PURPOSE: To minimize an interruption in chest compression, reduce the hands-off time, the American Heart Association has recommended changing the ratio of chest compression to ventilation ratio to 30:2. However, current studies have shown that the hands-off time was >10 seconds with that method. For this reason, we reasoned that a chest compression to ventilation ratio of 15:1 would be a more suitable way to reduce hands-off time because this ratio will not change the total compression and ventilation count. METHODS: The subjects were asked to perform CPR for 5 cycles with a compression to ventilation ratio of 30:2. The subjects rested for 5 minutes, then performed CPR with a compression to ventilation of 15:1. The skill performance was measured and analyzed using a statistical program. RESULTS: In the group which performed CPR with a chest compression to ventilation ratio of 30:2, the average number of compressions per minute was 76+/-9, while at a chest compression to ventilation ratio of 15:1, the average number of compressions per minute was 68+/-9. Between the compression to ventilation ratios of 30:2 and 15:1, the count gap was 8.3+/-3.2. When CPR was performed at a chest compression to ventilation ratio of 30:2, the average hands-off time was 9.3+/-1.9. When CPR was performed at a chest compression to ventilation ratio of 15:1, the average hands-off time was 6.7+/-1.3. Between chest compression to ventilation ratios of 30:2 and 15:1, the time gap of the average hands-off time was 2.7+/-1.2 seconds. CONCLUSION: When the chest compression to ventilation ratio was 15:1, the hands-off time was significantly reduced, but the compressions per minute were also reduced.
American Heart Association ; Cardiopulmonary Resuscitation ; Manikins ; Thorax ; Ventilation

Several authors suggested that the clinical characteristics of incomplete presentation of Kawasaki disease are similar to those of complete presentation and that the 2 forms of presentation are not separate entities. Based on this suggestion, a diagnosis of incomplete Kawasaki disease in analogy to the findings of complete presentation is reasonable. Currently, the diagnosis of incomplete Kawasaki disease might be made in cases with fewer classical diagnostic criteria and with several compatible clinical, laboratory or echocardiographic findings on the exclusion of other febrile illness. Definition of incomplete presentation in which coronary artery abnormalities are included as a necessary condition, is restrictive and specific. The validity of the diagnostic criteria of incomplete presentation by the American Heart Association should be thoroughly tested in the immediate future.
American Heart Association ; Coronary Vessels ; Mucocutaneous Lymph Node Syndrome

Several authors suggested that the clinical characteristics of incomplete presentation of Kawasaki disease are similar to those of complete presentation and that the 2 forms of presentation are not separate entities. Based on this suggestion, a diagnosis of incomplete Kawasaki disease in analogy to the findings of complete presentation is reasonable. Currently, the diagnosis of incomplete Kawasaki disease might be made in cases with fewer classical diagnostic criteria and with several compatible clinical, laboratory or echocardiographic findings on the exclusion of other febrile illness. Definition of incomplete presentation in which coronary artery abnormalities are included as a necessary condition, is restrictive and specific. The validity of the diagnostic criteria of incomplete presentation by the American Heart Association should be thoroughly tested in the immediate future.
American Heart Association ; Coronary Vessels ; Mucocutaneous Lymph Node Syndrome

PURPOSE: We studied which structures were compressed in 1 rescuer cardiopulmonary resuscitation (CPR) in order to determine the optimal compression site on infants. METHODS: Charts and multidirectional computed tomography of infants who presented in the hospitals from March, 2004 to March, 2009 were reviewed retrospectively. We measured the length of the sternum (Stotal), the index finger` s mark (L1) and the two fingers` mark (L2) that were located on the sternum during one rescuer CPR simulation. We studied those structures located at the following points: the lower half of the sternum (Stotal/2), the sternum at the inter-nipple line (Xn), the point of maximal anterior-posterior heart diameter (Xm), and the lower margin of L1 and L2 from Stotal/2, Xn, Xm. RESULTS: Of 75 enrolled infants, Stotal was 5.68+/-2.00 cm; Xn was 2.11+/-1.47 cm; Xm was 1.43+/-1.18 cm; L1 was 1.25+/- 0.21 cm; L2 was 2.88=/-0.33 cm; the ratio of Xm to Stotal was 0.24+/-0.19. 16(21.3%) had ascending aorta, 31(41.3%) had aortic root, and 14(18.7%) had a left ventricular outflow tract in Stotal/2. 14(18.7%) had aortic root, 35(46.7%) had left ventricular outflow tract in Xn. All had left ventricle in the Xm. 12(16.0%) had liver in the lower margin of L1 from Xm. All had liver in the lower margin of L2 from Xm. CONCLUSION: We knew that we had compressed the aortic root, left ventricular outflow tract as we complied with the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. However, the left ventricle was located at the lower quarter of the sternum.
American Heart Association ; Aorta ; Cardiopulmonary Resuscitation ; Emergencies ; Heart ; Heart Ventricles ; Humans ; Infant ; Liver ; Retrospective Studies ; Sternum

PURPOSE: Acute aortic dissection is a rare and life-threatening disease, requiring an immediate evaluation and treatment. In 2010, the American College of Cardiology/American Heart Association suggested a new risk score system for the detection of an acute aortic dissection. This system was applied to our known patients with acute aortic dissection. METHODS: 155 patients with acute aortic dissection regardless of the types from January 2000 to June 2012 were examined. The known risk factors and 12 newly proposed risk factors were compared, based on the new guidelines, after dividing them into a delayed diagnosis group and early diagnosis group. The impact of the aortic dissection detection (ADD) risk score on the diagnostic process was assessed. RESULTS: The abrupt onset of pain was the most frequent symptom (65.2%) and only had an impact on an early diagnosis (p=0.021). 83 patients (53.5%) showed a widened mediastinum in the chest X-rays. The diagnosis was delayed in 21 patients (13.8%). According to the new guideline, 149(96.1%) were identified by 1 or more of the 12 clinical markers. 6(3.8%), 88(56.8%) and 61(39.3%) patients were classified as low, intermediate and high risk, respectively. Three of the 6 low risk patients showed mediastinal widening. CONCLUSION: The clinical risk markers and the ADD risk score system in the 2010 guidelines detected patients with high sensitivity. The new risk score system appears to be a valuable diagnostic index at the initial presentation.
American Heart Association ; Biomarkers ; Delayed Diagnosis ; Early Diagnosis ; Emergencies ; Heart ; Humans ; Mediastinum ; Risk Factors ; Thorax

PURPOSE: To evaluate the types of questions and the quality of Internet information regarding basic life support (BLS) in the general public. METHODS: We identified the questions and answers by entering the following keywords into the famous Korean search engine, Naver, in the year 2015: ‘ Basic life support’, ‘ chest compression’, ‘ rescue breath’, ‘ defibrillation’, ‘ cardiac arrest’, and ‘ airway obstruction’. A total of 269 cases were identified. We classified the questions into one of 17 subgroups. The accuracy of answers was analyzed based on the contents of the 2010 American Heart Association Cardiopulmonary Resuscitation Guidelines. The reliability of the answers was analyzed by the health on the net foundation code of conduct (authoritative, attribution, transparency). RESULTS: The most frequently asked question was about ‘ when do I perform BLS?’. The second is ‘ chest compression technique’, and third is ‘ how to do BLS’. In assessing the accuracy of answers, 196 answers (72.9%) were determined to be correct. However, the reliability of answers was relatively low, except author's transparency (80.7%); authoritative is 49.4% and attribution is only 16.4%. CONCLUSION: The most common question for the general public was when to perform BLS. Other questions were ‘ how to perform BLS’ or questions regarding chest compression techniques as well as issues regarding female patient and legal problem. This result can be used to educate the public on BLS. According to our results, the accuracy of the information regarding BLS is moderate, but reliability is not acceptable. The quality of BLS information on the Internet should be managed at an expert level.
American Heart Association ; Cardiopulmonary Resuscitation* ; Female ; Humans ; Internet ; Republic of Korea ; Search Engine ; Thorax

PURPOSE: Traditional cardiopulmonary resuscitation (CPR) training methods have been gradually replaced by practice-oriented methods such as the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. We attempted to investigate nurses' and other healthcare professionals' retention of BLS skills over time after taking the AHA BLS course for healthcare providers. METHODS: Healthcare providers were screened for their retention of CPR skills at regular intervals up to 1 year after completing the AHA BLS course. Certified BLS instructors administered skills tests. RESULTS: The degree of skills maintained over time decreased, but not significantly (p=0.207, p=0.160). The scores of written tests decreased over time, but not significantly (p=0.082). The degree of CPR knowledge and skills main-tained was higher in the nurse group than in the healthcare professional group; this difference was statistically significant (p=0.02, <0.001, <0.001). However, regarding the degree of knowledge and skills for CPR maintained over time, there was no statistically significant difference between each group. CONCLUSION: After the AHA BLS course for healthcare providers, in-hospital healthcare professionals retain significantly less information after 3 months. We suggest that a skill review is needed within 3 months after CPR training.
American Heart Association ; Cardiopulmonary Resuscitation ; Delivery of Health Care ; Health Personnel ; Hospitals, General ; Humans ; Retention (Psychology)

OBJECTIVES: We aimed to investigate the relationship between anxiety and stroke warning signs in the elderly. METHODS: Data obtained from 1,078 subjects (256 men and 822 women) aged above 65 years was analyzed from Suwon Project, which was a cohort comprising of nonrandom convenience samples. All the subjects completed the study questionnaire including their demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), SGDS-K (Korean version of the Geriatric Depression Scale-Short Form), BAI (Beck Anxiety Inventory). Stroke warning signs were defined as 5 stroke warning signs consistent with the American heart association public health message. RESULTS: There was significant relationship of anxiety and the number of stroke warning signs after adjusting age, sex, educational level and depression (beta=2.145, p<0.0001). On analysis of covariance, the interaction of the number of experienced stroke warning signs with sex on anxiety was observed after adjusting for the age, educational level, K-MMSE, and SGDS-K (p=0.011). CONCLUSION: These results suggest that there was significant relationship of anxiety and stroke the elderly.
Aged ; American Heart Association ; Anxiety ; Cohort Studies ; Depression ; Humans ; Male ; Public Health ; Surveys and Questionnaires ; Stroke

Symptomatic bradycardia might be regarded as a serious emergency disease and it requires prompt emergency treatments. The American Heart Association has recommended transcutaneous pacing as a gold standard of treatment and also atropine, epinephrine or dopamine as the first line drugs. We report here on a case of symptomatic bradycardia that was treated with norepinephrine and the patient was not treated with pacing, atropine and dopamine.
American Heart Association ; Atropine ; Bradycardia ; Dopamine ; Emergencies ; Emergency Service, Hospital ; Emergency Treatment ; Epinephrine ; Humans ; Norepinephrine

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) inthe 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Nerve Growth Factors ; Resuscitation ; S100 Proteins