Search for Structural Cardiac Abnormalities Following Sudden Cardiac Arrest Using Post-mortem Echocardiography in the Emergency Department: A Preliminary Study

PURPOSE: Sudden cardiac arrest (SCA) accounts for approximately 15% of all-cause mortality in the US and 50% of all cardiovascular mortalities in developed countries; 10% of cases have an underlying structural cardiac abnormality. An echocardiography has widely been used to evaluate cardiac abnormality, but it needs to be performed by emergency physicians available in the emergency department immediately after death, rather than by cardiologists. We aimed to determine whether post-mortem echocardiography (PME) performed in the emergency department may reveal such abnormalities. METHODS: We evaluated the reliability and validity of PME performed by emergency physicians in the emergency department. Measurement by a cardiologist was used as reference. RESULTS: Two emergency physicians performed PME on 3 out of the 4 included patients who died after unsuccessful cardiopulmonary resuscitation. PME was started within 10 minutes of death, and it took 10 minutes to complete. Parasternal views in either supine or left decubitus position were most helpful. The adequacy of the image was rated good to fair, and that of measurements was acceptable to borderline. Regarding the chamber size and left ventricular wall thickness, intraclass correlation coefficients for reliability and validity were 0.97 (n=15) and 0.95 (n=35), respectively (p<0.001). Evaluation of presence/absence of left ventricular wall thinning, valve calcification, and pericardial effusion was incomplete (3/7-5/7), precluding further analysis. CONCLUSION: Emergency physicians could perform reliable and valid PME to assess the chamber size and left ventricular wall thickness. A large prospective study with collaboration between emergency physicians and cardiologists would reveal the feasibility and usefulness of PME in diagnosing structural causes of sudden cardiac arrest.

The Effect on Age, Body Weight, Height, Body Mass Index and Smoking to Coagulation Factor VII, VIII and Fibrinogen in Pilots

BACKGROUND: The pilots with cardiovascular events have a possibility for a risk of suffering from sudden incapacitation which is closely related to flying safety. The coagulation factors such as fibrinogen, factor VII, and factor VIII are possibly related to cardiovascular events. Several studies for general population have shown that an increase of those coagulation factors with age, a correlation of Factor VII and fibrinogen with BMI, and of fibrinogen with smoking. However, this study is to find out whether pilots' age, body weight, body mass index (BMI) and smoking are related to the baseline measurement of coagulation factor VII, factor VIII and fibrinogen. METHOD: Samples were taken from 21 pilots from Asiana Airlines: 11 smokers and 10 non-smokers. In order to measure the relationship between age, body weight, BMI, and the coagulation factors, Pearson correlation was used in this analysis. Independent two sampled t-test was used to analyze the correlation between smoking and the coagulation factors. RESULTS: Mean age, mean height, mean body weight and mean BMI of pilots were examined: 38 years, 171.81 cm, 70.67 Kg and 23.94 Kg/m(2). Mean fibrinogen, mean factor VII, and mean factor VIII were also obtained: 236.0 mg/dl, 92.93%, and 60.16%. The coagulation factor VII, factor VIII and fibrinogen were not significant related to age, body weight, BMI, smoking of pilots. CONCLUSION: This study has no correlation between age, body weight, BMI, smoking and the coagulation factors because the age of this study does not have pilots with over 60 years old and healthy behaviors (e.g., exercise, smoking, drinking, etc.) of most pilots are relatively well.

Relationship between Body Weight and Pulmonary Function in Pilots from a Airlines: The Comparison of Data from 1996 with 2002

BACKGROUND: Obesity increases the risk of cardiovascular disease, hypertension, diabetes, and other disorders. Several studies have shown that excess weight or weight gain was related to the decline of pulmonary function. This study is to find out whether pilot's age, height, body weight, body mass index(BMI) and smoking are related to the baseline measurement of pulmonary function in order to promote the healthy behavior of pilots. METHOD: The analysis was based on data from the annual physical examination of pilots which was conducted in one airlines company of Korea. This study compared the data obtained from 73 pilots in 1996 with the data in 2002. Pulmonary function(forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximal mid expiratory flow (MMEF), peak expiratory flow (PEF)), age, height, body weight and body mass index were measured in both surveys. Multivariate analysis of variance (MANOVA) was used to examine the relationship weight gain, smoking and pulmonary function. RESULTS: According to the data from 2002, mean age, mean height, mean body weight and mean BMI of pilots were examined: 47.62 years, 171.60 cm, 70.6 Kg and 24.03 Kg/m(2). Age was significantly related to FVC, FEV1 and MMEF. Height was significantly related to FVC and FEV1. However, body weight was significantly related to PEF and MMEF. The effect of smoking on pulmonary function was not significant. Pilots who gained body weight and BMI after 7 years were not related significantly to the pulmonary function. CONCLUSION: This study shows that age, height, weight are significantly related to pulmonary function. And other studies show that weight gain is significantly related to the decline of pulmonary function, but the relationship from this study is not significant because the number of sample is not enough and healthy behaviors of most pilots are relatively well.