OBJECTIVE: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation. METHODS: We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients’ next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups. RESULTS: During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg⁻¹·min⁻¹ in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg⁻¹·min⁻¹ in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg⁻¹·min⁻¹ in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03). CONCLUSION: In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.
Angiography ; Coma ; Coronary Stenosis ; Coronary Vessels ; Dopamine ; Echocardiography ; Humans ; Hypothermia ; Myocardial Infarction* ; Norepinephrine ; Out-of-Hospital Cardiac Arrest* ; Rewarming ; Shock, Cardiogenic* ; Vasoconstrictor Agents

Background: Refractory ceramic fibers (RCFs) are a suspected carcinogen but have been widely used as insulations. Depending on the temperature, RCFs can transform into crystalline SiO2, which is a carcinogen that can be present in the air during bulk RCF handling. This study analyzed the physicochemical and morphological characteristics of RCFs at high temperatures and determined the exposure levels during the semiconductor scrubber maintenance. Methods: Sampling was conducted at a company that manufactures semiconductor scrubbers using RCFs as insulation. Bulk RCF samples were collected both before and after exposure to a scrubber temperature of 700°C. Airborne RCFs were collected during scrubber maintenance, and their characteristics were analyzed using microscopes. Results: The components of bulk RCFs were SiO2 and Al2O3, having an amorphous structure. Airborne RCFs were morphologically different from bulk RCFs in size, which could negatively affect maintenance workers’ health. 58% of airborne RCFs correspond to the size of thoracic and respirable fibers. RCFs did not crystallize at high temperatures. The exposure caused by airborne RCFs during the scrubber frame assembly and insulation replacement was higher than the occupational exposure limit. Conclusion Workers conducting insulation replacement are likely exposed to airborne RCFs above safe exposure limits. As RCFs are suspected carcinogens, this exposure should be minimized through prevention and precautionary procedures.

Zinc is an antioxidant trace mineral, scavenging free radicals and known to be involved in inflammatory reactions. The prevalence of atherogenic diseases such as coronary heart disease (CHD) are increasing in Korean adults of middle age and elderly. The increased cell damage from free radicals and inflammation have been implicated in etiology of CHD, and the evidence is accumulating that low zinc status is involved in the prevalence of this inflammatory atherogenic disease. However, little is known about the zinc status of Korean CHD and its relationship with dietary zinc intake and zinc bioavailabilty. In this study the serum zinc levels of male patients with CHD over 40 yrs. were compared with that of healthy adult males and its associations with dietary zinc intake and zinc bioavailabilty affecting factors were examined. Serum zinc level was measured by HANARO research reactor using neutron activation analysis (NAA) method. The overall proportion of patients with zinc deficiency, serum zinc concentrations below 74.0 microgram/dL was 32.8% compared to the 10.3% in healthy group. The average serum zinc levels were 80.7 microgram/dL and 88.3 microgram/dL in patients and healthy group, respectively, showing significantly low zinc status in CHD patients compared to healthy group. The intake of nutrients such as energy, carbohydrate, iron, and copper of CHD patients was significantly higher compared to that of the healthy group. In addition, the intake of calcium, iron, and protein from vegetable foods was significantly higher in CHD patients than that of healthy group. The dietary zinc intake was 12.7+/-4.5 mg and 11.5+/-6.9 mg in CHD patients and control group, respectively, which showed no difference. The phytate intake of patients group, which is 1389.0 mg, was significantly higher than the control group which showed 1104.8 mg. However, the ratio of phytate :zinc or phytate *calcium :zinc per 1000 kcal energy intake did not show any difference between two groups. The serum zinc levels did not show any correlation with zinc or factors that affect the bioavailability of zinc. The dietary factors influencing the zinc status were not found in CHD patients.
Adult ; Aged ; Biological Availability ; Calcium ; Copper ; Coronary Disease* ; Energy Intake ; Free Radicals ; Humans ; Inflammation ; Iron ; Male* ; Middle Aged ; Neutron Activation Analysis ; Phytic Acid ; Prevalence ; Vegetables ; Zinc*

BACKGROUND: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). METHODS: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05). RESULTS: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). CONCLUSIONS: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
Catheterization, Central Venous* ; Central Venous Catheters* ; Emergencies ; Humans ; Jugular Veins ; Prospective Studies ; Radiography ; Retrospective Studies ; Subclavian Vein ; Tertiary Care Centers ; Thorax ; Ultrasonography ; Vena Cava, Superior