Clinical and Experimental Emergency Medicine

Guidelines

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care: Young-Min Kim, Kyung Woon Jeung, Won Young Kim, Yoo Seok Park, Joo Suk Oh, Yeon Ho You, Dong Hoon Lee, Minjung Kathy Chae, Yoo Jin Jeong, Min Chul Kim, Eun Jin Ha, Kyoung Jin Hwang, Won-Seok Kim, Jae Myung Lee, Kyoung-Chul Cha, Sung Phil Chung, June Dong Park, Han-Suk Kim, Mi Jin Lee, Sang-Hoon Na, Ai-Rhan Ellen Kim, Sung Oh Hwang, on behalf of the Steering Committee of 2020 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Clin Exp Emerg Med 2021;8(S):S41-S64. Published online May 21, 2021; DOI: https://doi.org/10.15441/ceem.21.025

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2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Clin Exp Emerg Med. 2021;8(S):S41-S64. Published online May 21, 2021

DOI: https://doi.org/10.15441/ceem.21.025

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2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Clin Exp Emerg Med. 2021;8(S):S41-S64. Published online May 21, 2021

DOI: https://doi.org/10.15441/ceem.21.025

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Resuscitation

Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry: Soo Hyun Kim, Kyu Nam Park, Chun Song Youn, Minjung Kathy Chae, Won Young Kim, Byung Kook Lee, Dong Hoon Lee, Tae Chang Jang, Jae Hoon Lee, Yoon Hee Choi, Je Sung You, In Soo Cho, Su Jin Kim, Jong-Seok Lee, Yong Hwan Kim, Min Seob Sim, Jonghwan Shin, Yoo Seok Park, Young Hwan Lee, HyungJun Moon, Won Jung Jeong, Joo Suk Oh, Seung Pill Choi, Kyoung-Chul Cha, Korean Hypothermia Network investigators; Clin Exp Emerg Med 2020;7(4):250-258. Published online December 31, 2020; DOI: https://doi.org/10.15441/ceem.20.035

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Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Clin Exp Emerg Med. 2020;7(4):250-258. Published online December 31, 2020

DOI: https://doi.org/10.15441/ceem.20.035

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Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Clin Exp Emerg Med. 2020;7(4):250-258. Published online December 31, 2020

DOI: https://doi.org/10.15441/ceem.20.035

Close

Objective
High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry.
Methods
We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months.
Results
Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours.
Conclusion
The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

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Toxicology | Epidemiology

Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea: Seungho Ham, Young Gi Min, Minjung Kathy Chae, Hyuk-Hoon Kim; Clin Exp Emerg Med 2020;7(1):43-51. Published online March 31, 2020; DOI: https://doi.org/10.15441/ceem.19.014

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Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea

Clin Exp Emerg Med. 2020;7(1):43-51. Published online March 31, 2020

DOI: https://doi.org/10.15441/ceem.19.014

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Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea

Clin Exp Emerg Med. 2020;7(1):43-51. Published online March 31, 2020

DOI: https://doi.org/10.15441/ceem.19.014

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Objective
We aimed to analyze the differences in epidemiological aspects and clinical courses of acute poisonings in each region of the Gyeonggi-do province in Korea.

Methods
This retrospective study analyzed data from the National Emergency Department Information System of Korea. We retrospectively reviewed cases of acute poisonings between April 2006 and March 2015 recorded at 13 emergency departments in eight different cities of Gyeonggi-do province in Korea. The differences in the incidence, age distribution, causative agent, and clinical course of poisonings among regions were the main outcomes measured.

Results
The proportion of poisonings in the ≤9 age group was high in Yongin (17.44%) and that in ≥65 age group was high in Gwangmyeong (21.76%). The proportion of cases involving carbon monoxide was high in Ansan (8.82%) in patients hospitalized and the proportion of cases involving pesticides was high in Pyeongtaek (52.78%) in patients admitted to the intensive care unit. The admission rate of poisoned patients was high in Osan (36.02%).

Conclusion
In this study, differences in the characteristics of poisoned patients between 8 cities were noted. Therefore, hospitals need to arrange treatment resources for poisoned patients according to the characteristics of the specific region. The results of this study may serve as evidence for new strategies to prepare for the acute poisonings in hospitals.

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Resuscitation

Brain computed tomography angiography in postcardiac arrest patients and neurologic outcome: Juho An, Eunsom Cho, Eunjung Park, Sung Eun Lee, Miran Han, Young Gi Min, Minjung Kathy Chae; Clin Exp Emerg Med 2019;6(4):297-302. Published online December 31, 2019; DOI: https://doi.org/10.15441/ceem.18.062

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Brain computed tomography angiography in postcardiac arrest patients and neurologic outcome

Clin Exp Emerg Med. 2019;6(4):297-302. Published online December 31, 2019

DOI: https://doi.org/10.15441/ceem.18.062

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Brain computed tomography angiography in postcardiac arrest patients and neurologic outcome

Clin Exp Emerg Med. 2019;6(4):297-302. Published online December 31, 2019

DOI: https://doi.org/10.15441/ceem.18.062

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Objective
This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.
Methods
Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.
Results
Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.
Conclusion
Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.

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Prognostic value of machine learning for brain computed tomography as a predictor of neurologic outcomes after cardiac arrest: a systematic review and meta-analysis
Kyung Hun Yoo, Juncheol Lee, Wonhee Kim, Bitnarae Kim, Elleah Jueun Chin, Jae-Guk Kim, Hyun-Young Choi, Jaehoon Oh
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2026;[Epub] CrossRef
Taking a New SLANT on Postcardiac Arrest Prognostication?*
Neha S. Dangayach, Brian J. Wright
Critical Care Medicine.2022; 50(3): 519. CrossRef

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Pilot study on a rewarming rate of 0.15°C/hr versus 0.25°C/hr and outcomes in post cardiac arrest patients: Eunhye Cho, Sung Eun Lee, Eunjung Park, Hyuk-Hoon Kim, Ji Sook Lee, Sangchun Choi, Young Gi Min, Minjung Kathy Chae; Clin Exp Emerg Med 2019;6(1):25-30. Published online February 20, 2019; DOI: https://doi.org/10.15441/ceem.17.275

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Pilot study on a rewarming rate of 0.15°C/hr versus 0.25°C/hr and outcomes in post cardiac arrest patients

Clin Exp Emerg Med. 2019;6(1):25-30. Published online February 20, 2019

DOI: https://doi.org/10.15441/ceem.17.275

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Pilot study on a rewarming rate of 0.15°C/hr versus 0.25°C/hr and outcomes in post cardiac arrest patients

Clin Exp Emerg Med. 2019;6(1):25-30. Published online February 20, 2019

DOI: https://doi.org/10.15441/ceem.17.275

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Objective
Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management in post cardiac arrest patients. Yet, studies on different rewarming rates and patient outcomes are limited. This study aimed to investigate post cardiac arrest patients who were rewarmed with different rewarming rates after 24 hours of hypothermia and the association of these rates to the neurologic outcomes.
Methods
This study retrospectively investigated post cardiac arrest patients treated with targeted temperature management and rewarmed with rewarming rates of 0.15°C/hr and 0.25°C/hr. The association of the rewarming rate with poor neurologic outcomes (cerebral performance category score, 3 to 5) was investigated.
Results
A total of 71 patients were analyzed (0.15°C/hr, n=36; 0.25°C/hr, n=35). In the comparison between 0.15°C/hr and 0.25°C/hr, the poor neurologic outcome did not significantly differ (24 [66.7%] vs. 25 [71.4%], respectively; P=0.66). In the multivariate analysis, the rewarming rate of 0.15°C/hr was not associated with the 1-month neurologic outcome improvement (odds ratio, 0.54; 95% confidence interval, 0.16 to 1.69; P=0.28).
Conclusion
The rewarming rates of 0.15°C/hr and 0.25°C/hr were not associated with the neurologic outcome difference in post cardiac arrest patients.

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Association Between Rewarming Rate and Survival and Neurologic Outcome of Accidental Hypothermia
Chiaki Hara, Takuya Taira, Akihiko Inoue, Takeshi Nishimura, Shota Kikuta, Nobuhiro Yamamoto, Shinichi Ijuin, Shuhei Takauji, Mineji Hayakawa, Satoshi Ishihara
Critical Care Medicine.2025; 53(7): e1416. CrossRef
Temperature Control After Cardiac Arrest: A Narrative Review
Samantha Fernandez Hernandez, Brooke Barlow, Vera Pertsovskaya, Carolina B. Maciel
Advances in Therapy.2023; 40(5): 2097. CrossRef
Rapid rewarming rate associated with favorable neurological outcomes in patients with post–cardiac arrest syndrome patients treated with targeted temperature management
Masaru Shin, Motoki Fujita, Toru Hifumi, Yasutaka Koga, Takeshi Yagi, Takashi Nakahara, Masaki Todani, Kotaro Kaneda, Ryosuke Tsuruta
Acute Medicine & Surgery.2023;[Epub] CrossRef
Targeted Temperature Management After Cardiac Arrest
Nicole Kupchik
Critical Care Nursing Clinics of North America.2021; 33(3): 303. CrossRef
Impact of rewarming rate on interleukin-6 levels in patients with shockable cardiac arrest receiving targeted temperature management at 33 °C: the ISOCRATE pilot randomized controlled trial
Jean-Baptiste Lascarrou, Elie Guichard, Jean Reignier, Amélie Le Gouge, Caroline Pouplet, Stéphanie Martin, Jean-Claude Lacherade, Gwenhael Colin, M. Azais, K. Bachoumas, A. Bailly, L. Camous, G. Colin, L. Crosby, M. Fiancette, M. Henry Lagarrigue, J. C.
Critical Care.2021;[Epub] CrossRef
Rewarming: The neglected phase of targeted temperature management
Niklas Nielsen, Hans Kirkegaard
Resuscitation.2020; 146: 249. CrossRef
High Quality Targeted Temperature Management (TTM) After Cardiac Arrest
Fabio Silvio Taccone, Edoardo Picetti, Jean-Louis Vincent
Critical Care.2020;[Epub] CrossRef
Resuscitating the Globally Ischemic Brain: TTM and Beyond
Melika Hosseini, Robert H. Wilson, Christian Crouzet, Arya Amirhekmat, Kevin S. Wei, Yama Akbari
Neurotherapeutics.2020; 17(2): 539. CrossRef
A practical approach to the use of targeted temperature management after cardiac arrest
Filippo Annoni, Katia Donadello, Leda Nobile, Fabio S. Taccone
Minerva Anestesiologica.2020;[Epub] CrossRef

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Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study: Patrick J. Coppler, Benjamin S. Abella, Clifton W. Callaway, Minjung Kathy Chae, Seung Pill Choi, Jonathan Elmer, Won Young Kim, Young-Min Kim, Michael Kurz, Joo Suk Oh, Joshua C. Reynolds, Jon C. Rittenberger, Kelly N. Sawyer, Chun Song Youn, Byung Kook Lee, David F. Gaieski, on behalf of the Korean Hypothermia Network Investigators and the National Post-Arrest Research Consortium; Clin Exp Emerg Med 2018;5(2):100-106. Published online April 30, 2018; DOI: https://doi.org/10.15441/ceem.17.219

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Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study

Clin Exp Emerg Med. 2018;5(2):100-106. Published online April 30, 2018

DOI: https://doi.org/10.15441/ceem.17.219

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Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study

Clin Exp Emerg Med. 2018;5(2):100-106. Published online April 30, 2018

DOI: https://doi.org/10.15441/ceem.17.219

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Objective
A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea.
Methods
In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics.
Results
Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers.
Conclusion
A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.

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Association between gasping and survival among out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: The SOS-KANTO 2017 study
Makoto Aoki, Shotaro Aso, Yohei Okada, Akira Kawauchi, Tomoko Ogasawara, Takashi Tagami, Yusuke Sawada, Hideo Yasunaga, Nobuya Kitamura, Kiyohiro Oshima
Resuscitation Plus.2024; 18: 100622. CrossRef
Beyond Extracorporeal Cardiopulmonary Resuscitation: Systems of Care Supporting Cardiac Arrest Patients
Nicholas George, Alexandra Lawler, Ian Leong, Ankur A. Doshi, Francis X. Guyette, Patrick J. Coppler
Prehospital Emergency Care.2022; 26(2): 189. CrossRef
Extracorporeal Life-support for Out-of-hospital Cardiac Arrest: A Nationwide Multicenter Study
Daun Jeong, Gun Tak Lee, Jong Eun Park, Hansol Chang, Taerim Kim, Won Chul Cha, Hee Yoon, Sung Yeon Hwang, Tae Gun Shin, Min Sub Sim, IkJoon Jo, Seung-Hwa Lee, Sang Do Shin, Jin-Ho Choi
Shock.2022; 57(5): 680. CrossRef
Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation
SungJoon Park, Jung-Youn Kim, Young-Duck Cho, Eusun Lee, Bosun Shim, Young-Hoon Yoon
Acute and Critical Care.2021; 36(1): 67. CrossRef
Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out‐of‐hospital cardiac arrest from the emergency department to intensive care unit in Japan
Toru Hifumi, Akihiko Inoue, Toru Takiguchi, Kazuhiro Watanabe, Takayuki Ogura, Tomoya Okazaki, Shinichi Ijuin, Ryosuke Zushi, Hideki Arimoto, Hiroaki Takada, Shinichirou Shiraishi, Yuko Egawa, Jun Kanda, Michitaka Nasu, Makoto Kobayashi, Masaaki Sakuraya,
Acute Medicine & Surgery.2021;[Epub] CrossRef
Perspectives on Temperature Management
Graham Nichol, Kees H. Polderman, Hans Friberg, Michael Kurz, Gregory Kapinos
Therapeutic Hypothermia and Temperature Management.2018; 8(4): 188. CrossRef

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Gastrointestinal

Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?: Min Seok Chae, Chong Kun Hong, Young Rock Ha, Minjung Kathy Chae, Young Sik Kim, Tae Yong Shin, Jung Hwan Ahn; Clin Exp Emerg Med 2017;4(4):214-221. Published online October 20, 2017; DOI: https://doi.org/10.15441/ceem.16.168

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Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

Clin Exp Emerg Med. 2017;4(4):214-221. Published online October 20, 2017

DOI: https://doi.org/10.15441/ceem.16.168

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Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

Clin Exp Emerg Med. 2017;4(4):214-221. Published online October 20, 2017

DOI: https://doi.org/10.15441/ceem.16.168

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Objective
Adult appendicitis (AA) with equivocal computed tomography (CT) findings remains a diagnostic challenge for physicians. Herein we evaluated the diagnostic performance of several clinical scoring systems in adult patients with suspected appendicitis and equivocal CT findings. Methods We retrospectively evaluated 189 adult patients with equivocal CT findings. Alvarado, Eskelinen, appendicitis inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and adult appendicitis score (AAS) scores were evaluated, receiver operating characteristic analysis was conducted, and the optimal, low, and high cut-off values were determined for patient classification into three groups: low, intermediate, or high. Results In total, 61 patients were included in the appendicitis group and 128 in the non-appendicitis group. There were no significant differences between the area under the curve of the clinical scoring systems in the final diagnosis of AA for equivocal appendicitis on CT (Alvarado, 0.698; Eskelinen, 0.710; appendicitis inflammatory response, 0.668; RIPASA, 0.653; AAS, 0.726). A RIPASA score greater than 7.5 had a high positive predictive value (90.9) and an AAS score less than or equal to 5 had a high negative predictive value (91.7) in the diagnosis of AA. Conclusion The accuracy of clinical scoring systems in the diagnosis of AA with equivocal CT findings was moderate. Therefore, a high RIPASA score may assist in the diagnosis of AA in patients with equivocal CT findings, and a low AAS score may be used as a criterion for patient discharge. Most patients presented with intermediate scores. The patients with equivocal CT findings may be considered as a third diagnostic category of AA.

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Does the Alvarado Score combined with computed tomography reduce negative appendectomy?
Murat Akıcı, Emre Ballı
Health Sciences Quarterly.2026; 6(1): 11. CrossRef
Efficacy of automated machine learning models and feature engineering for diagnosis of equivocal appendicitis using clinical and computed tomography findings
Juho An, Il Seok Kim, Kwang-Ju Kim, Ji Hyun Park, Hyuncheol Kang, Hyuk Jung Kim, Young Sik Kim, Jung Hwan Ahn
Scientific Reports.2024;[Epub] CrossRef
Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings
Massupa Krisem, Pinporn Jenjitranant, Tharin Thampongsa, Sirote Wongwaisayawan
Scientific Reports.2023;[Epub] CrossRef
Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis
Mohamed Said Ghali, Samer Hasan, Omer Al-Yahri, Salah Mansor, Mohannad Al-Tarakji, Munzir Obaid, Amjad Ali Shah, Mona S. Shehata, Rajvir Singh, Raed M. Al-Zoubi, Ahmad Zarour
Surgery Open Science.2023; 14: 96. CrossRef
The Effectiveness of Appendicitis Inflammatory Response Score in the Evaluation of Acute Appendicitis: A Meta-analysis
İlkay Güler, Dilay Satılmış, Sinan Ömeroğlu, Nurgül Balcı
Hamidiye Medical Journal.2023; 4(1): 15. CrossRef
Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis
Giuliana Favara, Andrea Maugeri, Martina Barchitta, Andrea Ventura, Guido Basile, Antonella Agodi, Ibrahim Umar Garzali
PLOS ONE.2022; 17(9): e0275427. CrossRef
A STUDY TO VALIDATE RIPASA SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS AMONG CLINICALLY SUSPECTED CASES.
Sudhansu Sarkar, Arpan Nandi
PARIPEX INDIAN JOURNAL OF RESEARCH.2021; : 1. CrossRef
Does Scoring System Help Us in the Diagnosis of Acute Appendicitis? A Prospective Clinical Trial
Yilmaz Guler, Pasa Dogan, Serkan Sengul, Hasan Calis, Zulfikar Karabulut
Indian Journal of Surgery.2020; 82(4): 507. CrossRef
Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules
Juan Ramón Gómez López, Juan Carlos Martín del Olmo, María Antonia Montenegro Martín, Pilar Concejo Cutoli, María Luz Martín Esteban, Miguel Toledano Trincado, Isabel Cristina López Mestanza, Carlos Vaquero Puerta
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(2): 184. CrossRef
Evaluation of the diagnostic performance of a decision tree model in suspected acute appendicitis with equivocal preoperative computed tomography findings compared with Alvarado, Eskelinen, and adult appendicitis scores
Hyo Jung Kang, Hyuncheol Kang, Bohyun Kim, Min Seok Chae, Young Rock Ha, Seong Beom Oh, Jung Hwan Ahn
Medicine.2019; 98(40): e17368. CrossRef
Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores
Khawaja Bilal Waheed, Waseem Jan Shah, Ali Salman Alshehri, Bilal Altaf, Muhammad Amjad, Muhammad Sohail Amin, Emad Fouad Mahmoud Said, Noor Riyadh Bukhamsin
Journal of Evolution of Medical and Dental Sciences.2019; 8(40): 3005. 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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Procedures | Infectious Disease

Contamination during doffing of personal protective equipment by healthcare providers: Seong Mi Lim, Won Chul Cha, Minjung Kathy Chae, Ik Joon Jo; Clin Exp Emerg Med 2015;2(3):162-167. Published online September 30, 2015; DOI: https://doi.org/10.15441/ceem.15.019

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Contamination during doffing of personal protective equipment by healthcare providers

Clin Exp Emerg Med. 2015;2(3):162-167. Published online September 30, 2015

DOI: https://doi.org/10.15441/ceem.15.019

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Contamination during doffing of personal protective equipment by healthcare providers

Clin Exp Emerg Med. 2015;2(3):162-167. Published online September 30, 2015

DOI: https://doi.org/10.15441/ceem.15.019

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Objective
In this study, we aimed to describe the processes of both the donning and the doffing of personal protective equipment for Ebola and evaluate contamination during the doffing process.
Methods
We recruited study participants among physicians and nurses of the emergency department of Samsung Medical Center in Seoul, Korea. Participants were asked to carry out doffing and donning procedures with a helper after a 50-minute brief training and demonstration based on the 2014 Centers for Disease Control and Prevention protocol. Two separate cameras with high-density capability were set up, and the donning and doffing processes were video-taped. A trained examiner inspected all video recordings and coded for intervals, errors, and contaminations defined as the outside of the equipment touching the clinician’s body surface.
Results
Overall, 29 participants were enrolled. Twenty (68.9%) were female, and the mean age was 29.2 years. For the donning process, the average interval until the end was 234.2 seconds (standard deviation [SD], 65.7), and the most frequent errors occurred when putting on the outer gloves (27.5%), respirator (20.6%), and hood (20.6%). For the doffing process, the average interval until the end was 183.7 seconds (SD, 38.4), and the most frequent errors occurred during disinfecting the feet (37.9%), discarding the scrubs (17.2%), and putting on gloves (13.7%), respectively. During the doffing process, 65 incidences of contamination occurred (2.2 incidents/person). The most vulnerable processes were removing respirators (79.2%), removing the shoe covers (65.5%), and removal of the hood (41.3%).
Conclusion
A significant number of contaminations occur during the doffing process of personal protective equipment.

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A pilot trial of internet-delivered mastery-based Ebola simulation education in Uganda
Catherine D. Tobin, Lacey MenkinSmith, Dulaney A. Wilson, Kenneth Catchpole, J.G. Reves
Healthcare in Low-resource Settings.2025;[Epub] CrossRef
Artificial intelligence-assisted personal protective equipment donning and doffing training for health professions students and healthcare workers: a scoping review
Yu Lv, Minhong Cai, Qian Xiang, Pingping Wang
BMC Medical Education.2025;[Epub] CrossRef
Removal of Contaminated Personal Protective Equipment With and Without Supervision. A Randomized Crossover Simulation-Based Study
Mostafa Somri, Ohad Hochman, Lina Somri-Gannam, Luis Gaitini, Alona Paz, Tami Bumard, Manuel Á. Gómez-Ríos
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2024; 19(3): 137. CrossRef
Perspectives on Preparedness for Chemical, Biological, Radiological, and Nuclear Threats in the Middle East and North Africa Region: Application of Artificial Intelligence Techniques
Hassan Farhat, Guillaume Alinier, Mariana Helou, Ionnais Galatis, Nidaa Bajow, Denis Jose, Sarra Jouini, Sermet Sezigen, Samia Hafi, Sheena Mccabe, Naoufel Somrani, Kawther El Aifa, Henda Chebbi, Asma Ben Amor, Yosra Kerkeni, Ahmed M. Al-Wathinani, Nassem
Health Security.2024; 22(3): 190. CrossRef
Assessing efficacy of instructor based orientation to donning doffing protocols and modifications to doffing area infrastructure in reducing SARS-CoV-2 infection among Doctors assigned to COVID-19 patient care
Sunil V. Furtado, Parichay J. Perikal, Monica Narayanaswamy, T.V. Ravikumar, Lissy John, K. Harish
Infection Prevention in Practice.2023; 5(2): 100279. CrossRef
A hood shield reduces postdoffing contamination during simulated COVID-19 airway management: an exploratory, simulation-based randomized study
Felipe Muñoz-Leyva, Anahi Perlas, Ki Jinn Chin, Mehdi Soheili, Qixuan Li, Ella Huszti, Vincent Chan
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2023; 70(5): 869. CrossRef
Unfamiliar personal protective equipment: The role of routine practice and other factors affecting healthcare personnel doffing strategies
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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

Close

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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