Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest / 대한구급학회지

BACKGROUND: If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest. METHODS: A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups. RESULTS: Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%). CONCLUSIONS: The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.

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 / 대한구급학회지

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.

The Effect of Mild Therapeutic Hypothermia on the non-Vf Cardiac arrest

PURPOSE: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation (Vf). However, although it is well known that the cardiac arrest due to non-Vf is associated with poorer neurologic outcome that Vf, there is no study that evaluates the effect of mild hypothermia on the cardiac arrests due to non-Vf. So, we intend whether mild hypothermia would improve the neurologic outcome of them saftly. METHODS: We retrospectively analyzed the patients with cardiac arrest due to asystole or pulseless electrical activity who was presented at hopsital and successfully showed the return of spontaneous circulation. We divided the patients to two groups according to implementation of hypothermia and statistically compared the complication and neurologic outcome at discharge. RESULTS: A total of sixty one patients were analyzed in this study. Baseline clinical and physiological characteristic were similar between patients treated with mild hypothermia or with conservative treatment. The complication rate did not differ significantly between the two groups. However, the good outcome at hospital discharge was observed in 13 of 41 patients treated with mild hypothermia compared with 0 of 27 patients treated with conservative treatment. CONCLUSION: Mild therapeutic hypothermia for the treatment of postcardiac arrest due to non-Vf can be saftly implemented with a major benefit on patient outcome.