Youngsuk Cho

Polarized secretion of CXC chemokines by human intestinal epithelial cells in response to Bacteroides fragilis enterotoxin : NF-κB plays a major role in the regulation of IL-8 expression

Enterotoxigenic B. fragilis, which produces a ∼20 kD heat‐labile toxin (BFT), has been associated with diarrhoeal diseases and mucosal inflammation. To determine if epithelial cells can contribute to BFT‐induced inflammation, we assessed the expression of CXC chemokines by BFT‐stimulated human intestinal epithelial cells. BFT stimulation increased expression of the neutrophil chemoattractant and activators ENA‐78, GRO‐α, and IL‐8. Up‐regulated chemokine mRNA expression was paralleled by increased protein levels. Activation of the IL‐8 and NF‐κB transcriptional reporters was inhibited in cells cotransfected with the IκB kinase β and IkBα superrepressor plasmids. Whereas lactate dehydrogenase, which was used to monitor cell lysis, was released predominantly from the apical surface, CXC chemokines were predominantly secreted from the basolateral surface of BFT‐treated epithelial cells. The basolateral secretion of CXC chemokines from BFT‐stimulated colon epithelial cells suggests that these chemokines can contribute to the inflammatory cell infiltrate in the underlying intestinal mucosa.

An application of the learning curve–cumulative summation test to evaluate training for endotracheal intubation in emergency medicine

Objective The learning curve–cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency. Methods We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained. Results The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase. Conclusions By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM.

Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis

We performed a meta-analysis to compare the impact of extracorporeal cardiopulmonary resuscitation (ECPR) to that of conventional cardiopulmonary resuscitation (CCPR) in adult patients who experience cardiac arrest of cardiac origin. A literature search was performed using criteria set forth in a predefined protocol. Report inclusion criteria were that ECPR was compared to CCPR in adult patients with cardiac arrest of cardiac origin, and that survival and neurological outcome data were available. Exclusion criteria were reports describing non-cardiac origin arrest, review articles, editorials, and nonhuman studies. The efficacies of ECPR and CCPR were compared in terms of survival and neurological outcome. A total of 38,160 patients from 7 studies were ultimately included. ECPR showed similar survival (odds ratio [OR] 2.26, 95% confidence interval [CI] 0.45–11.20) and neurologic outcomes (OR 3.14, 95% CI 0.66–14.85) to CCPR in out-of-hospital cardiac arrest patients. For in-hospital cardiac arrest (IHCA) patients, however, ECPR was associated with significantly better survival (OR 2.40, 95% CI 1.44–3.98) and neurologic outcomes (OR 2.63, 95% CI 1.38–5.02) than CCPR. Hence, ECPR may be more effective than CCPR as an adjuvant therapy for survival and neurologic outcome in cardiac-origin IHCA patients.

Videographic Analysis of Glottic View With Increasing Cricoid Pressure Force

STUDY OBJECTIVE Cricoid pressure may negatively affect laryngeal view and compromise airway patency, according to previous studies of direct laryngoscopy, endoscopy, and radiologic imaging. In this study, we assess the effect of cricoid pressure on laryngeal view with a video laryngoscope, the Pentax-AWS. METHODS This cross-sectional survey involved 50 American Society of Anesthesiologists status I and II patients who were scheduled to undergo elective surgery. The force measurement sensor for cricoid pressure and the video recording system using a Pentax-AWS video laryngoscope were newly developed by the authors. After force and video were recorded simultaneously, 11 still images were selected per 5-N (Newton; 1 N = 1 kg·m·s(-2)) increments, from 0 N to 50 N for each patient. The effect of cricoid pressure was assessed by relative percentage compared with the number of pixels on an image at 0 N. RESULTS Compared with zero cricoid pressure, the median percentage of glottic view visible was 89.5% (interquartile range [IQR] 64.2% to 117.1%) at 10 N, 83.2% (IQR 44.2% to 113.7%) at 20 N, 76.4% (IQR 34.1% to 109.1%) at 30 N, 51.0% (IQR 21.8% to 104.2%) at 40 N, and 47.6% (IQR 15.2% to 107.4%) at 50 N. The number of subjects who showed unworsened views was 20 (40%) at 10 N, 17 (34%) at 20 and 30 N, and 13 (26%) at 40 and 50 N. CONCLUSION Cricoid pressure application with increasing force resulted in a worse glottic view, as examined with the Pentax-AWS Video laryngoscope. There is much individual difference in the degree of change, even with the same force. Clinicians should be aware that cricoid pressure affects laryngeal view with the Pentax-AWS and likely other video laryngoscopes.

A novel method to decrease mattress compression during CPR using a mattress compression cover and a vacuum pump

BACKGROUND Mattress compression causes feedback devices to over-estimate the chest compression depth measurement during CPR. We propose a novel method to decrease the mattress compression using a vinyl cover. This mattress compression cover encloses the foam mattress and is compressed by a vacuum pump immediately prior to performing CPR. METHODS Nine CPR providers performed chest compressions on manikins placed on a conventional foam mattress on a bed frame (surface CONV), a backboard and foam mattress on a bed frame (surface BB), and a foam mattress, compressed with a vacuum pump, on a bed frame (surface VAC). Dual accelerometers were used to simultaneously measure the mattress compression and chest compression depths. RESULTS The mattress compression depth levels decreased from 14.9 mm (SD 1.4 mm) on surface CONV to 7.0 mm (SD 0.6 mm) on surface VAC (p<0.001) whereas 14.0 mm (SD 1.3 mm) on surface BB. The total compression depth was 65.4 mm (SD 3.8 mm) on surface CONV, and 58.3 mm (SD 3.0 mm) on surface VAC (p<0.001). CONCLUSION Using a mattress compression cover and a vacuum pump appears to increase the rigidity of the mattress and allow for efficient chest compressions. This novel method could decrease the mattress compression depth and increase the efficiency of chest compression during CPR in hospitals.

Part 2. Adult basic life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation.

1 Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam, Korea Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea Department of Nursing Science, Baekseok University, Cheonan, Korea 6 Department of Emergency Medical Service, Namseoul University, Cheonan, Korea Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study

Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support‐trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30° left lateral tilt and 30° semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty‐six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99–100 [96–117]) compressions.min−1 with and 115 (95–128 [77–164]) compressions.min−1 without feedback (p = 0.05), and the proportion of compressions of correct depth was 55 (0–96 [0–100])% with and 1 (0–30 [0–100])% without feedback (p = 0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0–87 [0–100])% with and 1 (0–26 [0–100])% without feedback (p = 0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted.

Chest compression with kneeling posture in hospital cardiopulmonary resuscitation: A randomised crossover simulation study

We suggest an alternative chest compression (CC) in kneeling posture using a ‘kneeling stool’ on which the performer kneels beside the patient on a bed in‐hospital. In kneeling posture, we can maintain high quality cardiopulmonary resuscitation (CPR) without the bed height adjustment, which is necessary and inconvenient in standing posture.

The delta neutrophil index (DNI) as a prognostic marker for mortality in adults with sepsis: a systematic review and meta-analysis

We performed a meta-analysis to seek evidence for the usefulness of the delta neutrophil index (DNI) as a prognostic blood biomarker for mortality in the early stage of sepsis in adults. A literature search was performed using criteria set forth in a predefined protocol. Studies of adults with sepsis that provided a DNI measurement and that had mortality as the outcome, were included. Review articles, editorials, and non-human studies were excluded. The methodological quality of identified studies was assessed independently by two authors using the Quality in Prognosis Studies (QUIPS) tool. A total of 1,822 patients from eleven studies were ultimately included. Standardized mean differences between non-survivors and survivors were compared. An elevated DNI was associated with mortality in patients with sepsis (standardized mean difference [SMD] 1.22; 95% confidence interval 0.73–1.71; I2 = 91%). After excluding two studies—one that included paediatric patients and one with a disproportionately low mortality rate—heterogeneity was minimized (SMD 0.74, 95% confidence interval 0.53–0.94; I2 = 43%). Overall, the findings suggest that high DNI values are associated with mortality in septic patients.

Prognostic role of copeptin after traumatic brain injury: A systematic review and meta-analysis of observational studies

Purpose: Copeptin, the C‐terminal portion of provasopressin, has emerged as a novel prognostic marker in neurocritical care, such as in traumatic brain injury (TBI). The aim of this study was to quantitatively assess the prognostic significance of initial plasma copeptin levels in the neurological outcome and mortality after traumatic brain injury. Materials and methods: Six relevant studies with data from 552 patients were included in this meta‐analysis. Results: The plasma copeptin levels were found to be significantly higher in patients who died than in the survivors (standardized mean difference [SMD], 1.80). In the four studies reporting Glasgow outcome scale (GOS) data, patients with unfavorable outcomes had significantly higher copeptin levels than those with favorable outcomes (SMD, 1.62). The plasma copeptin level predicted mortality and unfavorable outcomes (AUC, 0.873; AUC, 0.876). Conclusions: The present meta‐analysis suggests that early measurement of plasma copeptin levels can provide better prognostic information about the functional outcome and mortality in patients with TBI.