Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea.
Direct medical control using video conferencing capabilities of smartphones has never been conducted in out-of-hospital cardiac arrest patients. This study was conducted to investigate the feasibility and treatment effectiveness of real-time smartphone video conferencing calls for the management of out-of-hospital cardiac arrest.This study was a pre-post-intervention prospective cohort study conducted from January 2013 to July 2015. The intervention was pre-hospital advanced life support under a physician's direction using a smartphone video call.In total, 942 cardiac arrests occurred over the 2-year period; 308 patients were excluded, and 314 (49.5%) and 320 (50.5%) cardiac arrest patients were enrolled during the pre- and post-intervention study periods, respectively. There were 248/320 (77.5%) cases of smartphone video-assisted advanced life support during the post-intervention period. For patients in the pre- and post-intervention groups, the pre-hospital return of spontaneous circulation was 6.7 and 20%, respectively (adjusted odds ratio 3.3, 95% confidence interval 1.6-6.8, P < 0.01), and favourable neurological outcomes were ascertained in 1.9 and 6.9%, respectively (adjusted odds ratio 23.6, 95% confidence interval 3.4-164.0, P < 0.01). The smartphone voice and video quality were rated 8.5 and 8.2 out of 10, respectively, in physician evaluation, while the overall utility was rated 9.1.We concluded that a multidisciplinary approach including the re-education of basic life support, simulation training for advanced life support, real-time medical direction via video call, and dispatching two teams rather than one team improved the outcome of out-of-hospital cardiac arrest.
The suicide rate of middle-aged adults has increased rapidly, which is a significant public health concern. A depressed mood and suicidal ideation are significant risk factors for suicide, and non-pharmacological interventions such as exercise therapy have been suggested as potential treatments. Walking is a feasible and accessible form of exercise therapy for middle-aged adults.We conducted a study based on the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) data of 6,886 general middle-aged adults in South Korea to investigate the relationships of walking exercise with depressed mood and suicidal ideation. Multiple logistic regression analysis was used to adjust for confounding variables. Sampling weights were applied to obtain estimates for the general Korean population.Participants who walked ≥5 days per week had a significantly lower odds ratio (OR) for depressed mood [OR = 0.625, 95% confidence interval (CI): 0.424-0.921, p = 0.018] and suicidal ideation (OR = 0.252, 95% CI: 0.125-0.507, p < 0.001) compared to those who never walked, regardless of the duration of exercise. The same results were obtained for males after stratifying the data by sex and suicidal ideation was associated with walking in females.Regular walking exercise was associated with diminished mental health problems in middle-aged adults. Light walks may serve as a useful starting point for patients with serious mental health issues, such as suicidal ideation.
Delayed neuropsychiatric sequelae are major complications of carbon monoxide poisoning; carbon monoxide triggers brain oxidation and inflammation. Corticosteroids such as dexamethasone modulate neurological damage after carbon monoxide poisoning through anti-inflammatory actions and immune response inhibition. However, it is not known whether corticosteroids prevent delayed neuropsychiatric sequelae. We thus studied whether dexamethasone reduced the incidence of delayed neuropsychiatric sequelae.This registry-based study enrolled patients with carbon monoxide poisoning treated in a Korean tertiary care hospital from March 1st, 2020 to November 30th, 2021. Data of patients were prospectively collected during the study period, and retrospectively analyzed. One group received intravenous dexamethasone. We performed multivariable logistic regression analysis to identify factors associated with delayed neuropsychiatric sequelae.A total of 128 patients were enrolled, of which 99 patients received dexamethasone therapy and 29 patients did not. The incidences of delayed neuropsychiatric sequelae in the dexamethasone and non-dexamethasone groups were 16.2% and 37.9%, respectively. Multivariable logistic regression analysis revealed that dexamethasone use (odds ratio = 0.122, 95% confidence interval 0.031-0.489) and a higher Glasgow Coma Scale (odds ratio = 0.818, 95% confidence interval 0.682-0.981) was associated with a lower incidence of delayed neuropsychiatric sequelae.Early dexamethasone treatment was significantly associated with a decreased incidence of delayed neuropsychiatric sequelae. A higher Glasgow Coma Scale at presentation also was associated with a lower incidence of delayed neuropsychiatric sequelae.
To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014.Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent.One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims.In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.
Cardiac arrest is a major social and public healthcare issue. According to the 2015 statistics of the Korea Centers for Disease Control and Prevention, 45.1 persons per 100,000 population had a cardiac arrest and the rate of resuscitation for cardiac arrest is 4.8%, which is low in comparison with the economic scale of the country [1]. Moreover, the mean prevalence of patients discharged with cerebral performance categories 1 or 2, which indicate good neurological prognosis for patients who had cardiac arrest, was only 2.3% [2]. This is also lower than the 9.6% of the overall survival rate to hospital discharge reported in a CARES (Cardiac Arrest Registry to Enhance Survival) research that covered the entire United States of America from 2005 to 2010 and the 8.9% reported for Osaka, Japan, from 2007 to 2009 [3,4]. In addition, resuscitation rates differ by five- to six-fold at the maximum between regions, thus requiring multilateral considerations. In order to successfully apply the newly introduced 2015 cardiopulmonary resuscitation (CPR) guidelines to the society, a well-planned integrated application strategy is required, along with an educational strategy as a core factor.
Abstract Background Out-of-Hospital Cardiac Arrest (OHCA) is a leading cause of mortality worldwide, with approximately 30,000 cases managed annually by Emergency Medical Services (EMS) in South Korea. Prolonged on-scene Advanced Life Support (ALS) in OHCA patients has demonstrated potential for prehospital return of spontaneous circulation (ROSC) and neurological improvement. However, the optimal timing for terminating on-scene CPR in patients who do not achieve ROSC remains challenging. This study aims to develop and validate a predictive model for patient outcomes based on the duration of on-scene CPR in OHCA patients using data from the Smart ALS (SALS) protocol in South Korea. Methods A multi-regional observational study was conducted from August 2015 to December 2022, involving 19 fire stations and nine academic tertiary hospitals across seven provinces. Data were sourced from the SALS database, including EMS prehospital care reports, SALS intervention logs, and hospital patient records. The study focused on non-traumatic OHCA patients who underwent SALS, excluding those with obvious signs of death, those under 18 years old, those who refused on-scene CPR, or those with a DNR status. Statistical analyses were performed using R software, employing logistic regression models to predict prehospital ROSC, survival to discharge, and favorable neurological outcomes. Results Out of 98,569 OHCA patients evaluated, 34,989 were eligible for SALS, and 16,052 received SALS. Significant predictors of prehospital ROSC included younger age, male gender, arrest occurring in public places, witnessed arrest, bystander CPR, and initial shockable rhythm. Logistic regression models for patients who did not achieve prehospital ROSC showed that longer on-scene CPR duration negatively impacted the probability of ROSC, survival to discharge, and neurological outcomes. The predictive model for ROSC had an AUC of 0.730, for survival to discharge AUC of 0.838, and for favorable neurological outcome AUC of 0.917. Conclusions This study emphasizes the critical role of prehospital ROSC in improving survival and neurological outcomes in OHCA patients. The predictive models can aid in making informed decisions about the cessation of on-scene CPR. Further research is needed to validate these models and explore their application in different EMS settings. Trial registration Retrospectively registered.
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