Validation of Termination Guidelines for Out of Hospital Cardiac Arrest in Korea

PURPOSE: There have been no studies on the termination of resuscitation (TOR) in Korea. We retrospectively applied TOR rules to OHCA patient data in order to validate the BLS and ALS TOR rules for Korea. METHODS: We collected OHCA (out-of-hospital cardiac arrest) data from 3 hospitals for the period January 1 to December 31, 2009. We then retrospectively applied BLS and ALS TOR rules to this data. We measured both the specificity and positive predictive value for each BLS and ALS TOR rule. RESULTS: The overall rate of survival until hospital discharge was 14.5%. Out of 102 patients who met BLS criteria TOR rules, 8 patients survived until hospital discharge. Out of 52 patients who met ALS criteria TOR rules, 4 patients survived until hospital discharge. The BLS rule had a specificity of 0.57 and a positive predictive value of 0.92. The ALS rule had a specificity of 0.78 and a positive predictive value of 0.92. CONCLUSION: In this study, the BLS and ALS TOR rules had relatively low positive predictive value and were not applicable to patients with low survival probability in Korea.

Emergency Ultrasonography for the Detection of a Pneumothorax in Blunt Thoracic Trauma Patients

PURPOSE: This study was conducted to determine the accuracy of ultrasonography (US) in the detection of a traumatic pneumothorax. METHODS: We prospectively evaluated thoracic US for the detection of a pneumothorax in blunt thoracic trauma patients. The presence of "lung sliding"and "comet tail" artifacts were determined in patients by using ultrasound before radiologic verification of a pneumothorax by residents and attending physicians of the emergency department who had been instructed in thoracic ultrasound. Finally, the diagnosis of a pneumothorax was confirmed by using chest computed tomography (CT). RESULTS: Forty nine patients were enrolled in this study. Twenty-five of the 49 patients had a pneumothorax at chest CT, and for 24 patients, the pneumothoraces had been detected at thoracic US and for 13 patients, they were seen at supine chest radiography. The sensitivity and the specificity of US were 96% and 92%, relatively the positive predictive value was 92%, and the negative predictive value was 96%. The sign of disappearance of "lung sliding" had a sensitivity and negative predictive value of 100% and a specificity of 88% for the diagnosis of a pneumothorax. The absence sign of a "comet tail"artifact had a specificity and positive predictive value of 100%, and a sensitivity of 95% for the diagnosis of a pneumothorax. CONCLUSION: In this study, US was more sensitive than supine chest AP view in the detection of a traumatic pneumothorax. Thoracic US is a reliable method for the detection of a pneumothorax and should be added to the currently performed FAST examination in trauma cases.