• 한국안전학회지
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• 제30권5호
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• pp.74-79
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• 2015

The purpose of this study is to find out its effect on changes in the joint angle and the success rate of cardiopulmonary resuscitation by conducting cardiopulmonary resuscitation (CPR) when wearing and not wearing PPE (personal protective equipment) targeting 20 paramedics with more than 5 years of experience. The subjects carried out CPR in 30:2 for 4 minutes and collected images were digitized by Kwon3D XP Software Package(Version 4.0) and then data were obtained. Data, which were collected by analyzing the motion when starting in one cycle, when pressing to the maximum, in the final position (relaxed), were analyzed by using SPSS 18.0. In conclusion, during CPR, the angle of the both shoulder joints was not significant (p>.05) and the angle of the right elbow joint was reduced in all positions and was statistically significant (p<.05) and the angle of the left was significantly reduced in the maximum pressure posture and the final position (p>.05). In the case of the trunk, the angle increased statistically significantly at all stages (p<.01, p<.001). Also, during CPR, the average compression rate was significantly reduced after wearing PPE (p<.05) and average hand escape time by cycle increased statistically significantly (p<.05) but chest compression execution rate at the correct depth did not show any significant difference between the two groups (p>05).

• Journal of Chest Surgery
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• 제26권3호
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• pp.180-185
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• 1993

From February 1982 to December 1991, 49 neonates and 105 infants in less than 3 months of age underwent open heart surgery in Seoul National University Hospital. There were 98 males and 56 females, and their mean ages were 16 days in neonatal group and 67 days in early infant group. Their body weight and height were less than 3 percentile of normal developmental pattern. In order of decreasing incidence, the corrected conditions included Transposition of great arteries with or without ventricular septal defect [43], isolated ventricular septal defect [34], Total anomalous pulmonary venous return [21], Pulmonary atresia with intact ventricular septum [9] and others [47]. Various corrective or palliative procedures were performed on these patients; Arterial switch operation [36], patch closure for ventricular septal defect [34], Repair of total anomalous pulmonary venous return [21], RVOT reconstruction for congenital anomalies with compromised right ventricular outflow tract [17]. Profound hypothermia and circulatory arrest were used in 94 patients [ 61% ]: 42 patients [ 85.7% ] for neonatal group and 52 patients [ 49.5% ] for early infant group. The durations of circulatory interruption were within the safe margin according to the corresponding body temperature in most cases [ 84% ]. The hospital mortality was 36.4% ; 44.9% in neonatal group and 32.4% in infant group 1 to 3 months of age. The mortality was higher in cyanotic patients [ 46.6% ], in those who underwent palliative procedures [ 57.8% ], in patients whose circulatory arrest time was longer than safe periods [ 60% 0] and in patients who had long periods of cardiopulmonary bypss and aortic crossclamping. In conclusion, there has been increasing incidence of open heart surgery in neonates and early infants in recent years and the technique of deep hypothermia and circulatory arrest was applied in most of these patients, and the mortality was higher in cyanotic neonates who underwent palliative procedures and who had long cardiopulmonary bypass , aortic cross-clamping and circulatory arrest.

• Journal of Chest Surgery
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• 제23권5호
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• pp.844-853
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• 1990

We have performed 27 cases of orthotopic homologous cardiac transplantation using Korean mongrel dogs and one case of sham operation for the evaluation of harmful effect of cardiopulmonary bypass itself on the dog from April, 1989 to June, 1990. Our previous reports have already demonstrated basal hemodynamic and hematologic data on the canine homologous heart transplantation and the fundamental principles of transplantation of the heart. The mean body weight of recipients was 13.2$\pm$1.2kg with a rage of 11 ~ 15kg, and the hemodynamic and hematologic pictures were almost same as the result of previous reports from our hospital, except marked decrease in postoperative platelet count[from 3.18 $\pm$0.80x106/mm3 to 1.41$\pm$0 37x 106/mm3]. Mean survival time was 24.82$\pm$49.40 hours with the longest survival of 264 hours. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and the rapid cooling of the heart suspending in the specially designed ice-bath. Median sternotomy provided excellent exposure of the surgical field. 6 \ulcorner0 prolene suture was used for the anastomosis of both atrial cuffs and the great arteries, and we found the fact that stenosis, bleeding, thrombus formation around the anastomotic site could be decreased with the use of everted horizontal mattress suture techniques. Immunosuppression was done with a combination of lower dose Cyclosporin-A, Azathioprine, methyl-prednisolone, but our cases still showed too short survival to worry about graft rejection. Still poor was our quality control of experimental animal, we had much difficulties in postmortem evaluation of the dogs. Low cardiac output due to biventricular failure, intractable supraventricular or ventricular tachyarrhythmia, postoperative massive bleeding, sepsis were most frequent findings that could be thought as a cause of death. A few cases showed subendocardial patch hemorrhage in both ventricular cavity or atrial septum at autopsy, suggesting acute subendocardial infarction. Although our team overcome most of the technical problems of orthotopic heart transplantation, we should pile up further knowledges about donor heart preservation, quality control of animal, infection, rejection, the effect of the cardiopulmonary bypass to improve the results.

• Journal of Chest Surgery
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• 제43권4호
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• pp.421-423
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• 2010

완전 방실 차단으로 우측 쇄골하 정맥을 통해 영구심박동기를 삽입한 52세 여자환자가 영구심박동기 발생장치(generator) 삽입 부위의 반복적인 감염을 주소로 내원하였다. 환자는 24년 전 유방암으로 좌측 변형근치유방절제술(Modified radical mastectomy, MRM)과 방사선 치료로 주변 조직의 심한 변화가 있었다. 이로 인해 정중 흉골 절개는 불가능할 것으로 판단하여 우측 개흉 술을 계획하였고, 개흉 후 체외순환 없이 우심방을 절개한 후 심박동기 와이어를 제거하고 새로운 심외막 와이어로 영구심박동기를 삽입하였다.

• International Journal of Oral Biology
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• 제45권2호
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• pp.51-57
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• 2020

Thromboelastography or rotational thromboelastometry, is being increasingly utilized in cardiac surgery of late. However, it is an indirect test and is not available in all centers. Low fibrinogen levels before and after cardiopulmonary bypass (CPB) have been described to be associated with postoperative bleeding in cardiac surgery. This study explored the usefulness of reduction ratio of the fibrinogen levels before CPB (preCPB) and after CPB (postCPB) in predicting postoperative hemorrhage. A retrospective, observational study of adult patients who underwent cardiac surgery with CPB between February 2014 and January 2016 was conducted, which included a total of 264 patients. The fibrinogen levels were measured twice, preCPB and postCPB, and the fibrinogen reduction ratio was acquired [(preCPB - postCPB)/preCPB]. Postoperative blood loss, which was defined as the blood collected from the chest drain for 12 hours following arrival at the intensive care unit, was considered severe if it was more than 1,000 mL. A multivariate analysis showed that fibrinogen reduction ratio, sex, and postCPB platelet count were significantly associated with severe postoperative bleeding. However, the pre- and postCPB fibrinogen levels were not significantly associated with severe bleeding. Furthermore, a fibrinogen reduction ratio of > 41.3% was independently associated with postoperative severe bleeding, with an odds ratio of 3.472 (1.483-8.162). These results suggest that the reduction ratio of pre- and postCPB fibrinogen levels may be utilized in predicting postoperative bleeding.

• 대한의생명과학회지
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• 제19권1호
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• pp.61-69
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• 2013

The aim of this study was to evaluate the effect of exercise-based cardiac rehabilitation on pro- and anti-inflammatory markers in patients with acute coronary syndrome (ACS). ACS patients who underwent percutaneous coronary intervention (PCI) and took medicine during phase II of rehabilitation were recruited for study. Subjects were divided into two groups; exercise group (EX, n=21) and a non-exercise group (non-EX, n=13). Supervised exercise program in hospital consisted of treadmill and bicycle exercise was performed three times per week for 6 weeks. Patients of EX received individual counseling, including knowledge of heart disease, risk factor modification, and physical training. Cardiopulmonary fitness, body composition, and biochemical blood factors were analyzed before and after experiment. There was no significant difference in serum levels of hs-CRP and TGF-${\beta}1$ between groups, and between time intervals. But there was a significant decrease in serum levels of IL-18 (P<.001). And there was a significant increase in ratio of IL-18 to IL-10 (P<.01) and serum levels of IL-10 (P<.001). After cardiac rehabilitation, there was significant increase in exercise duration (P<.001), maximal oxygen uptake ($VO_{2peak}$; P<.001) and decrease in submaximal rate-pressure product (sRPP; P<.05) in EX. In conclusion, exercise-based cardiac rehabilitation during phase II in patients with ACS after PCI decreased serum IL-18 (pro-inflammatory) content and ratio of IL-18 to IL-10 in serum (highly related with disease recurrence), and increased serum IL-10 (anti-inflammatory) content. In addition, it led to improved cardiopulmonary fitness.

• 한국전산유체공학회지
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• 제21권1호
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• pp.103-109
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• 2016

With the rapid increase in the number of patients with cardiopulmonary diseases, more cardiopulmonary circulatory assist devices are also needed. These devices can be employed when heart and/or lung function poorly. Due to the critical role they take, these devices have to be designed optimally from both mechanical and biomechanical aspects. This paper presents the CFD results of a baseline model of a centrifugal blood pump for the ECMO condition. The details of flow characteristics of the baseline model together with the performance curves and the modified index of hemolysis(MIH) are investigated. Then, the geometry of baseline impeller and the volute are modified in order to improve the biomechanical performance and reduce the MIH value. The numerical simulations of two cases represent that when impeller radius and prime volume decrease the MIH value also decreases. In addition, the modified geometry shows more uniform pressure distribution inside the volute. The findings provide valuable information for further modification and improvement of centrifugal blood pumps from both mechanical and biomechanical aspects.

• The Journal of Korean Physical Therapy
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• 제23권5호
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• pp.23-28
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• 2011

Purpose: The aim of this study was to evaluate functional gait and pulmonary function of patients with subacute or chronic stroke for aperiod after the onset of stroke. Healthy people of similar ages served as a control group. The study focused on the clinical importance of intervention with cardiopulmonary rehabilitation treatment in patients with stroke. Methods: The standard time period used to differentiate the subacute and the chronic stroke groups was six months. Each group, including the control, was allocated 11 subjects. Vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume at one second ($FEV_1$) were measured with a spirometer for each subject. Walk tests (10 m and 6 min) and functional gait tests were then conducted. Results: Significant differences were noted for VC, FVC, and $FEV_1$ between the subacute stroke group and the normal group and between the chronic stroke group and the normal group (p<0.05), but no significant difference was evident between the subacute stroke group and the chronic stroke group (p>0.05). No significant difference was seen between the subacute stroke group and the chronic stroke group in the 6min walk test (p>0.05), whereas a significant difference was observed between the subacute stroke group and the chronic stroke group in the 10 m walk test (p<0.05). Conclusion: The general rehabilitation treatment is effective with respect to functional aspects, but it has limited effect in improving pulmonary function and muscular endurance. Therefore, additional intervention of cardiopulmonary rehabilitation is necessary in the rehabilitation treatment process of patients with stroke.

• Journal of Chest Surgery
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• 제26권2호
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• pp.141-147
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• 1993

A total of 40 patients having a diagnosis of atherosclerotic coronary arterial disease were analysed on the operative outcomes according to variables as follows: 1) preoperative risk factors such as age, sex, CCS (Canadian Cardiovascular Society) functional class, type of angina, number of diseased vessel, presence of left main coronary artery stenosis, previous history of habitual smoking and presence of other medical diseases (diabetes mellitus, essential hypertension), 2) preoperative management such as intravenous infusion of nitroglycerine, preoperative IABP (intra-aortic balloon pump) support and whether the operation was scheduled as emergency or not, 3) intraoperative variables such as infusion method and composition of cardioplegic solutions, number of distal anastomosis, use of internal mammary artery, total cardiopulmonary bypass time and total cross clamp time. Complications included operative death in 12.5％, perioperative myocardial infarction in 25.0％ and perioperative arrhythmia in 17.5％. Nineteen perioperative variables were analyzed to identify risk factors for these end points. For operative death, presence of left main coronary artery stenosis (p = 0.056) and cardiopulmonary bypass time (p = 0.029) were significant in the univariate analysis, but presence of left main coronary artery lesion (p = 0.011, $\chi$$^2$= 6.45) and abscence of preoperative of IABP support (p = 0.069, $\chi$$^2$ = 3.30) were independent predictor in multivariate analysis (stepwise linear logistic regression).

• Journal of Chest Surgery
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• 제35권11호
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• pp.831-834
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• 2002

감염된 심박조율기의 부분적 제거 후에 발생되는 재감염율은 51%에서 77%에 이르기 때문에 심박조율기의 어느 부위라도 감염이 된다면 모든 심박조율기의 하드웨어는 제거되어야 한다. 심폐기 가동하에서 감염된 심박조율기를 제거하는 것은 감염과 증식물의 확산 뿐만 아니라 기계적 손상을 방지 할 수 있다. 저자 등은 좌쇄골하 정맥에서 심장내로 이동된, 감염된 경정맥 심박조율기 도관에 의해 발생한 심내막염의 1예를 보고 한다. 심장내로 이동된 심박조율기 도관과 증식물이 부착된 전극은 심폐우회를 이용하여 제거하였다.