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31 "cardiac arrest"
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Original Articles
Pediatrics
Development of a deep learning model for predicting critical events in a pediatric intensive care unit
In Kyung Lee, Bongjin Lee, June Dong Park
Acute Crit Care. 2024;39(1):186-191.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.01424
Correction in: https://doi.org/
  • 361 View
  • 38 Download
AbstractAbstract PDF
Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality. Methods: This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing. Results: Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000). Conclusions: The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.
Pediatrics
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute Crit Care. 2023;38(4):498-506.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01354
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  • 37 Download
AbstractAbstract PDFSupplementary Material
Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.
CPR/Resuscitation
Lower limb muscle matters in patients with hypoxic brain injury following out-of-hospital cardiac arrest
Dong-Hyun Jang, Seung Min Park, Dong Keon Lee, Dong Won Kim, Chang Woo Im, You Hwan Jo, Kui Ja Lee
Acute Crit Care. 2023;38(1):104-112.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01389
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AbstractAbstract PDFSupplementary Material
Background
There are conflicting results regarding the association between body mass index and the prognosis of cardiac arrest patients. We investigated the association of the composition and distribution of muscle and fat with neurologic outcomes at hospital discharge in successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. Methods: This prospective, single-centre, observational study involved adult OHCA patients, conducted between April 2019 and June 2021. The ratio of total skeletal muscle, upper limb muscle, lower limb muscle, and total fat to body weight was measured using InBody S10, a bioimpedance analyser, after achieving the return of spontaneous circulation. Restricted cubic spline curves with four knots were used to examine the relationship between total skeletal muscle, upper limb muscle, and lower limb muscle relative to total body weight and neurologic outcome at discharge. Multivariable logistic regression analysis was performed to assess an independent association. Results: A total of 66 patients were enrolled in the study. The proportion of total muscle and lower limb muscle positively correlated with the possibility of having a good neurologic outcome. The proportion of lower limb muscle showed an independent association in the multivariable analysis (adjusted odds ratio, 2.29; 95% confidence interval, 1.06–13.98), and its optimal cut-off value calculated through receiver operating characteristic curve analysis was 23.1%, which can predict a good neurological outcome. Conclusions: A higher proportion of lower limb muscle to body weight was independently associated with the probability of having a good neurologic outcome in OHCA patients.
Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
  • 2,556 View
  • 178 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
CPR/Resuscitation
Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest
Hui Hwan Kim, Ji Ho Lee, Dong Hun Lee, Byung Kook Lee
Acute Crit Care. 2022;37(4):601-609.   Published online August 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00542
  • 2,318 View
  • 118 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality. Methods: The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients’ 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality. Results: Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027–1.244) and 72 hours (OR, 1.241; 95% CI, 1.059–1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489–0.673), 0.622 (95% CI, 0.528–0.710), 0.706 (95% CI, 0.615–0.786), and 0.762 (95% CI, 0.675–0.835), respectively. Conclusions: CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

Citations

Citations to this article as recorded by  
  • Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development
    Asser M. J. Seppä, Markus B. Skrifvars, Pirkka T. Pekkarinen
    Acta Anaesthesiologica Scandinavica.2023; 67(9): 1273.     CrossRef
  • Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome
    Ju Hee Yoon, Woo Sung Choi, Yong Su Lim, Jae Ho Jang
    Journal of Clinical Medicine.2023; 12(14): 4568.     CrossRef
  • C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram
    Xin Zhou, Shouzhi Fu, Yisi Wu, Zhenhui Guo, Wankang Dian, Huibin Sun, Youxia Liao
    Scientific Reports.2023;[Epub]     CrossRef
Review Articles
CPR/Resuscitation
Role of extracorporeal cardiopulmonary resuscitation in adults
Hongsun Kim, Yang Hyun Cho
Acute Crit Care. 2020;35(1):1-9.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2020.00080
  • 9,590 View
  • 365 Download
  • 20 Web of Science
  • 22 Crossref
AbstractAbstract PDF
Extracorporeal cardiopulmonary resuscitation (ECPR) has been performed with increasing frequency worldwide to improve the low survival rate of conventional cardiopulmonary resuscitation (CCPR). Several studies have shown that among patients who experience in-hospital cardiac arrest, better survival outcomes and neurological outcomes can be expected after ECPR than after CCPR. However, studies have not clearly shown a short-term survival benefit of ECPR for patients who experience out-of-hospital cardiac arrest. Favorable outcomes are associated with a shorter low-flow time, an initial shockable rhythm, lower serum lactate levels, higher blood pH, and a lower Sequential Organ Failure Assessment score. Indications for ECPR include young age, witnessed arrest with bystander cardiopulmonary resuscitation, an initial shockable rhythm, correctable causes such as a cardiac etiology, and no return of spontaneous circulation within 10–20 minutes of CCPR. ECPR is a complex intervention that requires a highly trained team, specialized equipment, and multidisciplinary support within a healthcare system, and it has the risk of several life-threatening complications. Therefore, physicians should carefully select patients for ECPR who can gain the most benefit, instead of applying ECPR indiscriminately.

Citations

Citations to this article as recorded by  
  • Impact of independent early stage extracorporeal cardiopulmonary resuscitation in the emergency department following the establishment of an extracorporeal life support team
    Zhan-Xiao Liu, Ya Yang, Huan-Huan Song, Wei Liu, Peng Sun, Cai-Wei Lin
    Heliyon.2024; 10(1): e23411.     CrossRef
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    Christopher Jer Wei Low, Ryan Ruiyang Ling, Michele Petrova Xin Ling Lau, Nigel Sheng Hui Liu, Melissa Tan, Chuen Seng Tan, Shir Lynn Lim, Bram Rochwerg, Alain Combes, Daniel Brodie, Kiran Shekar, Susanna Price, Graeme MacLaren, Kollengode Ramanathan
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  • Clinician Perspectives on Cannulation for Extracorporeal Cardiopulmonary Resuscitation: A Mixed Methods Analysis
    Devindi Wanigasekara, Vincent A. Pellegrino, Aidan JC. Burrell, Nyein Aung, Shaun D. Gregory
    ASAIO Journal.2023; 69(3): 332.     CrossRef
  • Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis
    Christopher Jer Wei Low, Kollengode Ramanathan, Ryan Ruiyang Ling, Maxz Jian Chen Ho, Ying Chen, Roberto Lorusso, Graeme MacLaren, Kiran Shekar, Daniel Brodie
    The Lancet Respiratory Medicine.2023; 11(10): 883.     CrossRef
  • Anticoagulation strategies in patients with extracorporeal membrane oxygenation: A network meta‐analysis and systematic review
    Jiale Chen, Guoquan Chen, Wenyi Zhao, Wenxing Peng
    Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2023; 43(10): 1084.     CrossRef
  • Prophylactic antibiotic treatment for preventing nosocomial infection in extracorporeal membrane oxygenation–resuscitated circulatory arrest patients
    Lan-Pin Kuo, Yi-Chen Wang, Po-Lin Chen, Wei-Hung Lin, Wei-Ming Wang, Chao-Jung Shih, Pei-Ni Yang, Yu-Ning Hu, Chih-Hsin Hsu, Jun-Neng Roan, Meng-Ta Tsai
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    International Journal of Emergency Medicine.2023;[Epub]     CrossRef
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    Wachira Wongtanasarasin, Sarunsorn Krintratun, Witina Techasatian, Daniel K. Nishijima, Gaetano Santulli
    PLOS ONE.2023; 18(11): e0289054.     CrossRef
  • Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study
    Georg Trummer, Christoph Benk, Jan-Steffen Pooth, Tobias Wengenmayer, Alexander Supady, Dawid L. Staudacher, Domagoj Damjanovic, Dirk Lunz, Clemens Wiest, Hug Aubin, Artur Lichtenberg, Martin W. Dünser, Johannes Szasz, Dinis Dos Reis Miranda, Robert J. va
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CPR/Resuscitation
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute Crit Care. 2019;34(3):173-178.   Published online August 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00654
  • 33,138 View
  • 2,127 Download
  • 30 Web of Science
  • 33 Crossref
AbstractAbstract PDF
Post-cardiac arrest syndrome is a complex and critical issue in resuscitated patients undergone cardiac arrest. Ischemic-reperfusion injury occurs in multiple organs due to the return of spontaneous circulation. Bundle of management practicies are required for post-cardiac arrest care. Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease. Vasopressors such as norepinephrine and dobutamine are the first-line treatment for shock. Maintainance of oxyhemoglobin saturation greater than 94% but less than 100% is recommended to avoid fatality. Target temperature therapeutic hypothermia helps to resuscitated patients. Strict temperature control is required and is maintained with the help of cooling devices and monitoring the core temperature. Montorings include electrocardiogram, oxymetry, capnography, and electroencephalography (EEG) along with blood pressue, temprature, and vital signs. Seizure should be treated if EEG shows evidence of seizure or epileptiform activity. Clinical neurologic examination and magnetic resonance imaging are considered to predict neurological outcome. Glycemic control and metabolic management are favorable for a good neurological outcome. Recovery from acute kidney injury is essential for survival and a good neurological outcome.

Citations

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    Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani
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  •  Management of Post-Resuscitative Era in Patients with Cardiac Arrest: Post-Cardiac Arrest Syndrome
    Sedat Ozbay, Canan Akman, Neslihan Ergun Suzer, Ilknur Simsik, Mustafa Ayan, Orhan Ozsoy, Ozgur Karcioglu
    International Journal of Pharmaceutical Research and Allied Sciences.2023; 12(3): 78.     CrossRef
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    Dan Viox, Richa Dhawan, Husam H. Balkhy, Daniel Cormican, Himani Bhatt, Andre Savadjian, Mark A. Chaney
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    Carrigan Belcher, Vivek Kataria, Klayton M Ryman, Xuan Wang, Joon Yong Moon, Ariel Modrykamien, Adan Mora
    Hospital Pharmacy.2022; 57(4): 504.     CrossRef
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    Chenglei Su, Yan Xiao, Guozhen Zhang, Lian Liang, Hui Li, Cheng Cheng, Tao Jin, Jennifer Bradley, Mary A. Peberdy, Joseph P. Ornato, Martin J. Mangino, Wanchun Tang
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    Antioxidants.2022; 11(11): 2192.     CrossRef
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    Gun Woo Kim, Young-Il Roh, Kyoung-Chul Cha, Sung Oh Hwang, Jae Hun Han, Woo Jin Jung
    Acute and Critical Care.2022; 37(4): 610.     CrossRef
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    Troy Seelhammer, Erica Wittwer
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    Libo Chuan, Lei Zhang, Hao Fu, Ying Yang, Quanyu Wang, Xingpeng Jiang, Zhengchao Li, Kuang Ni, Li Ding
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    Jiangang Wang, Lin Shi, Jiefeng Xu, Wen Zhou, Mao Zhang, Chunshuang Wu, Qijiang Chen, Xiaohong Jin, Jungen Zhang
    The American Journal of Emergency Medicine.2021; 47: 231.     CrossRef
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    Seok In Lee, Yong Su Lim, Chul‐Hyun Park, Woo Sung Choi, Chang Hyu Choi
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    Dae Ki Hong, Yoo Seok Park, Ji Sun Woo, Ju Hee Kim, Jin Ho Beom, Sung Phil Chung, Je Sung You, Sang Won Suh
    International Journal of Molecular Sciences.2021; 22(10): 5114.     CrossRef
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    Yunis Mayasi, Romergryko G. Geocadin
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    Linda Dalessio
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Case Report
Cardiology
Two women presenting aborted sudden cardiac arrest as the first event of mitral valve disease
Sua Kim, Jae Min Shim, Seong-Mi Park
Acute Crit Care. 2019;34(4):289-293.   Published online November 13, 2018
DOI: https://doi.org/10.4266/acc.2017.00570
  • 5,727 View
  • 91 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Mitral valve prolapse (MVP) is a relatively common valvular heart disease and is known to have a benign course. However, a certain subtype of MVP has a pathologic prognosis and can be accompanied by malignant cardiac arrhythmia causing sudden cardiac arrest, which can be characterized by bileaflet mitral valvular thickening and prolapse and frequent premature ventricular ectopic activity upon electrocardiography. Herein, we present two patients with bileaflet mitral prolapse who survived aborted sudden cardiac arrest. These cases show a precise MVP diagnosis that may prevent a devastating life event with the unique MVP subtype.

Citations

Citations to this article as recorded by  
  • Mitral annular disjunction identified peripartum: A case highlighting key features of a recently classified syndrome
    Monique Doran, Gemma Reemst, Kenny Ng, Courtney Shaw, Paul Stoodley
    Sonography.2023; 10(1): 30.     CrossRef
Review Article
Rapid response system
Deep Learning in the Medical Domain: Predicting Cardiac Arrest Using Deep Learning
Youngnam Lee, Joon-myoung Kwon, Yeha Lee, Hyunho Park, Hugh Cho, Jinsik Park
Acute Crit Care. 2018;33(3):117-120.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00290
  • 12,793 View
  • 531 Download
  • 17 Web of Science
  • 19 Crossref
AbstractAbstract PDF
With the wider adoption of electronic health records, the rapid response team initially believed that mortalities could be significantly reduced but due to low accuracy and false alarms, the healthcare system is currently fraught with many challenges. Rule-based methods (e.g., Modified Early Warning Score) and machine learning (e.g., random forest) were proposed as a solution but not effective. In this article, we introduce the DeepEWS (Deep learning based Early Warning Score), which is based on a novel deep learning algorithm. Relative to the standard of care and current solutions in the marketplace, there is high accuracy, and in the clinical setting even when we consider the number of alarms, the accuracy levels are superior.

Citations

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  • External Validation of Deep Learning-Based Cardiac Arrest Risk Management System for Predicting In-Hospital Cardiac Arrest in Patients Admitted to General Wards Based on Rapid Response System Operating and Nonoperating Periods: A Single-Center Study
    Kyung-Jae Cho, Kwan Hyung Kim, Jaewoo Choi, Dongjoon Yoo, Jeongmin Kim
    Critical Care Medicine.2024; 52(3): e110.     CrossRef
  • Evaluation of optimal scene time interval for out-of-hospital cardiac arrest using a deep neural network
    Seung Jae Shin, Hee Sun Bae, Hyung Jun Moon, Gi Woon Kim, Young Soon Cho, Dong Wook Lee, Dong Kil Jeong, Hyun Joon Kim, Hyun Jung Lee
    The American Journal of Emergency Medicine.2023; 63: 29.     CrossRef
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  • Artificial Intelligence in Resuscitation: A Scoping Review
    Dmitriy Viderman, Yerkin Abdildin, Kamila Batkuldinova, Rafael Badenes, Federico Bilotta
    Journal of Clinical Medicine.2023; 12(6): 2254.     CrossRef
  • Prediction of Out-of-Hospital Cardiac Arrest Survival Outcomes Using a Hybrid Agnostic Explanation TabNet Model
    Hung Viet Nguyen, Haewon Byeon
    Mathematics.2023; 11(9): 2030.     CrossRef
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    Alberto Nogales, Fernando Pérez-Lara, Álvaro J. García-Tejedor
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    Hansol Chang, Ji Woong Kim, Weon Jung, Sejin Heo, Se Uk Lee, Taerim Kim, Sung Yeon Hwang, Sang Do Shin, Won Chul Cha, Marcus Ong
    Scientific Reports.2023;[Epub]     CrossRef
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    Bassel Soudan, Fetna F. Dandachi, Ali Bou Nassif
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Original Articles
CPR/Resuscitation
APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management
Sang-Il Kim, Youn-Jung Kim, You-Jin Lee, Seung Mok Ryoo, Chang Hwan Sohn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Won Young Kim
Acute Crit Care. 2018;33(2):83-88.   Published online May 31, 2018
DOI: https://doi.org/10.4266/acc.2017.00514
  • 6,218 View
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  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM).
Methods
Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study.
Results
Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014).
Conclusions
In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.

Citations

Citations to this article as recorded by  
  • Prediction performance of scoring systems after out-of-hospital cardiac arrest: A systematic review and meta-analysis
    Boldizsár Kiss, Rita Nagy, Tamás Kói, Andrea Harnos, István Ferenc Édes, Pál Ábrahám, Henriette Mészáros, Péter Hegyi, Endre Zima, Jignesh K. Patel
    PLOS ONE.2024; 19(2): e0293704.     CrossRef
  • Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks
    Wei-Ting Chiu, Chen-Chih Chung, Chien-Hua Huang, Yu-san Chien, Chih-Hsin Hsu, Cheng-Hsueh Wu, Chen-Hsu Wang, Hung-Wen Chiu, Lung Chan
    Journal of the Formosan Medical Association.2022; 121(2): 490.     CrossRef
  • Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management
    Szu-Yi Chou, Oluwaseun Adebayo Bamodu, Wei-Ting Chiu, Chien-Tai Hong, Lung Chan, Chen-Chih Chung
    Scientific Reports.2022;[Epub]     CrossRef
  • Novel Approaches to Risk Stratification of In-Hospital Cardiac Arrest
    Jason J. Yang, Xiao Hu, Noel G. Boyle, Duc H. Do
    Current Cardiovascular Risk Reports.2021;[Epub]     CrossRef
Cardiology/Emergency
Moderate to Severe Left Ventricular Ejection Fraction Related to Short-term Mortality of Patients with Post-cardiac Arrest Syndrome after Out-of-Hospital Cardiac Arrest
Kyoung Jeen Min, Jin Joo Kim, In Cheol Hwang, Jae Hyuk Woo, Yong Su Lim, Hyuk Jun Yang, Keun Lee
Korean J Crit Care Med. 2016;31(4):342-350.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00570
Correction in: Acute Crit Care 2017;32(1):88
  • 8,842 View
  • 114 Download
AbstractAbstract PDF
Background
The aim of this study was to investigate the relationships between left ventricular ejection fraction (LVEF) and mortality and neurologic outcomes with post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA).
Methods
Patients with PCAS after OHCA admitted to the intensive care unit between January 2014 and December 2015 were analyzed retrospectively.
Results
A total of 104 patients were enrolled in this study. The mean age was 54.4 ± 15.3 years, and 75 of the patients were male (72.1%). Arrest with a cardiac origin was found in 55 (52.9%). LVEF < 45%, 45-55%, and > 55% was measured in 39 (37.5%), 18 (17.3%), and 47 (45.2%) of patients, respectively. In multivariate analysis, severe LV dysfunction (LVEF < 45%) was significantly related to 7-day mortality (odds ratio 3.02, 95% Confidence Interval 1.01-9.0, p-value 0.047).
Conclusions
In this study, moderate to severe LVEF within 48 hours after return of spontaneous circulation was significantly related to 7-day short-term mortality in patients with PCAS after OHCA. Clinicians should actively treat myocardial dysfunction, and further studies are needed.
Case Report
Obstetric/Emergency
Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage
Kwang Ho Lee, Seong Jin Choi, Yeong Gwan Jeon, Raing Kyu Kim, Dae Ja Um
Korean J Crit Care Med. 2016;31(4):359-363.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00325
  • 11,345 View
  • 99 Download
  • 1 Crossref
AbstractAbstract PDF
Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

Citations

Citations to this article as recorded by  
  • Persephin as a diagnostic marker of acute brain injury in critically ill newborns: a clinical trial
    A. A. Zadvornov, E. V. Grigoriev
    Fundamental and Clinical Medicine.2021; 6(3): 15.     CrossRef
Original Article
Emergency/Neurology
Brain Magnetic Resonance Imaging in Patients with Favorable Outcomes after Out-of-Hospital Cardiac Arrest: Many Have Encephalopathy Even with a Good Cerebral Performance Category Score
Woo Sung Choi, Jin Joo Kim, Hyuk Jun Yang
Korean J Crit Care Med. 2015;30(4):265-271.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.265
  • 7,195 View
  • 101 Download
AbstractAbstract PDF
Background
The aim of this study was to retrospectively evaluate and analyze the brain magnetic resonance imaging (B-MRI) findings of patients with a favorable neurological outcome following cerebral performance category (CPC) after out-of-hospital cardiac arrest (OHCA) at single university hospital emergency center.
Methods
Patients with return of spontaneous circulation (> 24 h) after OHCA who were older than 16 years of age and who had been admitted to the emergency intensive care unit (EICU) for over a 57-month period between July 2007 and March 2012 and survived with a favorable neurological outcome were enrolled. B-MRI was taken after recovery of their mental status.
Results
Fifty-two patients among the 305 admitted patients had a good CPC, and 33 patients’ B-MRI were analyzed (CPC 1: 26 patients, CPC 2: 7 patients). Among these, 18 (54.5%) patients had a normal finding on B-MRI. On the other hand, ischemia/infarction/microangiopathy compatible with hypoxic-ischemic encephalopathy (HIE) were found on various brain areas including subcortical white matter (7/13), cerebral cortex, central semiovlae, basal ganglia, putamen, periventricular white matter, and cerebellum.
Conclusions
Survivors with a favorable neurological outcome from OHCA showed HIE on B-MRI, especially all of the patients with a CPC 2. More detail neurologic category including brain imaging would be needed to categorize patients with favorable outcome after OHCA.
Case Report
Cardiology
Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction
Dong Hyun Lee, Seul Lee, Hyo Jin Jung, Soo Jin Kim, Jeong Min Seo, Jae Hyuk Choi, Jong Sung Park
Korean J Crit Care Med. 2014;29(4):331-335.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.331
  • 4,207 View
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AbstractAbstract PDF
A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.
Original Article
Hematology/Emergency
Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest
Seongtak Kim, Jinseong Cho, Yongsu Lim, Jinjoo Kim, Hyukjun Yang, Gun Lee
Korean J Crit Care Med. 2014;29(4):313-319.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.313
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AbstractAbstract PDF
BACKGROUND
The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated.
METHODS
Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%).
RESULTS
A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time.
CONCLUSIONS
RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.

ACC : Acute and Critical Care