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J Korean Soc Emerg Med > Volume 16(5); 2005 > Article
Journal of The Korean Society of Emergency Medicine 2005;16(5): 495-504.
Outcome in a Tertiary Emergency Department for Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest
Sung Eun Kim, Eun Kyung Eo, Young Jin Cheon, Koo Young Jung, Hyea Sook Park
1Department of Emergency Medicine, College of Medicine, Inje University, Seoul, Korea.
2Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Korea. liz0803@ewha.ac.kr
3Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
The "Out-of-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data for out-of-hospital resuscitation events. This study was designed to evaluate the current status of out-of-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report on guidelines for resuscitation in Korea.
A clinical analysis of the out-of-hospital cardiac arrest (OHCA) patients, CPR performed in a tertiary emergency department, from July 1995 to December 2002 was conducted. The evaluation was made using Utstein reporting guidelines.
Four hundred forty-nine patients were included in this study. The cardiac arrests were caused by non-cardiac medical diseases (41.9%), cardiac diseases (39.6%), unknown (10.0%), and trauma (8.5%). The initial electrocardiogram (ECG) showed asystole in 58.6% of the cases, other rhythms in 29.4%, and ventricular fibrillation/ventricular tachycardia (VF/VT) in 12.0%. Spontaneous circulation was restored (ROSC) in 41.2% of the cases. Twenty-four (5.3%) patients with witnessed and cardiogenic cardiac arrests had VF/VT on initial ECG, and of them, 5 (20.8%) patients were discharged alive. The mean circulatory arrest time was 19.7+/-13.6 minutes, and it was shorter in patients with ROSC (16.9+/-11.6) than in patients without ROSC (22.1+/-14.7, p= 0.003).
The overall survival rate of OHCA patients was 6.7%, which was poorer than those of western countries. The overall duration from collapse to advanced cardiac life support (ACLS) was 19.7 minutes, which was too long. Major factors contributing to the low survival rate were most likely the lack of bystander CPR, delay in activating the emergency medical system (EMS), and inappropriate CPR by the EMT. We should make every effort to improve these areas.
Key words: Cardiac arrest, Cardiopulmonary resuscitation
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