Clinical and Experimental Emergency Medicine

Resuscitation

Impact of early coronary angiography on the survival to discharge after out-of-hospital cardiac arrest: Jikyoung Shin, Eunsil Ko, Won Chul Cha, Tae Rim Lee, Hee Yoon, Sung Yeon Hwang, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong, Jin-Ho Choi; Clin Exp Emerg Med 2017;4(2):65-72. Published online June 30, 2017; DOI: https://doi.org/10.15441/ceem.16.167

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Impact of early coronary angiography on the survival to discharge after out-of-hospital cardiac arrest

Clin Exp Emerg Med. 2017;4(2):65-72. Published online June 30, 2017

DOI: https://doi.org/10.15441/ceem.16.167

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Impact of early coronary angiography on the survival to discharge after out-of-hospital cardiac arrest

Clin Exp Emerg Med. 2017;4(2):65-72. Published online June 30, 2017

DOI: https://doi.org/10.15441/ceem.16.167

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Objective
Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated.
Methods
The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ≤2.
Results
Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05).
Conclusion
Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.

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Guidelines

Part 1. The update process and highlights: 2015 Korean Guidelines for Cardiopulmonary Resuscitation: Sung Oh Hwang, Sung Phil Chung, Keun Jeong Song, Hyun Kim, Tae Ho Rho, Kyu Nam Park, Young-Min Kim, June Dong Park, Ai-Rhan Ellen Kim, Hyuk Jun Yang; Clin Exp Emerg Med 2016;3:S1-S9. Published online July 5, 2016; DOI: https://doi.org/10.15441/ceem.16.133

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Part 1. The update process and highlights: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

Clin Exp Emerg Med. 2016;3:S1-S9. Published online July 5, 2016

DOI: https://doi.org/10.15441/ceem.16.133

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Part 1. The update process and highlights: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

Clin Exp Emerg Med. 2016;3:S1-S9. Published online July 5, 2016

DOI: https://doi.org/10.15441/ceem.16.133

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Part 2. Adult basic life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation: Keun Jeong Song, Jae-Bum Kim, Jinhee Kim, Chanwoong Kim, Sun Young Park, Chang Hee Lee, Yong Soo Jang, Gyu Chong Cho, Youngsuk Cho, Sung Phil Chung, Sung Oh Hwang; Clin Exp Emerg Med 2016;3:S10-S16. Published online July 5, 2016; DOI: https://doi.org/10.15441/ceem.16.129

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

Clin Exp Emerg Med. 2016;3:S10-S16. Published online July 5, 2016

DOI: https://doi.org/10.15441/ceem.16.129

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

Clin Exp Emerg Med. 2016;3:S10-S16. Published online July 5, 2016

DOI: https://doi.org/10.15441/ceem.16.129

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Toxicology

Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder: Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong; Clin Exp Emerg Med 2016;3(2):109-111. Published online June 30, 2016; DOI: https://doi.org/10.15441/ceem.15.023

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Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder

Clin Exp Emerg Med. 2016;3(2):109-111. Published online June 30, 2016

DOI: https://doi.org/10.15441/ceem.15.023

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Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder

Clin Exp Emerg Med. 2016;3(2):109-111. Published online June 30, 2016

DOI: https://doi.org/10.15441/ceem.15.023

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A 59-year-old man presented to the emergency department with a chief complaint of sore throat after swallowing sodium picosulfate/magnesium citrate powder for bowel preparation, without first dissolving it in water. The initial evaluation showed significant mucosal injury involving the oral cavity, pharynx, and epiglottis. Endotracheal intubation was performed for airway protection in the emergency department, because the mucosal swelling resulted in upper airway compromise. After conservative treatment in the intensive care unit, he underwent tracheostomy because stenosis of the supraglottic and subglottic areas was not relieved. The tracheostomy tube was successfully removed after confirming recovery, and he was discharged 3 weeks after admission.

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Clinical Endoscopy.2021; 54(1): 122. CrossRef

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Cardiovascular | Resuscitation

Successful fibrinolytic and therapeutic hypothermic management of cardiac arrest following massive pulmonary embolism: Eunsil Ko, Jeong Hoon Lee, Minjung Kathy Chae, Tae Rim Lee, Min Seob Sim, Tae Gun Shin, Won Chul Cha, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong; Clin Exp Emerg Med 2015;2(3):193-196. Published online September 30, 2015; DOI: https://doi.org/10.15441/ceem.15.021

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Successful fibrinolytic and therapeutic hypothermic management of cardiac arrest following massive pulmonary embolism

Clin Exp Emerg Med. 2015;2(3):193-196. Published online September 30, 2015

DOI: https://doi.org/10.15441/ceem.15.021

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Successful fibrinolytic and therapeutic hypothermic management of cardiac arrest following massive pulmonary embolism

Clin Exp Emerg Med. 2015;2(3):193-196. Published online September 30, 2015

DOI: https://doi.org/10.15441/ceem.15.021

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Massive pulmonary embolism (MPE) with hemodynamic instability is a clinical condition with a poor prognosis and high mortality rates. There are no definitive treatment options for cardiac arrest due to MPE. A 52-year-old female presented at our emergency department with cardiac arrest, and a 62-year-old female presented after achieving return of spontaneous circulation of cardiac arrest from a local hospital, respectively. In each case, computed tomographic pulmonary angiography after return of spontaneous circulation demonstrated heavy burdens of pulmonary embolism in the pulmonary arteries. We immediately started therapeutic hypothermia and fibrinolytic therapy. They were transferred to the thoracic surgery and cardiology departments respectively, and then discharged with a cerebral performance categories scale score of 1. In summary, we report two cases of out-of-hospital cardiac arrest due to MPE in which fibrinolytic therapy was successfully combined with therapeutic hypothermia.

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Medical Emergencies | Procedures

Finger necrosis after accidental radial artery puncture: Jun Sik Kang, Tae Rim Lee, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong; Clin Exp Emerg Med 2014;1(2):130-133. Published online December 31, 2014; DOI: https://doi.org/10.15441/ceem.14.045

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Finger necrosis after accidental radial artery puncture

Clin Exp Emerg Med. 2014;1(2):130-133. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.045

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Finger necrosis after accidental radial artery puncture

Clin Exp Emerg Med. 2014;1(2):130-133. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.045

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Radial artery puncture, an invasive procedure, is frequently used for critical patients. Although considered safe, severe complications such as finger necrosis can occur. Herein, we review the clinical course of finger necrosis after accidental radial artery puncture. A 63-year-old woman visited the emergency department (ED) with left second and third finger pain after undergoing intravenous (IV) access in her wrist for procedural sedation. During the IV access, she experienced wrist pain, which increased during the 12 hours prior to her ED presentation. Emergency angiography revealed a pseudoaneurysm in her left radial artery and absence of blood flow to the proper palmar digital artery. Subsequent angiointervention and urokinase thrombolysis failed. The second finger was eventually amputated owing to gangrene. Radial artery puncture can occur accidentally during IV wrist access, resulting in severe morbidity. Providers should carefully examine the puncture site and collateral flow, followed by multiple examinations to ensure distal circulation.

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Resuscitation | Education & Simulation

Factors affecting the accuracy of chest compression depth estimation: Jung Hee Kang, Won Chul Cha, Minjung Kathy Chae, Hang A Park, Sung Yeon Hwang, Sang Chan Jin, Tae Rim Lee, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong; Clin Exp Emerg Med 2014;1(2):101-108. Published online December 31, 2014; DOI: https://doi.org/10.15441/ceem.14.006

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Factors affecting the accuracy of chest compression depth estimation

Clin Exp Emerg Med. 2014;1(2):101-108. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.006

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Factors affecting the accuracy of chest compression depth estimation

Clin Exp Emerg Med. 2014;1(2):101-108. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.006

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Objective
We aimed to estimate the accuracy of visual estimation of chest compression depth and identify potential factors affecting accuracy.
Methods
This simulation study used a basic life support mannequin, the Ambu man. We recorded chest compression with 7 different depths from 1 to 7 cm. Each video clip was recorded for a cycle of compression. Three different viewpoints were used to record the video. After filming, 25 clips were randomly selected. Health care providers in an emergency department were asked to estimate the depth of compressions while watching the selected video clips. Examiner determinants such as experience and cardiopulmonary resuscitation training and environment determinants such as the location of the camera (examiner) were collected and analyzed. An estimated depth was considered correct if it was consistent with the one recorded. A multivariate analysis predicting the accuracy of compression depth estimation was performed.
Results
Overall, 103 subjects were enrolled in the study; 42 (40.8%) were physicians, 56 (54.4%) nurses, and 5 (4.8%) emergency medical technicians. The mean accuracy was 0.89 (standard deviation, 0.76). Among examiner determinants, only subjects’ occupation and clinical experience showed significant association with outcome (P=0.03 and P=0.08, respectively). All environmental determinants showed significant association with the outcome (all P<0.001). Multivariate analysis showed that accuracy rate was significantly associated with occupation, camera position, and compression depth.
Conclusions
The accuracy rate of chest compression depth estimation was 0.89 and was significantly related with examiner’s occupation, camera view position, and compression depth.

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Critical Care

Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department: Young Min Joo, Minjung Kathy Chae, Sung Yeon Hwang, Sang-Chan Jin, Tae Rim Lee, Won Chul Cha, Ik Joon Jo, Min Seob Sim, Keun Jeong Song, Yeon Kwon Jeong, Tae Gun Shin; Clin Exp Emerg Med 2014;1(1):35-40. Published online September 30, 2014; DOI: https://doi.org/10.15441/ceem.14.012

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Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department

Clin Exp Emerg Med. 2014;1(1):35-40. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.012

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Impact of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock in the emergency department

Clin Exp Emerg Med. 2014;1(1):35-40. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.012

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Objective

We aimed to investigate the effect of timely antibiotic administration on outcomes in patients with severe sepsis and septic shock.

Methods

We analyzed data from a sepsis registry that included adult patients who initially presented to the emergency department (ED) and met criteria for severe sepsis or septic shock. Timely antibiotic use was defined as administration of a broad-spectrum antibiotic within three hours from the time of ED arrival. Multivariable logistic and linear regression analyses were performed to assess associations between timely administration of antibiotics and outcomes, including hospital mortality, 48-hour change in Sequential Organ Failure Assessment (SOFA) score (delta SOFA), and hospital length of stay (LOS).

Results

A total of 591 patients were included in the study. In-hospital mortality was 16.9% for patients receiving timely antibiotics (n=377) and 22.9% for patients receiving delayed antibiotics (n=214; P=0.04). The adjusted odds ratio for in-hospital survival was 0.54 (95% confidence interval [CI], 0.34 to 0.87; P=0.01) in patients who received timely antibiotics. Timely antibiotic administration was also significantly associated with higher delta SOFA (2 vs. 1) and shorter hospital LOS among survivors (11 days vs. 15 days). Multivariable linear regression analyses showed that timely antibiotic administration was significantly associated with increased delta SOFA and decreased hospital LOS.

Conclusion

Antibiotic administration within three hours from the time of ED arrival was significantly associated with improved outcomes, including in-hospital survival, reversal of organ failure, and shorter hospital LOS, in patients with severe sepsis and septic shock.

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