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Postanoxic Seizure Was Not Related to Mortality and Neurologic Outcome in Postcardiac Arrest Syndrome: A Retrospective Cohort Study
946 rate of return of spontaneous circulation, and the secondary outcome was survival to discharge. Results: Among the 288 patients enrolled in the 15:2 (n = 84) and 30:2 (n = 204) phases, characteristics were similar, including mean age (63.0 vs. 65.0 years), sex ratio (male 63.1% vs. 60.7%), and presumptive cause of arrest - cardiac (48.8% vs. 53.6%); return of spontaneous circulation rate did differ overall (40.5% among patients in the 15:2 phase vs. 61.8% among those in 30:2; p < 0.05). Survival discharge did differ overall (8.3% among patients in the 15:2 phase vs. 19.7% among those in 30:2; p < 0.05). Conclusions: The survival outcome from OHCA patients was significantly improved after the implementation of the 30:2 chest compression-ventilation ratio into the pre-hospital and hospital field around our single tertiary ED. The influences by other possible improving factors such as bystander cardiopulmonary resuscitation, pre-hospital automated external defibrillators, presenting rhythms, and arrest time, will be analyzed and presented independent from this study.
, IMPLEMENTATION OF THERAPEUTIC HYPOTHERMIA AFTER PEDIATRIC OUT-OF-HOSPITAL CARDIAC ARREST IN ONE TERTIARY EMERGENCY CENTER. J. J. Kim, W. J. Kim, J. H. Jang, H. J. Yang, S. Y. Hyun, Emergency Department, Gachon University Gil Hospital, Incheon, KOREA. Objective: Cardiac arrest in infants and children is more rare than in adults, but critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proven through many studies, but there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-ofhospital cardiac arrest. Methods: Infants and children (ages 1–17 years old) admitted to our emergency intensive care units after return of spontaneous circulation after out-of-hospital cardiac arrest from January 2009 to June 2012 were included in this study. Basal patients’ characteristics and variables about therapeutic hypothermia were analyzed. Results: A total 42 patients after pediatric cardiac arrest visit our emergency center during the study period. Among these, 37 patients suffered out-of-hospital cardiac arrest: 12 patients were admitted to intensive care units and 9 patients received therapeutic hypothermia. Overall, survival discharge was 14.3% (6 of 42). Among admitted patients, 3 patients (33.3%) had a good Cerebral Performance Category. Two patients received endovascular cooling and 7 patients received surface cooling. Mean time from induction of therapeutic hypothermia to reaching the temperature with therapeutic range was 193.9 min. There were no critical adverse events during induction, maintenance, and rewarming period of therapeutic hypothermia. Conclusions: Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established to be used widely in pediatric intensive care units. Further larger studies are needed in pediatric therapeutic hypothermia.
Abstracts , POSTANOXIC SEIZURE WAS NOT RELATED TO MORTALITY AND NEUROLOGIC OUTCOME IN POSTCARDIAC ARREST SYNDROME: A RETROSPECTIVE COHORT STUDY. J. J. Kim, H. S. Lee, W. J. Kim, H. J. Yang, S. Y. Hyun, Emergency Department, Gachon University Gil Hospital, Icheon, KOREA. Objective: The aim of this study was to evaluate relevance of post-anoxic seizure with prognosis in out-of hospital cardiac arrest (OHCA) patients treated with therapeutic hypothermia (TH) and to research the prognostic role of portable electroencephalogram (EEG) in post-cardiac arrest syndrome (PCAS) patients with seizure. Methods: One hundred eighty OHCA patients admitted to our emergency intensive care units during July of 2008 and June of 2011, and 147 patients who had been treated with TH were included. Portable EEG had been taken 24 h after induction of TH and classified by an attending neurologist. As outcome variables, overall mortality and neurological outcome at 6 months after hospital discharge were evaluated. Good neurological outcome = Cerebral Performance Category (CPC) 1, 2; Poor neurological outcome = CPC 3–5. Results: Among 147 patients, 94 patients (63.9%) were male; mean age was 51 years. Eighty-three patients (56.5%) survived, and almost 30% (43/147) of patients had a good neurological outcome. Sixty-five patients (44.2%) had seizures, and among this group, 19 patients (29.2%) were discharged with good neurological outcome. There was no statistical relevance between seizure group and non-seizure group. With multiple logistic regression analysis, initial rhythm, Acute Physiology and Chronic Health Evaluation (APACHE) II score, time from basic life support to return of spontaneous circulation (odds ratio [OR] 2.169; 95% confidence interval [CI] 1.158–4.063, OR 1.107; 95% CI 1.064–1.152, OR 1.014; 95% CI 1.006–1.022, respectively) had statistical importance, but seizure group (OR 0.67, 95% CI 0.356–1.032, p = 0.065) had no statistical relevance with mortality. Factors associated with good neurological outcome were ventricular fibrillation/ventricular tachycardia initial rhythm (p = 0.005), cardiac cause of arrest (p = 0.001), high initial body temperature (p < 0.001), low APACHE II score (p = 0.010), and shorter time interval between arrest and basic life support (p = 0.005). Conclusions: In our study, postanoxic seizure group showed no statistical relevance with mortality and neurologic outcome. We should aggressively treat PCAS with seizure. Larger, prospective studies are needed to evaluate post-anoxic seizure activity in PCAS. , LUNG INJURY SCORE IN OUT-OF-HOSPITAL CARDIAC ARREST AFTER DROWNING. J. H. Park, S. P. Choi, J. H. Wee, K. N. Park, C. S. Youn, Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, KOREA. Objective: Hypoxic encephalopathy is the most common consequence of drowning patients, and respiratory involvement is also very common in these patients. Nevertheless, few data are available about the prediction capability of lung injury score in adult victims of drowning. Our goal was to study the value of lung injury score to predict neurologic
, IMPLEMENTATION OF THERAPEUTIC HYPOTHERMIA AFTER PEDIATRIC OUT-OF-HOSPITAL CARDIAC ARREST IN ONE TERTIARY EMERGENCY CENTER. J. J. Kim, W. J. Kim, J. H. Jang, H. J. Yang, S. Y. Hyun, Emergency Department, Gachon University Gil Hospital, Incheon, KOREA. Objective: Cardiac arrest in infants and children is more rare than in adults, but critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proven through many studies, but there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-ofhospital cardiac arrest. Methods: Infants and children (ages 1–17 years old) admitted to our emergency intensive care units after return of spontaneous circulation after out-of-hospital cardiac arrest from January 2009 to June 2012 were included in this study. Basal patients’ characteristics and variables about therapeutic hypothermia were analyzed. Results: A total 42 patients after pediatric cardiac arrest visit our emergency center during the study period. Among these, 37 patients suffered out-of-hospital cardiac arrest: 12 patients were admitted to intensive care units and 9 patients received therapeutic hypothermia. Overall, survival discharge was 14.3% (6 of 42). Among admitted patients, 3 patients (33.3%) had a good Cerebral Performance Category. Two patients received endovascular cooling and 7 patients received surface cooling. Mean time from induction of therapeutic hypothermia to reaching the temperature with therapeutic range was 193.9 min. There were no critical adverse events during induction, maintenance, and rewarming period of therapeutic hypothermia. Conclusions: Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established to be used widely in pediatric intensive care units. Further larger studies are needed in pediatric therapeutic hypothermia.
Abstracts , POSTANOXIC SEIZURE WAS NOT RELATED TO MORTALITY AND NEUROLOGIC OUTCOME IN POSTCARDIAC ARREST SYNDROME: A RETROSPECTIVE COHORT STUDY. J. J. Kim, H. S. Lee, W. J. Kim, H. J. Yang, S. Y. Hyun, Emergency Department, Gachon University Gil Hospital, Icheon, KOREA. Objective: The aim of this study was to evaluate relevance of post-anoxic seizure with prognosis in out-of hospital cardiac arrest (OHCA) patients treated with therapeutic hypothermia (TH) and to research the prognostic role of portable electroencephalogram (EEG) in post-cardiac arrest syndrome (PCAS) patients with seizure. Methods: One hundred eighty OHCA patients admitted to our emergency intensive care units during July of 2008 and June of 2011, and 147 patients who had been treated with TH were included. Portable EEG had been taken 24 h after induction of TH and classified by an attending neurologist. As outcome variables, overall mortality and neurological outcome at 6 months after hospital discharge were evaluated. Good neurological outcome = Cerebral Performance Category (CPC) 1, 2; Poor neurological outcome = CPC 3–5. Results: Among 147 patients, 94 patients (63.9%) were male; mean age was 51 years. Eighty-three patients (56.5%) survived, and almost 30% (43/147) of patients had a good neurological outcome. Sixty-five patients (44.2%) had seizures, and among this group, 19 patients (29.2%) were discharged with good neurological outcome. There was no statistical relevance between seizure group and non-seizure group. With multiple logistic regression analysis, initial rhythm, Acute Physiology and Chronic Health Evaluation (APACHE) II score, time from basic life support to return of spontaneous circulation (odds ratio [OR] 2.169; 95% confidence interval [CI] 1.158–4.063, OR 1.107; 95% CI 1.064–1.152, OR 1.014; 95% CI 1.006–1.022, respectively) had statistical importance, but seizure group (OR 0.67, 95% CI 0.356–1.032, p = 0.065) had no statistical relevance with mortality. Factors associated with good neurological outcome were ventricular fibrillation/ventricular tachycardia initial rhythm (p = 0.005), cardiac cause of arrest (p = 0.001), high initial body temperature (p < 0.001), low APACHE II score (p = 0.010), and shorter time interval between arrest and basic life support (p = 0.005). Conclusions: In our study, postanoxic seizure group showed no statistical relevance with mortality and neurologic outcome. We should aggressively treat PCAS with seizure. Larger, prospective studies are needed to evaluate post-anoxic seizure activity in PCAS. , LUNG INJURY SCORE IN OUT-OF-HOSPITAL CARDIAC ARREST AFTER DROWNING. J. H. Park, S. P. Choi, J. H. Wee, K. N. Park, C. S. Youn, Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, KOREA. Objective: Hypoxic encephalopathy is the most common consequence of drowning patients, and respiratory involvement is also very common in these patients. Nevertheless, few data are available about the prediction capability of lung injury score in adult victims of drowning. Our goal was to study the value of lung injury score to predict neurologic