Acute and Critical Care

Original Article

CPR/Resuscitation
Is two-dimensional echocardiography better than electrocardiography for predicting patient outcomes after cardiac arrest?: Dong Ki Kim, Yong Soo Cho, Joochan Kim, Byung Kook Lee, Dong Hun Lee, Eujene Jung, Jeong Mi Moon, Byeong Jo Chun; Acute Crit Care. 2021;36(1):37-45. Published online December 21, 2020; DOI: https://doi.org/10.4266/acc.2020.00773

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Background
Coronary artery stenosis increases hospital mortality and leads to poor neurological recovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannot fully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determine whether regional wall motion abnormality (RWMA), as observed by two-dimensional echocardiography (2DE), predicted patient survival outcomes with greater accuracy than did ST segment elevation (STE) on ECG in CA patients who underwent coronary angiography (CAG) after return of spontaneous circulation.
Methods
This was a retrospective observational study of adult patients with CA of presumed cardiac etiology who underwent CAG at a single tertiary care hospital. We investigated whether RWMA observed on 2DE predicted patient outcomes more accurately than did STE observed on ECG. The primary outcome was incidence of hospital mortality. The secondary outcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6 months after discharge and significant coronary artery stenosis on CAG.
Results
Among the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariable analysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjusting the total arrest time for survival outcomes, were significant only for STE (OR, 0.40; 95% CI, 0.17–0.94). The presence of RWMA was not a significant factor.
Conclusions
While STE predicted survival outcomes in adult CA patients, RWMA did not. The decision to perform CAG after CA should include ECG under existing guidelines. The use of RWMA has limited benefits in treatment of this population.

Citations

Citations to this article as recorded by

Just the Facts: Management of return of spontaneous circulation after out-of-hospital cardiac arrest
Hashim Kareemi, Ariel Hendin, Christian Vaillancourt
Canadian Journal of Emergency Medicine.2023; 25(7): 580. CrossRef

Case Report

Neurology
Malignant Syndrome in Parkinson Disease Similar to Severe Infection: Dong Hun Lee, Jeong Mi Moon, Yong Soo Cho; Korean J Crit Care Med. 2017;32(4):359-362. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00087

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Abstract PDF

A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.

Citations

Citations to this article as recorded by

Parkinsonism-Hyperpyrexia Syndrome and Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: Two Cases and Literature Review
Jian-Yong Wang, Jie-Fan Huang, Shi-Guo Zhu, Shi-Shi Huang, Rong-Pei Liu, Bei-Lei Hu, Jian-Hong Zhu, Xiong Zhang
Journal of Parkinson's Disease.2022; 12(6): 1727. CrossRef

Original Article

The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia: Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon; Korean J Crit Care Med. 2012;27(4):255-262.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.255

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Abstract PDF: BACKGROUND
The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH.
METHODS
The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality.
RESULTS
One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622-42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003-1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0-228.0) mg/dl, 128.0 (102.0-165.0) mg/dl, and 105.0 (87.5-129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180-309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133-242) mg/dl of the maximal median blood glucose value during the cooling phase (p < 0.001).
CONCLUSIONS
High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.

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