Early defibrillation with an automated external defibrillator (AED) is crucial to survival success in sudden cardiac arrest. Dissemination of public-access AEDs have increased the frequency of early defibrillations and contributed to improved outcomes after out-of-hospital cardiac arrests (OHCAs). However, public-access AEDs are not yet widely-disseminated in Korea. We report the first survival case of an OHCA patient who received shocks from a public-access AED in Korea.
Death, Sudden, Cardiac ; Defibrillators ; Heart Arrest ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest ; Shock

Resuscitation medicine, which is a relatively young field of clinical medicine, has emerged as an endeavor to resuscitate victims suffering sudden death. Cardiopulmonary resuscitation (CPR) is utilized in order to treat a transient, reversible, sudden unexpected death. Currently, it is expected that millions of lay people worldwide learn CPR and millions of patients suffering sudden cardiac arrest receive CPR. Even though the history of CPR includes folklore related to various attempts that have been made to save lives, modern CPR based on clinical research and evidence has been introduced and developed over the last several decades. Researchers and organizations have contributed to the development of resuscitation skills by establishing CPR guidelines and disseminating this knowledge to lay people. Despite recent advances in CPR technique, sudden death remains a major health issue in developed countries and the survival rate resulting from out-of-hospital cardiac arrest remains low. This review provides insight into the progression of resuscitation medicine by evaluating the history of CPR.
Cardiopulmonary Resuscitation ; Clinical Medicine ; Death, Sudden ; Death, Sudden, Cardiac ; Developed Countries ; Folklore ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Stress, Psychological ; Survival Rate

PURPOSE: Studies have demonstrated that B-type natriuretic peptide (BNP) has a predictive value for sudden cardiac arrest in heart failure patients. The aim of this study was to investigate the usefulness of serum BNP levels for theprediction of death in post-cardiac arrest patients treated with-therapeutic hypothermia (TH). METHODS: Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between April 2007 and August 2010 were evaluated and divided into two groups based on death within 3 months. Initial serum BNP levels were checked and BNP levels compared between both groups. RESULTS: A total of 162 patients were enrolled in the study. Among 162 patients, 109 patients were male (mean age of 50 years). The BNP levels of the non-survival group (n=77) were higher than those of the survival group (n=85); however, there was no statistical difference (19.45 pg/ml vs. 30.75 pg/ml, p=0.174). The BNP cutoff value of 106 pg/ml for death within 3 months had a sensitivity of 35.1% and a specificity of 78.8%. In the logistic regression analysis, BNP levels higher than 106 pg/ml were significantly associated with death within 3 months (odds ratio [OR], 2.625; 95% confidence interval [CI], 1.066-6.463) and other independent factors were BLS to ROSC (OR, 1.105; CI, 0.082-1.038), non-VF/VT (OR, 3.698; CI, 1.632-8.380), and APACHE II score (OR, 1.117; CI, 1.035-1.204). CONCLUSION: Initial Serum BNP levels are related with death within 3 months for patients that received TH after OHCA. However, additional randomized and controlled studies are needed.
APACHE ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Heart Arrest ; Heart Failure ; Humans ; Hypothermia* ; Hypothermia, Induced ; Logistic Models ; Male ; Natriuretic Peptide, Brain* ; Out-of-Hospital Cardiac Arrest ; Sensitivity and Specificity ; Survivors

PURPOSE: Studies have demonstrated that B-type natriuretic peptide (BNP) has a predictive value for sudden cardiac arrest in heart failure patients. The aim of this study was to investigate the usefulness of serum BNP levels for theprediction of death in post-cardiac arrest patients treated with-therapeutic hypothermia (TH). METHODS: Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between April 2007 and August 2010 were evaluated and divided into two groups based on death within 3 months. Initial serum BNP levels were checked and BNP levels compared between both groups. RESULTS: A total of 162 patients were enrolled in the study. Among 162 patients, 109 patients were male (mean age of 50 years). The BNP levels of the non-survival group (n=77) were higher than those of the survival group (n=85); however, there was no statistical difference (19.45 pg/ml vs. 30.75 pg/ml, p=0.174). The BNP cutoff value of 106 pg/ml for death within 3 months had a sensitivity of 35.1% and a specificity of 78.8%. In the logistic regression analysis, BNP levels higher than 106 pg/ml were significantly associated with death within 3 months (odds ratio [OR], 2.625; 95% confidence interval [CI], 1.066-6.463) and other independent factors were BLS to ROSC (OR, 1.105; CI, 0.082-1.038), non-VF/VT (OR, 3.698; CI, 1.632-8.380), and APACHE II score (OR, 1.117; CI, 1.035-1.204). CONCLUSION: Initial Serum BNP levels are related with death within 3 months for patients that received TH after OHCA. However, additional randomized and controlled studies are needed.
APACHE ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Heart Arrest ; Heart Failure ; Humans ; Hypothermia* ; Hypothermia, Induced ; Logistic Models ; Male ; Natriuretic Peptide, Brain* ; Out-of-Hospital Cardiac Arrest ; Sensitivity and Specificity ; Survivors

BACKGROUND/AIMS: Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. METHODS: We analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events. RESULTS: Forty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality. CONCLUSIONS: Even though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.
Arrhythmias, Cardiac* ; Arrhythmogenic Right Ventricular Dysplasia ; Coronary Vasospasm* ; Death, Sudden, Cardiac* ; Electrocardiography ; Follow-Up Studies ; Heart Arrest ; Humans ; Long QT Syndrome ; Masks* ; Mortality ; Out-of-Hospital Cardiac Arrest ; Survivors

Sudden cardiac death (SCD) remains a major public health issue worldwide. Published reports of out-of-hospital cardiac arrest (OHCA) provide widely variable results. A large number of OHCA cases occur annually and the worldwide survival rate is less than 7~12%. In Korea, the recent standardized incidence rates (SIR) of OHCA was 44.4 per 100,000 persons (24,442 persons experienced OHCA in 2009), a result similar to that reported in other countries. However, the survival-to-discharge rate was 2.4% for Emergency Medical System (EMS)-assessed OHCA and 3.6% for resuscitation-attempted OHCA. Only 0.66~1.6% of survivors were discharged with a good neurological outcome status (cerebral performance category 1 or 2). This result was very poor as compared to those of Resuscitation Outcomes Consortium (ROC) study sites (8.4~11.4%), Europe (10.7%) and Japan (12%). The goal of this review was to better understand the global variability of OHCA outcomes and their determining factors in order to suggest the future direction of resuscitation research and prevention of OHCA in Korea.
Death, Sudden, Cardiac ; Emergencies ; Europe ; Heart Arrest ; Humans ; Incidence ; Japan ; Korea ; Out-of-Hospital Cardiac Arrest ; Public Health ; Resuscitation ; Survival Rate ; Survivors

Mostly of the sudden deaths, except in-hospital death and death within 48 hours of discharge, are declared in the emergency department by emergency physician. The purpose of this study is to review the protocol of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest by understanding the cause of sudden death from autopsy results. A retrospective analysis was performed by 48 months of medical records from emergency department of a tertiary hospital. The analysis was made from the patient group which gone through autopsy in the main office of National Institute of Scientific Investigation. In the emergency department, 1913 patients were declared death and 43 patients have received autopsy and 19 (1.0%) were natural death. 14 partients received CPR in the natural death group, and 13 were specified as cardiovascular disease. Result of this study represents the importance of prehospital CPR in case of unexpected cardiac arrest patients. However to generalize this result, all dead patients must go through autopsies for medical purpose which the frequency alse should be increased.
Autopsy ; Cardiopulmonary Resuscitation ; Cardiovascular Diseases ; Death, Sudden ; Emergencies ; Heart Arrest ; Humans ; Medical Records ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Tertiary Care Centers

A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.
Acute Coronary Syndrome ; Catheter Ablation ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Death, Sudden, Cardiac ; Echocardiography ; Electrocardiography ; Emergencies ; Heart Arrest* ; Humans ; Ischemia ; Male ; Middle Aged ; Myocardial Infarction* ; Out-of-Hospital Cardiac Arrest ; Reperfusion ; Ventricular Fibrillation* ; Ventricular Premature Complexes*

PURPOSE: The wide range of survival rates after out-of-hospital cardiac arrest (OHCA) suggests that some deaths are preventable if an optimal emergency medical service (EMS) system is operated. The objective of this study was to propose a definition of preventable cardiac arrest death (PCAD) and to estimate the rate of PCAD in an area. METHODS: This was a prospective cohort study of OHCA patients in the Gangnam-gu area of Korea. We collected data for OHCA patients from January to December 2009. PCAD was defined as an arrest case who is expected to survive if the patient received optimal first aid from bystanders and EMS personnel. A consensus panel of three emergency physicians determined whether each event was preventable or not. The survivability of each event was calculated using formulas from previous studies. RESULTS: Among 104 arrests (an incidence of 18.3 per 100,000/year), 44 unexpected, non-traumatic arrests were analyzed. According to expert opinion, 16 of 30 (53%) who died within 24 hours after cardiac arrest were considered cases of PCAD. Survivability calculated using a previous formula was above 50% in 70% of patients. The Kappa value between the two estimations was only 0.247. CONCLUSION: The PCAD rate of Gangnam-gu area was estimated to be 53.3~70%. No bystander cardiopulmonary resuscitation, a delay in EMS activation, no use of an automated external defibrillator, or a delay in EMS arrival were considered problems in the process of pre-hospital care for sudden cardiac arrest.
Cardiopulmonary Resuscitation ; Cohort Studies ; Consensus ; Death, Sudden, Cardiac ; Defibrillators ; Emergencies ; Emergency Medical Services ; Expert Testimony ; First Aid ; Heart Arrest ; Humans ; Incidence ; Korea ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Survival Rate

Sudden cardiac arrest is a growing medical issue in developed countries. Annually, more than 25,000 out-of-hospital cardiac arrests (OHCA) occur in Korea. Only 3% of victims with OHCA discharge alive from hospital and less than 1% of them survive neurologically intact. Major changes of recent guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care includes modification of basic life support (BLS) sequence from A-B-C to C-A-B, an emphasis on minimally interrupted, high-quality chest compression, the introduction of chest compression-only CPR, and addition of integrated post-cardiac arrest care concept as the fifth chain in the Chain of Survival. Repetition of 2-minutes of CPR, rhythm check, and defibrillation if indicated is recommended as a universal algorithm during BLS. Defibrillation and drug administration including epinephrine should not be delayed to place an advanced airway during CPR. Important interventions during post-cardiac arrest care are comprised of the optimization of ventilation (arterial CO2 tension, 40 to 45 mmHg) and oxygenation (arterial O2 saturation, 94% to 98%), glucose control (blood glucose, 144 to 180 mg/dL), therapeutic hypothermia (body tem-perature, 32degrees C to 34degrees C) for unresponsive patients, and percutaneous coronary intervention for the patient with ST-segment elevation. Systemic approaches to increase public awareness of cardiac arrest and CPR, to spread CPR education to citizen, and to implement public access defibrillation are a prerequisite for improving survival from OHCA in the community. Effective advanced life support and integrated post-cardiac arrest care should be provided to increase neurologically intact survival among the patients resuscitated from cardiac arrest.
Cardiopulmonary Resuscitation ; Collodion ; Death, Sudden, Cardiac ; Developed Countries ; Emergencies ; Epinephrine ; Glucose ; Heart Arrest ; Humans ; Hypogonadism ; Hypothermia ; Korea ; Mitochondrial Diseases ; Ophthalmoplegia ; Out-of-Hospital Cardiac Arrest ; Oxygen ; Percutaneous Coronary Intervention ; Thorax ; Ventilation