The Outcomes of the Out-of-Hospital Cardiac Arrest: A collaborative research of three hospitals

BACKGROUND: There has been a lot of changes in prehospital medical environment with development of EMSS(emergency medical service systems). Especially in out-of-hospital cardiac arrest, the patients could survive when they are moved to the hospitals earlier. The purpose of this research is to know the status of EMSS in Korea by analyzing CPR(cardiopulmonary resuscitation) outcomes of out-of-hospital cardiac arrest patients at 3 hospital in the western area of Seoul and Incheon. METHODS: From July 1997 to June 1998, we collected data about out-of-hospital cardiac arrest victims at Ewha Womens University Mokdong Hospital, Catholic University Medical College St. Mary Hospital, and Kachon University Chung Ang Gil Hospital. We used same record form based on the 'Utstein Style'. RESULTS: CPR were performed in 265 out-of-hospital cardiac arrest patients at 3 hospitals. One hundred twelve(42.3%) patients recovered the spontaneous circulation at least once and eight(3.0%) patients discharged alive. One hundred ninety four(73.2%) patients died of medical causes, one hundred two(38.5%) cardiogenic and ninety two(34.7%) non-cardiogenic, and seventy(26.4%) patients died of traumatic causes. Initial EKG showed VT/VF(ventricular tachycardia/ventricular fibrillation) in thirty one(11.7%) patients, asystole in one hundred fifty one(57.0%) patients and other rhythms in eighty three(31.3%) patients. Among one hundred two cardiogenic cardiac arrest patients, two(2.0%) patients was discharged alive. CONCLUSION: Overall survival rate of out-of-hospital cardiac angst patients was 3% which was poorer than that of the western country. The proportion of the cardiogenic cause was 3% which was only hart of the western country. VT/VF is relatively not common as a initial EKG rhythm. These differences might be due to difference in the prevalence pattern of out-of-hospital cardiac arrest as well as prematurity of the EMSS.

Central Venous oxygen Saturation(ScvO2)Monitoring in Hemorrhagic Shock

An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.

SERUM POTASSIUM CHANGES ON SUCCINYLCHOLINE: ASSISTED ENDOTRACHEAL INTUBATION IN EMERGENCY DEPARTMENT

Succinylcholine is a depolarizing neuromuscular blocking agent(NMB) and is used in induction of anesthesia. Succinylcholine-assisted endotracheal intubation has been routinely used in the operating room and rapid sequence incubation with NMB agent has been the method for airway management in emergency department(ED). Adverse effects of succinylcholine are hyperkalemia, malignant hyperthermia, transient hypotension, arrhythmia, and increased intracranial, intraocular and gastric pressure, etc. This study carried out the change of serum potassium as an adverse effects of succinylcholine during endotracheal intubation in ED. A prospective, noncontrolled design was used to study serial serum potassium levels in pre- and postendotracheal intubation(5min) from February 1996 to August 1996. Succinycholine was selectively used in patient with a problem of difficult endotracheal intubation (alert to drowsy mental status with intact gag reflex). The dose of succinylcholine was 1.5 mg/kg and injected into intravenous line during preoxygenation with bag-valve-mask device. Student's two-tailed t-test was used and p-value was < 0.05. Among the total of 48 patients(male 27, female 21), the postintubation level of the serum potassium of 25 patients were increased and those of 21 persons were decreased compared with preintubation level. Two patients showed no change in amount. The average serum potassium indicated 3.7+/-.8 mEq/L before the injection of the succinylcholine and 3.8+/-.9 mEq/L 5 minutes after its injection. P-value showed more than 0.05 and as the result statistically there was no noteworthy difference. All patients were intubated within 30 sec and no patients were failed. We concluded that succinylcholine-assisted endotracheal incubation is a rapid and safe method as an endotracheal incubation practiced in ED and succinylcholin-induced hyperkalemia is minimal and no adverse effect.