Adequacy of Epinephrine Administration during Advanced Cardiovascular Life Support in terms of Dosing and Intervals between Doses / 대한구급학회지

BACKGROUND: Consensus guidelines clearly define how epinephrine is administered during cardiopulmonary resuscitation (CPR). In South Korea, it is not known whether epinephrine is administered in accordance with the current advanced cardiovascular life support (ACLS) guidelines during actual practice. We sought to investigate adherence to ACLS guidelines during actual CPR in terms of the dose of epinephrine and the interval between doses. METHODS: A retrospective review of medical records was performed on 394 adult cardiac arrest patients who received CPR at an emergency room. Data including the duration of CPR, the dose of epinephrine, and the interval between doses was collected from CPR records. RESULTS: Standard-dose epinephrine (1 mg) was used in 166 of 394 patients (42.1%). In 58.8% of patients, the average between-dose interval was within the 3-5 min recommended in the guidelines, whereas it was shorter than 3 min in 31.4% of patients. As a whole, epinephrine was administered in accordance with the current ACLS guidelines in only 96 of 394 patients (24.4%). Logistic regression analysis revealed the duration of CPR to be an independent factor affecting the use of standard-dose epinephrine and the adequate between-dose interval. CONCLUSIONS: Epinephrine was not administered according to the ACLS guideline in most patients. A national multi-center study is required to determine whether the poor adherence to the ACLS guideline is a widespread problem. In addition, efforts to improve adherence to the ACLS guideline are required.

Comparison of the Quality of Chest Compressions between CPR Performed by a Single Trained Rescuer and Two Rescuer CPR Performed by a Trained Rescuer and an Untrained Rescuer in a Prolonged Out-of-Hospital CPR Scenario

PURPOSE: The aim of this study is to compare the quality of chest compressions between cardiopulmonary resuscitation (CPR) performed by a single trained rescuer and two rescuer CPR performed by a trained rescuer and an untrained rescuer in a prolonged out-of-hospital CPR scenario. METHODS: For the phase I experiment, thirty-six emergency medical technician students (trained rescuers) were asked to perform 10 minutes of lone rescuer CPR on an instrumented manikin. For the phase II experiment, thirty-six volunteers with no previous CPR training (untrained rescuers) were recruited. Each untrained rescuer was randomly assigned to one trained rescuer. They were asked to perform 10 minutes of two rescuer CPR during the phase II experiment. RESULTS: During phase I, the percent of correct compressions diminished over time. The number of total compressions attempted for 10 minutes was increased significantly in phase II (786+/-50 versus 689+/-50 in phase I, p<0.01). However, the mean percentage of correct compressions for 10 minutes did not show a significant difference between phases (66+/-34% in phase I versus 64+/-22% in phase II). The duration of chest compression interruption was significantly reduced in phase II (3.0+/-0.4 versus 3.5+/-0.5 min in phase I, p<0.01). CONCLUSION: The quality of two rescuer CPR performed by a trained rescuer and an untrained rescuer was comparable to that of lone rescuer CPR performed by a single trained rescuer in a 10-min CPR scenario. When CPR goes on for a prolonged period, changing the person doing the chest compressions to an untrained rescuer may improve the quality of CPR.

Estimation of Central Venous Pressure using Ultrasound Imaging of Inferior Vena Cava

PURPOSE: There have been several studies addressing the correlation between central venous pressure (CVP) and ultrasonographic findings of the inferior vena cava (IVC). We performed the present study to discover the degree of correlation between CVP and the area of IVC as measured with ultrasound, and to determine which portion of the IVC shows the best correlation with CVP. METHODS: The present study was prospectively performed in emergency medical center of Chonnam National University Hospital from March 1 to October 31, 2006. Two intrahepatic portions and one extrahepatic portion of the IVC were evaluated. RESULTS: All tested areas of the IVC, and the collapsibility indices measured at each location, showed a substantial correlation with CVP. However, in multiple logistic regression analysis performed to identify the location best correlated with CVP, the area of the IVC just below the hepatic vein-IVC junction proved to be the only location to correlate with CVP with statistic significance. CONCLUSION: Measurement of IVC area using ultrasound can yield important information about a patient's volume status, especially in patients for whom central venous catheter insertion is contraindicated. We suggest that the portion of the IVC just below the hepatic vein-IVC junction is the optimal locatin for area measurement to estimate CVP.

A Clinical Analysis of the Patients Transported by EMS Helicopter - In Gwangju and Jeonnam

PURPOSE: Rapid transport of critically ill patients to advanced medical centers is important in improving the survival rate and prognosis. Helicopter Emergency Medical Services (HEMS) is rapid and fairly accessible, but it is expensive, influenced by weather, and has complications at high altitude. This study was performed to build the basic data for helicopter transportation through an analysis of the patients transported by EMS helicopter in Gwangju and Jeonnam. METHODS: The subjects of this study are patients transported by EMS helicopter from January 2002 to June 2004 in Gwangju and Jeonnam. The analysis focused on the clinical characteristics, including time and purpose of flight, and cause, severity and outcome of the diseases. RESULTS: 1. The 262 cases successfully transported. 162 involved men, and 100 involved women. 2. The mean age was 49.0+/-19.9 years. 3. The regional distribution of the 262 cases was 38 cases in Gwangju and, 224 cases in Jeonnam. There were 164 cases (58.6%) in Sinan, 38 cases in Gwangju, 10 cases in Wando, 10 cases in Youngam, 9 cases in Yeosu and Yeochun, the great majority of which were in island area. 4. Traumatic patients (137 cases) were 52.3% of the total number of patient. The average Injury Severity Score of 115 traumatic patients (except for 6 cases of burn and 16 cases of acute poisoning) was 15.5 +/- 8.6. 5. Non-traumatic patients (125 cases) were 47.7% of the total number of patient. The average Simplified Acute Physiology Score II of 125 non traumatic patients and 6 cases of burn and 16 cases of acute poisoning was 24.4+/-18.2. CONCLUSION: Considerations of the region and the reason for help are needed when assessing the indications for helicopter transport apart from the severity of the diseases. Also, advances in medical control and in the operation of emergency information centers are needed to improve the assessment and treatment of patients from the prehospital, and to allow the transport to the proper institutions.