Clinical and Experimental Emergency Medicine

Resuscitation

Performance of a transesophageal echocardiography probe at temperature monitoring during simulated hypothermia and rewarming: Madeline Larochelle, Margarita Popova, David Mackenzie, Andrew Fried, Peter Croft, Joshua Rehberg, Christina Wilson; Clin Exp Emerg Med 2026;13(1):81-85. Published online January 15, 2025; DOI: https://doi.org/10.15441/ceem.24.321

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Performance of a transesophageal echocardiography probe at temperature monitoring during simulated hypothermia and rewarming

Clin Exp Emerg Med. 2026;13(1):81-85. Published online January 15, 2025

DOI: https://doi.org/10.15441/ceem.24.321

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Performance of a transesophageal echocardiography probe at temperature monitoring during simulated hypothermia and rewarming

Clin Exp Emerg Med. 2026;13(1):81-85. Published online January 15, 2025

DOI: https://doi.org/10.15441/ceem.24.321

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Objective
To determine whether a transesophageal echocardiography (TEE) probe can accurately measure temperature and be used to monitor temperature changes over time without overheating in an experimental model of hypothermia and rewarming. Methods A 6-L water bath was heated with a sous vide immersion circulator to 24, 28, 32, and 36 °C to simulate severe hypothermia, moderate hypothermia, mild hypothermia, and normothermia, respectively. A TEE probe, esophageal temperature probe, and bladder temperature probe were used to measure temperature every 60 seconds for 15 minutes. Results The TEE probe reported temperatures with a mean difference of 0.60 °C (95% confidence interval [CI], 0.51 to 0.69 °C) compared to the sous vide immersion circulator. The esophageal probe and bladder probe reported temperatures with a mean difference of –0.19 °C (95% CI, –0.23 to –0.14 °C) and –0.20 °C (95% CI, –0.26 to –0.14 °C), respectively. Conclusion During this simulation, the TEE tip temperature did not increase beyond the expected changes produced by water temperature. The probe temperature was less accurate than the esophageal and bladder temperature probes but demonstrated precision in monitoring temperature changes and stable hypothermia. Based on this study, TEE probes should not be relied upon for an accurate initial temperature but can likely be used to monitor changes in temperature over time.

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Pediatrics | Resuscitation

Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report: Koji Kanno, Kentaro Watanabe, Yu Kanokogi, Marina Tsujimura, Akira Yoshida, Tomoya Hanada, Yuji Yamagami, Yusuke Ito; Clin Exp Emerg Med 2025;12(2):169-172. Published online September 6, 2024; DOI: https://doi.org/10.15441/ceem.24.213

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Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report

Clin Exp Emerg Med. 2025;12(2):169-172. Published online September 6, 2024

DOI: https://doi.org/10.15441/ceem.24.213

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Nonocclusive mesenteric ischemia in a toddler during hypothermia after cardiac arrest: a case report

Clin Exp Emerg Med. 2025;12(2):169-172. Published online September 6, 2024

DOI: https://doi.org/10.15441/ceem.24.213

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While nonocclusive mesenteric ischemia (NOMI) has been reported in a significant percentage of adults who were resuscitated after cardiac arrest, it is rare in children. This report presents the first known Japanese case of pediatric NOMI after return of spontaneous circulation following cardiac arrest. A 16-month-old boy experienced cardiac arrest due to asphyxiation from foreign bodies in the airway. After receiving 10 doses of adrenaline, with a maximum arrest time of 95 minutes, the patient achieved return of spontaneous circulation. However, 40 hours after onset, the patient developed NOMI, resulting in refractory hypotensive shock with decreased blood pressure, distended abdomen, and increased intravesical pressure. The patient was successfully rescued with two laparotomies and was discharged. Although NOMI is uncommon in children, appropriate treatment can be lifesaving.

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Intestinal necrosis due to nonocclusive mesenteric ischemia in a child with Mycoplasma pneumoniae pneumonia: a case report
Xuejing Li, Tingting Lin, Ken Chen, Danli Wang, Jiahui Yu, Lei Wu, Lanfang Tang
BMC Infectious Diseases.2025;[Epub] CrossRef

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Resuscitation

Targeted temperature management with hypothermia for comatose patients after cardiac arrest: Clifton W. Callaway; Clin Exp Emerg Med 2023;10(1):5-17. Published online February 16, 2023; DOI: https://doi.org/10.15441/ceem.23.012

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Targeted temperature management with hypothermia for comatose patients after cardiac arrest

Clin Exp Emerg Med. 2023;10(1):5-17. Published online February 16, 2023

DOI: https://doi.org/10.15441/ceem.23.012

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Targeted temperature management with hypothermia for comatose patients after cardiac arrest

Clin Exp Emerg Med. 2023;10(1):5-17. Published online February 16, 2023

DOI: https://doi.org/10.15441/ceem.23.012

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Targeted temperature management with mild hypothermia (TTM-hypothermia; 32–34 °C) is a treatment strategy for adult patients who are comatose after cardiac arrest. Robust preclinical data support the beneficial effects of hypothermia beginning within 4 hours of reperfusion and maintained during the several days of postreperfusion brain dysregulation. TTM-hypothermia increased survival and functional recovery after adult cardiac arrest in several trials and in realworld implementation studies. TTM-hypothermia also benefits neonates with hypoxic-ischemic brain injury. However, larger and methodologically more rigorous adult trials do not detect benefit. Reasons for inconsistency of adult trials include the difficulty delivering differential treatment between randomized groups within 4 hours and the use of shorter durations of treatment. Furthermore, adult trials enrolled populations that vary in illness severity and brain injury, with individual trials enriched for higher or lower illness severity. There are interactions between illness severity and treatment effect. Current data indicate that TTM-hypothermia implemented quickly for adult patients after cardiac arrest, may benefit select patients at risk of severe brain injury but not benefit other patients. More data are needed on how to identify treatment-responsive patients and on how to titrate the timing and duration of TTM-hypothermia.

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Comparison of intracranial pressure changes in out-of-hospital cardiac arrest patients with and without malignant blood-brain barrier disruption: Seungwoo Lee, Yeonho You, Hong Joon Ahn, Jung Soo Park, Wonjoon Jeong, Changshin Kang, Jin Hong Min, Yong Nam In; Clin Exp Emerg Med 2022;9(4):296-303. Published online October 5, 2022; DOI: https://doi.org/10.15441/ceem.22.319

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Comparison of intracranial pressure changes in out-of-hospital cardiac arrest patients with and without malignant blood-brain barrier disruption

Clin Exp Emerg Med. 2022;9(4):296-303. Published online October 5, 2022

DOI: https://doi.org/10.15441/ceem.22.319

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Comparison of intracranial pressure changes in out-of-hospital cardiac arrest patients with and without malignant blood-brain barrier disruption

Clin Exp Emerg Med. 2022;9(4):296-303. Published online October 5, 2022

DOI: https://doi.org/10.15441/ceem.22.319

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Objective
In the present study, intracranial pressure (ICP) changes were investigated in out-ofhospital cardiac arrest (OHCA) patients with and without malignant blood-brain barrier (BBB) disruption who underwent target temperature management.
Methods
This prospective, single-center, observational study was conducted from June 2019 to December 2021. ICP and albumin quotient values were measured on days 1, 2, 3, and 4 of hospitalization. Malignant BBB disruption was defined as the sum of scores for the degree of BBB disruption ≥9 on days 1 to 4.
Results
ICP in OHCA patients without malignant BBB disruption on days 1, 2, 3, and 4 of hospitalization was 9.58±0.53, 12.32±0.65, 14.39±0.76, and 13.88±0.87 mmHg, respectively, and in OHCA patients with malignant BBB disruption 13.65±0.74, 15.72±0.67, 16.10±0.92, and 15.22±0.87 mmHg, respectively (P<0.001, P<0.001, P=0.150, and P=0.280, respectively). The P-values of changes in ICP between days 1 and 2, days 2 and 3, and days 3 and 4 of hospitalization in OHCA patients without malignant BBB disruption were P<0.001, P=0.001, and P=0.540, respectively, and in OHCA patients with malignant BBB disruption were P=0.002, P=0.550, and P=0.100, respectively.
Conclusion
Among OHCA patients treated with target temperature management, ICP was higher on days 1 and 2 of hospitalization and an increase in ICP occurred earlier with malignant BBB disruption than without malignant BBB disruption.

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The agreement between jugular bulb and cerebrospinal fluid lactate levels in patients with out-of-hospital cardiac arrest
Jung Soo Park, Yeonho You, Changshin Kang, Wonjoon Jeong, Hong Joon Ahn, Jin Hong Min, Yong Nam In, So Young Jeon
Scientific Reports.2024;[Epub] CrossRef
Alteration in cerebrospinal fluid flow based on the neurological prognosis of out-of-hospital cardiac arrest patients
So-Young Jeon, Yeonho You, Changshin Kang, Jung Soo Park, Wonjoon Jeong, Hong Joon Ahn, Jin Hong Min, Yong Nam In, In Ho Lee
Scientific Reports.2024;[Epub] CrossRef
Optimizing brain protection after cardiac arrest: advanced strategies and best practices
Ida Giorgia Iavarone, Katia Donadello, Giammaria Cammarota, Fausto D’Agostino, Tommaso Pellis, Erik Roman-Pognuz, Claudio Sandroni, Federico Semeraro, Mypinder Sekhon, Patricia R. M. Rocco, Chiara Robba
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Quantification of Cerebral Vascular Autoregulation Immediately Following Resuscitation from Cardiac Arrest
Yucheng Shen, Qihong Wang, Hiren R. Modi, Arvind P. Pathak, Romergryko G. Geocadin, Nitish V. Thakor, Janaka Senarathna
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Time-course relationship between cerebrospinal fluid and serum concentrations of midazolam and albumin in patients with cardiac arrest undergoing targeted temperature management
Jong-il Park, Changshin Kang, Wonjoon Jeong, Jung Soo Park, Yeonho You, Hong Joon Ahn, Yongchul Cho, So Young Jeon, Jin Hong Min, Yong Nam In
Resuscitation.2023; 189: 109867. CrossRef
Differences in Cerebral Metabolism between Moderate- and High-Severity Groups of Patients with Out-of-Hospital Cardiac Arrest Undergoing Target Temperature Management
Yeonho You, Changshin Kang, Wonjoon Jeong, Hong Joon Ahn, Jung Soo Park, Jin Hong Min, Yong Nam In, Jae Kwang Lee, So Young Jeon
Brain Sciences.2023; 13(10): 1373. CrossRef
Quantitative analysis of early apparent diffusion coefficient values from MRIs for predicting neurological prognosis in survivors of out-of-hospital cardiac arrest: an observational study
Jung A. Yoon, Changshin Kang, Jung Soo Park, Yeonho You, Jin Hong Min, Yong Nam In, Wonjoon Jeong, Hong Joon Ahn, In Ho Lee, Hye Seon Jeong, Byung Kook Lee, Jae Kwang Lee
Critical Care.2023;[Epub] CrossRef

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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

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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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Jonathan Tam, Jonathan Elmer
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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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Hemoglobin concentration is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management: Daesung Kim, Soo Hyun Kim, Kyu Nam Park, Sang Hoon Oh, Young Min Kim, Chun Song Youn; Clin Exp Emerg Med 2018;5(3):150-155. Published online April 30, 2018; DOI: https://doi.org/10.15441/ceem.17.250

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Hemoglobin concentration is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management

Clin Exp Emerg Med. 2018;5(3):150-155. Published online April 30, 2018

DOI: https://doi.org/10.15441/ceem.17.250

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Hemoglobin concentration is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management

Clin Exp Emerg Med. 2018;5(3):150-155. Published online April 30, 2018

DOI: https://doi.org/10.15441/ceem.17.250

Close

Objective
The objective of this study was to test the hypothesis that hemoglobin concentration after return of spontaneous circulation (ROSC) is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management.
Methods
We studied consecutive adult patients with out-of-hospital cardiac arrest treated with targeted temperature management between January 2009 and December 2015. We quantified the association between post ROSC hemoglobin concentrations and good neurologic outcome (defined as Cerebral Performance Category of 1 and 2) at hospital discharge using multivariate logistic regression analysis.
Results
A total of 246 subjects were ultimately included in this study. The mean age was 54 years (standard deviation, 17); 168 (68%) subjects were male. Eighty-seven (35%) subjects had a good neurologic outcome at hospital discharge. Hemoglobin concentrations were higher in the good outcome group than in the poor outcome group (14.4±2.0 vs. 12.8±2.5 g/dL, P<0.001). Multivariate logistic regression analysis showed that hemoglobin concentrations were associated with good neurologic outcome at hospital discharge after adjusting for other confounding factors (adjusted odds ratio, 1.186; 95% confidence interval, 1.008 to 1.395).
Conclusion
These results show that hemoglobin concentrations after ROSC are associated with neurologic outcome at hospital discharge. Future research to examine the association between hemoglobin levels and neurologic outcome after cardiac arrest is warranted.

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Association between early red blood cell transfusion after return of spontaneous circulation and clinical outcomes in cardiac arrest patients
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Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society
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Neurocritical Care.2024; 40(1): 1. CrossRef
Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society
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Hemoglobin as a prognostic marker for neurological outcomes in post-cardiac arrest patients: a meta-analysis
Hongxiang Hou, Li Pang, Liang Zhao, Zuolong Liu, Ji-Hong Xing
Scientific Reports.2023;[Epub] CrossRef
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Lior Shor, Yigal Helviz, Sharon Einav
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PROLOGUE (PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages): Development and validation of a scoring system for early prognostication in unselected adult cardiac arrest patients
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Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome
Christoph Schriefl, Christian Schoergenhofer, Florian Ettl, Michael Poppe, Christian Clodi, Matthias Mueller, Juergen Grafeneder, Bernd Jilma, Ingrid Anna Maria Magnet, Nina Buchtele, Magdalena Sophie Boegl, Michael Holzer, Fritz Sterz, Michael Schwameis
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Neurocritical Care.2020; 32(2): 448. CrossRef

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Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management: Jung Chang Kim, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Yong Soo Cho, Sung Min Lee, Seung Joon Lee, Chi Ho Park, Kyung Woon Jeung; Clin Exp Emerg Med 2017;4(1):10-18. Published online March 30, 2017; DOI: https://doi.org/10.15441/ceem.16.149

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Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management

Clin Exp Emerg Med. 2017;4(1):10-18. Published online March 30, 2017

DOI: https://doi.org/10.15441/ceem.16.149

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Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management

Clin Exp Emerg Med. 2017;4(1):10-18. Published online March 30, 2017

DOI: https://doi.org/10.15441/ceem.16.149

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Objective
We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM).
Methods
A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality.
Results
The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders.
Conclusion
Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.

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Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock: Gyuho Song, Yeonho You, Wonjoon Jeong, Junwan Lee, Yongchul Cho, Seungwhan Lee, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo; Clin Exp Emerg Med 2016;3(1):20-26. Published online March 31, 2016; DOI: https://doi.org/10.15441/ceem.15.090

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Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock

Clin Exp Emerg Med. 2016;3(1):20-26. Published online March 31, 2016

DOI: https://doi.org/10.15441/ceem.15.090

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Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock

Clin Exp Emerg Med. 2016;3(1):20-26. Published online March 31, 2016

DOI: https://doi.org/10.15441/ceem.15.090

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Objective
We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation.
Methods
We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients’ next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups.
Results
During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg^-1·min^-1 in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg^-1·min^-1 in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg^-1·min^-1 in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03).
Conclusion
In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.

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Survival, but not the severity of hypoxic–ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study
Sandra Preuß, Jan Multmeier, Werner Stenzel, Sebastian Major, Christoph J. Ploner, Christian Storm, Jens Nee, Christoph Leithner, Christian Endisch
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
Jae-Hyug Woo, Yong Su Lim, Jin Seong Cho, Hyuk Jun Yang, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi
Journal of Clinical Medicine.2023; 12(15): 5040. CrossRef
Study on the timing of severe blood-brain barrier disruption using cerebrospinal fluid-serum albumin quotient in post cardiac arrest patients treated with targeted temperature management
Jung Soo Park, Yeonho You, Jin Hong Min, Insool Yoo, Wonjoon Jeong, Yongchul Cho, Seung Ryu, Jinwoong Lee, Seung Whan Kim, Sung Uk Cho, Se Kwang Oh, Hong Joon Ahn, Junwan Lee, In Ho Lee
Resuscitation.2019; 135: 118. CrossRef
Optimal timing to measure optic nerve sheath diameter as a prognostic predictor in post-cardiac arrest patients treated with targeted temperature management
Jung Soo Park, Yongchul Cho, Yeonho You, Jin Hong Min, Wonjoon Jeong, Hong Joon Ahn, Changshin Kang, Insool Yoo, Seung Ryu, Jinwoong Lee, Seung Whan Kim, Sung Uk Cho, Se Kwang Oh, Junwan Lee, In Ho Lee
Resuscitation.2019; 143: 173. CrossRef
The Relationship Between the Decreased Rate of Initial Blood Glucose and Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Receiving Therapeutic Hypothermia
Jae-Hyug Woo, Yong Su Lim, Hyuk Jun Yang, Sung Youl Hyun, Jin Seong Cho, Jin Joo Kim, Gun Lee
Neurocritical Care.2017; 26(3): 402. CrossRef

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A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers: Tae Gwan Oh, Won Chul Cha, Ik Joon Jo, Mun Ju Kang, Dong Woo Lee; Clin Exp Emerg Med 2015;2(4):210-216. Published online December 28, 2015; DOI: https://doi.org/10.15441/ceem.15.018

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A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers

Clin Exp Emerg Med. 2015;2(4):210-216. Published online December 28, 2015

DOI: https://doi.org/10.15441/ceem.15.018

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A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers

Clin Exp Emerg Med. 2015;2(4):210-216. Published online December 28, 2015

DOI: https://doi.org/10.15441/ceem.15.018

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Objective
We aimed to summarize the therapeutic hypothermia (TH) protocols used in emergency departments (EDs) in Korea and to investigate the differences between level 1 and 2 centers.
Methods
The chief residents from 56 EDs were given a structured survey containing questions on the indications for TH, methods for TH induction, maintaining, and finalizing TH treatments. The participants were divided into 2 groups based on their work place (level 1 vs. level 2 centers).
Results
We received 36 responses to the survey. The majority of the participants (94.4%) reported that they routinely used TH. An average of 5.9 (standard deviation, 3.4) and 3.3 (standard deviation, 2.9) TH procedures were performed monthly in level 1 and 2 centers, respectively (P=0.01). The majority of level 1 and 2 centers (80.0% and 73.1%, respectively) had written TH protocols. Rectal (50.0%) and esophageal probes (38.9%) were most commonly used to monitor the patients’ body temperatures. Midazolam (80.6%) and remifentanyl (47.2%) were the most commonly used sedatives. For TH induction, external cooling devices (77.8%) and cold saline infusion (66.1%) were predominant. Between level 1 and 2 centers, only the number of TH, the usage of remifentanyl, and application of external cooling device showed significant differences (P<0.05)
Conclusion
Our study summarizes the TH protocols used in 36 EDs. The majority of study participants performed TH using a written protocol. We observed small number of differences in TH induction and maintenance methods between level 1 and 2 centers.

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Hypothermia Inhibits Endothelium-Independent Vascular Contractility via Rho-kinase Inhibition
Yoon Hee Chung, Keon Woong Oh, Sung Tae Kim, Eon Sub Park, Hyun Dong Je, Hyuk-Jun Yoon, Uy Dong Sohn, Ji Hoon Jeong, Hyen-Oh La
Biomolecules & Therapeutics.2018; 26(2): 139. 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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Experimental study | Critical Care

Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis: You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Kwang Pil Rim, In Soo Cho; Clin Exp Emerg Med 2014;1(2):120-125. Published online December 31, 2014; DOI: https://doi.org/10.15441/ceem.14.015

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Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis

Clin Exp Emerg Med. 2014;1(2):120-125. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.015

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Rapid rewarming after therapeutic hypothermia worsens outcome in sepsis

Clin Exp Emerg Med. 2014;1(2):120-125. Published online December 31, 2014

DOI: https://doi.org/10.15441/ceem.14.015

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Objective
This study was performed to investigate the effect of the rewarming rate on survival and acute lung injury in sepsis.
Methods
Male Sprague-Dawley rats underwent cecal ligation and incision. After 1 hour of sepsis induction, normothermia (37°C±0.5°C, NT group) or hypothermia (32°C±0.5°C) was induced. Hypothermia was maintained for 4 hours and rats were divided into two groups according to the rewarming rate: RW1 group, 1 hour of rewarming; and RW2 group, 2 hours of rewarming. In the survival study, rats were observed for 12 hours after sepsis induction (n=6 per group). In the second experiment, rats were sacrificed 7 hours after sepsis induction, and lung tissues and plasma were harvested (n=10 per group).
Results
In the survival study, the RW2 group survived longer than the RW1 group (P<0.05), but the RW1 and NT groups showed no significant difference in survival duration (P>0.05). The histological lung injury score and malondialdehyde concentrations in the lung tissues were significantly higher in the RW1 group than in the RW2 group (P<0.05). Plasma interleukin (IL)-6 concentration and the ratio of IL-6 to IL-10 were higher in the RW1 group than in the RW2 group (P<0.05).
Conclusion
Rapid rewarming after therapeutic hypothermia results in a shorter survival period and acute lung injury in sepsis, which could be associated with the inflammatory responses.

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Combination Therapy of Niacin and Apocynin Attenuates Lung Injury During Sepsis in Rats
Heesu Park, Yoon Sun Jung, Gil Joon Suh, Woon Yong Kwon, Kyung Su Kim, Taegyun Kim, Hayoung Kim, Jieun Shin
Journal of Surgical Research.2023; 285: 51. CrossRef
Clinicopathological prognostic indicators of survival and pathological findings in cold-stressed Florida manatees Trichechus manatus latirostris
M Martony, JA Hernandez, M de Wit, J St Leger, C Erlacher-Reid, J Vandenberg, NI Stacy
Diseases of Aquatic Organisms.2019; 132(2): 85. CrossRef
Is Therapeutic Hypothermia for Acute Respiratory Distress Syndrome the Future?
Adam J. Hayek, Heath D. White, Shekhar Ghamande, Christopher Spradley, Alejandro C. Arroliga
Journal of Intensive Care Medicine.2017; 32(7): 460. CrossRef

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Resuscitation

Outcome and current status of therapeutic hypothermia after out-of-hospital cardiac arrest in Korea using data from the Korea Hypothermia Network registry: Byung Kook Lee, Kyu Nam Park, Gu Hyun Kang, Kyung Hwan Kim, Giwoon Kim, Won Young Kim, Jin Hong Min, Yooseok Park, Jung Bae Park, Gil Joon Suh, Yoo Dong Son, Jonghwan Shin, Joo Suk Oh, Yeon Ho You, Dong Hoon Lee, Jong Seok Lee, Hoon Lim, Tae Chang Jang, Gyu Chong Cho, In Soo Cho, Kyoung Chul Cha, Seung Pill Choi, Wook Jin Choi, Chul Han, The Korean Hypothermia Network Investigators; Clin Exp Emerg Med 2014;1(1):19-27. Published online September 30, 2014; DOI: https://doi.org/10.15441/ceem.14.007

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Outcome and current status of therapeutic hypothermia after out-of-hospital cardiac arrest in Korea using data from the Korea Hypothermia Network registry

Clin Exp Emerg Med. 2014;1(1):19-27. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.007

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Outcome and current status of therapeutic hypothermia after out-of-hospital cardiac arrest in Korea using data from the Korea Hypothermia Network registry

Clin Exp Emerg Med. 2014;1(1):19-27. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.007

Close

Objective

Therapeutic hypothermia (TH) has become the standard strategy for reducing brain damage in the postresuscitation period. The aim of this study was to investigate current TH performance and outcomes in out-of-hospital cardiac arrest (OHCA) survivors using data from the Korean Hypothermia Network (KORHN) registry.

Methods

We used the KORHN registry, a web-based multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH between 2007 and 2012 were included. The primary outcomes were neurological outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH.

Results

A total of 930 patients were included, of whom 556 (59.8%) survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 minutes (interquartile range [IQR], 46 to 200 minutes). The induction, maintenance, and rewarming durations were 150 minutes (IQR, 80 to 267 minutes), 1,440 minutes (IQR, 1,290 to 1,440 minutes), and 708 minutes (IQR, 420 to 900 minutes), respectively. The time from the ROSC to coronary angiography was 1,045 hours (IQR, 121 to 12,051 hours). Hyperglycemia (46.3%) was the most frequent adverse event.

Conclusion

More than one-quarter of the OHCA survivors (26.8%) were discharged with good neurologic outcomes. TH performance was appropriately managed in terms of the factors related to its timing, including cooling start time and rewarming duration.

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Association Between the Timing of Coronary Angiography, Targeted Temperature Management, and Neurological Outcomes After Out‐of‐Hospital Cardiac Arrest: A Nationwide Population‐Based Registry Study in Korea
Sang Hoon Oh, Han Joon Kim, Kyu Nam Park, Chun Song Youn, Jee Yong Lim, Hyo Joon Kim, Hyo Jin Bang
Journal of the American Heart Association.2025;[Epub] CrossRef
Feasibility of Magnetic Resonance-Based Conductivity Imaging as a Tool to Estimate the Severity of Hypoxic-Ischemic Brain Injury in the First Hours After Cardiac Arrest
Yong Hun Jung, Hyoung Youn Lee, Byung Kook Lee, Bup Kyung Choi, Tae-Hoon Kim, Jin Woong Kim, Hyun Chul Kim, Hyung Joong Kim, Kyung Woon Jeung
Neurocritical Care.2024; 40(2): 538. CrossRef
Brain Death and Its Prediction in Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management
Hwan Song, Sang Hoon Oh, Hye Rim Woo
Diagnostics.2022; 12(5): 1190. CrossRef
Ultra-early neurologic outcome prediction of out-of-hospital cardiac arrest survivors using combined diffusion-weighted imaging findings and quantitative analysis of apparent diffusion coefficient
Jung Soo Park, Yong Nam In, Yeon Ho You, Jin Hong Min, Hong Joon Ahn, In Sool Yoo, Seung Whan Kim, Jin Woong Lee, Seung Ryu, Won Joon Jeong, Yong Chul Cho, Se Kwang Oh, Sung Uk Cho, Chang Shin Kang, In Ho Lee, Byung Kook Lee, Dong Hun Lee, Dong Hoon Lee
Resuscitation.2020; 148: 39. CrossRef
Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With and Without Targeted Temperature Management in a Multiethnic Asian Population
Wan Jing Tay, Huihua Li, Andrew FW Ho, Ching Hui Sia, Georgina GJ Kwek, Sohil Pothiawala, Nur Shahidah, Kenneth BK Tan, Aaron SL Aaron SL Wong, Duu Wen Sewa, Eric TS Lim, Chee Tang Chin, Marcus EH Marcus EH Ong
Annals of the Academy of Medicine, Singapore.2020; 49(3): 127. CrossRef
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
Clinical and Experimental Emergency Medicine.2020; 7(4): 250. CrossRef
Factors Predicting Bacterial Infection in Out-of-Hospital Cardiac Arrest Patients Undergoing Targeted Temperature Management
Seung Mok Ryoo, Seung Joon Yoo, Joon Sung Kim, Gina Yu, Sungmin Jung, Youn-Jung Kim, Chang Hwan Sohn, Won Young Kim
Therapeutic Hypothermia and Temperature Management.2019; 9(3): 190. CrossRef
Recovery from acute kidney injury as a potent predictor of survival and good neurological outcome at discharge after out-of-hospital cardiac arrest
Yoo Seok Park, Yoon Hee Choi, Je Hyeok Oh, In Soo Cho, Kyoung-Chul Cha, Byung-Sun Choi, Je Sung You
Critical Care.2019;[Epub] CrossRef
Association between acute kidney injury and neurological outcome or death at 6 months in out-of-hospital cardiac arrest: A prospective, multicenter, observational cohort study
Je Hyeok Oh, Dong Hoon Lee, In Soo Cho, Chun Song Youn, Byung Kook Lee, Jung Hee Wee, Kyoung-Chul Cha, Minjung Kathy Chae, Jonghwan Shin
Journal of Critical Care.2019; 54: 197. CrossRef
Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients
Seung Mok Ryoo, Dong Hun Lee, Byung Kook Lee, Chun Song Youn, Youn-Jung Kim, Su Jin Kim, Yong Hwan Kim, Won Young Kim
Journal of Clinical Medicine.2019; 8(9): 1360. CrossRef
Quantitative analysis of relative volume of low apparent diffusion coefficient value can predict neurologic outcome after cardiac arrest
Hyung Ki Moon, Jinhee Jang, Kyu Nam Park, Soo Hyun Kim, Byung Kook Lee, Sang Hoon Oh, Kyung Woon Jeung, Seung Pill Choi, In Soo Cho, Chun Song Youn
Resuscitation.2018; 126: 36. CrossRef
Optic nerve sheath diameter measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest
Dong Hoon Lee, Sun Hwa Lee, Je Hyeok Oh, In Soo Cho, Young Hwan Lee, Chul Han, Wook Jin Choi, You Dong Sohn
Resuscitation.2018; 128: 144. CrossRef
Neurologic outcome after out-of-hospital cardiac arrest could be predicted with the help of bispectral-index during early targeted temperature management
Jeong Ho Park, Jae Hun Oh, Seung Pill Choi, Jung Hee Wee
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Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Yong Hun Jung, Wook Jin Choi, Soo Hyun Kim, Chun Sung Youn, In Soo Cho, Dong Hun Lee
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A survey-based study on the protocols for therapeutic hypothermia in cardiac arrest patients in Korea: focusing on the differences between level 1 and 2 centers
Tae Gwan Oh, Won Chul Cha, Ik Joon Jo, Mun Ju Kang, Dong Woo Lee
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Environmental

Use of an external-cooling device for the treatment of heat stroke: Byung-Chan Lee, Jung Youn Kim, Sung Hyuk Choi, Young Hoon Yoon; Clin Exp Emerg Med 2014;1(1):62-64. Published online September 30, 2014; DOI: https://doi.org/10.15441/ceem.14.004

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Use of an external-cooling device for the treatment of heat stroke

Clin Exp Emerg Med. 2014;1(1):62-64. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.004

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Use of an external-cooling device for the treatment of heat stroke

Clin Exp Emerg Med. 2014;1(1):62-64. Published online September 30, 2014

DOI: https://doi.org/10.15441/ceem.14.004

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Heat stroke is caused by losing control of one’s body temperature. It can be life threatening without proper treatment. In this case report, we describe a heat stroke patient treated with an external-cooling device, which is commonly used for therapeutic hypothermia after cardiac arrest. A 67-year-old woman was found unconscious with spontaneous breathing in a sauna. Her body temperature was 40.5°C when she arrived at the emergency department, and she was diagnosed with heat stroke. At seven hours after applying the Arctic Sun Temperature Management System (Medivance), her body temperature declined to 36.5°C, with neurologic improvement (Glasgow Coma Scale score increased from 3 to 12). She was admitted to an intensive care unit and discharged 14 days after admission without any neurological sequelae. In conclusion, an external-cooling device can be used effectively for heat stroke, in addition to therapeutic hypothermia after cardiac arrest.

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Severe heat stroke with multiorgan failure following collapse in a sauna
William Jack McIver, Muhammad Zia
BMJ Case Reports.2025; 18(1): e262069. CrossRef
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The climate crisis in clinical practice: Addressing air pollution, heat, and microplastics
Elizabeth Cerceo
European Journal of Internal Medicine.2025; 139: 106435. CrossRef
Full neurological recovery from severe nonexertional heat stroke with multiple organ dysfunction: A case report
Fang Du, Jun-Wei Zheng, Yan-Bo Zhao, Kai Yang, Hu-Nian Li
World Journal of Clinical Cases.2023; 11(10): 2355. CrossRef
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