Sung Phil Chung, Youdong Sohn, Jisook Lee, Youngsuk Cho, Kyoung-Chul Cha, Ju Sun Heo, Ai-Rhan Ellen Kim, Jae Guk Kim, Han-Suk Kim, Hyungoo Shin, Chiwon Ahn, Ho Geol Woo, Byung Kook Lee, Yong Soo Jang, Yu Hyeon Choi, Sung Oh Hwang, on behalf of the Guideline Committee of the Korean Association of Cardiopulmonary Resuscitation (KACPR)
Clin Exp Emerg Med 2023;10(4):382-392. Published online August 25, 2023
Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (patient, intervention, comparison, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to COVID-19. Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.
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Objective Myocardial rupture is a fatal complication of acute myocardial infarction (AMI). Early diagnosis of myocardial rupture is feasible when emergency physicians (EPs) perform emergency transthoracic echocardiography (TTE). The purpose of this study was to report the echocardiographic features of myocardial rupture on emergency TTE performed by EPs in the emergency department (ED).
Methods This was a retrospective and observational study involving consecutive adult patients presenting with AMI who underwent TTE performed by EPs in the ED of a single academic medical center from March 2008 to December 2019.
Results Fifteen patients with myocardial rupture, including eight (53.3%) with free wall rupture (FWR), five (33.3%) with ventricular septal rupture (VSR), and two (13.3%) with FWR and VSR, were identified. Fourteen of the 15 patients (93.3%) were diagnosed on TTE performed by EPs. Diagnostic echocardiographic features were found in 100% of the patients with myocardial rupture, including pericardial effusion for FWR and a visible shunt on the interventricular septum for VSR. Additional echocardiographic features indicating myocardial rupture were thinning or aneurysmal dilatation in 10 patients (66.7%), undermined myocardium in six patients (40.0%), abnormal regional motions in six patients (40.0%), and pericardial hematoma in six patients (40.0%).
Conclusion Early diagnosis of myocardial rupture after AMI is possible using echocardiographic features on emergency TTE performed by EPs.
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Desafios diagnósticos e terapêuticos da Comunicação Interventricular pós-infarto do miocárdio: relato de caso Mara Flávia Mamedio Avallone, Marcos Gradim Tiveron, Eraldo Antônio Pelloso, Sérgio Marques Pereira, Rodolfo de Oliveira Medeiros, Piero Bitelli, Carlos Eduardo Bueno, Dauane Cristine Orso Toscan Rodrigues, Viviane Canhizares Evangelista de Araújo, Jeffer Caderno Pedagógico.2025; 22(7): e16612. CrossRef
Determining the cause of cardiac arrest (CA) and the heart status during CA is crucial for its treatment. Transesophageal echocardiography (TEE) is an imaging method that facilitates close observation of the heart without interfering with cardiopulmonary resuscitation (CPR). Intra-arrest TEE is a point-of-care ultrasound technique that is used during CPR. Intra-arrest TEE is performed to diagnose the cause of CA, determine the presence of cardiac contraction, evaluate the quality of CPR, assist with catheter insertion, and explore the mechanism of blood flow during CPR. The common causes of CA diagnosed using intra-arrest TEE include cardiac tamponade, aortic dissection, pulmonary embolism, and intracardiac thrombus, which can be observed on a few simple image planes at the mid-esophageal and upper esophageal positions. To operate an intra-arrest TEE program, it is necessary to secure a physician who is capable of performing TEE, provide appropriate training, establish implementation protocols, and prepare a plan in collaboration with the CPR team.
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Objective We conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system.
Methods This observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma.
Results Most of the patient’s physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system.
Conclusion The Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a two-tier system with special considerations would be more effective for providing optimum patient care and medical resource utilization.
Joo Yeong Kim, Sung Oh Hwang, Sang Do Shin, Hyuk Jun Yang, Sung Phil Chung, Sung Woo Lee, Kyung Jun Song, Seung Sik Hwang, Gyu Chong Cho, Sung Woo Moon, Kyuseok Kim, Won Young Kim, Seil Oh, Young Ho Kwak, on behalf of KoCARC
Clin Exp Emerg Med 2018;5(3):165-176. Published online September 30, 2018
Objective This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes.
Methods The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology.
Results A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals.
Conclusion The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.
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Global disparities in arrhythmia care: Mind the gap Zain Sharif, Leon M. Ptaszek Heart Rhythm O2.2022; 3(6): 783. CrossRef
Association between Survival and Time of On-Scene Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Cross-Sectional Retrospective Study Hang Park, Ki Ahn, Eui Lee, Ju Park International Journal of Environmental Research and Public Health.2021; 18(2): 496. CrossRef
Association between the body mass index and outcomes of patients resuscitated from out-of-hospital cardiac arrest: a prospective multicentre registry study Heekyung Lee, Jaehoon Oh, Hyunggoo Kang, Tae Ho Lim, Byuk Sung Ko, Hyuk Joong Choi, Seung Min Park, You Hwan Jo, Jong Suk Lee, Yoo Seok Park, Young-Hoon Yoon, Su Jin Kim, Young-Gi Min Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub] CrossRef
Prediction of Neurologically Intact Survival in Cardiac Arrest Patients without Pre-Hospital Return of Spontaneous Circulation: Machine Learning Approach Dong-Woo Seo, Hahn Yi, Hyun-Jin Bae, Youn-Jung Kim, Chang-Hwan Sohn, Shin Ahn, Kyoung-Soo Lim, Namkug Kim, Won-Young Kim Journal of Clinical Medicine.2021; 10(5): 1089. CrossRef
Can bystanders' gender affect the clinical outcome of out-of-hospital cardiac arrest: A prospective, multicentre observational study Han Bit Kim, Gyu Chong Cho, Young Hwan Lee The American Journal of Emergency Medicine.2021; 48: 87. CrossRef
Predictive Model of Good Clinical Outcomes in Patients Undergoing Coronary Angiography after Out-of-Hospital Cardiac Arrest: A Prospective, Multicenter Observational Study Conducted by the Korean Cardiac Arrest Research Consortium Jin Beom, Incheol Park, Je You, Yun Roh, Min Kim, Yoo Park Journal of Clinical Medicine.2021; 10(16): 3695. CrossRef
Dynamic changes in arterial blood gas during cardiopulmonary resuscitation in out-of-hospital cardiac arrest Seok-In Hong, June-Sung Kim, Youn-Jung Kim, Won Young Kim Scientific Reports.2021;[Epub] CrossRef
The ED-PLANN Score: A Simple Risk Stratification Tool for Out-of-Hospital Cardiac Arrests Derived from Emergency Departments in Korea Hyouk Jae Lim, Young Sun Ro, Ki Hong Kim, Jeong Ho Park, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin Journal of Clinical Medicine.2021; 11(1): 174. CrossRef
The Prognostic Usefulness of the Lactate/Albumin Ratio for Predicting Clinical Outcomes in Out-of-Hospital Cardiac Arrest: a Prospective, Multicenter Observational Study (koCARC) Study Taeyoung Kong, Sung Phil Chung, Hye Sun Lee, Sinae Kim, Jihwan Lee, Sung Oh Hwang, Sang Do Shin, Kyoung Jun Song, Kyung Chul Cha, Je Sung You Shock.2020; 53(4): 442. CrossRef
Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval Sol Kim, Dong Eun Lee, Sungbae Moon, Jae Yun Ahn, Won Kee Lee, Jong Kun Kim, Jungbae Park, Hyun Wook Ryoo Clinical and Experimental Emergency Medicine.2020; 7(1): 21. CrossRef
Neurological outcomes after an out-of-hospital cardiac arrest among people living in high-rise buildings in South Korea Youdong Sohn, Youngsuk Cho, Gyuchong Cho European Journal of Emergency Medicine.2020; 27(3): 207. CrossRef
Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage Elizabeth Davida Paratz, Luke Rowsell, Dominica Zentner, Sarah Parsons, Natalie Morgan, Tina Thompson, Paul James, Andreas Pflaumer, Christopher Semsarian, Karen Smith, Dion Stub, Andre La Gerche Open Heart.2020; 7(1): e001195. CrossRef
Initial red cell distribution width as a predictor of poor neurological outcomes in out-of-hospital cardiac arrest survivors in a prospective, multicenter observational study (the KoCARC study) Seon Hee Woo, Woon Jeong Lee, Dae Hee Kim, Youngsuk Cho, Gyu Chong Cho Scientific Reports.2020;[Epub] CrossRef
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Association between ambulance response time and neurologic outcome in patients with cardiac arrest Dong Wook Lee, Hyung Jun Moon, Nam Hun Heo The American Journal of Emergency Medicine.2019; 37(11): 1999. CrossRef
New Termination-of-Resuscitation Models and Prognostication in Out-of-Hospital Cardiac Arrest Using Electrocardiogram Rhythms Documented in the Field and the Emergency Department Dong Eun Lee, Mi Jin Lee, Jae Yun Ahn, Hyun Wook Ryoo, Jungbae Park, Won Young Kim, Sang Do Shin, Sung Oh Hwang Journal of Korean Medical Science.2019;[Epub] CrossRef
High Incidence and Mortality of Out-of-Hospital Cardiac Arrest on Traditional Holiday in South Korea Joon-myoung Kwon, Ki-Hyun Jeon, Hyue Mee Kim, Min Jeong Kim, Sungmin Lim, Kyung-Hee Kim, Pil Sang Song, Jinsik Park, Rak Kyeong Choi, Byung-Hee Oh Korean Circulation Journal.2019; 49(10): 945. CrossRef
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