Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.
Aorta* ; Balloon Occlusion* ; Cause of Death ; Cicatrix ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Korea ; Middle Aged ; Multiple Trauma ; Shock* ; Shock, Hemorrhagic ; Vital Signs

OBJECTIVE: To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis.METHODS: We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression.RESULTS: A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend <0.001) and from 26.5% (95% CI, 24.4% to 28.8%) to 30.1% (95% CI, 28.4% to 31.9%), respectively. After standardization, the increasing trend of incidence was slower but still significant (P-trend <0.001), while that for mortality was not (P-trend 0.883). The average cost increased by 75.5% (P-trend <0.001). Multivariable logistic regression identified various risk factors for mortality.CONCLUSION: The burden of sepsis in Korea was high and is expected to increase considering the aging population. Proactive measures to curtail this increase should be sought and implemented.
Adult ; Aging ; Anti-Bacterial Agents ; Cohort Studies ; Comorbidity ; Epidemiologic Studies ; Epidemiology ; Humans ; Incidence ; Korea ; Logistic Models ; Methods ; Mortality ; National Health Programs ; Prescriptions ; Risk Factors ; Sepsis

PURPOSE: Proteomics is a peptide screening approach to identify proteins related to physiological and pathological changes. Our objective was to analyze changes in serum proteome profiles in patients suffering from septic shock, during the first 24-h period of therapy and to determine whether these changes were associated with prognosis. METHODS: This was a retrospective observational study based on prospectively collected data that was conducted in an emergency intensive care unit (ICU) of a tertiary referral hospital. Consecutive patients admitted to the ICU with septic shock were enrolled. We obtained serum samples from the patients at admission (0 h) and 24 h after admission (24 h). Then, we analyzed the serum proteome profiles, performed Western blots, and measured serum lipid profiles. RESULTS: Twenty-seven patients were enrolled. Thirteen patients were grouped into the survivors (SURV) group and fourteen into the non-survivors group on day 30 (NON-SURV). Proteomic analyses and Western blot showed that the expression intensities of proapolipoprotein AI remained unchanged in SURV but decreased in NON-SURV during the first 24-h period of septic shock (p=0.015). Serum high density lipoprotein (HDL) cholesterol level also remained unchanged in SURV but decreased in NON-SURV (p=0.036). CONCLUSION: The decrease in serum proapolipoprotein AI expression during the first 24-h period of therapy was associated with a consistently low serum HDL cholesterol level and a poor prognosis in patients with septic shock.
Apolipoprotein A-I ; Blotting, Western ; Cholesterol ; Cholesterol, HDL ; Emergencies ; Humans ; Intensive Care Units ; Lipoproteins ; Lipoproteins, HDL ; Mass Screening ; Prognosis ; Prospective Studies ; Proteins ; Proteome ; Proteomics ; Retrospective Studies ; Shock ; Shock, Septic ; Stress, Psychological ; Survivors ; Tertiary Care Centers

PURPOSE: This study was performed to investigate whether therapeutic hypercapnia could attenuate systemic inflammatory responses in hemorrhagic shock in rats. METHODS: Male Sprague-Dawley rats were mechanically ventilated and underwent pressure-controlled (mean arterial pressure: 38+/-1 mmHg) hemorrhagic shock. At 10 minutes after the induction of hemorrhagic shock, the rats were divided into the normocapnia (PaCO2=35-45 mmHg, n=10) and the hypercapnia (PaCO2=60-70 mmHg) groups. The PaCO2 concentration was adjusted by using the concentration of inhaled CO2 gas. After 90 minutes of hemorrhagic shock, rats were resuscitated with shed blood for 10 minutes and were observed for 2 hours. The mean arterial pressure (MAP) and the heart rate were monitored continuously, and the results of arterial blood gas analyses, as well as the plasma concentrations of interleukin (IL)-6, IL-10, and nitrite/nitrate were compared between the normocapnia and the hypercapnia groups. RESULTS: The MAP and the heart rate were not different between the two groups. The plasma concentration of IL-6 was significantly lower in the hypercapnia group than in the normocapnia group (p<0.05). The IL-10 concentration was not different and the IL-6 to IL-10 ratio was significantly lower in the hypercapnia group compared to the normocapnia group. The plasma nitrite/nitrate concentration of the hypercapnia group was lower than that of the normocapnia group. CONCLUSION: Therapeutic hypercapnia attenuates systemic inflammatory responses in hemorrhagic shock.
Animals ; Arterial Pressure ; Blood Gas Analysis ; Cytokines ; Heart Rate ; Humans ; Hypercapnia ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Male ; Nitric Oxide ; Plasma ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic

Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.
Aorta ; Balloon Occlusion ; Cause of Death ; Cicatrix ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Korea ; Middle Aged ; Multiple Trauma ; Shock ; Shock, Hemorrhagic ; Vital Signs

Determining blood loss [100% – RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1 , Hct2 ) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2 ) – 1]. For validation, nonongoing haemorrhagic shock was induced in Sprague–Dawley rats by withdrawing 20.0%–60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct 2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2 ) – 1]. Seven rats losing 30.0%–60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2 ) – 1] + 32.8 (95% confidence interval [CI] of the slope: 3.14–8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N.Clinical validation is required before utilisation for emergency care of haemorrhagic shock.

Background: Particulate matter (PM) has been extensively observed due to its negative association with human health. Previousresearch revealed the possible negative effect of air pollutant exposure on oral health. However, the predictive model between air pollutant exposure and the prevalence of periodontitis has not been observed yet. Therefore, this study aims to propose a predictive model for the number of patients with periodontitis exposed to PM and atmospheric factors in South Korea using deep learning. Methods: This study is a retrospective cohort study utilizing secondary data from the Korean Statistical Information Service andthe Health Insurance Review and Assessment database for air pollution and the number of patients with periodontitis, respectively. Data from 2015 to 2022 were collected and consolidated every month, organized by region. Following data matching and management, the deep neural networks (DNN) model was applied, and the mean absolute percentage error (MAPE) value was calculated to ensure the accuracy of the model. Results: As we evaluated the DNN model with MAPE, the multivariate model of air pollution including exposure to PM2.5, PM10, and other atmospheric factors predict approximately 85% of the number of patients with periodontitis. The MAPE value ranged from 12.85 to 17.10 (mean±standard deviation=14.12±1.30), indicating a commendable level of accuracy. Conclusion In this study, the predictive model for the number of patients with periodontitis is developed based on air pollution,including exposure to PM2.5, PM10, and other atmospheric factors. Additionally, various relevant factors are incorporated into the developed predictive model to elucidate specific causal relationships. It is anticipated that future research will lead to the development of a more accurate model for predicting the number of patients with periodontitis.

PURPOSE: We aimed to investigate whether a trained layperson could perform high quality Cardiopulmonary Resuscitation (CPR) after conventional training and a self-learning program using the "CPR Anytime" kit. METHODS: Traditional CPR training for a lay rescuer was conducted two weeks before a CPR contest for high school students. "CPR Anytime" training kits were distributed to the students for their practical training at home or in school. The students were tested in pairs for two-person CPR with rescuer breaths and an automated external defibrillator. The quantitative and qualitative data regarding the quality of CPR, including chest compression and rescuer breaths, were collected using a standardized checklist and a skill reporter. RESULTS: A total of 161 teams with 322 students, including 116 males and 206 females, participated in the CPR contest in pairs. The mean depth and rate for the chest compression were 49.0+/-8.2 mm and 110.2+/-10.2 /min, respectively. The mean tidal volume for the rescue breaths was 604.8+/-208.7 ml. The percentage of participants satisfying the correct chest compression rate of > or =100/min and depth of > or =50 mm was 87.3% and 52.2%, respectively. Only 25.2% of the participants satisfied an optimal tidal volume (between 500 ml and 600 ml). Shallow compression (57.5%) and under-ventilation (44.4%) were the major causes of incorrect compression and ventilation, respectively. CONCLUSION: The quality of CPR with rescuer breaths in the trained lay rescuer was not adequate, especially for mouth-to-mouth rescue breathing. Therefore, the development of teaching methods to improve rescue breathing or omit mouth-to-mouth ventilation in training should be considered.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Female ; Humans ; Male ; Respiration ; Teaching ; Thorax ; Tidal Volume ; Ventilation

PURPOSE: Electrical shock is not always followed by a perfusing rhythm, and multiple shock failure (MSF) is common during CPR. We sought to investigate its risk factors and prognostic implications. METHODS: Adult OHCA patients with emergency department (ED) ACLS attempts were identified from a tertiary hospital OHCA registry extending from 2008 to 2012. Shock failure was defined as any electrical shock attempt not followed by a pulse-generating rhythm. Patients were assigned to one of three groups based on the number of shock failures: 1) MSF: ≥3 electrical shock failures before the first ROSC or CPR termination (if there was no ROSC), 2) early shock success (ESS): pulse-generating rhythm achieved within 3 electrical shock attempts and 3) others: all remaining patients. Baseline characteristics, initial laboratory measurements, and outcomes were compared. RESULTS: A total of 590 patients were included. There was no significant difference in baseline characteristics between the MSF group (n=49) and the early shock success group (n=50) except in its higher proportion of presumed cardiac aetiology. The MSF group showed less severe metabolic acidosis and coagulopathy on ED arrival and better renal function and higher haematocrit and serum albumin levels compared with the ESS group. MSF was associated with less sustained ROSC, but was also associated with more survival discharge and better long-term neurologic outcomes after sustained ROSC. CONCLUSION: MSF may indicate heart-specific problems rather than severe metabolic derangements. Better long-term outcomes can be expected once sustained ROSC is achieved, therefore, this phenomenon warrants more focused research.
Acidosis ; Adult ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Resuscitation* ; Risk Factors* ; Serum Albumin ; Shock* ; Tertiary Care Centers ; Ventricular Fibrillation

PURPOSE: The association of serum albumin concentration on hospital arrival with long-term mortality in survivors from out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: A retrospective analysis was conducted of patients presumed to have cardiac cause of arrest and achieved sustained return of spontaneous circulation (ROSC) from prospective OHCA. The individual medical records were reviewed for data, including initial serum albumin. The primary outcome was survival at 6 months and the secondary outcome was Cerebral Performance Category (CPC) at 6 months. Differences in variables between survivors and non-survivors at 6 months after cardiac arrest were analyzed. Albumin was categorized into tertiles of <2.9 g/dL, 2.9 to 3.7 g/dL, and >3.7 g/dL. Hazard ratios (HRs) were estimated using Cox-proportional hazard models in both univariate and multivariate analysis. All prognostic variables with p value<0.1 in univariate analysis were used in multivariate analysis for adjustment. Receiver operating curve (ROC) analysis was performed to evaluate the discriminative power of albumin. RESULTS: In a total of 547 OHCA patients, 136 patients had a presumed cardiac cause of arrest and sustained ROSC with available initial serum albumin. The survival rate at 6 months was significantly higher in patients in the higher albumin group and neurological outcomes were also more favorable in the higher albumin group (log rank test, p<0.05). In a Cox proportional hazard regression analysis, initial serum lactate and albumin levels were independently associated with 6-month mortality and albumin levels showed moderate discriminative power for 6-month mortality by ROC analysis (AUC=0.738, 95% CI: 0.652-0.825). CONCLUSION: Serum albumin is associated with long-term mortality and neurological outcome in patients with presumed cardiac cause of arrest and sustained ROSC from OHCA.
Heart Arrest ; Humans ; Lactic Acid ; Medical Records ; Mortality* ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Retrospective Studies ; ROC Curve ; Serum Albumin* ; Survival Rate ; Survivors