• Safety and Health at Work
• /
• 제14권1호
• /
• pp.131-134
• /
• 2023

The aim was to describe out-of-hospital cardiac arrest (OHCA) occurring in the workplace of a large emergency network, and compare the evolution of their management in the last 15 years. A retrospective study based on data from the Northern Alps Emergency Network compared characteristics of OHCA between cases in and out the workplace, and between cases occurring from January 2004 to December 2010 and from January 2011 to December 2017. Among the 15,320 OHCA cases included, 320 occurred in the workplace (2.1%). They were more often in younger men, and happened more frequently in an area with access to public defibrillation, had more often a shockable rhythm, had a cardiopulmonary resuscitation started by a bystander more frequently, and had a better outcome. Cardiopulmonary resuscitation started by a bystander was the only chain of survival link that improved for cases occurring after December 2010. Workplace OHCA seems to be managed more effectively than others; however, only a slight survival improvement was observed, suggesting that progress is still needed.

• 한국응급구조학회지
• /
• 제21권2호
• /
• pp.51-61
• /
• 2017

Purpose: This study measured return of spontaneous circulation (ROSC) in relation to dispatch distance in patients with out-of-hospital cardiac arrest. Methods: Of 2,347 out-of-hospital cardiac arrest patients transported by emergency medical technicians in J Province between January 1 and December 31, 2015, those under age 18, those with reserved resuscitation, and those with traumatic cardiac arrest, leaving 855 patients in the study sample. ROSC was compared between those with dispatch distance ${\leq}4km$ (short dispatch distance, 465 patients) and those with dispatch distance >4 km (long dispatch distance, 390 patients). Results: The mean was 2.17 km in the short dispatch group and 9.87 km in the long dispatch group (p=.000). Mean distance from was 6.49 km and 13.39 km in the two groups, respectively (p=.000). ROSC differed significantly between the short and long dispatch distance groups (7.1% for short dispatch distance, 3.6% for long dispatch distance, p=.025). The length of time from to cardiopulmonary resuscitation also differed significantly between the short and long dispatch distance groups (8.77 minutes and 14.63 minutes, respectively, p=.000). Conclusion: ROSC was lower in areas of long dispatch distance compared to those of short dispatch distance. We expect this was most likely due to differences in response time by age and dispatch distance to the scene of cardiac arrest. However, no significant differences were found between the groups in the factors affecting ROSC.

• 한국화재소방학회논문지
• /
• 제34권4호
• /
• pp.135-140
• /
• 2020

본 연구의 목적은 소아에서 감전으로 인한 심정지 사례를 통하여 소아 감전에 대한 예방을 더 잘 하고자 하는데 있다. 소아기는 전기 손상의 위험성이 높은 환자군 중 하나이며, 본 증례에서도 2살의 소아가 가정 콘센트에 젓가락을 삽입하여 감전사고 된 상황이다. 이 사례는 119구급대에 의해 전문심폐소생술이 적절하게 이루어져 병원 전 자발순환회복(Return of spontaneous circulation, ROSC)된 사례이다. 국내에서 소아의 감전사고 소생 성공사례가 매우 드물며, 119구급대원의 적절한 소생술로 자발순환회복되어 퇴원한 1례를 문헌고찰과 함께 보고하는 바이다.

• 한국응급구조학회지
• /
• 제23권1호
• /
• pp.157-163
• /
• 2019

Purpose: Advanced airway maintenance improves the quality of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. In this study, we evaluate the factors associated with advanced airway management while performing CPR for out-of-hospital cardiac arrest patients by 119 emergency medical technicians (EMTs). Methods: The observational analysis method was used ro retrospectively collect data from 119 rescue run sheets. This study was conducted in a fire station in Seoul, Korea. The subjects of this study were defined as OHCA patients who received CPR from July 2016 to June 2018. We divided the subjects into two groups according to whether advanced airway maintenance was performed or not, and then compared and analyzed both groups. We performed logistic regression analyses for characteristics that differed significantly between groups. Results: Out of 188 OHCA patients, 146 (77.7%) had received advanced airway management. Statistically significant differences in the logistic analysis were found regarding the total number of EMT professionals (adjusted odds ration [aOR]: 1.955; 95% confidence interval [CI]: 1.227-3.115; p=0.005) and scene-time (aOR:1.119;95%CI:1.019-1.228;p=0.019). Conclusion: Advanced airway maintenance while performing CPR for OHCA patients by EMT associated primarily with ensuring an adequate numbers of EMT professionals and sufficient scene time.

• 한국화재소방학회논문지
• /
• 제27권4호
• /
• pp.61-67
• /
• 2013

이 연구는 병원 전 심정지 환자에게 심폐소생술과 후 72시간 이상 자발순환이 회복된 환자 8례를 대상으로 하였다. 분석 결과 심정지 원인으로는 심장질환이 3례, 응급상황으로 인해 병력을 구하지 못한 경우가 5례를 보였다. 심정지 환자의 6례가 가정에서 발생하였고, 가족이나 동료에 의해 심정지가 목격된 경우가 8례였으며, 가족이나 동료 등 목격자의 의해 시행된 심폐소생술은 5례였다. 구급대원 도착 후 임종 호흡을 보인 환자가 3례로 확인되었다. 심정지 환자의 최초 초기리듬은 심실세동 7례, 무맥성전기활동 1례를 보였다. 출동에서 현장 도착까지 소요시간은 6.1분(${\pm}2.7$), 출동에서 병원 도착까지 소요시간은 23.0분(${\pm}8.8$), 자발순환이 회복되기까지 심폐소생술 지속 시간은 8.7분(${\pm}3.4$)이 소요되었다. 출동한 구급대원의 자격은 1급응급구조사 6례, 2급응급구조사 2례였으며, 3명 출동이 7례를 보였다. 병원 전 심정지 환자의 소생률 향상을 위해서는 무엇보다도 목격자에 의한 심폐소생술이 필요하며, 이를 위해서는 일반인 심폐소생술 교육을 지속적으로 진행하여야 한다.

• 한국산학기술학회:학술대회논문집
• /
• 한국산학기술학회 2011년도 추계학술논문집 1부
• /
• pp.170-173
• /
• 2011

Therapeutic hypothermia(TH) improves neurological outcomes and reduces mortality among survivors of out-of-hospital cardiac arrest. Animal and human studies have shown that TH results in improved salvage of the myocardium, reduced infarct size, reduced left ventricular remodeling and better long-term left ventricular function in settings of regional myocardial ischemia. This study is to investigate the effect of TH on post-resuscitation myocardial dysfunction and survival time after cardiac arrest and resuscitation in a rat model of myocardial infarction (MI). Thoracotomies were performed in 10 Male Sprague-Dawley rats weighing 450-550 g. MI was induced by ligation of the left anterior descending coronary artery (LAD). Ninety min after LAD ligation, ventricular fibrillation induction and subsequent cardiopulmonary resuscitation was performed before defibrillation attempts. Animals were randomized to two groups: a) Acute MI-Normothermia b) Acute MI-Hypothermia ($32^{\circ}C$ for 4 h). Myocardial functions, including cardiac output, left ventricular ejection fraction, and myocardial performance index were measured echocardiographically together with duration of survival. Ejection fraction, cardiac output and myocardial performance index were $54.74{\pm}9.16$, $89.00{\pm}8.89$, $1.30{\pm}0.09$ respectively and significantly better in the TH group than those of the normothermic group at the first 4 h after resuscitation($32.20{\pm}1.85$,$41.60{\pm}8.62$,$1.77{\pm}0.19$)(p=0.00). The survival time of the hypothermic group ($31.8{\pm}14.8$ h) was greater than that of the normothermic group($12.3{\pm}6.5$ h, p<0.05). This study suggested that TH attenuated post resuscitation myocardial dysfunction in acute MI and would be a potential strategy in post resuscitation care.

• 한국응급구조학회지
• /
• 제25권3호
• /
• pp.7-16
• /
• 2021

Purpose: The I-gel device is Korea's most frequently used airway management method during pre-hospital cardiopulmonary resuscitation (CPR). This study aimed to compare changes in ventilation volume according to the fixation method with a simulated manikin. Methods: We placed I-gel into an advanced life support simulator and compared tape and band fixation conditions. CPR was performed according to the 2020 Korean CPR guidelines, using a mechanical chest compression device and an adult bag. The positional shift of I-gel and the ventilation volume of the simulated manikin were measured after performing CPR for 20 minutes. Five trials were carried out in each setting. Statistical analysis was carried out with SPSS 27.0. P < .05 was considered significant. Results: Positional shift after 20 minutes of CPR was as follows: tape fixation, 7.2 ± 0.2 mm; band fixation, no change, indicating a significant difference between the two groups (p=.003). The mean ventilation volume was tape fixation, 482.63 ± 30.84 mL; band fixation, 544.96 ± 22.98 mL, showing a significant difference (p=.002). Conclusion: When using the I-gel during pre-hospital CPR, using a band-type fixing device with elasticity rather than fixing the tape provides stable and appropriate ventilation by maintaining the fixed position.

• Clinical and Experimental Emergency Medicine
• /
• 제5권4호
• /
• pp.211-218
• /
• 2018

Objective This study aimed to determine whether simultaneous decreases in the serum levels of cell adhesion molecules (intracellular cell adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1], and E-selectin) and S100 proteins within the first 24 hours after the return of spontaneous circulation were associated with good neurological outcomes in cardiac arrest survivors. Methods This retrospective observational study was based on prospectively collected data from a single emergency intensive care unit (ICU). Twenty-nine out-of-hospital cardiac arrest survivors who were admitted to the ICU for post-resuscitation care were enrolled. Blood samples were collected at 0 and 24 hours after ICU admission. According to the 6-month cerebral performance category (CPC) scale, the patients were divided into good (CPC 1 and 2, n=12) and poor (CPC 3 to 5, n=17) outcome groups. Results No difference was observed between the two groups in terms of the serum levels of ICAM-1, VCAM-1, E-selectin, and S100 at 0 and 24 hours. A simultaneous decrease in the serum levels of VCAM-1 and S100 as well as E-selectin and S100 was associated with good neurological outcomes. When other variables were adjusted, a simultaneous decrease in the serum levels of VCAM-1 and S100 was independently associated with good neurological outcomes (odds ratio, 9.285; 95% confidence interval, 1.073 to 80.318; P=0.043). Conclusion A simultaneous decrease in the serum levels of soluble VCAM-1 and S100 within the first 24 hours after the return of spontaneous circulation was associated with a good neurological outcome in out-of-hospital cardiac arrest survivors.

• Journal of Korean Medical Science
• /
• 제33권51호
• /
• pp.328.1-328.12
• /
• 2018

Background: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. Methods: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. Results: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1-3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3-2.9 [1.6%]; 1.4-1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. Conclusion: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.

• Journal of Trauma and Injury
• /
• 제36권3호
• /
• pp.172-179
• /
• 2023

Purpose: Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient's COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea. Methods: This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre-COVID-19 and all subsequent data (from 2020 and 2021) as post-COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated. Results: During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre-COVID-19 and 404 (67.8%) were post-COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA. Conclusions: Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.