병원전 심정지환자의 심폐소생술 결과

황성오 ( Sung Oh Hwang ),안무업 ( Moo Eob Ahn ),김영식 ( Young Sik Kim ),임경수 ( Kyung Soo Lim ),윤정한 ( Jung Han Yun ),최경훈 ( Kyung Hoon Choe ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1

Background: In Korea, the victims with prehospital cardiac arrest have little chance to survive, because bystanders do not know how they resuscitate the victims and emergency medical system is incomplete. And there has been no report about resuscitation attempt and survival rate of the prehospital cardiac arrest in Korea. Study Objectives : This study was undertaken to determine the overall survival rate and the factors influencing to survival when cardiopulmonary resuscitation was attempted to the victims of prehospital cardiac arrest. Study Subjects . We studied prospectively 31 consecutive victims with prehospital cardiac arrest. Results . Cardiac arrest were caused by trauma(52 %), cardiac diseases(26%) and non-cardiac medical diseases(22%). Spontaneous circulation was restored (ROSC) in 12 victims(39 %). And patient with non-traumatic cardiac arrest were more likely to restore spontaneous circulation(73%) than were patients with traumatic cardiac arrest(0.7%, P<0.05). Patients having ventricular fibrillation on ECG monitoring were more likely to restore spontaneous circulation(64.3% ) than were other patients(13%, P<0.05). Mean circulatory arrest time was 19.1+-9.9 minutes and it was shorter in patients with ROSC(13.8+-5.3) than patients without ROSC(22.4+-10.7, P<0.05). Cutting point between two group was 19 minutes. Among 12 patients who restored spontaneous circulation, 6 patients had only transient ROSC, 5 patients died from brain death(two moribund discharge was included) and only 1 patient discharged alive without neurologic complication.Conclusion . Under the current setting of emergency medical system in Korea, our data revealed improved rate of ROSC in victims of prehospital cardiac arrest, when circulatory arrest time was short(<19 minutes) and ECG rhythm on hospital arrival was ventricular fibrillation from non-traumatic causes. And considering the feasibility to survive, cardiopulmonary resuscitation should be attempted to the victims with prehospital cardiac arrest.

병원전 심정지환자의 심폐소생술 결과

황성오,안무업,김영식,임경수,윤정한,최경훈 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

Background : In Korea, the victims with prehospital cardiac arrest have little chance to survive, because bystanders do not know how they resuscitate the victims and emergency medical system is incomplete. And three has been no report about resuscitation attempt and survival rate of the prehospital cardiac arrest in Korea. Study Objectives : This study was undertaken to determine the over survival rate and the factors influencing to survival when cardiopulmonary resuscitation attempt to the victims of prehosptal cardiac arrest. Study Subjects : We studied prospectively 31 consecutive victims with prehospital cardiac arrest. Results : Cardiac arrest were caused by trauma(52%), cardiac diseases(26%) and non-cardiac medical diseases(22%). Spontaneous circulation was restored (ROSC) in 12 victims(39%). And patient with non-traumatic cardiac arrest were likely to restore spontaneous circulation(73%) than were patients with traumatic cardiac arrest(0.7%, P<0.05). Patients having ventricular fibrillation on ECG monitoring were more likely to restore spontaneous circulation(64.3%) than were other patients (13%, P<0.05). Mean circulatory arrest time was 19.1±9.9 minutes and it was shorter in patients with ROSC(13.8±5.3) than patients without ROSC(22.4±10.7, P<0.05). Cutting point between two groups was 19 minutes. Among 12 patients who restored spontaneous circulation, 6 patients had only transient ROSC, 5 patients died from brain death(two moribund discharge was included) and only 1 patient discharged alive without neurologist complication. Conclusion : Under the current setting of emergency medical system in Korea, our data revealed improved rate of ROSC in victims of prehospital cardiac arrest when circulatory arrest time was short(<19 minutes) and ECG rhythm on hospital arrival was ventricular fibrillation form non-traumatic causes. And considering the feasibility to survive, cardiopulmonary resuscitation should be attempted to the victims with prehospital cardiac arrest.

병원외 심정지 후 집중치료실에 입원한 환자의 예후: 심장성과 비심장성 심정지 비교

강환석,이훈재,조재화,백진휘,김지혜,김준식,한승백 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.4

Background: To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA). Methods: We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients’ clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups. Results: Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 ± 15.1 years of age in the cardiac group and 61.9± 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 ± 3.8min in the cardiac group and 6.0 ± 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 ± 202.2 min in the cardiac group and 327.7 ± 264.1min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group. Conclusions: The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.

1개 3차 병원의 응급의료센터에 내원한 병원전 심정지 환자에서 119 구급대에 의한 자동제세동기 사용 실태 및 효과

정시영,배현아,어은경 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.1

Objective:The objective of this study was to evaluate the use and the effect of an automated external defibrillator(AEDs) by emergency medical technicians(EMTs) in prehospital cardiac arrest. Methods:After application of exclusion criteria, 293 patients who transported to emergency center of our hospital after cardiac arrest in consecutive 36 months from Jan, 1, 2003 to Dec, 31, 2005 were included in this study. We reviewed the 119 rescue service records and the hospital chart of the patients including, demographic data, types of eletrocardiogram(ECG) rhythms, witness of arrest, cause of arrest, basic life support(BLS), use of AED, transport time, time intervals from cardiac arrest to the advanced cardiac life support(ACLS), and return of spontaneous circulation(ROSC). Results:The mean age was 56.1±21.8 years with 185 males and 108 females. Time intervals from cardiac arrest to ACLS were 27.2±18.1 minutes and 259 patients(88.4%) were transported by EMTs. AEDs were used by EMTs in 119 patients(45.9%) and 20 patients(8.6%) were defibrillated. After ACLS, 17 patients experienced ROSC and 2 patients survived until discharge. There were no statistical differences in the ROSC rate between the patients transported by EMTs and those by non-EMTs(p=0.067), between the group of AED used and of no-AED used(p=0.116). Conclusion:The use of AEDs by EMTs was still low and the effect of AEDs and BLS by EMTs were not significant in ROSC.

이형협심증(Variant Angina)에 의한 급성심장사(Sudden Cardiac Death) 환자의 성공적인 소생

윤정한,황성오,안무업,임경수,박금수,김영식,최경훈 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

In our contry, prehospital cardiac arrest means death because layman can not perform cardiopulmonary resuscitation(CPR) and there is no emergency medical technician and transport system for treating victims with prehospital cardiac arrest. And many of physicians usually do not try to perform CPR because they used to treat victims with prehospital cardiac arrest as the dead, so-called “death on arrival(DOA)”. Recently, we experienced a 52 year-old mean who sustained from prehospital cardiac arrest induced presumably by variant angina initiated about 20 minutes before hospital arrival. On hospital arrival, he had a fine ventricular fibrillation, but spontaneous circulation was restored (ROSC) at 14 minutes after CPR strated. At 2 hours after ROSC, marked elevation of ST segment appeared and shortly, complete AV block developed. After sublingual and intravenous administration of nitroglycerin, ECG changes disappeared. Diffuse spasm of coronary artery with ST segment elevation was documented during coronary angiogram which showed no atherosclerotic change of coronary artery. He recovered good neurologic function (cerebral performance categories 1) and discharged on his foot.

119 구급대원의 비외상성 심정지 환자의 병원전 처치실태 및 전문 처치율 향상을 위한 개선 방안

이경열,윤성우 한국화재소방학회 2011 한국화재소방학회논문지 Vol.25 No.5

This study aimed at evaluating and developing 119 emergency medical technicians' prehospital care for non-traumatic cardiac arrest. Total 322 EMT in Chungnam province and Daejeon city filled out the self-administered questionnaire. The data were analyzed by SPSS 18.0 for descriptive statistics. Among the 322 EMT, 309 (97 %) and 169(53%) always or almost performed CPR and AED for nontraumatic cardiac arrest patient, respectively. Among the advanced EMT and nurse, IV were sometimes or not performed at 94.7 % and medication including epinephrine which commonly used for survival of cardiac arrest were treated just at 9.3 % (14 person). The reason they did not perform each procedure for airway management, AED or IV was lack of manpower, limit of time or joggle of ambulance and legal restrictions. In conclusion, to increase survival rate of non-traumatic cardiac arrest in out-of-hospital, it is necessary to increase manpower, legal protection of EMS, establishment of standard operating procedure, practice for improvement technique and use of medication for ACLS. 병원 밖에서 발생한 비외상성 심정지 환자에 대한 119 구급대원의 처치 현황과 개선방안을 연구하기위해 대전충남에 근무하는 119 구급대원 322명에게 설문을 실시하였다. 119 구급대원들은 병원전 비외상성 심정지 환자에 대해 CPR은 96.9 %(309명), AED는 53 %(169명)에서 거의 매번 또는 매번 실시한다고 하였다. 1급 응급구조사와 간호사의 경우 IV는 94.7 %(143명)에서 가끔 실시하거나 실시한 적이 없다고 하였고 약물처치의 경우도 90.7 %(136명)에서 실시한 적이 없다고 응답하였다. AED, 기도확보 및 IV 를 실시하지 못했던 이유에 대해서는 구급인원이 부족하고, 시간이 부족하며, 흔들리는 구급차 때문이라는의견이 많았다. 임상실습이나 병원실습의 경험이 있는 119 구급대원이 IV나 약물처치를 더 자주 실시하는것으로 나타났다. 결론적으로, 심정지 환자의 소생률을 향상시키기 위해서는 구급차에 탑승하는 구급인원을 보강하고, 일반인들도 할 수 있는 기본심폐소생술 처치에서 더 나아가 전문심장소생술을 실시할 수 있도록 1급 응급구조사에게 에피네프린의 사용을 허가하며, 임상실기 교육을 강화하고 구급대원을 법적으로보호할 수 있는 방안이 마련되어야 할 것이다.

병원전 외상성 심정지 환자의 심폐소생술 결과: 강원도를 중심으로

임창우,이태헌,옥택근,김오현,정상구,김윤성,마범석,안무업,서정열,김동원 대한응급의학회 2020 대한응급의학회지 Vol.31 No.2

Objective: This aim examined the outcomes of resuscitation and the clinical characteristics of patients with pre-hospital traumatic cardiac arrests (TCA). Methods: The charts of patients with pre-hospital TCA who visited the various emergency department (ED) in Gangwondo from January 2013 to December 2017 were reviewed retrospectively. Results: TCA patients comprised 0.3% of patients transferred by 119. A total of 367 patients were enrolled in the study. Traffic accidents were the leading cause of the arrest. The initial field and ED rhythm were mostly asystole (field, 79.6%; ED, 82.3%). It took 11.24±9.95 minutes from the call to the field. From the field to ED, it took 22.87±15.37 minutes. The total CPR time before ED arrival was 21.62±15.29 minutes. The causes of TCA were brain injury (35.7%), hypovolemic shock (29.2%), and severe lung injury (16.3%). Seventy TCA patients experienced at least one return of spontaneous circulation (ROSC). Twenty-six patients (7.14%) were admitted to the ward, and their average injury severity score was 38.96. Eight patients expired before 12 hours after transient ROSC. Four more patients expired before 24 hours. Four patients were discharged alive among patients who lived for more than 24 hours. Conclusion: In this study, 1.5% of patients were discharged alive. The possibility of ROSC was higher as the time to ED, and the cardiopulmonary resuscitation time of 119 was shorter. Pulseless electrical activity rather than asystole tends to promote ROSC. The survival rate increased when ROSC occurred before arriving at the ED.

심정지후 발생한 중증 저산소성 허혈성 뇌병증환자(Hypoxic Ischemic Encephalopathy)의 성공적인 소생

박규남,최세민,이운정,한주랑,박승현,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Prediction of individual outcome after cardiopulmonary resuscitation of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case that the patient got complete neurologic recovery after the 123th day from cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia for mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration. but spontaneous circulation was restored at 10 minutes after CPR started. We started cerebral oriented resuscitation including mild ;hypothermia(34℃), hemodilution, calcium channel blocker infusion. On hospital day 4, patients glasgow coma scale(GCS) was 4. On hospital day 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2W1, involving the bilateral basal ganglia. After contrast administration, marked enhancement can be seen at the lesion site. Patients glasgow coma scale(GCS) increased step by to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day, 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination (MMSE) score(26). Long-term Follow up revealed that all neurolgic functional abnormality including hand, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.

2년간 응급실에 내원한 비외상성 병원전 심정지 환자에 대한 임상적 분석 : 광주ㆍ전남 지역을 중심으로

윤한덕,박주경,민용일 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Background : Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. Methods : After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan, 1,1994 to Dec, 31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories, t-test or chi-square analysis was used. Results : 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35±27 vs 37±24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. Conclusion : We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).

제세동이 가능한 심정지 환자를 119구급상황관리센터 상황요원이예측한 지령 분석

정은경,정지연 한국화재소방학회 2013 한국화재소방학회논문지 Vol.27 No.6

This study analyzed the emergency activity daily reports and emergency instruction sheets of the research subjects and proceeded with the shockable cardiac arrest cases transported to 119 emergency units for two years before the hospital from January 1, 2010 through December 31, 2011. The most frequently predicted instruction by the dispatchers at the 119Emergency Situation Control Center was 74 cases of fainting (33.3%). Among varied types of predicted instructions, 112cases (50.5%) like fainting, chest pain, general prostration and others were not able to be predicted while predictable instructions involved with cardiac arrest such as consciousness disorders, difficult breathing, cardiac attacks and convulsion were 110 cases (49.5%). In such cases, success rates of cardiopulmonary resuscitation (CPR) trials by eyewitnesses at predictable instructions involved with cardiac arrests were significantly higher. As mentioned, situation agents must categorize types of cardiac arrests accurately by posing questions over assessments regarding patients’ consciousness and respiration in detail. The patients categorized by such methods must guide eyewitnesses to be able to do CPR. Moreover, not only emergency medical technicians who receive predictable instructions involved with cardiac arrests given by dispatchers (49.5%) but also filed emergency medical technicians who are not able to reach a precise conclusion to non-cardiac arrests on unpredictable instructions on cardiac arrests (50.5%) must prepare for situations related to cardiac arrests before being dispatched to the field. 본 연구는 2010년 1월 1일부터 2011년 12월 31일까지 2년간 119구급대로 이송된 병원 전 제세동 가능한 심정지 환자를 대상으로 연구를 진행하였으며 연구대상자들의 구급활동일지와 구급지령서를 분석하였다. 119구급상황관리센터 상황요원(Dispatcher)이 가장 많이 예측한 지령은 실신으로 74건(33.3%)이었다. 다양하게 예측된 지령 중 실신, 흉통, 전신쇠약, 기타와 같은 지령은 심정지로 예측 불가능한 지령으로 112건(50.5%)을차지하였으며, 심정지로 예측 가능한 의식장애, 호흡곤란, 무호흡, 심정지, 경련과 같은 지령은 110건(49.5%)을 차지하였다. 이 때 심정지로 예측 가능한 지령에서 목격자의 심폐소생술이 유의하게 높았다. 이와 같이 상황요원은 환자의 의식평가와 호흡평가를 구체적으로 질문하여 심정지를 정확하게 분류해야하며, 이렇게 분류된 심정지 환자는 목격자가 심폐소생술을 할 수 있도록 지도해야 한다. 또한 상황요원에 의해 심정지로 예측 가능한 지령(49.5%)을받은 구급대원뿐만 아니라 심정지로 예측 불가능한 지령(50.5%)에서도심정지가 아니라고 정확하게 판단되지 않았다면 현장 구급대원은 심정지 상황에 대비하여 현장출동 준비를 해야 한다.