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.
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