Clinical and experimental emergency medicine, Jul 5, 2016
The chain of survival suggested in the 2015 Korean cardiopulmonary resuscitation (CPR) guidelines... more The chain of survival suggested in the 2015 Korean cardiopulmonary resuscitation (CPR) guidelines consists of the five links of prevention and early detection of cardiac arrest, early access, early cardiopulmonary resuscitation, early defibrillation, and effective advanced life support (ALS) and post-cardiac arrest care. ALS, which constitutes the last link, should immediately follow the basic life support (BLS) if the required manpower, equipment, and drugs are available. ALS includes the following elements: quick recognition of cardiac arrest and activation of the resuscitation team; immediate CPR, manual defibrillation, and pharmacological therapy; and advanced airway management and monitoring of physiological parameters. 1 Comprehensive post-cardiac arrest care, which begins immediately after recovery of spontaneous circulation, is also included in ALS. Improvements in the survival and neurologic outcomes in patients with cardiac arrest can be expected only when BLS and ALS are provided in combination. In case of in-hospital cardiac arrest, effective BLS begins with the first responder quickly confirming cardiac arrest, immediately calling for help, asking for manual defibrillator while calling the resuscitation team in the hospital, and conducting a high-quality CPR. The most important principle in cardiac arrest treatment through ALS is that it should be based on effective BLS. When ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) occurs, the survival rate can be increased with immediate CPR and early defibrillation conducted by the witness. Advanced airway management, mechanical chest compression devices, and extracorporeal circulation devices increase the shortterm survival rate including the return of spontaneous circulation (ROSC) and survival admission. 2-7 However, the evidence supporting that these improve the survival or neurologic out
AIMS We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for... more AIMS We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for sudden cardiac arrest. METHODS A case-control study, including patients with sudden cardiac arrest aged 20-79 years and community-based 1:2 matched controls, was conducted from September 2017 to December 2020. All participants completed a structured questionnaire. Using multivariable logistic regression, we assessed cardiovascular comorbidities (diabetes, hypertension, dyslipidaemia, myocardial infarction, congestive heart failure, arrhythmia, and stroke) and healthy lifestyle factors (low red meat consumption, low fish consumption, high fruit consumption, high vegetable consumption, current non-smoking, regular exercise, and adequate sleep duration) as sudden cardiac arrest risk factors. RESULTS Among 3,027 eligible cases, informed consent was obtained from 949 (31.3%) cases. A total of 1,731 controls were enrolled. Cardiovascular comorbidities, except dyslipidaemia, were associated with an increased risk of sudden cardiac arrest, whereas all healthy lifestyle factors were associated with a decreased risk. Relative to patients in the 0-2 healthy lifestyle factors group, the adjusted odds ratio (95% confidence interval) for sudden cardiac arrest was 0.25 (0.16-0.40) in patients with 3 healthy lifestyle factors, 0.08 (0.05-0.13) in patients with 4 healthy lifestyle factors, and 0.04 (0.03-0.06) in patients with over 5 healthy lifestyle factors. When the number of healthy lifestyle factors was analysed as a continuous variable, each additional factor was associated with a significant decrease in the likelihood of sudden cardiac arrest (adjusted odds ratio [95% confidence interval]: 0.41 [0.36-0.46]). CONCLUSION The increased risk of sudden cardiac arrest by cardiovascular comorbidities could be significantly reduced with healthy lifestyle factors.
No existing device for cardiopulmonary resuscitation (CPR) is designed to exploit both the &q... more No existing device for cardiopulmonary resuscitation (CPR) is designed to exploit both the "cardiac pump" and the "thoracic pump" effect simultaneously. The purpose of this study was to measure the haemodynamic effect of a new simultaneous sternothoracic cardiopulmonary resuscitation (SST-CPR) device that could compress the sternum and constrict the thoracic cavity simultaneously in a canine cardiac arrest model. After 4 min of ventricular fibrillation, 24 mongrel dogs were randomized to receive standard CPR (n=12) or SST-CPR (n=12). SST-CPR generated a new pattern of the aortic pressure curve presumed to be the result of both sternal compression and thoracic constriction. SST-CPR resulted in significantly higher mean arterial pressure than standard CPR (68.9+/-16.1 vs. 30.5+/-10.0 mmHg, P<0.01). SST-CPR generated higher coronary perfusion pressure than standard CPR (47.0+/-11.4 vs. 17.3+/-8.9 mmHg, P<0.01). End tidal CO(2) tension was also higher during SST-CPR than standard CPR (11.6+/-6.1 vs. 2.17+/-3.3 mmHg, P<0.01). In this preliminary animal model study, simultaneous sternothoracic cardiopulmonary resuscitation generated better haemodynamic effects than standard, closed chest cardiopulmonary resuscitation.
Background: Little is known about the hemodynamic effects of chest compression at different posit... more Background: Little is known about the hemodynamic effects of chest compression at different positions on the sternum during cardiopulmonary resuscitation (CPR). Objectives: This study aimed to test whether external chest compression at the lower end of the sternum as an alternative position (alternative compression) results in superior hemodynamic effects compared to standard external chest compression (standard compression). Methods: We enrolled 17 patients with non-traumatic cardiac arrest who failed to regain spontaneous circulation within 30 min after CPR initiation. Standard compression was begun when cardiac arrest was confirmed. Alternative compression was performed for 2 min if spontaneous circulation was not attained after 30 min of standard CPR. We compared hemodynamics and end-tidal CO 2 pressure during the last 2 min of standard compression and during alternative compression. Results: Peak arterial pressure during compression systole (114 ± 51 vs. 95 ± 42 mm Hg, p < 0.001) and end-tidal CO 2 pressure (11.0 ± 6.7 vs. 9.6 ± 6.9 mm Hg, p < 0.05) were higher with alternative than standard compression, whereas arterial pressure during compression diastole, peak right atrial pressure, and coronary perfusion pressure did not differ between standard and alternative compression. Conclusions: Compared to standard compression, alternative compression results in a higher peak arterial pressure and end-tidal CO 2 pressure, but no change in coronary perfusion pressure.
Clinical and experimental emergency medicine, Jul 5, 2016
The chain of survival suggested in the 2015 Korean cardiopulmonary resuscitation (CPR) guidelines... more The chain of survival suggested in the 2015 Korean cardiopulmonary resuscitation (CPR) guidelines consists of the five links of prevention and early detection of cardiac arrest, early access, early cardiopulmonary resuscitation, early defibrillation, and effective advanced life support (ALS) and post-cardiac arrest care. ALS, which constitutes the last link, should immediately follow the basic life support (BLS) if the required manpower, equipment, and drugs are available. ALS includes the following elements: quick recognition of cardiac arrest and activation of the resuscitation team; immediate CPR, manual defibrillation, and pharmacological therapy; and advanced airway management and monitoring of physiological parameters. 1 Comprehensive post-cardiac arrest care, which begins immediately after recovery of spontaneous circulation, is also included in ALS. Improvements in the survival and neurologic outcomes in patients with cardiac arrest can be expected only when BLS and ALS are provided in combination. In case of in-hospital cardiac arrest, effective BLS begins with the first responder quickly confirming cardiac arrest, immediately calling for help, asking for manual defibrillator while calling the resuscitation team in the hospital, and conducting a high-quality CPR. The most important principle in cardiac arrest treatment through ALS is that it should be based on effective BLS. When ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) occurs, the survival rate can be increased with immediate CPR and early defibrillation conducted by the witness. Advanced airway management, mechanical chest compression devices, and extracorporeal circulation devices increase the shortterm survival rate including the return of spontaneous circulation (ROSC) and survival admission. 2-7 However, the evidence supporting that these improve the survival or neurologic out
AIMS We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for... more AIMS We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for sudden cardiac arrest. METHODS A case-control study, including patients with sudden cardiac arrest aged 20-79 years and community-based 1:2 matched controls, was conducted from September 2017 to December 2020. All participants completed a structured questionnaire. Using multivariable logistic regression, we assessed cardiovascular comorbidities (diabetes, hypertension, dyslipidaemia, myocardial infarction, congestive heart failure, arrhythmia, and stroke) and healthy lifestyle factors (low red meat consumption, low fish consumption, high fruit consumption, high vegetable consumption, current non-smoking, regular exercise, and adequate sleep duration) as sudden cardiac arrest risk factors. RESULTS Among 3,027 eligible cases, informed consent was obtained from 949 (31.3%) cases. A total of 1,731 controls were enrolled. Cardiovascular comorbidities, except dyslipidaemia, were associated with an increased risk of sudden cardiac arrest, whereas all healthy lifestyle factors were associated with a decreased risk. Relative to patients in the 0-2 healthy lifestyle factors group, the adjusted odds ratio (95% confidence interval) for sudden cardiac arrest was 0.25 (0.16-0.40) in patients with 3 healthy lifestyle factors, 0.08 (0.05-0.13) in patients with 4 healthy lifestyle factors, and 0.04 (0.03-0.06) in patients with over 5 healthy lifestyle factors. When the number of healthy lifestyle factors was analysed as a continuous variable, each additional factor was associated with a significant decrease in the likelihood of sudden cardiac arrest (adjusted odds ratio [95% confidence interval]: 0.41 [0.36-0.46]). CONCLUSION The increased risk of sudden cardiac arrest by cardiovascular comorbidities could be significantly reduced with healthy lifestyle factors.
No existing device for cardiopulmonary resuscitation (CPR) is designed to exploit both the &q... more No existing device for cardiopulmonary resuscitation (CPR) is designed to exploit both the &quot;cardiac pump&quot; and the &quot;thoracic pump&quot; effect simultaneously. The purpose of this study was to measure the haemodynamic effect of a new simultaneous sternothoracic cardiopulmonary resuscitation (SST-CPR) device that could compress the sternum and constrict the thoracic cavity simultaneously in a canine cardiac arrest model. After 4 min of ventricular fibrillation, 24 mongrel dogs were randomized to receive standard CPR (n=12) or SST-CPR (n=12). SST-CPR generated a new pattern of the aortic pressure curve presumed to be the result of both sternal compression and thoracic constriction. SST-CPR resulted in significantly higher mean arterial pressure than standard CPR (68.9+/-16.1 vs. 30.5+/-10.0 mmHg, P&lt;0.01). SST-CPR generated higher coronary perfusion pressure than standard CPR (47.0+/-11.4 vs. 17.3+/-8.9 mmHg, P&lt;0.01). End tidal CO(2) tension was also higher during SST-CPR than standard CPR (11.6+/-6.1 vs. 2.17+/-3.3 mmHg, P&lt;0.01). In this preliminary animal model study, simultaneous sternothoracic cardiopulmonary resuscitation generated better haemodynamic effects than standard, closed chest cardiopulmonary resuscitation.
Background: Little is known about the hemodynamic effects of chest compression at different posit... more Background: Little is known about the hemodynamic effects of chest compression at different positions on the sternum during cardiopulmonary resuscitation (CPR). Objectives: This study aimed to test whether external chest compression at the lower end of the sternum as an alternative position (alternative compression) results in superior hemodynamic effects compared to standard external chest compression (standard compression). Methods: We enrolled 17 patients with non-traumatic cardiac arrest who failed to regain spontaneous circulation within 30 min after CPR initiation. Standard compression was begun when cardiac arrest was confirmed. Alternative compression was performed for 2 min if spontaneous circulation was not attained after 30 min of standard CPR. We compared hemodynamics and end-tidal CO 2 pressure during the last 2 min of standard compression and during alternative compression. Results: Peak arterial pressure during compression systole (114 ± 51 vs. 95 ± 42 mm Hg, p < 0.001) and end-tidal CO 2 pressure (11.0 ± 6.7 vs. 9.6 ± 6.9 mm Hg, p < 0.05) were higher with alternative than standard compression, whereas arterial pressure during compression diastole, peak right atrial pressure, and coronary perfusion pressure did not differ between standard and alternative compression. Conclusions: Compared to standard compression, alternative compression results in a higher peak arterial pressure and end-tidal CO 2 pressure, but no change in coronary perfusion pressure.
Uploads
Papers by Sung Oh Hwang