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Over the last 50 years, the recommended chest compression for cardiopulmonary resuscitation (CPR) has become faster and deeper, but maintaining deep compressions may be difficult at higher rates. Our study aimed to determine whether adequate compression (chest compression at an appropriate depth and rate) is being performed in emergency departments (ED). We also investigated the effect of adequate compression performance on the return of spontaneous circulation (ROSC). This prospective observational study was conducted at the EDs of two urban academic medical centers. We included adult patients (age=18 years) with cardiac arrest who underwent CPR in the ED between May and November 2020. We excluded patients with cardiac arrest related to trauma, repeated arrest except the first, and those for whom a monitor-defibrillator (ZOLL X-series) was not used. The following data were obtained from the monitordefibrillator devices: compression depth, rate, chest compression fraction, CPR time, and percentage of compressions at the recommended rate and, at the recommended depth, at over and below rates, and depth, and at the appropriate depth and rate. Our study included 50 patients, from whom 441 chest compression sequences were obtained and analyzed. The mean compression depth, rate, and fraction were 6.48 ± 0.87 cm, 117 ± 5/min, 92.1 ± 3.70%, respectively. As the compression rate increased, the depth decreased, and most compressions were over-depth. Adequate compression (appropriate depth at recommended rate) was observed in 97 of the 441 compression sequences (21.9%). Below-depth and below-rate percentages were higher in the deceased group than that in the ROSC group (9.7 ± 15.2% vs. 3.3 ± 3.5%, p = 0.27; 2.7 ± 2.6% vs. 1.2 ± 0.9%, p = 0.06). The global ratio of chest compression showed low compliance with the recommended rate and depth, even when performed by skilled ED staff. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation (CPR) quality is crucial for improving patient survival rates after cardiac arrest. This study aimed to investigate the usefulness of femoral artery collapse ratio (systolic diameter/diastolic diameter ratio) measurement using Mmode ultrasound versus end-tidal carbon dioxide (ETCO2) for the assessment of highquality CPR in a porcine cardiac arrest model. A total of 10 male mongrel pigs (age range, 16-20 weeks; weight, 45-50 kg) were used. After anesthesia, the carotid artery was dissected and exposed. The animals were instrumented with an arterial catheter in the exposed carotid artery to monitor arterial blood pressure. Cardiac arrest was induced by injecting potassium chloride (KCl, 40 equivalents of weight). The animals underwent chest compression using a mechanical device, and the chest compression depth and ETCO2 were measured using a defibrillator. To obtain hemodynamic information, two investigators performed an ultrasound examination on both femoral arteries. One examiner measured the femoral peak systolic velocity (PSV), while the other measured the diameters of the femoral artery (systolic diameter and diastolic diameter) in a transverse or longitudinal position using the M-mode of the linear ultrasound probe. As the compression depth increased, ETCO2, femoral artery diameter, collapse ratio (systolic diameter/diastolic diameter), and blood flow increased; however, PSV decreased. The ETCO2 and collapse ratio were positively correlated. The femoral artery collapse ratio, measured using the M-mode ultrasound, could be an alternative and simple method to evaluate high-quality CPR. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effect of the code blue activation system and factors affecting patients' survival to discharge and neurologic outcomes after inhospital cardiac arrest. Methods: We retrospectively reviewed the data of patients aged ≥ 18 years who experienced in-hospital cardiac arrest between July 2014 and September 2019 at a tertiary hospital. The outcomes included survival to hospital discharge and neurologic outcomes (cerebral performance category score). Results: In total, 605 patients were included. The rate of survival to discharge was 21.8% (n = 132), and the rate of sustained return of spontaneous circulation was 69.7% (n = 422). Predisposing conditions, such as sepsis, cancer, pneumonia, and use of vasopressors, were associated with poor prognosis, and the survival rate was low (P = 0.01). The rate of survival to discharge was higher in patients who underwent defibrillation (odds ratio: 2.48, 95% confidence interval: 1.36-4.53) than in those who did not. The median cardiopulmonary resuscitation (CPR) duration time was 11.0 and 26.5 min in the survival and non-survival groups, respectively (P < 0.01). Code blue activation to CPR team arrival time (advanced cardiovascular life support activation time) was not significantly different within 1 minute in both groups (P = 0.95). Similarly, no differences in basic life support activation time and first time to defibrillation were observed between the survival and non-survival groups. Among survivors, factors affecting favorable neurologic outcomes were young age, cerebral performance before CPR, whether witnessed, admission days, and CPR duration. Conclusions: The compulsory availability of a systematic code blue activation is not sufficient. Further, appropriate monitoring and continuous observation are crucial for improving survival to discharge and neurologic outcomes and preventing cardiac arrest in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma. Methods: Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed. Results: During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality. Conclusions: Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma. [ABSTRACT FROM AUTHOR]

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately. [ABSTRACT FROM AUTHOR]