• Journal of Chest Surgery
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• v.49 no.4
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• pp.273-279
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• 2016

Background: The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). Methods: Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. Results: Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). Conclusion: These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients.

• The Korean Journal of Emergency Medical Services
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• v.9 no.2
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• pp.55-78
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• 2005

The purpose of this study was to provide basic data for the improvement of the guidelines and training programs regarding the cardiopulmonary resuscitation performance of bystanders who can respond to the incidents in earlier times as the first responder of the cardiac arrest incident, by reviewing the performance of basic CPR and the influencing factors after providing 70 students of Department of Emergency Medical Technology with the CPR training. For the purpose of the study, the collected data were computerized and analyzed by SPSS-WIN program(ver. 10.1). The results for this study were as follows The duration of session between the groups in the BLS CPR were 3 minutes and 36 seconds, 2 minutes and 32 seconds respectively. The average compression number per minute were 24.3 times and 33,2 times respectively(p=.000), and the average compression rate per minute were 112 times and 122 times respectively(p=.000). The average ventilation number per minute were 3.54 times and 5.1 times respectively(p=.000). The errors in compression "Too shallow" were 20.73 times(34.6%) and 23,23 times(38,7%) out of 60 times in 4 cycles with the standard of 38 nun. In CPR performance results according to gender in the first episode, males showed better results in compression depth as 41.5 mm comparing to females average 38.2 mm(p=.015). When ventilation results were compared according to the use of FS, the average ventilation number per minute, total ventilation per minute and the average volume per episode were significantly higher when FS was not used(<.040), There was no significant difference in ventilation accuracy between two groups. According to the results, we need to improve and distribute portable barrier devices, and to be familiar with those devices. We need to enforce ventilations as well as to include compressions so that faster and more accurate CPR can be performed. Additionally, we need to exclude ventilation only cases, minimize the interference time of chest compression due to inaccurate ventilation, simplify or minimize the complicatedness of CPR performance and responding time related to breathing, provide first responders with various training programs such as initial assessment and ventilations only, or initial assessment and chest compression-only CPR and than provide advanced training with AHA BLS education including CPR for more than two people according to CPR skills and target characteristics.

• The Korean Journal of Emergency Medical Services
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• v.16 no.1
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• pp.7-18
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• 2012

Purpose: The purpose of this study is to help care workers to do their best as first respondents by analysing their recognition, knowledge, and self-efficacy on basic CPR (cardiopulmonary resuscitation) that is directly connected to the lives of patients and thus their education and methods can be improved for their positive basic lifesaving work. Method: For this purpose 360 structured questionnaires were used to the subjects in the eastern area of Jeonnam province from June 20 to July 4, 2011. Of these questionnaires 217 were used excluding 113 incomplete, 27 error, and 3 male ones. The collected data were analysed by the real number, the percentage, the average, the standard deviation, t-test, ANOVA, and Tukey with SPSS WIN 18.0. Results: 1. In the view of subjects, those aged over 51 accounted for 96(44.2%) as the majority, high school graduates, 95(43.8%), worked for 1 or more than 1 year-less than 2 years, 66(30.4%), experienced to see persons collapsed losing their consciousness, 46(21.2%), took the education, 184(85.7%), had 1 session of education, 80(43%), got the last education for 2 or more than 2 years 68(37%), and practiced through mannequin for the education aids, 86(46.7%). 2. There was significant difference in the view of recognition with the length of work (p=.010) and experienced to see persons collapsed losing their consciousness (p=.020), in the view of knowledge with academic background (p=.040) and the length of work, and in the view of self-efficacy with academic background (p=.002), the length of work (p=.010) and experienced to see persons collapsed losing their consciousness (p=.000). 3. There was significant difference in the session of education (p=.000), last education (p=.025) and education aids for basic CPR. Self-efficacy had significant difference according to the session of education for basic CPR (p=.001) and the time of education (p=.000). 4. There was correlation between recognition and self-efficacy (r=.41). The higher the recognition is, the better the self-efficacy improves. However the correlation between knowledge and self-efficacy was so low that the former did not have influence on self-efficacy. Conclusions: It needs to offer education to the lifesaving workers based on their experiences. If there is education more than 2 sessions in a year with mannequin and the simulation providing sufficient hours, care workers' recognition would be increased resulting in higher self-efficacy and thus they could keep the role of active lifesaving worker at the first practical site.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.2
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• pp.156-163
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• 2016

This study examined the level of knowledge, attitude, and performance ability of automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) among university students who were not in health-related majors and to explore the relationships among these variables. In this study, 291 students were recruited from 3 universities in D city. Among them, 77.0% had ever seen or heard of AED and 61.9% did not know how to use it. The levels of knowledge, attitudes and performance ability differed significantly according to the CPR training experience and AED awareness (p<.002~.001). The performance ability showed significant correlations with knowledge (r=. 42, p<.001) and attitude (r=. 55, p<.001) of AED and CPR. These findings suggest that future AED and CPR training programs should be developed to promote a positive attitude towards the willingness to perform AED and CPR as well as to increase the participants' confidence by repeated training.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.9
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• pp.146-155
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• 2018

This study was conducted to evaluate the clinical outcomes of coronary artery bypass surgery for ischemic heart disease according to use of a cardiopulmonary bypass machine. The subjects were 10,981 patients who underwent coronary artery bypass grafting for ischemic heart disease from July 2008 to June 2012. Analysis data were retrospectively collected using health insurance claims data. The results of the study showed that mean time to surgery (280 min vs 357 min, p<0.0001) and intubation time (about 24 hours vs 40 hours, p<0.0001) were significantly shorter in the Off-Pump CABG (OPCAB) group than in the On-Pump CABG (ONCAB) group. The rate of reoperation because of postoperative bleeding and hematoma was lower in the OPCAB group (2.7% vs 8.3%, p<.0001). The odds ratio of risk adjusted 30 days mortality rate was 0.339 (0.266-0.434) and the postoperative length of stay was decreased in the OPCAB (p<0.0001). Overall, the 30 days mortality and reoperation rates were lower in the OPCAB, as was the resources use.

• Fire Science and Engineering
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• v.27 no.5
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• pp.75-79
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• 2013

Application of the left lateral tilt position has been recommended during cardiopulmonary resuscitation (CPR) of pregnant patients. However, the left lateral tilt could displace the left ventricle (LV) besides the gravid uterus and may compromise the cardiac pump mechanism of CPR. Thus, we investigated the effect of left lateral tilt on the spatial relationship between the anterior-posterior axis (AP axis), which represents the direction of sternal displacement during CPR, and the LV. We retrospectively reviewed the medical records and multidetector computed tomography (MDCT) scans of 90 patients who underwent virtual gastroscopy using MDCT. Virtual gastroscopy was performed with the patient both in the left lateral tilt position and in the supine position. On an axial image showing the maximal area of the LV, the angle between the AP axis and the LV axis ($Angle_{AP-LV}$), the shortest distance between the AP axis and the mid-point of LV cavity ($D_{AP-MidLV}$) and the shortest distance between the AP axis and the LV apex ($D_{AP-Apex}$) were measured. In the supine scans, the LV was situated on the left side of the AP axis in 87 patients (96.7%). On the left lateral tilt scans, the mean tilt angle was $43.4{\pm}11.0^{\circ}$. $D_{AP-MidLV}$ and $D_{AP-Apex}$ were significantly longer in the left lateral tilt position (p<0.001), but $Angle_{AP-LV}$ was comparable between the positions. This study indicates that the left lateral tilt position may compromise the cardiac pump mechanism of chest compression in pregnant cardiac arrest patients.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.1-6
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• 1998

Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration(MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36∼42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls(n=7) to ultrafiltered(n=10). There was no death in each group. The mean filtrate volume(ml/kg) was 42(30∼68). Blood loss(ml/kg/24hr) was 14.5 mean(4.0∼26.6) in controls versus 12.1 mean(6.0∼21.5) in MUF(P＞0.05) ; blood transfused(ml/kg/24hr) was 9.4 mean (6.0∼36.3) in controls versus 3.4 mean(0∼11.4) in MUF(P<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2(0∼11.7) in controls versus 19.8(7.0∼36.9) in MUF(P=0.001). Percent rise of diastolic blood pressure was 10.0(1.6∼20.8) in controls versus 30.6(5.8∼73.3) in MUF(P<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.11
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• pp.3418-3426
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• 2009

The purpose of this study was to investigate the feasibility of field operation protocol for cardiopulmonary resuscitation(CPR) in person with non-traumatic arrest. This study was performed from May 1 through June 27, 2008, and subjects were 150 students who are attending the department of Emergency Medical Service in J and K universities which located in Jeollabuk-do and Jeollanam-do areas. Practical conformance was verified using by nonequivalent control group pretest-posttest design. This study divided into two groups; experimental group that employed field operation protocol and control group that applied conventional CPR protocol, and comparative analyzed statistically the necessary time of the items of each protocol. The results indicated that each performance time of 18 items was reduced over 3 seconds except 5 items(assessment of consciousness, airway control, two times of artificial respiration, check of circulation, and five cycles of CPR). And time of 6 items(intubation, peripheral intravenous line, reassessment of consciousness, pupil reaction, carotid artery pulse, and vital sign) was minimized more than 60 seconds, and total performing time was shortened 110.85 seconds. The results suggested that total performing time in pre and post test where the protocol was applied for two groups showed a statistically significant decrease(t=-6.580, p=.000). Consequently, field operation protocol for cardiopulmonary resuscitation(CPR) in person with non-traumatic arrest will be a available manual which support prompt and accurate decision making, and improve emergency medical service.

• Journal of agricultural medicine and community health
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• v.36 no.1
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• pp.13-24
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• 2011

Objectives: The purpose of this study is to compare educational effects between traditional classroom instruction and video self-instruction (VSI) for cardiopulmonary resuscitation (CPR) in boy's high school students. Methods: This study was carried out targeting totally 96 boy students(47 people for experimental group, 49 people for control group) in the second grade of high school where is located in G city of G province from July 9-10, 2009. The experimental group and control group were arbitrarily selected two classes in the second grade. One class was assigned to the experimental group. another class was assigned to the control group. The experimental group was educated with VSI for CPR. The control group was educated with traditional classroom instructions for CPR. The analysis was performed with SPSS WIN (version 12.0) program using frequency chi-square($x^2$) test, independent samples t-test, and paired t-test. Results: After instructions, the knowledge, attitude, self-confidence, and skill performance accuracy scores on CPR increased statistically in both group. The increases of self-confidence ($2.40{\pm}0.73$) and skill performance accuracy score ($2.67{\pm}0.29$) in the experiment group were significantly higher than those ($2.01{\pm}0.96$ and $2.54{\pm}0.31$) in the control group, respectively. Conclusion: This study suggested that VSI was more effective than traditional classroom education for self-confidence and skill-performance accuracy in CPR. To confirm it, more studies are warranted.

• The Korean Journal of Emergency Medical Services
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• v.20 no.2
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• pp.7-19
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• 2016

Purpose: To investigate the effect of early hypothermia on post-resuscitation myocardial recovery and survival time after cardiac arrest and resuscitation in a rat model of myocardial infarction(MI). Methods: Thoracotomies were performed in 10 male Sprague Dawley rats weighing 450-455g. Myocardial infarction was induced by ligation of the left anterior descending coronary artery. Ninety minutes after arterial ligation, ventricular fibrillation was induced, cardiopulmonary resuscitation was subsequently performed before defibrillation was attempted. Animals were randomized to control group and experimental group(acute MI-normothermia)($32^{\circ}C$ for 4 hours). Duration of survival was recorded. Myocardial functions, including cardiac output, left ventricular ejection fraction, and myocardial performance index were measured using echocardiography. Results: Myocardial function was significantly better in hypothermia group than the control group during the first 4 hours post-resuscitation. The survival time of the experimental group was greater than that of the control group(p<.050). Conclusion: This study suggests that early hypothermia can attenuate post-resuscitation myocardial dysfunction after acute myocardial function, and may be a useful strategy in post-resuscitation care.