Comparison of the effectiveness of cardiopulmonary resuscitation before and after using the LUCAS device in in-hospital cardiac arrest

Objective@#High-quality chest compressions are consistently delivered by mechanical chest compression devices. This study assesses the feasibility of LUCAS in in-hospital cardiac arrest (IHCA) patients. @*Methods@#This was a single-center, retrospective, before and after clinical study comparing the clinical outcomes of LUCAS cardiopulmonary resuscitation (CPR) in IHCA patients. The return of spontaneous circulation (ROSC) rate and 7-day mortality were evaluated to assess short-term outcomes. Additional outcomes included epinephrine dose, CPR time, and the number of medical workers participating in CPR. @*Results@#The number of medical workers who participated in CPR in the LUCAS CPR group was fewer than in the manual CPR group (manual CPR 9.3 vs. LUCAS CPR 4.5; P=0.001). In IHCA patients, no significant differences were obtained in the ROSC rate (manual CPR 46.4% vs. LUCAS CPR 31.4%; P=0.051) and 7-day mortality (manual CPR 81% vs. LUCAS CPR 86.3%; P=0.434) between the two groups. However, the median CPR time (manual CPR 28.1 vs. LUCAS CPR 42.8; P=0.001) and the epinephrine dose (manual CPR 8.3 vs. LUCAS CPR 13.3; P=0.001) were significantly longer in the LUCAS CPR group than the manual CPR group. @*Conclusion@#Compared to manual CPR, CPR with LUCAS required fewer healthcare workers and had no significant difference in the ROSC rate and mortality in patients with IHCA.

Combined hydrocortisone, ascorbic acid, and thiamine therapy for septic shock with complicated intraabdominal infection: before and after cohort study

Purpose@#The aim of this study was to assess the efficacy of intravenous hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in complicated intraabdominal infection (cIAI) patients with septic shock. @*Methods@#This was a single-center, retrospective before-after clinical study comparing clinical outcomes of cIAI patients with septic shock treated with HAT in a surgical intensive care unit (ICU). Delta modified sequential organ failure assessment (mSOFA) scores were evaluated to assess recovery of organ dysfunction. Additional outcomes included procalcitonin level change, daily vasopressor dosage, mean number of days free of mechanical ventilation in 28 days, and renal replacement therapy days. @*Results@#The delta mSOFA score (ICU admission mSOFA score minus 7th-day mSOFA score) was significantly higher in the HAT group than in the control group on the 7th day (2.30 vs. –0.90, P = 0.003). The median 7-day change in procalcitonin score was higher in the control group than in the HAT group (5.94 vs. 10.72, P = 0.041). The difference in vasopressor score between the 1st day and the 4th day was significantly higher in the HAT group (17.63 vs. 9.91, P = 0.005). @*Conclusion@#In our study of cIAI in patients with septic shock, administration of HAT therapy may improve the recovery from organ dysfunction.

Combined hydrocortisone, ascorbic acid, and thiamine therapy for septic shock with complicated intraabdominal infection: before and after cohort study

Purpose@#The aim of this study was to assess the efficacy of intravenous hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in complicated intraabdominal infection (cIAI) patients with septic shock. @*Methods@#This was a single-center, retrospective before-after clinical study comparing clinical outcomes of cIAI patients with septic shock treated with HAT in a surgical intensive care unit (ICU). Delta modified sequential organ failure assessment (mSOFA) scores were evaluated to assess recovery of organ dysfunction. Additional outcomes included procalcitonin level change, daily vasopressor dosage, mean number of days free of mechanical ventilation in 28 days, and renal replacement therapy days. @*Results@#The delta mSOFA score (ICU admission mSOFA score minus 7th-day mSOFA score) was significantly higher in the HAT group than in the control group on the 7th day (2.30 vs. –0.90, P = 0.003). The median 7-day change in procalcitonin score was higher in the control group than in the HAT group (5.94 vs. 10.72, P = 0.041). The difference in vasopressor score between the 1st day and the 4th day was significantly higher in the HAT group (17.63 vs. 9.91, P = 0.005). @*Conclusion@#In our study of cIAI in patients with septic shock, administration of HAT therapy may improve the recovery from organ dysfunction.

Estimation of Optimal Pediatric Chest Compression Depth by Using Computed Tomography

PURPOSE: The purpose of this study was to assess optimal chest compression depth for infants and children compared with adults, when the simulated compression depth was delivered according to the current guidelines. METHODS: A total of 467 consecutive chest computed tomography scans (93 of infants, 110 of children, and 264 of adults) were reviewed. The anteroposterior (AP) diameter and compressible diameter (CD) for infants and children were measured at the inter-nipple level and at the middle of the lower half of the sternum for adults. Compression ratio (CR) to CD was calculated at simulated one-fourth, onethird, and one-half AP compressions in infants and children and simulated 5-cm, 6-cm compressions in adult. RESULTS: In adults, the CRs to CD at simulated 5-cm, 6-cm compression depth were 41.7±0.16%, 50.0±7.3%, respectively. In children and infants, the CRs to CD at onethird chest compression were, respectively, 55.1±2.4%, 51.8±2.4% and 82.7±3.7%, 77.7±3.6% at one-half chest compression. The CRs to CD of 4-cm compression depth in infants and 5-cm compression depth in children were 74.4±10.9%, 62.5±8.7%, respectively. The CRs to CD for children and infants were significantly higher compared with adults (p<0.001). The CR to CD of 4-cm compression depth in children was similar to that of 6-cm compression depth in adults (50.0±6.9% vs 50.0±7.3%, p=0.985). CONCLUSION: The current pediatric guideline for compression depth was too deep compared with adults. We suggest that one third of the AP chest diameter or approximately 4-cm in children and less than 4-cm in infants is more appropriate.

Is there any quality improvement in the randomized controlled trial abstracts in the Korean Journal of Anesthesiology after the publication of the CONSORT abstract guidelines in 2008? / 대한마취과학회지

No abstract available.

Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation / 대한구급학회지

BACKGROUND: Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR. METHODS: This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR. RESULTS: During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC. CONCLUSIONS: During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Prediction of Rupture of Pre-existing Cerebral Aneurysm by CT Findings in Patients with Traumatic Brain Injury

PURPOSE: Rupture of pre-existing cerebral aneurysms has occasionally been reported as a cause of traumatic subarachnoid hemorrhage (TSAH) and intraparenchymal hemorrhage (IPH). SAH due to rupture of pre-existing cerebral aneurysm is an important differential diagnosis in TSAH. The aim of our study was to determine whether a rupture in a pre-existing cerebral aneurysm could be predicted based on the pattern of hemorrhage on the initial computed tomography (CT) scan in patients with traumatic brain injury (TBI). METHODS: A total of 336 patients who had undergone computed tomography angiography (CTA) for detection of rupture of pre-existing cerebral aneurysm in TBI between the years 2004 and 2013 were retrospectively studied. In order to investigate CT findings of ruptured cerebral aneurysm, patients who had a lesion of SAH, IPH, or IVH were compared with the control group (who had intracranial lesions of contusion, epidural hematoma, subdural hematoma, or hemorrhagic contusion). RESULTS: Fifty eight (17.3%) patients with TSAH harbored cerebral aneurysms, and 45 (13.4%) patients had ruptured cerebral aneurysms. The ruptured aneurysms showed significant association with CT findings of a diffuse hemorrhage in the basal cisterns (29.2%, p=0.003, OR=23.130), unilateral sylvian fissure (13.8%, p=0.039, OR=8.842), anterior interhemispheric fissure (20.0%, p=0.028, OR=14.000), and associated IPH (22.6%, p=0.011, OR=16.333). However, the ruptured aneurysms did not show association with CT findings of hemorrhage on convexities, perimesencephalic cisterns, bilateral sylvian fissure, and IVH (p>0.1). CONCLUSION: Patterns of distribution of SAH and associated IPH on initial CT can be predicted of rupture pre-existing cerebral aneurysm in patients with TBI.

Reduction of propofol infusion pain using target controlled infusion of remifentanil

BACKGROUND: Propofol has a high incidence of infusion pain. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target controlled infusions (TCI) of both drugs were used. We compared the efficacy of remifentanil TCI administered 90 seconds before propofol TCI with remifentanil TCI and propofol TCI given immediately after a 40 mg lidocaine bolus in prevention of propofol infusion pain. METHODS: One hundred sixty five ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups. Group C: propofol TCI and remifentanil TCI was started at the same time (n = 55), group L: lidocaine 40 mg injection immediately prior to propofol TCI and remifentanil TCI (n = 55), group R: remifentanil TCI was started 90 seconds before propofol TCI (n = 55). Pain severity of propofol infusion was evaluated using a four-point scale (none, mild, moderate, severe). RESULTS: The incidence of pain in group R and group L was significantly lower than in group C. There was no significant difference between group R and group L. But the incidence of moderate and severe pain in group R was significantly lower than in group L (P < 0.05). CONCLUSIONS: Remifentanil TCI 90 seconds before propofol TCI reduces propofol infusion pain than propofol TCI and remifentanil TCI started at the same time. This protocol is considered to be more effective in alleviating moderate and severe pain than lidocaine.

A unilateral large bronchopleural fistula caused by rupture of bulla with coexisting bilateral giant bullae: A case report

A patient with a large bronchopleural fistula presents several intraoperative challenges for the anesthesiologist, particularly if bullae coexist bilaterally. Ideally, a double lumen tube is inserted while the patient is conscious or breathing spontaneously under general anesthesia to prevent possible tension pneumothorax in the contralateral lung due to positive-pressure ventilation and the possibility of inadequate ventilation due to an air leak from the fistula. However, we inserted a single lumen tube instead of a double lumen tube, because this patient had multiple giant bullae bilaterally and the contralateral lung tissue was almost completely compressed and destroyed. We report the use of a single lumen tube under volatile general anesthesia with synchronized intermittent mandatory ventilation with small tidal volume. In addition, we used permissive hypercapnia to further minimize barotraumas. Due to permissive hypercapnia, there were no cardiovascular consequences.

End-tidal concentration of sevoflurane for preventing rocuronium-induced withdrawal of the arm in pediatric patients / 대한마취과학회지

BACKGROUND: During induction of general anesthesia, the intravenous injection of rocuronium is often associated with withdrawal movement of the arm due to pain, and this abrupt withdrawal may result in dislodgement of the venous catheter, injury, or inadequate injection of rocuronium. We performed this study to evaluate the 50 and 95% effective end-tidal concentrations of sevoflurane (ETsev) for preventing rocuronium-induced withdrawal of the arm. METHODS: We conducted a prospective double-blind study in 31 pediatric patients. After free flow of lactated Ringer's IV fluid was confirmed, anesthesia was induced in the patients by using 2.5% thiopental sodium (4 mg/kg) and sevoflurane (4 vol%) with 6 L/min of oxygen. When the target ETsev was reached, preservative-free 1% lidocaine (1.5 mg/kg) was intravenously injected during manual venous occlusion and rocuronium (0.6 mg/kg) was injected after lidocaine injection under free-flow intravenous fluid. A nurse who was an investigator and was blinded to the ETsev injected the rocuronium. The nurse evaluated the response. RESULTS: Non-withdrawal movement was observed in 5 out of 11 patients with ETsev 3.0 vol% and in 5 out of 6 patients with ETsev 3.5 vol%. By Dixon's up-and-down method, the 50% effective concentration (EC50) of sevoflurane for non-withdrawal movement at rocuronium injection was 3.1 +/- 0.4 vol%. A logistic regression curve of the probability of non-withdrawal movements showed that the 50% effective ETsev for abolishing withdrawal movement at rocuronium injection was 2.9 vol% (95% confidence interval [CI] 2.4-3.8 vol%) and the 95% effective ETsev was 4.3 vol% (95% CI 3.6-9.8 vol%). CONCLUSIONS: This study showed that the 50 and 95% effective ETsev that prevent withdrawal movement at rocuronium injection are 2.9 and 4.3 vol%, respectively.

A Case of Facial Nerve Schwannoma Extending into the Middle Cranial Fossa / 대한이비인후과학회지

Schwannomas of the facial nerve are uncommon tumors, accounting for about 0.8% of all intrapetrous mass lesion.1-3) Very rarely do these lesions acts as expansile tumors of the petrous bone that extend to involve the intracranial cavity.1-10) Recently we experienced 1 case of facial nerve schwannoma unusually extending into middle cranial fossa which was removed by transcochlear and middle fossa approach. So we report the case with review of literature.

Histopathologic Distribution of Fibers and Glands in Nasal Polyps / 대한이비인후과학회지

The purpose of this study is to investigate the distribution and the direction of fibers in nasal polyps. The distribution of fibers is not well known about position and quantity. From June 1993 to April 1996, the authors obtained 232 nasal polyps from 191 patients. The polyps had been stained with H-E method. Authors observed the histopathologic type of polyps, and then the polyps have been stained with Weigert's method getting information about the fibers of polyps. In the polyps, the origin site of polyp showed dense collagen fibers of which direction resembled the movement of sand in hour-glass. In the submucosa, the direction of fibers is parallel to epithelium. Each gland or grouped glands in the polyps were circumscribed with collagen fibers. Our current study on the fibers and glands in nasal polyps is very fundamental, but we suggest that further investigation about the fibers and glands in polyps would enable to reveal pathogenesis of polyp investigated.