• 제목/요약/키워드: Return of spontaneous circulation (ROSC)

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심실세동 심전도 파형 추출 파라미터를 이용한 관상동맥 관류압 예측 (A Prediction of Coronary Perfusion Pressure Using the Extracted Parameter From Ventricular Fibrillation ECG Wave)

  • 장승진;황성오;윤영로;이현숙
    • 대한전기학회논문지:시스템및제어부문D
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    • 제54권4호
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    • pp.274-283
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    • 2005
  • Coronary Perfusion Pressure(CPP) is known for the most important parameter related to the Return of Spontaneous Circulation (ROSC), however, clinically measuring CPP is difficult either invasive or non-invaisive method. En this paper, we analyze the correlation between the extracted parameter from VF ECG wave and the CPP with the statistical method, and predict CPP value using the extracted parameters within significance level. the extracted parameters are median frequency(MF), peak frequency(PF), average segment amplitude(ASA), MSA(maximum segment amplitude), Two parameters, MF, and ASA are selected in order to predict CPP value with general regression neural network, and then we evaluated the agreement statistics between the simulated CPP and the measured CPP. In conclusion, the mean and variance of the difference between the simulated CPP and the measured CPP are 8.9716±1.3526 mmHg, and standard deviation 6.4815 mmHg with one hundred-times training and test results. the simulated CPP and the measured CPP are agreed with the overall accuracy $90.68\%$ and kappa coefficient $81.14\%$ as a discriminant parameter of ROSC.

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.

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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심정지 및 심각한 뇌병변 장애를 초래한 전자 담배용 Nicotine 중독 1례 (Cardiac arrest and severe encephalopathy following e-cigarette nicotine intoxication: a case report)

  • 박진원;윤성현
    • 대한임상독성학회지
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    • 제20권2호
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    • pp.82-85
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    • 2022
  • Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or "e-liquid" leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

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.

Hilbert-Huang 변환을 이용한 제세동 성공 예측 (Prediction of the Successful Defibrillation using Hilbert-Huang Transform)

  • 장용구;장승진;황성오;윤영로
    • 전자공학회논문지SC
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    • 제44권5호
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    • pp.45-54
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    • 2007
  • 시/주파수 분석은 생체 신호 처리에서 널리 사용되어왔다. 전기 생리학적 신호로부터 중요한 특징들을 추출함으로써 이 방법들은 특정 질병의 임상 병리학적 기전 해석이 가능하다. 하지만 이 방법은 신호가 안정하다는 가정 아래 적용되었으며 불안정한 시스템에서의 적용은 제한이 되어 있다. 본 연구에서는 비선형적이고 비정상적인 심실세동 심전도 파형의 분석을 위해 Hilbert-Huang 변환을 사용한 새로운 신호처리 방법을 제안하였다. Hilbert-Huang 변환은 경험모드분리법(EMD)과 힐버트 변환으로 크게 두 가지로 구성된다. Hilbert-Huang 변환은 EMD를 사용하여 각각의 특성을 지니고 있는 독립적인 내부모드함수들로 나누어지며, 힐버트 변환에 의해 순간 주파수와 크기를 구할 수 있게 된다. 이런 특성으로 신호의 국부적인 작용에 대하여 정확하게 설명할 수 있게 된다. 본 연구에서는 Hilbert-Huang 변환을 기반으로 심실세동 심전도 파형으로부터 두 종류의 파라미터(EMD-IF, EMD-FFT)를 추출하고 서포트 벡터 머신(Support Vector Machine)을 이용하여 소생성공 및 실패 여부 예측에 관하여 연구하였다. 평균적으로 민감도와 특이도는 각각 87.57%와 76.92%로 나타났다. Hilbert-Huang 변환은 더욱 정확하게 심실세동에서의 소생성공 예측을 가능하게 하였다.

심폐소생술 후 발생한 다량의 기복증 (Massive pneumoperitoneum following cardiopulmonary resuscitation)

  • 최정우;신상열;황용
    • 한국산학기술학회논문지
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    • 제16권5호
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    • pp.3303-3307
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    • 2015
  • 본 연구는 74세 여자 환자가 심정지 후 일반인과 119구급대원들에게 시행된 심폐소생술의 합병증인 기복증에 대한 증례를 경험하였기에 이에 대한 임상양상과 병태생리를 조사하기 위해 시도되었다. 평소 건강했던 74세 여자가 식당에서 일하던 중 갑자기 발생한 의식저하로 쓰러졌다. 증상발생 후 즉시 119에 신고를 하였고 현장에서 목격자에 의한 즉각적인 심폐소생술이 시행되었으며, 현장에 도착한 119구급대원에 의한 심폐소생술과 제세동이 시행된 결과 자발순환을 회복하였다. 자발순환 회복 후 환자는 인근 2차병원으로 이송되어 시행한 심전도 검사에서 급성심근경색이 의심되어 추가적인 검사와 치료를 위해 3차병원으로 이송되었다. 이후 시행한 X-ray 검사와 복부전산화 단층촬영 검사결과 위문접합부의 파열과 다량의 기복증을 보여 수술치료를 결정하였으나 수술실에서 다시 심정지가 발생하여 심폐소생술을 시행하였으나 환자는 결국 사망하였다. 따라서 병원 전 현장에서 심폐소생술을 시행 할 때 흉부압박의 정확한 위치 선정이 필요하며 양압 환기에 대한 신중한 고려가 필요하겠다. 또한 심폐소생술 후 발생한 기복증의 치료는 환자의 혈역학적 상태를 충분히 고려해야 할 것으로 사료된다.

고엽제 노출과 병원 밖 심정지 후 생존 퇴원과의 연관성 (Association between defoliant exposure and survival to discharge after out-of-hospital cardiac arrest)

  • 김동욱;계유찬;이정엽;정의기;김동성;최현정;이영
    • 대한임상독성학회지
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    • 제19권1호
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    • pp.38-43
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    • 2021
  • Purpose: We investigated the association between defoliant exposure and survival to discharge after out-of-hospital cardiac arrest. Methods: This is a retrospective case-control study based on the cardiopulmonary resuscitation (CPR) registry. The electronic medical records of out-of-hospital cardiac arrest victims from 6/9/2008 to 12/31/2016 were analyzed statistically. The case patients group had a history of defoliant exposure while the control group did not. Among the 401 victims studied, a total of 110 patients were male out-of-hospital cardiac arrest patients. Baseline characteristics and the parameters involved in cardiac arrest were analyzed and compared between the two groups after propensity score matching. The primary outcome was survival to discharge, and secondary outcomes were sustained return of spontaneous circulation (ROSC) and survival to admission. Results: After propensity score matching a total of 50 patients (case=25, control=25) were analyzed. Primary outcome (survival to discharge) was not significantly different between case and control groups [(OR, 1.759; 95% C.I., 0.491-6.309) and (OR, 1.842; 95% C.I., 0.515-6.593), respectively]. In the subgroup analysis, there were also no significant differences between the control group and subgroups in primary and secondary outcomes according to defoliant exposure severity. Conclusion: There is no statistically significant association between defoliant exposure and survival of out-of-hospital cardiac arrest.

외상으로 인한 심정지 환자의 생존율 및 신경학적 예후 (Survival Rate and Neurologic Outcome for Patients after Traumatic Cardiac Arrest)

  • 박신웅;현성열;김진주;임용수;조진성;양혁준;박원빈;우재혁;장재호
    • Journal of Trauma and Injury
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    • 제26권3호
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    • pp.190-197
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    • 2013
  • Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included out-of-hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.

병원 전 심폐소생술에 의한 자발순환 회복 8례: 일 지역 하트세이버 수여자를 기준으로 (A Case Report of ROSC for Out-of Hospital Cardiopulmonary Resuscitation: Based on one Area Heart Saver)

  • 방성환;김지희;김경용;노상균
    • 한국화재소방학회논문지
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    • 제27권4호
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    • pp.61-67
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    • 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.