• 제목/요약/키워드: Out-of-hospital resuscitation

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병원전 심정지환자의 심폐소생술 성적 (A Study of Resuscitation in Victims in Out-of-hospital Cardiac Arrests)

  • 강병우
    • 한국응급구조학회지
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    • 제8권1호
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    • pp.149-160
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    • 2004
  • Background : To save out-of-hospital cardiac arrest cases is a major concern for Korea. Cardiac arrest is a very common problem, with > 18,000 cases dying each year in Korea. Overall, survival to hospital discharge remains poor. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, we do not know the true effectiveness of resuscitation. There are no guideline for reviewing, reporting, conducting research on resuscitation in Korea. This study evaluated the out-of-hospital factor associated with survival discharge of out-of-hospital cardiac arrest, was especially to provide basic data for the unified reporting guideline of resuscitation in Korea. Methods : From January 1990 to July 2004, we collected data about out-of-hospital cardiac arrest at Wonju Christian Hospital(WCH-CAD), Ewha Women University Mokdong Hospital(Ewha-CAD), I used same record form based on the "Utstein Style". The "Utstein Style" is internationally recommended guidelines for reporting outcome data from resuscitation events. Results : Resuscitation was performed in 1443 out-of-hospital cardiac arrest patients at 2 hospitals. Five hundred eighty(40.25%) patients recovered the spontaneous circulation at least once and One hundred sixty eight(11.66%) patients discharged alive. Initial EKG showed Ventricular Tachycardia/Ventricular Fibrillation in One hundred thirty five(9.33%) patients, asystole in one thousand nine(69.73%) patients and other rhythms in one hundred thirty nine(20.94%) patients. Among one hundred two cardiogenic cardiac arrest patients, two(2.0%) patients was discharged alive. Conclusion : Overall survival rate of out-of-hospital cardiac arrest patients was 11.66% which was poorer than that of the western country. The proportion of the cardiogenic cause was 33.38% which was only half of the western country. VT/VF is relatively not common ac a initial EKG rhythm. These differences might be to due difference in the prevalence pattern of out-of-hospital cardiac arrest as well as prematurity of the EMSS. It is needed that the best survival can be achieved if all following links have been optimized : rapid access, early CPR, early defibrillation, early ACLS.

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119구급대원의 심폐소생술 성적 분석 - 병원전 심정지를 중심으로 - (Factors Affecting the Survivals of Out-of-hospital Cardiac Arrests by 119 Fire Service)

  • 강병우
    • 한국응급구조학회지
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    • 제9권2호
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    • pp.111-128
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    • 2005
  • Background: Cardiac arrest is one of the most critical diseases which can likely lead to severe cerebral disability or brain death when the cases can not recover their circulation within 10 minutes. Saving out-of-hospital cardiac arrest cases is a recent concern in Korea. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. The best survival can be achieved if all the following links have been optimized : rapid access, and early CPR, defibrillation and ACLS, Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, it is not known how effective resuscitation has become to the patients. In other words, there are no guidelines for reviewing, reporting, and conducting research on resuscitation in Korea. This dissertation aims to provide the basic data for a unified reporting guideline of resuscitation in Korea and evaluating the out-of-hospital factors associated with survival discharge of out-of-hospital cardiac arrest. Methods: As for this study, uses the collected data about Out-of-hospital cardiac arrests at 4 area, from January, 2005 to April. 2005. With a retrospective study, 174 cases were analyzed. The data was recorded based on the Out-of-Hospital Utstein Style. Results: Resuscitation was performed on 174 out-of-hospital cardiac arrest cases at the 4 area 14 patients(8.1%) recovered their spontaneous circulation. Overall, the ROSC of the out-of-hospital cardiac arrest patients was 8.1%, which was poorer than that of western countries. Gender distribution was 50 females(28.7%) and 124 males(71.3%), approximately twice as many males as females. ROSC of witnessed arrests was found out to be 97.7%. The ratio of the witnessed arrest groups showed higher results than that of unwitnessed arrest groups in the above-examined cases. Cardiac etiology consisted of cardiac(33.5%), non-cardiac(45.7%), trauma(20.1%), and unknown(6.0%). Cardiac was the best performance. Initial rhythm showed Ventricular Tachycardia/pulseless Ventricular Fibrillation in 8 patients(6.0%), asystole in 100(75.2%) and unknown in 25(18.8%). The results of the Ventricular Tachycardia/pulseless Ventricular Fibrillation showed higher results than the others cases, The proportion of the cardiogenic cause was 33.5%, which was only half of western countries. Ventricular Tachycardia/pulseless Ventricular Fibrillation is relatively rare. These differences were due to the prevalent pattern of Out-of-hospital cardiac arrest as well as prematurity of the EMSS. Bystander CPR was practiced on 13 patients(7.52%). ROSC was shown in 46.2% cases. CPR by EMT was carried out on 167 cases(96.5%). ACLS by EMf was rare. From collapse, 4 cases(2.6%) arrived to ED within 6 minutes. 13 (8.6%) within 10 minutes, and 49(32.5%) over 31 minutes. The sooner the patients arrived, the greater the ratio of ROSC and discharged alive became, and the same with collapse time to ROSC. As the results of the logistic regression analysis, ROSC was found out to be highly influenced by the time of ED arrival from collapse and Ventricular Tachycardia/pulseless Ventricular Fibrillation. Therefore, the ratio of ROSC depends on not any single factor but various intervention factors. Conclusion: This dissertation presents the following suggestions and directions of the study hereafter. First, the first step for a chain of survival should be taken to activate EMSS early with a phone as soon as cardiac arrests are witnessed. Second, it is keenly needed that emergency medical technicians should be increased through emergency education for living. Third, it is necessary to establish the emergency transportation system. Fourth, most of the Koreans have little understanding of EMT and the present operation systems have many problems, which should be fundamentally changed. Fifth, it is required to have an active medical control over Out-of-hospital CPR, And proper psychological supports should be given not only to patients themselves and their family but also individuals who are engaged in emergency situation. Finally, through studies hereafter on nationwide, comprehensive, and standard forms, it is needed to examine into the biological figures of human body, causes and trends of cardiac arrests, and then, to enhance the survival rate of Out-of-hospital cardiac arrests. Korean guidelines for Cardiopulmonary resuscitation need to be made.

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병원 전 심폐소생술에 의한 순환회복 환자의 사례 분석: 두 지역 하트세이버 수여자를 대상으로 (Analysis of ROSC cases for out-of-hospital cardiopulmonary resuscitation: Based on Heart Saver laureate for two area)

  • 고봉연;이정은;홍성기
    • 한국응급구조학회지
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    • 제19권3호
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    • pp.7-18
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    • 2015
  • Purpose: The purpose of this study was to describe and compare the return of spontaneous circulation (ROSC) cases of out-of-hospital cardiac arrest on the basis of Heart Saver laureate. Methods: This study aimed to investigate the cardiopulmonary resuscitation (CPR) outcomes and the clinical characteristics of patients with out-of-hospital cardiac arrest by analyzing the data of two regions. The data were prehospital emergency reports of 473 patients who survived for > 72 hours after ROSC in two region from January 2012 to December 2013. Results: Among the ROSC patients, 86.8% (G), 77.9% (S) were men and 72.9% (G), 67.9% (S) were of age 41~70 years, 87.6% (G), 82.9% (S) had a witnessed cardiac arrest; and 66.7% (G), 70.6% (S) received cardiopulmonary resuscitation from bystander. Of those who performed the resuscitation, paramedics in 89.1% (G), 89.8% (S). Furthermore, 119 emergency medical technicians were involved in 69.0% of two-rescue teams in G and in 90.4% of three-rescue team in S. Conclusion: Most heart savers were qualified paramedics, and three-rescuer-teams resulted in better survival rate than two-rescuer-teams.

병원 전 영아 심정지 환자에서 150J 제세동과 심폐소생술 시행 후 생존한 1례 (A survived case after 150J defibrillation and CPR were performed for out-of-hospital infant cardiac arrest)

  • 윤형완;홍수미;전윤철;이재민
    • 한국응급구조학회지
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    • 제17권3호
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    • pp.53-60
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    • 2013
  • Purpose: The purpose of the study is to emphasize the importance of out-of-hospital cardiac arrest resuscitation. This resuscitation by paramedic is very effectively performed under the medical direction of the doctors. Methods: The cardiac arrest victim was 4 month old infant. Informed consent from the parents of the infant was received. CPR combined with 150J defibrillation was performed to the 4 month old infant. Results: We reported that the 4 month old infant survived the cardiac arrest. Out-of-hospital cardiac arrest infant survived after 150J automated external defibrillator and CPR performance. Conclusion: Specific operative protocol is important because the paramedic can apply the proper manual defibrillator effectively. It is important to extend the work scpoe of the EMT.

병원 전 심정지 환자의 자발순환 회복에 관한 병원전 처치 - 하트세이버 수상자를 중심으로 - (Prehospital care after return of spontaneous circulation in out-of-hospital cardiac arrest patients: Based on Heart Saver laureate)

  • 고봉연;홍성기;김진영
    • 한국응급구조학회지
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    • 제18권2호
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    • pp.125-136
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    • 2014
  • Purpose: We aimed to improve the survival rates of out-of-hospital cardiac arrest patients. Methods: We analyzed data regarding cardiopulmonary resuscitation (CPR) outcomes and clinical characteristics of out-of-hospital cardiac arrest patients. The data included prehospital emergency medical service reports of 207 patients, 135 patients of Heart Saver, who survived over 72 hours after return of spontaneous circulation (ROSC) in Gyeonggi-do from January, 2012 to December, 2013. Data were analyzed using SPSS 18.0 descriptive statistics. Results: Among patients who achieved ROSC, 87.6% were men and 73.6% were aged 41-70 years; 86.7% were cases of witnessed cardiac arrest, and cardiopulmonary resuscitation was performed by bystanders in 65.9% of cases. The initial electrocardiogram showed ventricular fibrillation or pulseless ventricular tachycardia in 96.3% of patients. The call time was 1.0 minutes, arrival time was 6.3 minutes, time spent at the scene was 8.0 minutes, hospital arrival time was 10.0 minutes, and total CPR duration was 9.6 minutes. The certificate of them was paramedics in 89.6%. Conclusion: To improve the survival rates of out-of-hospital cardiac arrest patients, standard prehospital care for these patients and educational programs regarding CPR for lay rescues should be developed.

Comparison of Extracorporeal Cardiopulmonary Resuscitation with Conventional Cardiopulmonary Resuscitation: Is Extracorporeal Cardiopulmonary Resuscitation Beneficial?

  • Lee, Seung-Hun;Jung, Jae-Seung;Lee, Kwang-Hyung;Kim, Hee-Jung;Son, Ho-Sung;Sun, Kyung
    • Journal of Chest Surgery
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    • 제48권5호
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    • pp.318-327
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    • 2015
  • Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR). Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records. Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis. Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

119구급대에 의한 병원 전 임산부 심장정지 소생환자 1례 (Out-of-Hospital Cardiac Arrest Response to a Pregnant Woman by the 119 Emergency Medical Service System: A Case Study)

  • 이재민;홍수미;안국기;윤형완
    • 한국화재소방학회논문지
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    • 제34권1호
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    • pp.127-134
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    • 2020
  • 임신부에서 심정지가 발생하였을 때, 가장 중요한 것은 임신부를 소생시키는 것이다. 임신부에서의 심정지는 산모와 태아를 동시에 고려해야 한다는 점 때문에 일반적인 심정지와 다른 부분이 있다. 임신부 심정지 환자에서는 태아를 분만해야 하는지를 결정하는 것은 산모와 태아 모두를 위하여 매우 중요하다. 심폐소생술이 수행되더라도 임신부 심정지 환자가 모두 소생되는 것은 아니며, 얼마나 신속하고 정확하게 심폐소생술이 시행되었느냐에 따라 환자의 생존율이 결정된다. 임신부 심정지 환자는 30세 목격당시 보호자에 의한 빠른 인지와 신속한 신고 및 목격자 심폐소생술이 이루어져 졌으며 119구급대에 의한 전문소생술이 적용되었고, 환자와 태아 모두 적절한 치료 후 6일 만에 건강하게 퇴원한 사례이다. 병원 전 단계에서 임신부 환자가 자발순환회복(Return of spontaneous circulation, ROSC)되어 이송하는 경우와 전문심장구조술을 시행 하는 경우는 매우 드물다. 임신부 심정지가 발생하여 목격자에 의한 심폐소생술과 119구급대원에 의한 전문심장소생술로 현장에서 자발순환회복되어 생존퇴원한 1례를 경험하여 문헌고찰과 함께 보고하는 바이다.

기내 심폐소생술과 COVID-19 (In-Flight Cardiopulmonary Resuscitation and COVID-19)

  • 김정언
    • 항공우주의학회지
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    • 제31권3호
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    • pp.68-72
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    • 2021
  • As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-ofhospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

심폐소생술 실시의사에 대한 요인분석 (Analysis of factors for intention to perform cardiopulmonary resuscitation)

  • 임승환
    • 한국응급구조학회지
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    • 제17권3호
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    • pp.169-179
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    • 2013
  • Purpose: The performance rate to perform Cardiopulmonary Resuscitation (CPR) by witness in out-of-hospital Cardiac Arrest (OHCA) is very low in South Korea. To prevent the death caused by OHCA, it is important to encourage the witness to perform CPR actively. The purpose of the study is to investigate the influencing factors to affect bystander CPR rate. Methods: I conducted a questionnaire survey from 25 February to 4 March, 2013, receiving responses from 517 people in Korea. The questionnaire included social demographic factors, history of heart disease, knowledge of CPR, and the reliability of emergency medical service (EMS). A logistic regression analysis was conducted. Results: Among the 517 respondents, 294 (57.4%) had intention of performing CPR. Multiple logistic regression analysis found the following significant predictors of CPR intention: gender (odds ratio [OR] = 0.390), age (OR = 1.024), religion (OR = 0.843), and knowledge of CPR (OR = 4.734). Conclusion: This study indicated that the strongest predictor is knowledge of CPR. Therefore, it would be helpful to teach CPR nationwide to encourage performing CPR. In addition, effect of CPR education in religious facilities is necessary.

119구급대에 의해 소생한 병원 전 심장정지 환자 1례 (Out-of-Hospital Resuscitation of Cardiac Arrest by 119 Emergency Medical Service System)

  • 윤형완;이재민;정지연
    • 한국화재소방학회논문지
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    • 제24권5호
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    • pp.142-149
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    • 2010
  • 심폐소생술이란 인공호흡과 순환보조를 통하여 조직으로의 산소 공급을 유지하여 임상적 사망에서 생물학적 사망으로 진행을 막고, 심장박동과 순환을 회복시켜 환자를 소생시켜주는 술기이다. 심폐소생술이 시행되더라도 모든 심장정지 환자가 소생되는 것은 아니며, 얼마나 신속하고 정확하게 심폐소생술이 시행되었느냐에 따라 환자의 생존률이 결정된다. 현장에서 심장정지가 목격되지 않은 환자는 병원이송 전 현장에서 2분간 5주기 심폐소생술을 수행하고 자동제세동기를 사용하도록 하였고, 목격된 환자에게는 즉시 자동제세동기를 사용할 것을 권장하고 있으며 이후 전문적인 심장구조술이 필요하다. 병원 전 단계에서 119 구급대가 이송한 환자 중 자발순환회복(return of spontaneous circulation, ROSC)되어 이송하는 경우와 전문심장구조술을 시행 하는 경우는 매우 드물다. 현장에서 심장정지가 목격되었으나 심폐소생술이 시행되지 않았고 구급대원이 도착한 후 심폐소생술 시행 및 전문심장구조술로 현장에서 자발순환회복되어 생존퇴원한 1례를 경험하여 문헌고찰과 함께 보고하는 바이다.