Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Kim, Soo Hyun; Park, Kyu Nam; Youn, Chun Song; Chae, Minjung Kathy; Kim, Won Young; Lee, Byung Kook; Lee, Dong Hoon; Jang, Tae Chang; Lee, Jae Hoon; Choi, Yoon Hee; You, Je Sung; Cho, In Soo; Kim, Su Jin; Lee, Jong Seok; Kim, Yong Hwan; Sim, Min Seob; Shin, Jonghwan; Park, Yoo Seok; Lee, Young Hwan; Moon, Hyung Jun; Jeong, Won Jung; Oh, Joo Suk; Choi, Seung Pill; Cha, Kyoung‐Chul

doi:10.15441/ceem.20.035

Cited by 21 publications

(16 citation statements)

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“…The KORHN-PRO registry was registered under clinicaltrials.gov as protocol NCT02827422. Design, participation, data collection and results have previously been published [ 15 ]. Briefly, nontraumatic OHCA patients treated with TTM at each center were reported in KORHN-PRO 1.0.…”

Section: Methodsmentioning

confidence: 99%

“…A new, more simplified prognostication strategy algorithm was published in 2020 [ 14 ]. The Korean Hypothermia Network Prospective Registry 1.0 (KORHN-PRO 1.0) is a web-based registry of OHCA patients treated with TTM between October 2015 and December 2018 [ 15 ]. KORHN-PRO 1.0 is an ideal source for validation of the proposed prognostication algorithm due to the minimal practice of WLST in Korean intensive care.…”

Section: Introductionmentioning

confidence: 99%

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External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

et al. 2022

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Purpose To assess the performance of the post-cardiac arrest (CA) prognostication strategy algorithm recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) in 2020. Methods This was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0. Unconscious patients without confounders at day 4 (72–96 h) after return of spontaneous circulation (ROSC) were included. The association between the prognostic factors included in the prognostication strategy algorithm, except status myoclonus and the neurological outcome, was investigated, and finally, the prognostic performance of the prognostication strategy algorithm was evaluated. Poor outcome was defined as cerebral performance categories 3–5 at 6 months after ROSC. Results A total of 660 patients were included in the final analysis. Of those, 108 (16.4%) patients had a good neurological outcome at 6 months after CA. The 2020 ERC/ESICM prognostication strategy algorithm identified patients with poor neurological outcome with 60.2% sensitivity (95% CI 55.9–64.4) and 100% specificity (95% CI 93.9–100) among patients who were unconscious or had a GCS_M score ≤ 3 and with 58.2% sensitivity (95% CI 53.9–62.3) and 100% specificity (95% CI 96.6–100) among unconscious patients. When two prognostic factors were combined, any combination of prognostic factors had a false positive rate (FPR) of 0 (95% CI 0–5.6 for combination of no PR/CR and poor CT, 0–30.8 for combination of No SSEP N20 and NSE 60). Conclusion The 2020 ERC/ESICM prognostication strategy algorithm predicted poor outcome without an FPR and with sensitivities of 58.2–60.2%. Any combinations of two predictors recommended by ERC/ESICM showed 0% of FPR.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

et al. 2022

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“… 1 Most patients resuscitated from cardiac arrest fail to achieve long‐term survival with favorable neurologic outcomes because of brain injury. 2 , 3 Targeted temperature management may improve neurological outcomes after cardiac arrest and is the standard treatment for patients who are comatose following cardiac arrest. 4 , 5 , 6 However, despite implementation of this therapy, the number of patients who fail to achieve meaningful neurologic recovery remains overwhelmingly greater than that of patients who survive with favorable neurologic outcomes.…”

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confidence: 99%

Effects of Sodium Nitroprusside Administered Via a Subdural Intracranial Catheter on the Microcirculation, Oxygenation, and Electrocortical Activity of the Cerebral Cortex in a Pig Cardiac Arrest Model

Lee

Jung

Mamadjonov

et al. 2022

JAHA

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Background Postischemic cerebral hypoperfusion has been indicated as an important contributing factor to secondary cerebral injury after cardiac arrest. We evaluated the effects of sodium nitroprusside administered via a subdural intracranial catheter on the microcirculation, oxygenation, and electrocortical activity of the cerebral cortex in the early postresuscitation period using a pig model of cardiac arrest. Methods and Results Twenty‐nine pigs were resuscitated with closed cardiopulmonary resuscitation after 14 minutes of untreated ventricular fibrillation. Thirty minutes after restoration of spontaneous circulation, 24 pigs randomly received either 4 mg of sodium nitroprusside (IT‐SNP group) or saline placebo (IT‐saline group) via subdural intracranial catheters and were observed for 5 hours. The same dose of sodium nitroprusside was administered intravenously in another 5 pigs. Compared with the IT‐saline group, the IT‐SNP group had larger areas under the curve for tissue oxygen tension and percent changes of arteriole diameter and number of perfused microvessels from baseline (all P <0.05) monitored on the cerebral cortex during the 5‐hour period, without severe hemodynamic instability. This group also showed faster recovery of electrocortical activity measured using amplitude‐integrated electroencephalography. Repeated‐measures analysis of variance revealed significant group–time interactions for these parameters. Intravenously administered sodium nitroprusside caused profound hypotension but did not appear to increase the cerebral parameters. Conclusions Sodium nitroprusside administered via a subdural intracranial catheter increased post–restoration of spontaneous circulation cerebral cortical microcirculation and oxygenation and hastened electrocortical activity recovery in a pig model of cardiac arrest. Further studies are required to determine its impact on the long‐term neurologic outcomes.

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“…The twenty-two academic hospitals that participated in the KORHN-PRO were required to fill out the participation form provided on the website of the KORHN-PRO registry (http:// pro.korhn.or.kr/), which collected 136 variables with 839 datasets, and the participating institutions were distributed evenly across the country. The study included an informed consent form approved by the Institutional Review Boards (IRB) of all participating hospitals, including the IRB of Seoul St. Mary's Hospital (XC15OIMI0081K) and the study was registered on the International Clinical Trials Registry Platform (NCT02827422) [10]. Written informed consent was obtained from all patients' legal surrogates.…”

Section: Methodsmentioning

confidence: 99%

The association of different target temperatures in targeted temperature management with neurological outcome after out-of-hospital cardiac arrest based on a prospective multicenter observational study in Korea (the KORHN-PRO registry): IPTW analysis

Kim

Youn²,

Park³

et al. 2022

PLoS ONE

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Background Among comatose survivors of out-of-hospital cardiac arrest (OHCA), targeted temperature management (TTM) has improved neurological outcomes. However, although the target temperature shifted from 33°C to 33°C~36°C, the optimal target temperature is still unclear. The goal of this study was to evaluate neurological outcomes at 6 months at target temperatures of 33°C and 36°C. Materials and methods We analyzed OHCA survivors who underwent TTM and were recorded in the Korean Hypothermia Network, a prospective multicenter registry, from October 2015 to December 2018. The primary outcome was good neurological outcome at six months, defined as a cerebral performance category of 1–2, and the secondary outcome was survival at 6 months. Results A total of 1339 patients were treated with TTM in twenty-two emergency departments. Of those, 1054 were treated at 33°C, and 285 were treated at 36°C. There was no significant difference in good neurological outcomes at 6 months (30.6% vs. 31.2%, p = 0.850, adjusted OR 0.97, 95% CI = 0.73–1.29]) and survival at six months (41.4% vs. 38.7%, p = 0.401, adjusted HR 1.08, 95% CI = 0.91–1.28]) between TTM 33°C and TTM 36°C. After propensity score matching, good neurological outcomes at 6 months (OR 0.93, 95% CI = 0.74–1.18) and survival at 6 months (HR 1.05, 95% CI = 0.92–1.21) were still not associated with TTM 33°C and TTM 36°C. Conclusion In this study, patients treated with a target temperature of 33°C had similar good neurological outcomes and survival at six months compared with those treated with a target temperature of 36°C.

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Outcome and status of postcardiac arrest care in Korea: results from the Korean Hypothermia Network prospective registry

Cited by 21 publications

References 24 publications

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

External validation of the 2020 ERC/ESICM prognostication strategy algorithm after cardiac arrest

Effects of Sodium Nitroprusside Administered Via a Subdural Intracranial Catheter on the Microcirculation, Oxygenation, and Electrocortical Activity of the Cerebral Cortex in a Pig Cardiac Arrest Model

The association of different target temperatures in targeted temperature management with neurological outcome after out-of-hospital cardiac arrest based on a prospective multicenter observational study in Korea (the KORHN-PRO registry): IPTW analysis

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