneous circulation and neurologic outcome in arrest victims. For fear of rescuer's fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommended that chest compression (CC) should be switched every 2 minutes, but there is little evidence. We investigated whether health personnel could provide consistent quality of CC for 2 minutes.
METHODS
We recruited prospectively health personnel working on one university hospital. On the day assigned randomly, CPR performance data was collected with use of CPR recording technology. Quality of CPR was calculated every 30 seconds interval. To identify the quality decay, we used repeated measure analysis of variance with SPSS 17.0 for analysis.
RESULTS
We analyzed 8,485 CCs performed by 41 subjects. Total number of CC decayed between 90 to 120 seconds (51.6 +/- 3.3 to 50.8 +/- 3.5, p = 0.020) within recommended range. The ratio of correct depth CC decayed between 90 to 120 seconds, falling from 83.4 +/- 24.9% to 68.3 +/- 38.4% (p = 0.002). The ratio of low depth CC increased significantly over time (10.2 +/- 20.7% to 31.3 +/- 38.5%, p < 0.001).
CONCLUSIONS
Health personnel may provide adequate number of CC for 2 minutes. But, the number of correct depth CC may decay between 90 to 120 seconds. Also the number of low depth CC may increase over time.

Citations

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  • Comparisons of the qualities of chest compression according to various positions of rescuer to patient at the in-hospital cardiopulmonary resuscitation model
    Geon-Nam Kim, Seong-Woo Choi, Jin-Yeong Jang, So-Yeon Ryu
    The Korean Journal of Emergency Medical Services.2014; 18(1): 7.     CrossRef
  • Comparison on the Quality and fatigue of hands-Only CPR According to the Presence or Absence of Verbal counting by Some Middle-aged Women
    Geon-Nam Kim, Sung-Soo Choi, Seong-Woo Choi
    Journal of the Korea Academia-Industrial cooperation Society.2013; 14(3): 1320.     CrossRef
Outcome after Admission to Intensive Care Unit Following Out-of-Hospital Cardiac Arrest: Comparison between Cardiac Etiology and Non-Cardiac Etiology
Hwan Seok Kang, Hun Jae Lee, Jae Hwa Cho, Jin Hui Paik, Ji Hye Kim, Jun Sig Kim, Seung Baik Han
Korean J Crit Care Med. 2010;25(4):212-218.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.212
  • 4,911 View
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  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA).
METHODS
We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients' clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups.
RESULTS
Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 +/- 15.1 years of age in the cardiac group and 61.9 +/- 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 +/- 3.8 min in the cardiac group and 6.0 +/- 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 +/- 202.2 min in the cardiac group and 327.7 +/- 264.1 min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group.
CONCLUSIONS
The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.

Citations

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  • Management of post-cardiac arrest syndrome
    Youngjoon Kang
    Acute and Critical Care.2019; 34(3): 173.     CrossRef
Case Report
Successful Embolectomy of a Pulmonary Saddle Embolism Post-cesarean Section Complicated by Cardiac Arrest: A Case Report
Jae Jun Lee, Jin Kim, Hyoung Soo Kim, Min Sun Kyung, Eu Sun Ro, Sung Mi Hwang, So Young Lim
Korean J Crit Care Med. 2009;24(3):164-167.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.164
  • 3,286 View
  • 22 Download
AbstractAbstract PDF
A 41-year-old female underwent an uneventful cesarean section, which was followed by a pulmonary saddle embolism complicated by cardiac arrest. This case shows that successful embolectomy is possible, despite a potentially lethal pulmonary saddle embolism, 34 cm in length, and intra-operative cardiopulmonary resuscitation. We report our case and discuss the anesthetic considerations based on the literature.
Original Articles
Development of Assessment Tools for Performance and Leadership of a Cardiopulmonary Resuscitation Team
Sung Pil Chung, Junho Cho, Yoo Seok Park, Hyung Goo Kang, Seung Whan Kim, Chan Woong Kim, Yoo Sang Yoon, Keun Jeong Song, Hoon Lim, Gyu Chong Cho, Young Hwan Choi
Korean J Crit Care Med. 2009;24(2):64-68.
DOI: https://doi.org/10.4266/kjccm.2009.24.2.64
  • 4,859 View
  • 51 Download
  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
The assessment tools for leadership and performance of resuscitation teams are have not been developed. We evaluated the checklists for resuscitation team performance and teamwork.
METHODS
We developed two checklists for team dynamics (D1, D2) and two checklists for team performances (P1, P2). The videotaped mock resuscitation before and after a 2-hr Advanced Cardiovascular Life Support (ACLS) training were also evaluated by two emergency physicians and two nurses using the four checklists. The validity and agreement between assessors were determined. Internal consistency was determined using Cronbach-alpha.
RESULTS
There were no significant differences in scores by expert consensus and the checklist score. The average scores between different assessors were different except for the D1 and D2 between doctors. The Cronbach-alpha for internal consistency were within acceptable ranges in the checklists D2 and P2.
CONCLUSIONS
This study suggests that the D2 and P2 checklists are provisionally acceptable due to relatively high validity, agreement, and internal consistency. However, further research is needed to develop validated checklists for resuscitation teams.

Citations

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  • Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial
    Soyeon Yun, Hyeoun‐Ae Park, Sang‐Hoon Na, Hee Je Yun
    Nursing & Health Sciences.2024;[Epub]     CrossRef
  • Focused and Corrective Feedback Versus Structured and Supported Debriefing in a Simulation-Based Cardiac Arrest Team Training
    Ji-Hoon Kim, Young-Min Kim, Seong Heui Park, Eun A Ju, Se Min Choi, Tai Yong Hong
    Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2017; 12(3): 157.     CrossRef
  • Nurses' Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest
    Eun Jung Kim, Kyeong Ryong Lee, Myung Hyun Lee, Jiyoung Kim
    Journal of Korean Academy of Nursing.2012; 42(3): 361.     CrossRef
  • Assessment and Training of Teamwork and Leadership for Critical Care Nurses: A Pilot Study
    Hyun Jin Kim, Sang Mo Je, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee
    Korean Journal of Critical Care Medicine.2012; 27(2): 75.     CrossRef
Factors of Cardiopulmonary Resuscitation Outcome for In-hospital Adult Patients
In Byung Kim, Sang Won Chung, Dong Seok Moon, Ki Hyun Byun
Korean J Crit Care Med. 2007;22(2):83-90.
  • 2,472 View
  • 82 Download
AbstractAbstract PDF
BACKGROUND
The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea.
METHODS
All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template.
RESULTS
For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge.
CONCLUSIONS
In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea. Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.
The Study of Rescuer's Fatigue by Changes of Compression-Vetilation Ratio using Manikin Model of the One-Rescuer CPR
Hee Bum Yang, Young Mo Yang, Jong Wan Kim, Won Young Sung, Ho Lee, Jang Young Lee, Sung Youp Hong
Korean J Crit Care Med. 2006;21(2):116-125.
  • 2,594 View
  • 52 Download
AbstractAbstract PDF
BACKGROUND
The point of this study is focused on the rescuer's fatigue may increase as the ratio of chest compression-ventilation increases.
METHODS
10 students of emergency medical service and resucue had participated in this study. Cardiopulmonary resuscitation (CPR) was carried out with Laerdal's ResusciAnne with 4 types of compression-ventilation ratio (C-V ratio), and the data was recorded. The rescuer's fatigue was subjectively estimated with the visual analogue scale (VAS), objective fatigue was measured by median frequency which was acquired from the electromyography (EMG) signal, heart rate and the serum lactate level was measured. Statistical analysis was accomplished within each C-V ratios.
RESULTS
As C-V ratio increased from 15 : 2 to 30 : 2, the quality of chest compression was improved. Subjective fatigue was increased significantly when C-V ratio increased to 30 : 2 from 15 : 2 and to 60 : 2 from 45 : 2. Gradual downward transition of the median frequency on EMG was shown as a result of increments of C-V ratio. Significant serum lactate accumulation had shown on ratio of 60 : 2 compare to other ratios.
CONCLUSIONS
Fatigue of the rescuers will be aggravated by increase of C-V ratio. Rapid rescuer change is preferable when C-V ratio is increased.
Case Report
Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve
Il Woo Shin, Hyoung Chan Cho, Wan Soo Choi, Woo Chang Yang, Hyun Keun Lee, Young Kyun Chung
Korean J Crit Care Med. 2000;15(1):47-51.
  • 2,183 View
  • 8 Download
AbstractAbstract PDF
Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.
ACC : Acute and Critical Care
© The Korean Society of Critical Care Medicine.
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