Jisook Lee, Do Kyun Kim, Jin-Tae Kim, Jae Yoon Na, Bobae Park, Soo In Jeong, June Dong Park, Sung Phil Chung, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S101-S114. Published online May 31, 2026
Pediatric cardiac arrest primarily arises from asphyxia in infants and trauma in older children, contrasting with adult etiologies dominated by cardiac events. This underscores prevention as the cornerstone of pediatric basic life support, through injury mitigation like child restraint systems and water supervision, safe sleep practices including supine positioning on firm surfaces with caregiver smoking cessation to reduce sudden infant death syndrome, plus awareness of child abuse and adolescent suicide prevention. In hospitals, pediatric early warning systems (PEWS) enable early deterioration detection via vital sign scoring for timely intervention. Major updates in the 2025 pediatric basic life support guidelines reflect evidence-driven refinements. First, hospitals should implement PEWS to prompt rapid response teams for at-risk inpatients. Second, all rescuers (lay and healthcare providers) should employ the two-thumb encircling hands technique for infant chest compressions for optimal depth (about 4 cm), rate (100–120/min), and recoil; one-hand heel compression serves as backup if infeasible. Third, lay rescuers may apply automated external defibrillators for nontraumatic out-of-hospital cardiac arrest in children aged 1 year or older, prioritizing prompt attachment after initial cardiopulmonary resuscitation (CPR) cycles to address potential shockable rhythms. Fourth, for infant foreign body airway obstruction, alternate five back blows (over the spine between scapulae) with five chest thrusts (using heel-of-hand on sternum) until cleared or unresponsive, then transition to CPR. These updates aim to enhance bystander intervention, CPR quality, and survival with favorable neurologic outcomes in pediatric cardiac arrest.
Do Kyun Kim, Jin-Tae Kim, Jae Yoon Na, Bobae Park, Jisook Lee, Soo In Jeong, June Dong Park, Sung Phil Chung, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S115-S141. Published online May 31, 2026
The 2025 Korean pediatric advanced life support guideline update introduces clinically important revisions emphasizing airway strategy, physiologic resuscitation targets, post–cardiac arrest hemodynamics, neuroprotection, and extracorporeal support. In out-of-hospital pediatric cardiac arrest, bag-mask ventilation is now suggested over endotracheal intubation or supraglottic airway placement. In in-hospital arrest, evidence is insufficient to favor bag-mask ventilation versus advanced airways; however, endotracheal intubation or supraglottic airway insertion is reasonable when performed with minimal interruption or when bag-mask ventilation is ineffective. For patients with an advanced airway in place, age-adjusted ventilation rates are proposed to avoid hypoventilation and hyperventilation: 30/min (<1 yr), 20–30/min (1–8 yr), and 10–20/min (8–18 yr in healthcare settings). When invasive arterial monitoring is available during in-hospital cardiac arrest, target diastolic blood pressure is ≥25 mmHg in infants and ≥30 mmHg in children ≥1 year. After return of spontaneous circulation, systolic blood pressure during the first 6 hours should be maintained above the age-specific 10th percentile. Neuroprognostication should be multimodal, incorporating serial examinations, electroencephalography (up to 72 hours), early computed tomography (<24 hours), magnetic resonance imaging (72 hours to 2 weeks), lactate trends, and pupillary reflexes. Extracorporeal cardiopulmonary resuscitation (CPR) is limited to appropriately resourced hospitals and may be considered for selected in-hospital arrests (e.g., cardiac disease) unresponsive to conventional CPR; evidence remains insufficient for out-of-hospital use. These revisions shift pediatric resuscitation toward physiology-guided, resource-stratified, and neuroprotective care.
Yunhee Oh, Youdong Sohn, Mi Jin Lee, Sang-Hoon Na, Jundong Moon, Heeje Yun, Hoon Jung, Chang Hee Lee, Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Gyuhong Shim, Young Hwa Jung, Chun Song Youn, Jisook Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S169-S184. Published online May 31, 2026
The 2025 Korean education and system implementation guidelines were updated using a structured evidence evaluation process and recent systematic reviews. The guidelines present a comprehensive update that aims to bridge the gap between educational theory and clinical performance and emphasize the transition toward high-fidelity, field-based training environments through the implementation of in situ simulation and rapid cycle deliberate practice to foster automaticity in high-quality cardiopulmonary resuscitation (CPR) and team coordination. The integration of real-time feedback devices during training and the adoption of structured “hot” and “cold” debriefing to maximize learning outcomes are critical shifts in this update. Furthermore, these guidelines enhance teamwork competency by recommending the integration of a dedicated CPR coach within the hospital code team. Despite acknowledging the potential of digital health, a cautious approach toward gamified and blended learning is maintained. The guidelines prioritize face-to-face instruction to ensure psychomotor proficiency. From a policy perspective, the 2025 update removes the prehospital termination of resuscitation criteria in alignment with domestic legal constraints and social consensus. In addition to context-based training strategies within hospitals, we discussed the mandatory age for CPR training. We also added recommendations to address the “decoupling” between high automated external defibrillator awareness and low bystander utilization rates in the prehospital setting. In conclusion, the 2025 Korean guidelines emphasize repetitive, evidence-based educational methods and systematic policy refinements to enhance resuscitation quality and survival outcomes across clinical and community settings.
Yong Soo Jang, Gyu Chong Cho, Youngsuk Cho, Sun Gyoung Na, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Sung Phil Chung, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S18-S31. Published online May 31, 2026
The 2025 Korean basic life support guidelines are evidence-based treatment recommendations for basic cardiopulmonary resuscitation (CPR). The 2025 guidelines recommend that after checking the response of a patient suspected of cardiac arrest, call 119 (emergency medical services) immediately and request an automated external defibrillator (AED) before performing procedures to confirm cardiac arrest, such as checking breathing. There is currently insufficient evidence into the clinical effectiveness of dispatcher actively instructing individuals who report an emergency to retrieve and use an AED, but one observational study reported an increase in some survival rates. The guidelines recommend that lay rescuers and emergency medical personnel who have been trained in and are willing to perform artificial ventilation should apply standard CPR including artificial ventilation, and that lay rescuers who are not trained in or do not want to perform artificial ventilation should perform compression-only CPR. The guidelines emphasize high-quality CPR, including effective chest compressions and ventilation. The application of a rapid AED is continuously emphasized, and the anterolateral positioning method is recommended as a priority for ease of application. Healthcare workers are recommended to perform standard CPR with a compression to ventilation ratio of 30:2 for patients suspected of having a high-risk pathogen infection and to wear appropriate personal protective equipment, including a mask or respirator appropriate for the suspected pathogen, gloves, a gown, and eye protection.
Ju Sun Heo, Young Hwa Jung, Ai-Rhan Ellen Kim, Gyuhong Shim, Su Jin Cho, Jung Hyun Lee, Hyun-Joo Seol, Gi-Su Lee, Ah-Young Oh, Hye Jin Myung, Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S142-S168. Published online May 31, 2026
The 2025 Korean Guidelines for Cardiopulmonary Resuscitation provide updated, evidence-based recommendations to optimize the transition from intrauterine to extrauterine life. While approximately 85% of term newborns initiate spontaneous breathing independently, timely intervention is critical for those requiring assistance. Key updates in the 2025 guidelines emphasize umbilical cord management, recommending deferred cord clamping for at least 60 seconds in vigorous term and preterm infants (<37 weeks). When deferred cord clamping cannot be performed, intact umbilical cord milking may be reasonable for nonvigorous term and late preterm infants (≥35 weeks’ gestation) and for preterm infants born between 28⁰⁄₇ and 36⁶⁄₇ weeks’ gestation who do not require immediate resuscitation. Respiratory support should be initiated within the "golden minute," starting with 21% oxygen for term and late preterm infants (≥35 weeks) and ≥30% for those <32 weeks’ gestation. The guidelines introduce video laryngoscopy as a preferred tool for less experienced providers and recognize supraglottic airways as a viable alternative to face masks or when intubation fails. For advanced resuscitation, a compression to ventilation ratio of 3:1 is maintained, with intravascular epinephrine (0.01–0.03 mg/kg) as the primary pharmacologic intervention. Notably, the use of sodium bicarbonate is no longer recommended. Discussions regarding the discontinuation of resuscitation are now suggested at approximately 20 minutes after birth if no response is observed. These guidelines aim to standardize clinical practice in Korea to improve neonatal survival and long-term neurodevelopmental outcomes.
Hyo Jin Bang, Chun Song Youn, Min Chul Kim, Yongwhan Lim, Young-Jae Cho, Bitna Chu, June-Sung Kim, Youn-Jung Kim, Byoung-Gil Yoon, Jin Park, Min-Ju Kang, Kyung Woon Jeung, Soo Hyun Kim, Je Hyeok Oh, Taegyun Kim, Sang Hoon Oh, Yong Soo Kim, Changshin Kang, Dong Hun Lee, Jin Hong Min, Hyo Joon Kim, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang, Sung Phil Chung
Clin Exp Emerg Med 2026;13(Suppl 1):S75-S100. Published online May 31, 2026
This guideline summarizes evidence-based post–cardiac arrest care following the return of spontaneous circulation (ROSC) in adults, incorporating updates from the 2025 Korean Guidelines for Cardiopulmonary Resuscitation and contemporary international evidence. Recommendations were informed by recent randomized controlled trials and systematic reviews, with an emphasis on patient-centered outcomes and practical clinical applications. After ROSC, early evaluation should focus on identifying reversible causes. A 12-lead electrocardiogram should be obtained promptly, with echocardiography and whole-body computed tomography performed when clinically indicated to assess cardiac function and detect noncardiac or occult etiologies. Respiratory management aims to minimize secondary brain injury by preventing hypoxemia and hyperoxemia. High inspired oxygen concentrations may be used initially, followed by titration to an appropriate oxygen saturation level once reliable measurements are available, and ventilation should target normocapnia. Hemodynamic management prioritizes adequate organ perfusion and prompt treatment of shock, including active correction of hypotension. Routine immediate coronary angiography is not recommended in patients without ST-segment elevation. However, urgent angiography is indicated in those with ST-segment elevation, cardiogenic shock, or a high likelihood of ongoing myocardial ischemia. In comatose survivors, temperature control is essential. The selected target temperature should be maintained for at least 24 hours, with active fever prevention for 36 to 72 hours. Additional intensive care unit management includes glucose control and seizure monitoring. Routine prophylactic antibiotics or anticonvulsants are not recommended. Neuroprognostication should use a multimodal approach after confounders, such as sedation and temperature management, are addressed, integrating clinical examination, electrophysiology, biomarkers, and neuroimaging to support individualized decision-making.
Tae-Youn Kim, Gyo Jin Ahn, Kyoung-Chul Cha, Dong-Hyeok Kim, Youdong Sohn, Young Song, Gyuhong Shim, Do Kyun Kim, Yunhee Oh, Jin Wi, Chun Song Youn, Myung-Lyeol Lee, Mi Jin Lee, Byung Kook Lee, Byung Heon Lee, Jisook Lee, Chang Hee Lee, Hannah Lee, Youngbin Jang, Yong Soo Jang, Young Hwa Jung, Woo Jin Jung, Sung Phil Chung, Gyu Chong Cho, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S61-S74. Published online May 31, 2026
The 2025 update of the Korean guidelines for cardiac arrest under special circumstances incorporates new evidence and expert consensus to clarify when clinicians should modify standard resuscitation algorithms. For cardiac arrest caused by acute hyperkalemia, the guidelines suggest administering intravenous insulin with glucose; however, current evidence remains insufficient to recommend for or against routine use of sodium bicarbonate or calcium. In suspected pulmonary embolism–related cardiac arrest, thrombolytic therapy may be considered. In confirmed cases, thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy may be appropriate, despite very low certainty of evidence. For opioid-related cardiac arrest, current evidence does not support the routine administration of naloxone in addition to standard advanced life support; however, naloxone may be administered when it is unclear whether the patient is in true cardiac arrest. The guidelines also emphasize managing cardiac arrest in the prone position. If the patient is intubated and immediate repositioning is unsafe or impractical, prone cardiopulmonary resuscitation and defibrillation may be attempted using invasive arterial pressure or end-tidal carbon dioxide monitoring to guide the timing of repositioning. Immediate supination is strongly recommended for non-intubated patients. Additional updates address drowning, severe hypothermia, pregnancy, anaphylaxis, and cardiac arrest during interventional procedures, underscoring the importance of early correction of reversible causes, appropriate airway strategies, and timely consideration of extracorporeal life support in selected cases. Overall, the 2025 recommendations highlight cautious, etiology-directed interventions and explicitly grade recommendation strength and certainty to support context-sensitive clinical decision-making in high-risk and resource-variable settings.
Tae-Youn Kim, Gyo Jin Ahn, Kyoung-Chul Cha, Dong-Hyeok Kim, Youdong Sohn, Young Song, Gyuhong Shim, Do Kyun Kim, Yunhee Oh, Jin Wi, Chun Song Youn, Myung-Lyeol Lee, Mi Jin Lee, Byung Kook Lee, Byung Heon Lee, Jisook Lee, Chang Hee Lee, Hannah Lee, Youngbin Jang, Yong Soo Jang, Young Hwa Jung, Woo Jin Jung, Sung Phil Chung, Gyu Chong Cho, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S32-S60. Published online May 31, 2026
The 2025 Korean advanced life support guidelines were updated using a structured evidence evaluation process informed by recent randomized controlled trials and systematic reviews. The guideline development group prioritized patient-important outcomes and assessed the certainty of the evidence to formulate graded recommendations. For drug administration during adult cardiac arrest, intravenous access is the preferred initial route, with intraosseous access recommended when intravenous access cannot be rapidly established. Epinephrine remains the recommended vasopressor. Routine administration of vasopressin, either alone or in combination with corticosteroids, is not recommended for in-hospital or out-of-hospital cardiac arrest. In the absence of specific indications, the routine use of buffering agents and calcium is discouraged owing to insufficient evidence of their benefits and potential harm. Defibrillation recommendations were refined based on emerging evidence. In adults with refractory ventricular fibrillation or pulseless ventricular tachycardia after multiple unsuccessful defibrillation attempts, vector change or double sequential defibrillation may be considered in selected settings when performed by experienced teams with appropriate equipment. Airway management guidelines recommend cricothyroidotomy as a rescue technique when conventional airway management strategies fail. For patients receiving cardiopulmonary resuscitation while on mechanical ventilation, specific ventilator settings during chest compressions are recommended to optimize ventilation and minimize interference with high-quality cardiopulmonary resuscitation. The guidelines also address cardiopulmonary resuscitation–induced consciousness, allowing the cautious use of sedatives and/or analgesic agents when awareness interferes with resuscitation quality or safety. Overall, the guidelines emphasize evidence-based practice and individualized clinical decision-making.
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Serial Ultrasound-Guided Carotid Artery Compression During Chest Compressions for Assessing Circulatory Status: A Prospective Pilot Diagnostic Study Seung Jin Maeng, Hee Yoon, Ik Joon Jo, Sejin Heo, Hansol Chang, Gun Tak Lee, Jong Eun Park, Taerim Kim, Se Uk Lee, Sung Yeon Hwang, Jihyeon Kim, Min Ji Kim Diagnostics.2026; 16(18): 2956. CrossRef
Seon Hee Woo, Chang Hee Lee, Mi Yeon Kim, Yongin Kim, Chang Je Park, Myung-Lyeol Lee, Taehun Lee, Kyeongmin Jang, Jun-Ho Jung, Hyun-Kyung Ji, Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S185-S194. Published online May 29, 2026
The 2025 Korean Guidelines for Cardiopulmonary Resuscitation include a first aid section developed through a systematic review and evidence appraisal. The revision aimed to strengthen prehospital first aid response capacity while reflecting the Korean healthcare system, field feasibility, and relevant legal and institutional contexts. The guidelines provide evidence-based recommendations for seven priority emergencies: adult chest pain suggestive of myocardial infarction, suspected acute ischemic stroke, asthma-related dyspnea, anaphylaxis, seizures, shock, and syncope. Core principles emphasize early recognition, prompt activation of emergency medical services, minimizing delays to definitive care, and safe condition-specific interventions. Key recommendations include assisting with patient-prescribed medications when appropriate (e.g., nitroglycerin, inhaled bronchodilators, and epinephrine autoinjectors), using structured stroke screening tools, preventing aspiration through proper positioning and withholding oral intake in patients at risk of dysphagia, administering oxygen only for hypoxemia, and initiating cardiopulmonary resuscitation in patients who are unconscious and not breathing normally. Seizure management focuses on safety and emergency medical services activation criteria, while care for shock and syncope emphasizes patient positioning and post-event assessment. These recommendations provide practical, evidence-based guidance for improving patient safety and outcomes in prehospital settings.
Sung Oh Hwang, Kyoung-Chul Cha, Woo Jin Jung, Young-Il Roh, Gyo Jin Ahn, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Ju Sun Heo, Sung Phil Chung
Clin Exp Emerg Med 2026;13(Suppl 1):S10-S17. Published online May 29, 2026
In Korea, more than 30,000 out-of-hospital cardiac arrests (OHCAs) occur each year, and the survival rate remains below 10%. Because OHCA is difficult to predict and typically occurs outside medical facilities, effective management requires not only healthcare professionals but also laypersons, including bystanders and first responders. Survival depends on an uninterrupted and efficient sequence of time-critical actions: early recognition of cardiac arrest and activation of emergency services; prompt bystander cardiopulmonary resuscitation (CPR); use of an automated external defibrillator (AED) for shockable rhythms; on-scene and in-hospital advanced life support with comprehensive post–cardiac arrest care; and systematic assessment of neurologic and functional outcomes followed by rehabilitation and recovery. The chain of survival describes these essential steps required to maximize survival after cardiac arrest and comprises five links: (1) early recognition and call for help; (2) immediate bystander CPR; (3) early defibrillation with an AED; (4) advanced life support and post–cardiac arrest care; and (5) rehabilitation and recovery for survivors. The cardiac arrest survival environment represents a societal infrastructure that sustains and optimizes both medical and nonmedical factors across prevention, treatment, and rehabilitation to reduce mortality. Establishing such an environment requires each community to develop integrated medical systems for prevention, treatment, rehabilitation, and recovery, alongside nonmedical strategies, including public awareness initiatives, widespread CPR education and bystander participation, AED dissemination, and coordinated community responsiveness of the emergency medical system.
Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang
Clin Exp Emerg Med 2026;13(Suppl 1):S1-S9. Published online May 21, 2026
In response to the expanding body of research on cardiopulmonary resuscitation (CPR) and updates from the International Liaison Committee on Resuscitation, the 2020 Korean CPR guidelines have been revised. This article presents the development process and summarizes the major updates in the 2025 Korean CPR guidelines. Seven task forces were established, with members nominated by professional societies involved in CPR. Each task force formulated key clinical questions and conducted systematic evidence reviews using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. The 2025 CPR guidelines were finalized on the basis of the reviewed evidence and consensus discussions. The major updates are as follows: (1) addition of rehabilitation and recovery to the chain of survival; (2) inclusion of guidance for dispatchers on the use of automated external defibrillators; (3) recommendation that trained rescuers provide rescue breaths in cases of drowning-related cardiac arrest; (4) suggestion of double sequential defibrillation or vector-change defibrillation for refractory ventricular fibrillation; (5) revision of the target temperature range for post-resuscitation temperature management from 32–36 to 33–37.5 °C; (6) recommendation of public access defibrillation for children aged ≥1 year; (7) suggestion to use supraglottic airway devices and video laryngoscopy in neonatal resuscitation; (8) recommendation for the use of feedback devices in CPR training; and (9) addition of a first aid section addressing cardiac arrest–related emergencies. These guidelines reflect the most current evidence, and their implementation and dissemination are expected to improve survival after cardiac arrest.
Young-Min Kim, Chan Woong Kim, Kyung Hye Park, Hyo Joon Kim, Kyung Jun Song, Sung Phil Chung, Dong Ryul Ko, Tae Han Kim, on behalf of KSEM Quality Improvement in Residency Training Committee
Clin Exp Emerg Med 2026;13(2):227-235. Published online April 8, 2026
Daun Jeong, Minyoung Choi, Seung Jin Maeng, Hanbeom Yoon, Jong Eun Park, Gun Tak Lee, Sung Yeon Hwang, Tae Gun Shin, Sung Phil Chung, Tae Ho Lim, on behalf of the Korean Shock Society
In Press, Received October 15, 2025 Accepted December 29, 2025 Available online January 14, 2026
Objective Sepsis remains a major clinical challenge because of its complex, heterogeneous, and multidimensional clustering patterns. This study aimed to investigate the association between vasopressor administration and machine learning–derived clusters based on initial vital signs and lactate measurements obtained in emergency department (ED) and intensive care unit (ICU) settings.
Methods A retrospective cohort analysis was performed using data from the Korean Shock Society Septic Shock (KOSS) Registry (septic shock in the ED) and the Marketplace for Medical Information in Intensive Care (MIMIC)-IV database (ICU patients with suspected infection). To derive clusters, k-means clustering was applied to six initial vital signs and serum lactate measurements. The primary outcome was vasopressor administration. Secondary outcomes included second vasopressor administration and 28-day mortality.
Results A total of 17,500 patients were included in the analysis (KOSS cohort, n=7,130; MIMIC-IV cohort, n=10,370). K-means clustering identified three distinct clusters in each cohort. In the KOSS cohort, Cluster 3 was characterized by the lowest mean arterial pressure (MAP) (62 mmHg [IQR, 53–71]) and the highest diastolic shock index (DSI) (2.6 [2.3–3.0]). This cluster was associated with the highest rates of vasopressor administration (93.9%), second vasopressor administration (33.5%), and 28-day mortality (25.3%) (all p<0.001). Comparable physiological and clinical patterns were observed in the MIMIC-IV cohort, in which Cluster 3 likewise demonstrated the lowest MAP (68 mmHg [60–76]) and highest DSI (2.0 [1.8–2.3]). This group similarly exhibited the poorest outcomes, including vasopressor administration (41.0%), second vasopressor administration (16.7%), and 28-day mortality (29.0%).
Conclusion Machine learning–derived clusters based on initial vital signs and serum lactate levels demonstrated different patterns of vasopressor use and mortality. The clinical utility of this approach for guiding timely or targeted vasopressor therapy requires prospective validation.
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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Gil Joon Suh, Tae Gun Shin, Woon Yong Kwon, Kyuseok Kim, You Hwan Jo, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, for the Korean Shock Society investigators
Clin Exp Emerg Med 2023;10(3):255-264. Published online July 13, 2023
Although the Surviving Sepsis Campaign guidelines provide standardized and generalized guidance, they are less individualized. This review focuses on recent updates in the hemodynamic management of septic shock. Monitoring and intervention for septic shock should be personalized according to the phase of shock. In the salvage phase, fluid resuscitation and vasopressors should be given to provide life-saving tissue perfusion. During the optimization phase, tissue perfusion should be optimized. In the stabilization and de-escalation phases, minimal fluid infusion and safe fluid removal should be performed, respectively, while preserving organ perfusion. There is controversy surrounding the use of restrictive versus liberal fluid strategies after initial resuscitation. Fluid administration after initial resuscitation should depend upon the patient’s fluid responsiveness and requires individualized management. A number of dynamic tests have been proposed to monitor fluid responsiveness, which can help clinicians decide whether to give fluid or not. The optimal timing for the initiation of vasopressor agents is unknown. Recent data suggest that early vasopressor initiation should be considered. Inotropes can be considered in patients with decreased cardiac contractility associated with impaired tissue perfusion despite adequate volume status and arterial blood pressure. Venoarterial extracorporeal membrane oxygenation should be considered for refractory septic shock with severe cardiac systolic dysfunction.
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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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Tae Gun Shin, Sung Yeon Hwang, Gu Hyun Kang, Won Young Kim, Seung Mok Ryoo, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Sung-Hyuk Choi, Young Hoon Yoon, Woon Yong Kwon, Tae Ho Lim, Kap Su Han, Han Sung Choi, Gil Joon Suh
Clin Exp Emerg Med 2017;4(3):146-153. Published online September 30, 2017
Objective To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.
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Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients Jikyoung Shin, Sung Yeon Hwang, Ik Joon Jo, Won Young Kim, Seung Mok Ryoo, Gu Hyun Kang, Kyuseok Kim, You Hwan Jo, Sung Phil Chung, Young Seon Joo, Jin Ho Beom, Young Hoon Yoon, Kap Su Han, Tae Ho Lim, Han Sung Choi, Woon Yong Kwon, Gil Joon Suh, Sung-Hyu Shock.2018; 50(5): 545. CrossRef
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Objective During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea.
Methods Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar.
Results A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85.
Conclusion This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low.
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2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 6. Pediatric basic life support Jisook Lee, Do Kyun Kim, Eun Kyeong Kang, Jin-Tae Kim, Jae Yoon Na, Bobae Park, Seok Ran Yeom, Joo Suk Oh, Won Kyoung Jhang, Soo In Jeong, Jin Hee Jung, Yu Hyeon Choi, Jea Yeon Choi, June Dong Park, Sung Oh Hwang Clinical and Experimental Emergency Medicine.2021; 8(S): S65. CrossRef
Functional Status Change Among Children With Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Pediatric Cardiac ICU: A Single Institution Report* Asaad G. Beshish, Mathew R. Baginski, Thomas J. Johnson, Barry K. Deatrick, Ryan P. Barbaro, Gabe E. Owens Pediatric Critical Care Medicine.2018; 19(7): 665. CrossRef
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