Acute and Critical Care

Original Articles

Pediatrics
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

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Abstract 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.

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

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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

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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

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Abstract PDF Supplementary 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.

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

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Abstract 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.

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

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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

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
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

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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

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

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Abstract 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

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

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Abstract 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

Citations to this article as recorded by

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
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute and Critical Care.2024; 39(2): 294. 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
Dying in the ICU
Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
Die Anaesthesiologie.2022; 71(12): 930. 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
Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A Cross-Sectional Study
Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
Journal of Palliative Medicine.2022; 25(12): 1802. CrossRef
Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
Yunji Lee, Minjeong Jo, Taehwa Kim, Kyoungsun Yun
BMJ Open.2021; 11(8): e049711. CrossRef

Rapid response system
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients: Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh; Acute Crit Care. 2020;35(2):77-86. Published online May 13, 2020; DOI: https://doi.org/10.4266/acc.2019.00661

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Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

Citations

Citations to this article as recorded by

Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration
Bryan D. Steitz, Allison B. McCoy, Thomas J. Reese, Siru Liu, Liza Weavind, Kipp Shipley, Elise Russo, Adam Wright
Journal of General Internal Medicine.2024; 39(1): 27. CrossRef
Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review
Qiuxia Zhang, Khuan Lee, Zawiah Mansor, Iskasymar Ismail, Yi Guo, Qiao Xiao, Poh Ying Lim
Heart & Lung.2024; 63: 51. CrossRef
Development and Validation of a Deep Learning Model for Prediction of Adult Physiological Deterioration
Supreeth P. Shashikumar, Joshua Pei Le, Nathan Yung, James Ford, Karandeep Singh, Atul Malhotra, Shamim Nemati, Gabriel Wardi
Critical Care Explorations.2024; 6(9): e1151. CrossRef
Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
Annals of Surgical Treatment and Research.2023; 104(1): 43. CrossRef
The associations between rapid response systems and their components with patient outcomes: A scoping review
Rebecca J. Piasecki, Cheryl R. Dennison Himmelfarb, Kelly T. Gleason, Rachel M. Justice, Elizabeth A. Hunt
International Journal of Nursing Studies Advances.2023; 5: 100134. CrossRef
Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2022; 37(2): 237. CrossRef
Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance
Juliana Vanessa Rincón-López, Diego Larrotta-Castillo, Kelly Estrada-Orozco, Hernando Gaitán-Duarte
Revista Colombiana de Obstetricia y Ginecología.2021; 72(2): 171. CrossRef
Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
Sang Hyuk Kim, Ji Young Hong, Youlim Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
Mi-Jung Yoon, Jin-Hee Park
Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491. CrossRef

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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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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The impact of pediatric intensivists on the management of pediatric diabetic ketoacidosis in pediatric intensive care units
Ah Young Choi, Esther Park
BMC Pediatrics.2023;[Epub] CrossRef
Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit
Sung Jun Ko, Jaeyoung Cho, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Jinwoo Lee, Sang-Min Lee, Robert Jeenchen Chen
PLOS ONE.2021; 16(10): e0259092. CrossRef
Intensivists in the pediatric intensive care unit: conductors for better operational efficiency
June Dong Park
Acute and Critical Care.2020; 35(2): 115. CrossRef

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

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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.

Citations

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Zhichu Dai, Sisen Zhang, Hongyu Wang, Liwei He, Jiankun Liao, Xuanyu Wu
Shock.2024; 61(2): 266. CrossRef
Effects of Vasopressin Receptor Agonists during the Resuscitation of Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Experimental and Clinical Studies
Eleni Laou, Nikolaos Papagiannakis, Androniki Papadopoulou, Theodora Choratta, Minas Sakellakis, Mariachiara Ippolito, Ioannis Pantazopoulos, Andrea Cortegiani, Athanasios Chalkias
Journal of Personalized Medicine.2023; 13(7): 1143. CrossRef
Hemodynamic Effects of Cardiovascular Medications in a Normovolemic and Hemorrhaged Yorkshire-cross Swine Model
Jacob H Cole, Scott B Hughey, Phillip G Geiger, Kamala J Rapp-Santos, Gregory J Booth
Comparative Medicine.2022; 72(1): 38. CrossRef
Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study
Athanasios Chalkias, Eleni Laou, Nikolaos Papagiannakis, Giolanda Varvarousi, Dimitrios Ragias, Anastasios Koutsovasilis, Demosthenes Makris, Dimitrios Varvarousis, Nicoletta Iacovidou, Ioannis Pantazopoulos, Theodoros Xanthos
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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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Abstract 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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Citations to this article as recorded by

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Zhan-Xiao Liu, Ya Yang, Huan-Huan Song, Wei Liu, Peng Sun, Cai-Wei Lin
Heliyon.2024; 10(1): e23411. CrossRef
Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies
Christopher Jer Wei Low, Ryan Ruiyang Ling, Michele Petrova Xin Ling Lau, Nigel Sheng Hui Liu, Melissa Tan, Chuen Seng Tan, Shir Lynn Lim, Bram Rochwerg, Alain Combes, Daniel Brodie, Kiran Shekar, Susanna Price, Graeme MacLaren, Kollengode Ramanathan
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Perfusion.2024;[Epub] CrossRef
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Andrea M Elliott, Sean van Diepen, Steven M Hollenberg, Samuel Bernard
US Cardiology Review.2024;[Epub] CrossRef
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Amani Alenazi, Mohammed Aljanoubi, Joyce Yeung, Jason Madan, Samantha Johnson, Keith Couper
Resuscitation.2024; 204: 110403. CrossRef
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Devindi Wanigasekara, Vincent A. Pellegrino, Aidan JC. Burrell, Nyein Aung, Shaun D. Gregory
ASAIO Journal.2023; 69(3): 332. CrossRef
Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis
Christopher Jer Wei Low, Kollengode Ramanathan, Ryan Ruiyang Ling, Maxz Jian Chen Ho, Ying Chen, Roberto Lorusso, Graeme MacLaren, Kiran Shekar, Daniel Brodie
The Lancet Respiratory Medicine.2023; 11(10): 883. CrossRef
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Jiale Chen, Guoquan Chen, Wenyi Zhao, Wenxing Peng
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2023; 43(10): 1084. CrossRef
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JTCVS Open.2023; 16: 582. CrossRef
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PLOS ONE.2023; 18(11): e0289054. CrossRef
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Journal of Clinical Medicine.2023; 13(1): 56. CrossRef
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Perfusion.2022; 37(1): 46. CrossRef
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: first results and outcomes of a newly established ECPR program in a large population area
Ilija Djordjevic, Christopher Gaisendrees, Christoph Adler, Kaveh Eghbalzadeh, Simon Braumann, Borko Ivanov, Julia Merkle, Antje-Christin Deppe, Elmar Kuhn, Robert Stangl, Alex Lechleuthner, Christian Miller, Roman Pfister, Navid Mader, Stephan Baldus, An
Perfusion.2022; 37(3): 249. CrossRef
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Christopher Gaisendrees, Ilija Djordjevic, Anton Sabashnikov, Christopher Adler, Kaveh Eghbalzadeh, Borko Ivanov, Sebastian Walter, Georg Schlachtenberger, Julia Merkle‐Storms, Stephen Gerfer, Henning Carstens, Antje‐Christin Deppe, Elmar Kuhn, Thorsten W
Artificial Organs.2022; 46(3): 451. CrossRef
Vascular complications based on mode of extracorporeal membrane oxygenation
Juliet Blakeslee-Carter, Connie Shao, Ryan LaGrone, Irina Gonzalez-Sigler, Danielle C. Sutzko, Benjamin Pearce, Kyle Eudailey, Emily Spangler, Adam W. Beck, Graeme E. McFarland
Journal of Vascular Surgery.2022; 75(6): 2037. CrossRef
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Journal of the Formosan Medical Association.2022; 121(10): 1917. CrossRef
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Sasa Rajsic, Robert Breitkopf, Dragana Jadzic, Marina Popovic Krneta, Helmuth Tauber, Benedikt Treml
Journal of Clinical Medicine.2022; 11(17): 5147. CrossRef
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Critical Care Medicine.2021; 49(4): 682. CrossRef
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Ilija Djordjevic, Thorsten Wahlers
Journal of Cardiac Surgery.2021; 36(8): 2751. CrossRef
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Young Su Kim, Yang Hyun Cho, Jeong Hoon Yang, Ji-Hyuk Yang, Suryeun Chung, Gee Young Suh, Kiick Sung
European Journal of Cardio-Thoracic Surgery.2021; 60(6): 1318. CrossRef
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Medicina.2021; 57(9): 886. CrossRef
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Hyoung Soo Kim, Kyu Jin Lee, Sang Ook Ha, Sang Jin Han, Kyoung-Ha Park, Sun Hee Lee, Yong Il Hwang, Seung Hun Jang, Sunghoon Park
Medicine.2020; 99(29): e21272. CrossRef
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The Korean Journal of Thoracic and Cardiovascular Surgery.2020; 53(5): 277. CrossRef

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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Abstract 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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Critical Care Medicine.2024; 52(2): 314. CrossRef
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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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Abstract 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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BMJ Open.2024; 14(1): e074614. CrossRef
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World Journal of Cardiology.2024; 16(3): 126. CrossRef
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International Journal of Molecular Sciences.2023; 24(7): 6665. CrossRef
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IJC Heart & Vasculature.2023; 46: 101207. CrossRef
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Jan Andreas Kloka, Benjamin Friedrichson, Petra Wülfroth, Rainer Henning, Kai Zacharowski
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European Heart Journal: Acute Cardiovascular Care.2023; 12(6): 364. CrossRef
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Intensive Care Research.2023; 3(3): 229. CrossRef
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Cureus.2023;[Epub] CrossRef
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Resuscitation.2023; 192: 109935. CrossRef
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Muhammad Shoaib, Nancy Kim, Rishabh C. Choudhary, Blanca Espin, Mitsuaki Nishikimi, Ann Iverson, Tsukasa Yagi, Seyedeh Shadafarin Marashi Shoshtari, Koichiro Shinozaki, Lance B. Becker, Junhwan Kim
Free Radical Research.2023; 57(5): 384. CrossRef
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International Journal of Pharmaceutical Research and Allied Sciences.2023; 12(3): 78. CrossRef
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World Journal of Emergency Medicine.2023; 14(6): 462. CrossRef
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Ha Na Rhee, Jeong Yun Park
Journal of Korean Critical Care Nursing.2023; 16(3): 99. CrossRef
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Acute and Critical Care.2022; 37(4): 610. CrossRef
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Scottish Medical Journal.2021; 66(1): 16. CrossRef
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International Journal of Molecular Sciences.2021; 22(10): 5114. CrossRef
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Seminars in Neurology.2021; 41(04): 388. CrossRef
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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

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Abstract PDF Supplementary Material

There has been no report about aortic dissection due to cardiopulmonary resuscitation (CPR). We present here a case of acute aortic dissection as a rare complication of CPR and propose the potential mechanism of injury on the basis of transesophageal echocardiographic observations. A 54-year-old man presented with cardiac arrest after choking and received 19 minutes of CPR in the emergency department. Transesophageal echocardiography (TEE) during CPR revealed a focal separation of the intimal layer at the descending thoracic aorta without evidence of aortic dissection. After restoration of spontaneous circulation, hemorrhagic cardiac tamponade developed. Follow-up TEE to investigate the cause of cardiac tamponade revealed aortic dissection of the descending thoracic aorta. Hemorrhagic cardiac tamponade was thought to be caused by myocardial hemorrhage from CPR.

Citations

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Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair
Aniekeme S Etuk, Olanrewaju F Adeniran , Bernard I Nkwocha, Nformbuh Asangmbeng, Mina Jacob
Cureus.2023;[Epub] CrossRef
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Dong-Hyun Jang, Dong Keon Lee, You Hwan Jo, Seung Min Park, Young Taeck Oh, Chang Woo Im
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Gentaro Yamasaki, Marie Sugimoto, Takeshi Kondo, Motonori Takahashi, Mai Morichika, Azumi Kuse, Kanako Nakagawa, Yasuhiro Ueno, Migiwa Asano
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Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation
Sung Oh Hwang, Woo Jin Jung, Young-Il Roh, Kyoung-Chul Cha
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Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes
Woo Jin Jung, Kyoung-Chul Cha, Yong Won Kim, Yoon Seop Kim, Young-Il Roh, Sun Ju Kim, Hye Sim Kim, Sung Oh Hwang
Resuscitation.2020; 154: 31. CrossRef
Aortic Rupture as a Complication of Cardiopulmonary Resuscitation
Prashanth Venkatesh, Edward J. Schenck
JACC: Case Reports.2020; 2(8): 1150. CrossRef

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