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황성오 대한의사협회 2013 대한의사협회지 Vol.56 No.7
Sudden cardiac arrest is a growing medical issue in developed countries. Annually, more than 25,000 out-of-hospital cardiac arrests (OHCA) occur in Korea. Only 3% of victims with OHCA discharge alive from hospital and less than 1% of them survive neurologically intact. Major changes of recent guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care includes modification of basic life support (BLS) sequence from A-B-C to C-A-B, an emphasis on minimally interrupted, high-quality chest compression, the introduction of chest compression-only CPR, and addition of integrated post-cardiac arrest care concept as the fifth chain in the Chain of Survival. Repetition of 2-minutes of CPR, rhythm check, and defibrillation if indicated is recommended as a universal algorithm during BLS. Defibrillation and drug administration including epinephrine should not be delayed to place an advanced airway during CPR. Important interventions during post-cardiac arrest care are comprised of the optimization of ventilation (arterial CO2 tension, 40 to 45 mmHg) and oxygenation (arterial O2 saturation, 94% to 98%), glucose control (blood glucose, 144 to 180 mg/dL), therapeutic hypothermia (body temperature,32oC to 34oC) for unresponsive patients, and percutaneous coronary intervention for the patient with ST-segment elevation. Systemic approaches to increase public awareness of cardiac arrest and CPR, to spread CPR education to citizen, and to implement public access defibrillation are a prerequisite for improving survival from OHCA in the community. Effective advanced life support and integrated post-cardiac arrest care should be provided to increase neurologically intact survival among the patients resuscitated from cardiac arrest.
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이중혈류유발 심폐소생술이 심정지를 유발한 개의 단기 생존율에 미치는 영향
황성오,조준휘,강구현,김성환,문중범,이강현,이승환,윤정한,최경훈,홍은석 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3
Background and Objectives: We previously reported that, compared with standard cardiopulmonary resuscitation(S-CPR), better hemodynamic effects could be achieved by simultaneous sterno-thoracic cardiopulmonary resuscitation(SST-CPR) in which we compressed the sternum and constricted the thorax circumferentially during the systolic period by using a device. This study was designed to assess whether SST-CPR, compared with S-CPR, improve the survival rate of dogs with cardiac arrest. Subjects and methods: Twenty-five mongrel dogs(19∼31㎏) were enrolled in this study. After four minutes of ventricular fibrillation induced by an AC current, animals were randomized to resuscitate with either S-CPR(n=13) or SST-CPR(n=12). Epinephrine(1 ㎎) was injected into the right atrium every three minutes after the beginning of CPR. Defibrillation was attempted after 6 minutes of CPR. Standard advanced cardiac life support was started if defibrillation was not successful. Results: SST-CPR resulted in significantly(p<0.001) higher systolic arterial pressure(91±47 vs 47±24 ㎜ Hg), diastolic pressure(43±24 vs 17±10 ㎜ Hg), coronary perfusion pressure(35±25 vs 13±9㎜ Hg), and end tidal CO2 tension(9±4 vs 3±2 ㎜ Hg). Two of 13 animals(15 %) resuscitated with S-CPR and six of 12 animals(50%) resuscitated with SST-CPR survived until 12 hours after cardiac arrest(p<0.05). Donclusion: SST-CPR, compared with S-CPR, improves the short-term survival rate in canine cardiac arrest.
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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.
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