OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.
Advanced Trauma Life Support Care ; Cardiopulmonary Resuscitation ; Epinephrine ; First Aid ; Hand ; Heart Arrest ; Humans ; Intubation ; Korea ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Retrospective Studies

No abstract available.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation*

PURPOSE: Education of adult laypersons in cardiopulmonary resuscitation (CPR) has been done frequently and done worldwide. Effective performance of bystander CPR has a decisive effect on outcomes for children as well as for adults. Although the chance of coming into contact with cardiac arrest and acute airway obstruction in a child is relatively high, there are only a few studies of the performance of CPR and abdominal thrust (Heimlich maneuver) done by teachers in child care centers. Therefore, we investigated the effects of CPR and abdominal thrust (Heimlich maneuver) education on teachers in child care centers, especially on their confidence and attitude while performing CPR and Heimlich maneuvers. METHODS: Between August 2009 and October 2009, 245 participants who worked in child care centers received 2 hours of education regarding CPR & emergency procedures for airway obstruction (Heimlich maneuver, abdominal thrust). Participants were asked questions (using a questionnaire) about their confidence and willingness to perform bystander CPR & the Heimlich maneuver. These questions were asked both before their education session and afterwards. Those who answered that they wouldn't perform bystander CPR & Heimlich maneuvers were asked to state the reason. In addition, participants were asked if they were aware of the law exempts from liability bystanders who are not health care providers and who provide CPR or Heimlich as an emergency procedure. RESULTS: The 'definitely yes' answer to 'willingness to perform CPR and abdominal thrust on a child increased from 33.1%, 41.2% before the education session to, respectively, 82.9%, 86.9% afterward (p<0.001). If we included 'yes' and 'relatively yes' answers, the accuracy of performance of acute airway obstruction (abdominal thrust, Heimlich maneuver) increased from 36% before education to 86.9% after. Meanwhile, the reasons for not performing bystander CPR and abdominal thrust, the ratio of 'fear of disease transmission' and 'fear of legal liability' was high in comparison to the ratio of 'fear of poor knowledge/performance'. Only 20.8% answered 'yes' to 'awareness that the law provided exemptions from liability for bystanders doing such emergency procedures. CONCLUSION: Adequate, constant education, including theoretical and practical child CPR and emergency maneuvers for acute airway obstruction of non-health care providers increased their confidence, accuracy and willingness to perform bystander CPR and abdominal thrust maneuvers.
Adult ; Airway Obstruction ; Cardiopulmonary Resuscitation ; Child ; Child Care ; Emergencies ; Health Personnel ; Heart Arrest ; Heimlich Maneuver ; Humans ; Jurisprudence

We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea.
Adult ; Advanced Cardiac Life Support/*mortality ; Cardiopulmonary Resuscitation/*mortality ; Critical Care/statistics & numerical data ; Decision Support Techniques ; Electric Countershock/*mortality ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Male ; Out-of-Hospital Cardiac Arrest/*epidemiology/*mortality/therapy ; Refusal to Treat ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate ; Time Factors ; Time-to-Treatment ; Treatment Outcome

PURPOSE: The aim of this study was to estimate the effect of counting numbers out for giving breaths on the interruption time (IT) of chest compressions (CCs) and chest compression fraction (CCF) in the 2-rescuer cardiopulmonary resuscitation (CPR). METHODS: Thirty medical students were enrolled in this randomized control simulation study, and were randomly divided into the control group and the study group. Both groups performed 2-rescuer CPR for 5-cycles with giving breaths using a bag-mask. Only participants in the study group were instructed to count numbers out for each breath verbally ("one, two") at the end point of each inspiration period and immediately perform CCs at the point of counting "two". RESULTS: However, no differences in terms of depth, rate, incorrect location, and duty cycle of CCs, as well as ventilation volume of each breath, time to delivery of two breaths, and counts of breathing during 1 minute were observed between the two groups. CONCLUSION: The study group had significantly shorter IT and higher CCF compared with the control group. And no significant differences in the other measured parameters of CPR quality were observed between the two groups.
Cardiopulmonary Resuscitation* ; Heart Massage ; Humans ; Manikins* ; Pilot Projects* ; Respiration ; Respiration, Artificial ; Students, Medical ; Thorax* ; Ventilation

PURPOSE: This study was done to identify differences in awareness and ethical attitudes associated with Do-Not-Resuscitate (DNR) and decision about advance directives among the general populations. METHODS: Participants were 193 ordinary people from 2 provinces and data were collected from December 23, 2013 to January 30, 2014. Structured questionnaires included awareness measuring tool and ethical attitudes measuring tool. Data were analyzed with descriptive analysis using descriptive statistics, t-test, and chi2-test with SPSS/WIN 18.0 program. RESULTS: Most of the participants responded that they agreed on the necessity of DNR and needed to do it by guidelines, while 47.2% responded that patients and their families should make a decision about the DNR. After the decision about DNR, they also agreed that efforts should be made to give the best treatment even if a DNR decision had been made by the patient. In general, there was a significant difference in advance directives for CPR depending on gender and living with family or not. CONCLUSION: For a professional and systematic approach to the problem, DNR guidelines sufficient to elicit social consensus are needed.
Advance Directives* ; Cardiopulmonary Resuscitation ; Consensus ; Humans ; Surveys and Questionnaires ; Resuscitation Orders

OBJECTIVES: A study was conducted by analysing the contents and frequency of emergency treatment practiced by emergency medical technicians(EMTs) in emergency situations and contains related factors. METHODS: The study subjects included 80 EMTs who participated in ongoing education classes during the period from June 25th to June 26th, 2008. the survey included 53 EMTs employed within 119 first aid teams in fire stations in both a metropolitan city and a medium-sized city. From the survey results relation between frequency of emergency treatment and subjects characteristics explored statistically including t-test, X2 test, Pearson correlation and finally stepwise multiple regression. RESULTS: The most frequent procedure by EMTs checking vital signs. The statistically significant related factors overall of the 23 items of emergency treatment frequency was the working area and the grading of EMT certification. In contrast, significant related factors with frequency of IV linkage were found to be the subjects gender, institution employed and the importance of recognizing the item. The statistically significant related factors of that of ECG monitoring was the gender of respondents. CONCLUSIONS: To keep the appropriate frequency of emergency treatment by EMT, active efforts to promote their individual importance and confidence cognition are necessary, especially towards males and persons who have 2nd class certification. Moreover, EMTs who work in small cities must be supported.
Certification ; Cognition ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Treatment ; Fires ; First Aid ; Humans ; Male ; Vital Signs

OBJECTIVETo study the weak loop in the treatment of children with out-of-hospital cardiac arrest (OHCA) and the treatment strategy for improvement.

METHODData of a total of 133 patients with OHCA who were rescued by Wuxi pre-hospital care center during the 2005 - 2011 were analyzed.

RESULTThe main causes of pediatric OHCA were drowning (52/133) and accidental injury disease (30/133). The cases of OHCA were mainly located in public places (60/133) and the majority occurred in winter and summer. The emergency rescue response time was (13.21 ± 8.09) min, the rate of first witness treatment was 3.91%, intubations was performed in 11.11%, opening of vein access was 23.15% and one case got restoration of spontaneous circulation (ROSC).

CONCLUSIONThe rate of ROSC of pre-hospital cardiac arrest in children was significantly lower than that of hospital cardiac arrest. Preventive interventions on children's accidents and the skills of pre-hospital staff on pediatric advanced life support (PALS) need to be urgently improved.

Advanced Cardiac Life Support ; education ; Cardiopulmonary Resuscitation ; methods ; Chi-Square Distribution ; Child ; Child, Preschool ; China ; epidemiology ; Emergency Medical Services ; methods ; organization & administration ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Out-of-Hospital Cardiac Arrest ; epidemiology ; etiology ; therapy ; Pediatrics ; education ; Retrospective Studies ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome

Cardiopulmonary resuscitation (CPR) is series of rescue measures for saving cardiac arrest patients. Early initiation and good quality of CPR is crucial for increasing chance of survival from out-of-hospital cardiac arrest. In recent years, the CPR guidelines have changed a lot, especially in basic life support. The guideline now pays more attention on chest compression and less to ventilation. CPR with chest compression only and without mouth-to-mouth ventilation is more popular. In this article, we outline the development and recent researches of CPR. As depriving oxygen from a collapsed patient for 6 min may result in poor outcome, the average time for ambulance transport is longer (about 10 to 16 min) in China, which makes rescuers easy to feel fatigue, chest compression only CPR is not suitable in China. Though non-professional rescuers have difficulty to perform mouth-to-mouth ventilation, they generally show a willingness to do so. To strengthen public standard CPR training including mouth-to-mouth ventilation and chest compression, is most important to promote CPR in China.
Cardiopulmonary Resuscitation ; methods ; China ; Heart Arrest ; Heart Massage ; Humans ; Oxygen ; Respiration, Artificial

PURPOSE: The number of medical malpractice suits on violation of informed consent is on the rise. While the medical community can encourage its members on informing their patients, the legal community has a considerable amount of studies on the subject. However, there has not been any systematic debate on the subject for emergency medical situations. The exemption of informed consent in emergency medical situations seems to be the common notion. Nevertheless, the recently enacted Emergency Medical Services Law mandates the provision of informed consent in emergency medical situations by the emergency medical personnel. Therefore, a systematic research focusing on the informed consent in emergency medical service was necessary. METHOD: This was a qualitative study by survey. The results of the opinions of emergency physicians surveyed was compared to previous studies by the legal community on informed consent. RESULTS: The legal community view informed consent as a legal duty. But the emergency physicians view it as a part of much professionalized medical act, so the professional ethics should guide the acquisition of informed consent. The legal community and the judicial precedents exempted informed consent in an emergency. But the emergency physicians see informed consent in emergency medical service equal to that of any other medical situation, only that it can be delayed. The emergency physicians have to provide an explanation for each step of the process, but the method varies and the unified form of informed consent provided by the law is not suitable. Informed consent should be acquired even in an emergency like cardiopulmonary resuscitation (CPR), but it can be delayed until the end. Professional ethics should guide the initiation of CPR, but the termination of CPR should be under the informed consent. Non-urgent patients should be informed even in an overcrowded emergency room. The duty is not released or relieved solely on the reason that it is the emergency room. CONCLUSION: There is a difference in opinion between the legal and the medical community, but for the benefit of the emergency patients a compromise should reached.
Cardiopulmonary Resuscitation ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Emergency Treatment ; Ethics, Professional ; Humans ; Informed Consent ; Jurisprudence ; Malpractice