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심폐소생술 중 하행 대동맥 내 압력 차이 발생의 혈역학적 의의
황성오,박해상,이서영,안희철,김현,이강현,유병수,이승환,윤정한,최경훈 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3
Purpose: There have been no reports concerning the role of the aorta in explaining why blood flow is low below the diaphragm and a pressure gradient is present between central and peripheral arteries during standard cardiopul-money resuscitation (CPR). The aim of this study was to assess the morphologic changes of the descending thoracic aorta and its effect on aortic pressure during precordial chest compression in cardiac arrest victims. Methods: Twelve patients with non-traumatic cardiac arrest (8 males, mean age: 58 years) were enrolled. Transesophageal echocardiography was performed to verify the morphologic changes of the descending thoracic aorta during standard manual CPR. The pressure gradient across the maximally compressed site of the aorta was measured by pullback tracing using a pigtail catheter. Results: Focal compression and deformation of the descending thoracic aorta was uniformly observed in all patients during compression systole. The mean systolic blood pressure of the descending thoracic aorta proximal and distal to the maximally compressed site was 135±36 mmHg and 115±21 mmHg, respectively. The mean systolic pressure gradient across the maximally compressed site was 20.5±17.7 mmHg. During compression systole, the pressure gradient between the right atrium and the descending thoracic aorta proximal to the maximally compressed site during compression systole was 49±12 mmHg while pressure gradient between the right atrium and the descending thoracic aorta distal to the maximally compressed site was 29±8 mmHg. Conclusion: We found that the descending thoracic aorta was focally compressed and that a pressure gradient developed across the maximally compressed site during compression systole. This may contribute to limiting blood flow to the subdiaphragmatic region during standard manual CPR in humans.
황성오 대한응급의학회 2012 대한응급의학회지 Vol.23 No.2
Resuscitation medicine, which is a relatively young field of clinical medicine, has emerged as an endeavor to resuscitate victims suffering sudden death. Cardiopulmonary resuscitation (CPR) is utilized in order to treat a transient,reversible, sudden unexpected death. Currently, it is expected that millions of lay people worldwide learn CPR and millions of patients suffering sudden cardiac arrest receive CPR. Even though the history of CPR includes folklore related to various attempts that have been made to save lives, modern CPR based on clinical research and evidence has been introduced and developed over the last several decades. Researchers and organizations have contributed to the development of resuscitation skills by establishing CPR guidelines and disseminating this knowledge to lay people. Despite recent advances in CPR technique,sudden death remains a major health issue in developed countries and the survival rate resulting from out-of-hospital cardiac arrest remains low. This review provides insight into the progression of resuscitation medicine by evaluating the history of CPR.
Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation
황성오,정우진,노영일,차경철 대한응급의학회 2022 Clinical and Experimental Emergency Medicine Vol.9 No.4
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.
황성오,이서영,김현,이강현,장용수,최한주,유병수,이승환,윤정한,최경훈,조준휘 대한응급의학회 2003 대한응급의학회지 Vol.14 No.2
Purpose: In the mechanism of forward blood flow during cardopulmonary resuscitation (CPR) in humans, the role of the left ventricle remains to be investigated. The aim of this study was to assess the role of the left ventricle in generating forward blood flow in humans during CPR by performing contrast echocardiography. Methods: Ten patients with non-traumatic cardiac arrest were enrolled. During CPR, a pigtail catheter was introduced to the left ventricle and a central venous catheter was introduced to the right atrium under transesophageal echocardiographic guidance. Ten (10) ml of agitated saline was injected into the left ventricle to perform contrast echocardiography during CPR. The direction of contrast flow and the presence of mitral regurgitation were assessed with a 135˚ longitudinal view. Pressures were traced in the left ventricle, the aorta, and the right atrium. Results: Forward flow toward the aorta and mitral regurgitation (MR) were visualized during compression systole on left ventricular contrast echocardiography in all patients: grade I in 1, grade 11 in 3, grade III in 4, and grade IV in 2 patients. There was no differences in the clearing times (29±24 vs 22±12 sec) or he numbers of chest compressions (53±32 vs 48±28) of the contrast from the left ventricle, the systolic left ventricular pressures (96±13 mmHg vs 126±48mmHg), the systolic aortic pressures (90±11 mmHg vs 116±58 mmHg), the diastolic aortic pressures (33±13 mmHg vs 32±9 mmHg), the coronary perfusion pressures (23±12 mmHg vs 26±8 mmHg), and the end tidal carbon dioxide tensions (13±12 mmHg vs 9±3 mmHg) between the mild MR group (MR grades I and 11) and the severe MR group (MR grades III and IV). The left ventricular ejection fraction was higher in the severe MR group than in the mild MR group. Conclusion: Mitral regurgitation on left ventricular contrast echocardiography during compression systole suggests that cardiac pumping is the dominant mechanism in generating forward blood flow during standard CPR in humans.