Hyoung Gon Song

Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation*

Objective:We investigated whether the survival of patients with inhospital cardiac arrest could be extended by extracorporeal cardiopulmonary resuscitation supported with extracorporeal membrane oxygenation compared with those of conventional cardiopulmonary resuscitation. Design:A retrospective, single-center, observational study. Setting:A tertiary care university hospital. Patients:We retrospectively analyzed a total of 406 adult patients with witnessed inhospital cardiac arrest receiving cardiopulmonary resuscitation for >10 mins from January 2003 to June 2009 (85 in the extracorporeal cardiopulmonary resuscitation group and 321 in the conventional cardiopulmonary resuscitation group). Interventions:None. Measurements and Main Results:The primary end point was a survival discharge with minimal neurologic impairment. Propensity score matching was used to balance the baseline characteristics and cardiopulmonary resuscitation variables that could potentially affect prognosis. In the matched population (n = 120), the survival discharge rate with minimal neurologic impairment in the extracorporeal cardiopulmonary resuscitation group was significantly higher than that in the conventional cardiopulmonary resuscitation group (odds ratio of mortality or significant neurologic deficit, 0.17; 95% confidence interval, 0.04–0.68; p = .012). In addition, there was a significant difference in the 6-month survival rates with minimal neurologic impairment (hazard ratio, 0.48; 95% confidence interval, 0.29–0.77; p = .003; p <.001 by stratified log-rank test). In the subgroup based on cardiac origin, extracorporeal cardiopulmonary resuscitation also showed benefits for survival discharge (odds ratio, 0.19; 95% confidence interval, 0.04–0.82; p = .026) and 6-month survival with minimal neurologic impairment (hazard ratio, 0.56; 95% confidence interval, 0.33–0.97; p = .038; p = .013 by stratified log-rank test). Conclusions:Extracorporeal cardiopulmonary resuscitation showed a survival benefit over conventional cardiopulmonary resuscitation in patients who received cardiopulmonary resuscitation for >10 mins after witnessed inhospital arrest, especially in cases with cardiac origins.

Acute health problems related to the operation mounted to clean the Hebei Spirit oil spill in Taean, Korea

The authors investigated acute health problems in people engaged in the operation mounted to clear the Hebei Spirit oil spill which occurred in December 2007 in Taean County, South Korea, and identified the risk factors associated with the development of symptoms. Eight hundred forty-six people engaged in the clean up operation for periods between 7 and 14 days were examined. Demographic information and risk factors were obtained using a questionnaire. Symptoms were classified into six categories: back pain, skin lesions, headache, and eye, neurovestibular, and respiratory symptoms. Residents and volunteers engaged in the Hebei Spirit oil spill clean up operation experienced acute health problems. Risk analyses revealed that more frequent and greater exposure was strongly associated with a higher occurrence of symptoms.

Improvements in Compliance With Resuscitation Bundles and Achievement of End Points After an Educational Program on the Management of Severe Sepsis and Septic Shock

ABSTRACT The objectives of this study were to determine whether an educational program could improve compliance with resuscitation bundles and the outcomes of patients with severe sepsis or septic shock and to evaluate which resuscitation bundle end points were associated with in-hospital mortality. This was a retrospective observational study of 366 patients (163 of historical controls and 203 of treatment patients) with severe sepsis or septic shock who presented to the emergency department between May 2007 and July 2009. Compliance with resuscitation bundles and achievement of the corresponding end points were compared before and after the 3-month educational program. Compliance with central line insertion and monitoring of central venous pressure (29% vs. 67%, P < 0.001) and central venous oxygen saturation (ScvO2) (25% vs. 68%, P < 0.001) was significantly improved after the educational program. The achievement of target ScvO2 within the first 6 h was significantly improved (62% vs. 88%, P < 0.001). In-hospital mortality was independently associated with adequate fluid challenge (odds ratio [OR], 0.161; 95% confidence interval [CI], 0.046–0.559) and the achievement of target mean arterial pressure (OR, 0.056; 95% CI, 0.008–0.384) and ScvO2 (OR, 0.251; 95% CI, 0.072–0.875) among the five sepsis resuscitation bundles. In conclusion, an educational program can improve compliance with resuscitation bundles and achievement of their corresponding end points.

Standardized approaches to syncope evaluation for reducing hospital admissions and costs in overcrowded emergency departments.

Purpose The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. Materials and Methods This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. Results A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). Conclusion Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.

Outcome of in-hospital adult cardiopulmonary resuscitation assisted with portable auto-priming percutaneous cardiopulmonary support.

BACKGROUND Outcome from in-hospital cardiopulmonary resuscitation (CPR) is still unsatisfactory. CPR assisted with percutaneous cardiopulmonary support (PCPS) is expected to improve the outcome of in-hospital CPR. METHODS We retrospectively analyzed 83 consecutive cases of adult in-hospital CPR assisted by a portable pre-assembled auto-priming PCPS system (EBS, Terumo, Japan) from January 2004 to December 2007. RESULTS PCPS was successfully performed in 97.6% of the patients and could be weaned in 57.8% of the patients. The survival-to-discharge rate was 41.0% with an acceptable neurological status in 85.3% of the patients. The 6-month survival was 38.6%. Survival-to-discharge decreased about 1% for each 1 min increase in the duration of CPR. The probability of survival was about 65%, 45%, and 19% when the duration of CPR was 10, 30, or 60 min, respectively. Multivariate analysis adjusted with clinical factors including organ dysfunction severity scores revealed that defibrillation and CPR duration less than 35 min were independent predictors for both survival-to-discharge (odds ratio=8.0, 95% CI=2.8-23.0, p<0.001) and 6-month survival (hazard ratio=3.3, 95% CI=1.9-5.9, p<0.001). CONCLUSIONS Our results showed that CPR assisted with PCPS results in an acceptable survival-to-discharge rate and mid-term prognosis.

Diagnostic patterns in the evaluation of patients presenting with syncope at the emergency or outpatient department.

Purpose Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

Basic cardiac life support education for non-medical hospital employees

Background: The International Liaison Committee on Resuscitation (ILCOR) recommends that strategies should be implemented that promote cardiopulmonary resuscitation (CPR) training in the workplace. Non-medical employees at a hospital were therefore trained to conduct basic life support (BLS). Subject background information, test results and survey findings were examined and factors affecting BLS skill acquisition were studied. Methods: Of 1432 non-medical employees at a hospital trained to conduct BLS, 880 agreed to participate in the survey. The training course consisted of a single session of 3 h of lectures, practice and testing. Skill acquisition was assessed using a 13-item skill checklist and a 5-point overall competency scale. The effects of age, gender, type of job, educational status, a previous history of CPR training and level of subject-perceived training difficulty were examined. Results: According to total checklist scores, subjects achieved a mean (SD) score of 8.66 (3.57). 22.3% performed all 13 skills. Based on 5-point overall competency ratings, 43.7% of subjects were rated as “competent”, “very good” or “outstanding”. Age (<40 years and ⩾40 years) was the only factor that significantly affected skill acquisition (skill acquisition by those ⩾40 years of age was poorer than by those aged <40 years). Conclusion: Traditional BLS training is less effective in individuals aged ⩾40 years.

Cardiovascular Effects and Predictability of Cardiovascular Collapse after Repeated Intravenous Bolus Injections of Absolute Ethanol in Anesthetized Pigs

PURPOSE To evaluate the effects of repeated intravenous bolus injections of absolute ethanol on cardiopulmonary hemodynamic changes and to investigate the predictability of ethanol-induced cardiovascular collapse in anesthetized pigs. MATERIALS AND METHODS Twenty pigs aged 3-6 months and weighing 28-38 kg were enrolled in the study. Absolute ethanol (0.1 mL/kg of body weight) was repeatedly injected through the inferior vena cava central to the renal vein at 10-minute intervals up to a total volume of 1.0 mL/kg. The subjects were divided into a cardiovascular collapse group and a no-collapse group according to the development or absence of cardiac collapse. RESULTS Among the 20 pigs, 12 died before the final injection. Hemodynamic parameters measured immediately before the injection of absolute ethanol did not differ between the cardiovascular collapse group and the no-collapse group except that among animals with cardiovascular collapse, the injection immediately before the one causing cardiovascular collapse resulted in significant increases in the following hemodynamic parameters: mean pulmonary arterial pressure (P < .01), pulmonary vascular resistance (P = .04), and right ventricular end-diastolic volume (P = .02). No such increases were observed in the no-collapse group. CONCLUSIONS Hemodynamic profiles in pigs obtained immediately before intravenous injection of absolute ethanol did not predict the subsequent occurrence of cardiovascular collapse except after the injection immediately preceding the one resulting in cardiovascular collapse. In this animal model, significant increases in select hemodynamic parameters occurred after the injection immediately preceding the one resulting in cardiovascular collapse.