Analysis of the factors associated with survival to hospital discharge in adult patients with cardiac arrest in the emergency department

Objective@#There is limited data on the outcomes of cardiac arrest occurring in emergency departments (ED). The objective of this study was to identify the factors associated with these outcomes, primarily the survival to hospital discharge and the neurological status at discharge in emergency department cardiac arrest (EDCA) patients. @*Methods@#A retrospective study was conducted in a tertiary hospital. Adult patients aged over 18 years who had suffered an in-hospital cardiac arrest in the ED between July 2018 to June 2021 were included. The primary outcome was the survival to hospital discharge. Descriptive statistics and logistic regression analyses were performed. @*Results@#We identified 157 ED arrests. Among these, 57.9% of the patients died in the emergency room. A total of 24.1% obtained survival discharge. The combined existing illnesses, such as renal insufficiency or malignancy were directly related to the survival of the patients. A cardiac and respiratory cause of arrest increased the probability of survival (P<0.001). The shorter the time spent on cardiopulmonary resuscitation (CPR), the higher the chances of survival (odds ratio of 0.84). The subjects in both the survivor and deceased groups were classified as Korean Triage and Acuity Scale 2 (KTAS 2: emergency) or higher (P=0.719). There was no difference in the ED occupancy, which is an emergency room overcrowding indicator. @*Conclusion@#EDCA patients are already in a clinically deteriorated condition. The underlying clinical conditions, the cause of cardiac arrest, the initial rhythm, and the CPR duration time are directly related to the patient’s chances of survival and prognoses. Therefore, it is possible to identify these factors at an early stage and take the appropriate management measures.

Is the shock index a useful tool in trauma patients with alcohol ingestion?

Objective@#Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol. @*Methods@#This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol. @*Results@#A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group. @*Conclusion@#The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.

Appropriateness of Korean Triage and Acuity Scale-based triage system for dizziness without neurologic symptoms

Objective@#This study aimed to identify the appropriateness of the Korean Triage and Acuity Scale (KTAS) for dizziness without neurological symptoms, which was level 3. @*Methods@#Using the registry of the National Emergency Department Information System (NEDIS), data regarding consecutive emergency patients from January 2016 to July 2018, who were aged 15 years and older, were reviewed retrospectively. The data were classified using KTAS and Dizziness KTAS level 3 were compared with non-dizziness KTAS level 3 including age, total admission rate, intensive care unit (ICU) admission rate, discharge rate, hospital cost, and length of stay in the emergency department (length of stay [LOS]). @*Results@#Of the 76,153 emergency patients, 345 (0.5%) had a KTAS level 1, 4,593 (6.0%) had a KTAS level 2, 21,561 (28.3%) had a KTAS level 3, 45,390 (59.6%) had a KTAS level 4, and 4,264 (5.6%) had a KTAS level 5. As the patient’s triage score decreased, the total admission rate, ICU admission rate, hospital cost, and LOS decreased. Patients discharged to home also had the same result. Dizziness KTAS level 3 had a significantly lower rate of total admission (23% vs. 56.2%, P<0.001) and ICU admission (0.9% vs. 6.2%, P<0.001) compared with non-dizziness KTAS level 3. On the other hand, the hospital cost and LOS were higher when patients were discharged to their home. The predictors of the admission rate of dizziness KTAS level 3 were the transportation method using a private ambulance service and older age, but older age was only slightly associated. @*Conclusion@#This study showed that KTAS level 3 for dizziness needs to be adjusted because of lower severity than other level 3. Old age and the transportation method should be considered factors.

The influence of symptom to balloon time in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVE@#The current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommends early reperfusion with a door to balloon (DTB) time of 90 minutes or less in patients undergoing primary percutaneous coronary intervention (PPCI). Therefore, the focus of most studies has been the DTB time. On the other hand, the ischemic time is related to the symptom to balloon (STB) time rather than the DTB time. This study examined the clinical effects of the STB time as well as the social and clinical factors affecting the STB time in STEMI patients.@*METHODS@#This study analyzed 286 patients diagnosed with STEMI from December 2008 to December 2016. The STB time (≤4 hours and>4 hours, ≤12 hours, and >12 hours) in the groups was compared. The mortality and ejection fraction were investigated. In addition, the characteristics of patients and socioeconomic factors affecting STB were analyzed.@*RESULTS@#The SBT time is inversely associated with the ejection fraction (R=−0.126, P=0.033), and the ejection fraction of the ≤12 hours group was higher than that of the >12 hours group (54% vs. 50%, P=0.047). On the other hand, there was no significant difference in mortality between the two groups (3.26% vs. 4.84%, P=0.506). In multivariate analysis, the variable related to SBT was only typical chest pain (adjusted odd ratio, 1.931; 95% confidential interval, 1.014-3.792; P=0.045).@*CONCLUSION@#The results of the study support the prognostic value of SBT in STEMI undergoing PPCI. Therefore, efforts should be made to shorten the STB time.