BACKGROUND AND OBJECTIVES: This study aimed to confirm the effects of traditional holidays on the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in South Korea. METHODS: We studied 95,066 OHCAs of cardiac cause from a nationwide, prospective study from the Korea OHCA Registry from January 2012 to December 2016. We compared the incidence of OHCA, in-hospital mortality, and neurologic outcomes between traditional holidays, Seollal (Lunar New Year's Day) and Chuseok (Korean Thanksgiving Day), and other day types (weekday, weekend, and public holiday). RESULTS: OHCA occurred more frequently on traditional holidays than on the other days. The median OHCA incidence were 51.0 (interquartile range [IQR], 44.0–58.0), 53.0 (IQR, 46.0–60.5), 52.5 (IQR, 45.3–59.8), and 60.0 (IQR, 52.0–69.0) cases/day on weekday, weekend, public holiday, and traditional holiday, respectively (p<0.001). The OHCA occurred more often at home rather than in public place, lesser bystander cardiopulmonary resuscitation (CPR) was performed, and the rate of cessation of CPR within 20 minutes without recovery of spontaneous circulation was higher on traditional holiday. After multivariable adjustment, traditional holiday was associated with higher in-hospital mortality (adjusted hazard ratio [HR], 1.339; 95% confidence interval [CI], 1.058–1.704; p=0.016) but better neurologic outcomes (adjusted HR, 0.503; 95% CI, 0.281–0.894; p=0.020) than weekdays. CONCLUSIONS: The incidence of OHCAs was associated with day types in a year. It occurred more frequently on traditional holidays than on other day types. It was associated with higher in-hospital mortality and favorable neurologic outcomes than weekday.
Cardiopulmonary Resuscitation ; Epidemiology ; Heart Arrest ; Holidays ; Hospital Mortality ; Incidence ; Korea ; Mortality ; Out-of-Hospital Cardiac Arrest ; Prospective Studies

BACKGROUND AND PURPOSE: The purpose of this study is to compare two clinical predictive rules, the pre-arrestmorbidity(PAM) index and the prognosis-after-resuscitation(PAR) score, which predict failure to survive following in-hospital cardiopulmonary resuscitation(CPR). METHOD: The study population consisted of 162 consecutive adult patients who underwent CPR at Wonju Christian Hospital over a year period. The PAM index and PAR score were calculated from the most recent data available for each variable prior to cardiac arrest. Each predictive tool was compared between the group of discharge alive and the group of in-hospital mortality. Performance of the predictive scores was also compared by receiver-operating characteristic(ROC) curves where appropriate. RESULTS: PAM index of study population was 4.39+/-2.69 and PAR score was 2.99+/-3.36. PAM index in the group of discharge alive was 1.87+/-2.79, and PAM index in the group of ih-hospital mortality was 4.51+/-2.62. PAR score in the group of discharge alive was 0.75+/-1.75, and PAR score in the group of in-hospital mortality was 3.1+/-3.4. The PAM index identified 15 patients with a score>8, while the PAR score identified 39 patients with a score>4, none of whom survived. The sensitivity of the PAR score for the prediction of failure to survive was 25%, while that of the PAM index was 10%; neither index incorrectly identified a patient as a non-survivor who eventually survived. Both of predictive methods were not significantly different in the ROC curve. CONCLUSION: Although further confirmation is necessary, PAM index and PAR score may provide useful prognostic information to physicians and patients involved with decisions about do-no- resuscitate orders.
Adult ; Cardiopulmonary Resuscitation* ; Gangwon-do ; Heart Arrest ; Hospital Mortality ; Humans ; Mortality ; ROC Curve

PURPOSE: The relationship between prognostic factors and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia was analyzed. METHODS: We conducted a tertiary center retrospective study of post-cardiac arrest patients treated with therapeutic hypothermia between January 2008 and December 2012. We investigated the association of the following factors with outcomes: BMI, time to ROSC, number of vasoactive drugs, smoking, alcohol, and short time to therapeutic range in hypothermia. RESULTS: A total of 251 patients were enrolled in this study. Large number of vasoactive drugs was a prognostic factor of 3-month mortality (adjusted OR 1.96, 95% CI:1.41-2.71, p<0.001). Obesity (BMI> or =25 kg/m2) was not associated with delayed time to therapeutic range in hypothermia. Both univariate and multivariate analysis showed that high initial BT (beta(SE)=63.64 (11.53), p<0.001) and a small number of vasoactive drugs (beta(SE)=18.66(8.74), p=0.034) were independent predictors of delayed time to therapeutic range in hypothermia. CONCLUSION: In this study, a small number of vasoactive drugs showed a significant influence on delayed time to therapeutic range in patients receiving therapeutic hypothermia after return of spontaneous circulation after out-of-hospital cardiac arrest.
Heart Arrest* ; Humans ; Hypothermia* ; Hypothermia, Induced ; Mortality ; Multivariate Analysis ; Obesity ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Smoke ; Smoking

BACKGROUND: The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH. METHODS: The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality. RESULTS: One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622-42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003-1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0-228.0) mg/dl, 128.0 (102.0-165.0) mg/dl, and 105.0 (87.5-129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180-309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133-242) mg/dl of the maximal median blood glucose value during the cooling phase (p < 0.001). CONCLUSIONS: High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.
Blood Glucose ; Glucose ; Heart Arrest ; Hospital Mortality ; Humans ; Hypothermia ; Hypothermia, Induced ; Insulin ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Rewarming ; Survivors

Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.
Heart ; Heart Arrest ; Heart Defects, Congenital* ; Hemodynamics ; Humans ; Liver ; Mortality ; Oximetry ; Spectroscopy, Near-Infrared ; Thorax ; Twins, Conjoined

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.
Cardioplegic Solutions ; Cardiopulmonary Bypass ; Consciousness ; Heart Arrest, Induced* ; Humans ; Intubation ; Mortality ; Potassium* ; Thoracic Surgery

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis* ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period

Tension pneumothorax during one-lung ventilation is an insidious, life threatening emergency. Even though early diagnosis and rapid intervention are necessary to prevent mortality, treatment may be difficult because of the clinical diagnosis-mediastinal shift, hypoxemia, hypotension and increased airway pressure may be confusing in the operative setting. We present here the case of a patient who underwent right thoracotomy with one-lung ventilation and the patient developed left tension pneumothorax with resulting cardiac arrest.
Anoxia ; Early Diagnosis ; Emergencies ; Heart Arrest* ; Humans ; Hypotension ; Mortality ; One-Lung Ventilation ; Pneumothorax* ; Thoracotomy*

Primary pulmonary hypertension is a rare disorder and rarely present in pregnant woman, but it make high risk of maternal morbidity and mortality. When a woman with subclinical primary pulmonary hypertension is pregnant, physiologic increase in maternal plasma volume aggravates pulmonary pressure cause cardiac arrest and maternal death. We diagnosed primary pulmonary hypertension in a pregnant woman who didn't present any symptoms before pregnancy but had dyspnea from 2nd trimester of gestation. She expired due to sudden aggravation of pulmonary overloading. We reports this case with brief review of literature.
Dyspnea ; Female ; Heart Arrest ; Humans ; Hypertension, Pulmonary* ; Maternal Death ; Mortality ; Plasma Volume ; Pregnancy* ; Pregnant Women

Adult respiratory distress syndroms(ARDS) is a clinical syndrome of variable etiology and non specific complex pathophysiology with high mortality. But management would be successful leaving less than 1% of permanent impairment by intensive care including serial blood gas analysis. We experienced a case of ARDS developed after twice of cardiac arrest of which the outcome was favorable despite the conservative management with lack of various modernized equipments.
Adult* ; Blood Gas Analysis ; Heart Arrest* ; Humans ; Critical Care ; Mortality ; Respiratory Distress Syndrome, Adult*