Kyung Soon Hong

The pre-ECMO simplified acute physiology score II as a predictor for mortality in patients with initiation ECMO support at the emergency department for acute circulatory and/or respiratory failure: a retrospective study.

BackgroundIn the emergency department (ED), extracorporeal membrane oxygenation (ECMO) can be used as a rescue treatment modality for patients with refractory circulatory and/or respiratory failure. Serious consideration must be given to the indication, and the PRESERVE and RESP scores for mortality have been investigated. However these scores were validated to predict survival in patients who received mainly veno-venous (VV) ECMO in the intensive care unit. The aim of the present study was to investigate the factors that predicted the outcomes for patients who received mixed mode (veno-arterial [VA] and VV) ECMO support in the ED.MethodsThis single center retrospective study included 65 patients who received ECMO support at the ED for circulatory or respiratory failure between January 2009 and December 2013. Pre-ECMO SAPS II and other variables were evaluated and compared for predicting mortality.ResultsFifty-four percent of patients received ECMO-cardiopulmonary resuscitation (E-CPR), 31xa0% received VA and V-AV ECMO, and 15xa0% received VV ECMO. The 28-day and 60-month mortality rates were 52xa0% and 63xa0%. In the multivariate analysis, only the pre-ECMO Simplified Acute Physiology Score II (SAPS II) (odd ratio: 1.189, 95xa0% confidence interval: 1.032–1.370, pu2009=u20090.016) could predict the 28-day mortality. The area under the receiver operating characteristic curve and the optimal cutoff value for pre-ECMO SAPS II in predicting 28-day mortality was 0.852 (95xa0% CI: 0.753–0.951, pu2009<u20090.001) and 80 (sensitivity of 97.1xa0% and specificity of 71.0xa0%), respectively. Validation of the 80 cutoff value revealed a statistically significant difference for the 28-day and 60-month mortality rates in the overall, E-CPR, and VA groups (28-day: pu2009<u20090.001, pu2009=u20090.004, pu2009=u20090.005; 60-month: pu2009<u20090.001, pu2009=u20090.004, pu2009=u20090.020). In the Kaplan-Meier analysis, the 28-day and 60-month survival rates were lower among the patients with a pre-ECMO SAPS II of ≤80, compared to those with a score of >80 (both, pu2009<u20090.001).ConclusionThe pre-ECMO SAPS II could be helpful for identifying patients with refractory acute circulatory and/or respiratory failure who will respond to ECMO support in the ED.

Out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal membrane oxygenation: focus on survival rate and neurologic outcome.

BackgroundExtracorporeal membrane oxygenation (ECMO) is a useful treatment for refractory out-of-hospital cardiac arrest (OHCA). However, little is known about the predictors of survival and neurologic outcome after ECMO. We analyzed our institution’s experience with ECMO for refractory OHCA and evaluated the predictors of survival and neurologic outcome after ECMO.MethodsThis was a retrospective review of the medical records of 23 patients who were treated with ECMO due to OHCA that was unresponsive to conventional cardiopulmonary resuscitation, between January 2009 and January 2014.ResultsOur ECMO team was activated within 10xa0min for refractory OHCA, and the 30-day survival rate was 43.5xa0%. In a multivariate analysis that evaluated independent factors contributing to mortality, urine output u2009≤u20090.5xa0mLu2009·u2009kg−1u2009·u2009h−1 (defined as oliguria) during the 24xa0h after ECMO was statistically significant (OR, 32.271; 95xa0% CI, 1.379–755.282; pu2009=u20090.031). Just after ECMO implantation, 6 of the 9 patients (66.7xa0%) who had normal findings on brain computed tomography (CT) survived with a cerebral performance category (CPC) of grade 1. However, only 3 of the 11 patients (27xa0%) who had evidence of hypoxic brain damage on initial brain CT survived (their CPC grade was 4).ConclusionsBased on our findings, the survival rate can be improved by rapid implantation of ECMO, and oliguria seen during the first 24xa0h after ECMO may be an independent predictor of mortality. Furthermore, findings on brain CT just after ECMO and subsequent images may represent an important predictor for neurologic outcome after ECMO.

Efficacy of Veno-Venous Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure

Purpose The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). Materials and Methods From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. Results Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. Conclusion VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.

The changes of individual carotid artery wall layer by aging and carotid intima-media thickness value for high risk.

AIMnIt is still unclear which layer (intima or media) is mainly involved in increased carotid intima-media thickness (CIMT) by aging and also unclear regarding CIMT value suggesting high cardiovascular risk, although 75th percentile value of CIMT is known as a high risk in asymptomatic adults. We sought to find the changes of carotid intima thickness (CIT) and carotid media thickness (CMT) by aging and the 75th percentile value of CIMT in asymptomatic Korean adults.nnnMETHODnThis is an observational cohort study. Carotid ultrasound findings (n=2204 from 12 hospitals) were prospectively collected. The carotid images were sent to Korea Research Institute of Standards and Science for analysis using specialized software which can measure intima and media wall also.nnnRESULTSnMean age was 58.1±13.5xa0years old (52% of men). Pearsons correlation coefficient between age and right CIMT (r=.489, P<.001) and right CMT (r=.482, P<.001) was higher than that between age and right CIT (r=.284, P<.001). Mean right CIMT in male and female was 0.696±0.163 and 0.686±0.167xa0mm (P=.180), and the 75 percentile value was 0.778 and 0.771xa0mm, respectively. Mean right CIT was 0.311±0.069 and 0.303±0.064xa0mm (P=.009), and mean right CMT was 0.391±0.124 and 0.388±0.131xa0mm (P=.694) in male and female, respectively. Left carotid ultrasound findings showed similar to the right one.nnnCONCLUSIONnAn increased CIMT by aging was mainly due to increased CMT rather than CIT in asymptomatic adults. The 75th percentile values of right CIMT were 0.778 and 0.771xa0mm in asymptomatic Korean male and female adults, respectively.

Aging Index using Photoplethysmography for a Healthcare Device: Comparison with Brachial-Ankle Pulse Wave Velocity

Objectives Recent studies have emphasized the potential information embedded in peripheral fingertip photoplethysmogram (PPG) signals for the assessment of arterial wall stiffening during aging. For the discrimination of arterial stiffness with age, the brachial-ankle pulse wave velocity (baPWV) has been widely used in clinical applications. The second derivative of the PPG (acceleration photoplethysmogram [APG]) has been reported to correlate with the presence of atherosclerotic disorders. In this study, we investigated the association among age, the baPWV, and the APG and found a new aging index reflecting arterial stiffness for a healthcare device. Methods The APG and the baPWV were simultaneously applied to assess the accuracy of the APG in measuring arterial stiffness in association with age. A preamplifier and motion artifact removal algorithm were newly developed to obtain a high quality PPG signal. In total, 168 subjects with a mean ± SD age of 58.1 ± 12.6 years were followed for two months to obtain a set of complete data using baPWV and APG analysis. Results The baPWV and the B ratio of the APG indices were correlated significantly with age (r = 0.6685, p < 0.0001 and r = -0.4025, p < 0.0001, respectively). A regression analysis revealed that the c and d peaks were independent of age (r = -0.3553, p < 0.0001 and r = -0.3191, p < 0.0001, respectively). Conclusions We determined the B ratio, which represents an improved aging index and suggest that the APG may provide qualitatively similar information for arterial stiffness.

Association of epicardial adipose tissue with coronary spasm and coronary atherosclerosis in patients with chest pain: analysis of data collated by the KoRean wOmen’S chest pain rEgistry (koROSE)

Epicardial adipose tissue (EAT) represents a cardio-metabolic risk factor; it secretes several adipokines related to coronary atherosclerosis. However, the precise relationship between EAT and coronary vasospasm is unknown. This study aimed to investigate the relationship between EAT and coronary vasospasm using data from the KoRean wOmen’S chest pain rEgistry (koROSE). This study included 551 patients (female/malexa0=xa0366/185; mean agexa0=xa060.2xa0±xa010.2xa0years) who presented with chest pain at an outpatient clinic, and who subsequently underwent echocardiography and coronary angiography. Coronary artery stenosis (CAS >50% narrowing of at least one coronary artery) was detected in 223 patients (40.5%). The remaining 328 patients underwent the coronary spasm provocation test. Coronary spasm was defined as >90% narrowing induced by intra-coronary acetylcholine or ergonovine injection. EAT thickness was measured using transthoracic echocardiography according to American society of echocardiography recommendations. The mean EAT thickness was higher in the patients with CAS than in those without (8.09xa0±xa02.51 versus 6.88xa0±xa02.54 mm, Pxa0=xa00.001) after adjusting for factors potentially influencing EAT thickness. Coronary vasospasm by provocation test was detected in 128 patients. The EAT thickness was higher in the patients with spasm than in those without (7.65xa0±xa02.52 versus 6.40xa0±xa02.45 mm, Pxa0<xa00.001) but was not statistically different from that of the patients with CAS (Pxa0=xa00.43). The EAT thickness had an independent relationship with CAS [odds ratio (OR) 1.166, 95% confidence interval (CI) 1.07–1.27, Pxa0<xa00.001] and coronary vasospasm [OR 1.276, 95% CI 1.14–1.43, Pxa0<xa00.001] after adjusting for clinical cardiovascular risk factors. EAT thickness is associated with coronary vasospasm and coronary atherosclerosis. The pathophysiology of coronary spasm may be similar to that of coronary atherosclerosis and could be an indicator of coronary stenosis.

Reproductive Factors Predicting Angiographic Obstructive Coronary Artery Disease: The KoRean wOmen'S Chest Pain rEgistry (KoROSE)

BACKGROUNDnWhether reproductive factors are associated with coronary artery disease (CAD) has been debated. The aim of this study was to investigate etiologic associations of a wide range of reproductive factors of women with the presence of angiographic obstructive CAD.nnnMATERIALS AND METHODSnStudy data were obtained from a nationwide registry that enrolled 687 Korean women (59.9u2009±u200911.4 years) with chest pain undergoing invasive coronary angiography (ICA). Obstructive CAD was defined as ≥50% luminal stenosis of one or more epicardial coronary arteries in ICA. Information on reproductive history, including ages at menarche and menopause, duration of reproductive capacity, number of pregnancies, hormonal replacement therapy, and history of twin pregnancy, was obtained using a standardized questionnaire.nnnRESULTSnA total of 178 women (25.9%) had obstructive CAD. Multivariable logistic regression analysis identified that later age at menarche (odds ratio [OR]u2009=u20091.265, 95% confidence interval [CI]u2009=u20091.064-1.504, pu2009=u20090.008, per year) and increased number of pregnancies (ORu2009=u20091.223, 95% CIu2009=u20091.026-1.457, pu2009=u20090.025, per pregnancy) were the independent predictors of obstructive CAD even after controlling for potential confounders, including age, diabetes mellitus, hypertension, dyslipidemia, renal function, high-density lipoprotein level, white blood cell count, hemoglobin, and E/e.nnnCONCLUSIONSnLater age at menarche and increased number of pregnancies may be reproductive risk factors for angiographic obstructive CAD, suggesting the important role of hormonal status in the development of CAD.

Myopericarditis in a Korean Young Male With Systemic Lupus Erythematosus

Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.