Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest - A multicentre matched cohort study.

Purpose: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.

Methods: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines.

The association between regional cerebral oxygen saturation and neurological outcomes in cardiac arrest survivors.

Regional cerebral oxygen saturation (rSO2) is recommended for monitoring cerebral perfusion status. We aimed to investigate the association between rSO2 and neurological outcomes and correlating parameters with rSO2 in cardiac arrest survivors. This observational study included adult comatose cardiac arrest survivors who underwent targeted temperature management and were monitored with rSO2 between June 2021 and February 2023.

Prediction of good functional outcome decreases diagnostic uncertainty in unconscious survivors after out-of-hospital cardiac arrest.

Purpose: To explore modifications of the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guideline algorithm for neuroprognostication after cardiac arrest to improve its prognostic accuracy.

Methods: Post-hoc analysis of four prospective multicentre studies (TTM, TTM2, KORHN and ProNeCA). We raised the Glasgow Coma Scale motor (GCS-M) inclusion threshold at 72 h after cardiac arrest from the current GCS-M < 4 to GCS-M < 6 (all unconscious patients).

Association Between Shift Work and Acute Coronary Syndrome According to Alcohol Intake and Smoking.

: Shift work is associated with an increased risk of acute coronary syndrome (ACS) and higher rates of smoking and alcohol consumption. This study examines how smoking and alcohol intake may influence the effect of shift work on ACS risk, indicating a complex interaction among these factors in individuals engaged in shift work. : This investigation utilized data from the Korean Genome and Epidemiology Study (KoGES).

Effectiveness of advanced cardiovascular life support in hyperkalemic cardiac arrest: A randomized experimental study in pigs.

Current treatment recommendations for hyperkalemic cardiac arrest focus exclusively on the addition of antihyperkalemic therapies and are otherwise identical to those for cardiac arrest caused by non-hyperkalemic etiologies. We were unable to find any studies that specifically examine the hemodynamic effects of cardiopulmonary resuscitation in hyperkalemic cardiac arrest compared to cardiac arrest from non-hyperkalemic etiologies. We hypothesized that myocardial ischemic contracture would be less severe in hyperkalemic cardiac arrest compared with ventricular fibrillation cardiac arrest, resulting in higher cerebral perfusion pressure, brain tissue oxygen tension, and coronary perfusion pressure during cardiopulmonary resuscitation.

Effect of the Interaction Between Depression and Sleep Disorders on Stroke Occurrence: A 17-Year Prospective Cohort Study in Korea.

Objective: Previous studies have provided inconclusive results on the association between depression and stroke risk, and the potential modifying effect of comorbid insomnia on this association remains unclear. Our study aimed to clarify the independent roles of depression and insomnia as risk factors for stroke and to investigate the possibility of an interaction effect between these two conditions on stroke incidence.

Methods: We used data from the Korean Genome and Epidemiology Study.

Prognostic value of gray-white matter ratio measured by brain MRI-based CT structures in comatose patients after cardiac arrest.

Background: Post-cardiac arrest care advancements have improved resuscitation outcomes, but many survivors still face severe neurological deficits or death from brain injury. Herein, we propose a consistent prognosis prediction approach using magnetic resonance imaging (MRI) to analyze anatomical regions represented by the gray and white matter, and subsequently apply it on computed tomography (CT) to calculate the gray-white matter ratio (GWR). We compared this novel method with traditional measures to validate its ability to predict the prognosis of patients resuscitated after cardiac arrest.

Sex-Specific Impact of Serum Calcium Levels on Acute Coronary Syndrome Risk: A 19-Year Cohort Study in Korea.

This study aims to investigate the association between serum calcium levels and acute coronary syndrome (ACS) risk, examining whether this relationship differs by sex, given the known differences in calcium metabolism and hormonal influences between males and females. Utilizing the Korean Genome Epidemiology Study (KoGES) prospective cohort data, our primary exposure variables were serum calcium level and sex. The incidence of ACS served as the main outcome of interest.

The Association of Vitamin B-12 Plasma Concentration with Stroke Incidence According to Sex.

Background: Previous studies reported that vitamin B-12 deficiency is associated with an increased risk of stroke. However, studies examining the association between excessive vitamin B-12 and stroke risk are limited. Our study aimed to investigate the relationship between excessive vitamin B-12 concentrations and risk of stroke and explore whether this association varies according to sex.

Validation of neuron-specific enolase in cardiac arrest patients with limited withdrawal of life-sustaining therapy.

Aim: We validated the prognostic performance of neuron-specific enolase (NSE) according to the recommended values in cardiac arrest (CA) survivors.

Methods: We analyzed the data of adult CA survivors who underwent targeted temperature management between January 2014 and December 2020. We measured the NSE level 48 h and 72 h after CA.

The Association between Troponin-I Clearance after the Return of Spontaneous Circulation and Outcomes in Out-of-Hospital Cardiac Arrest Patients.

Background: Elevated levels of troponin-I (TnI) are common in out-of-hospital cardiac arrest (OHCA) patients. However, studies evaluating the prognostic value of TnI clearance in OHCA patients are lacking. We aimed to examine how TnI clearance (TnI-C) differed according to the neurological outcome group and mortality group at 6 months.

The Relationship between the Ratio of Urine Osmolality to Serum Osmolality and Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients.

Background: Progressive ischemic brain injury after cardiac arrest can cause damage to the hypothalamic-pituitary axis, particularly the pituitary gland. This may impact serum osmolality (SOsm) and urine osmolality (UOsm) in patients who have experienced out-of-hospital cardiac arrest (OHCA). We assumed that a low ratio of UOsm to SOsm (USR) is related to poor outcomes among OHCA patients.

High incidence of acute kidney injury in extracorporeal resuscitation, Leading to poor prognosis.

Background: Extracorporeal membrane oxygenation (ECMO) patients have a high incidence of acute kidney injury (AKI). Extracorporeal cardiopulmonary resuscitation (ECPR) patients are more likely to develop AKI than ECMO patients because of serious injury during cardiac arrest (CA).

Objectives: This study aims to assess the occurrence and outcomes of AKI in ECPR and ECMO, and to identify specific risk factors and clinical implications of AKI in ECPR.

The association between lactate to albumin ratio and outcomes at early phase in patients with traumatic brain injury.

Background: The majority of traumatic brain injury (TBI) cases result in death in the early phase; predicting short-term progno-sis of affected patients is necessary to prevent this. This study aimed to examine the association between the lactate-to-albumin ratio (LAR) on admission and outcomes in the early phase of TBI.

Methods: This retrospective observational study included patients with TBI who visited our emergency department between January 2018 and December 2020.

The trend of ammonia levels in patients with glufosinate ammonium poisoning with respect to neurotoxicity.

Since glufosinate irreversibly inhibits glutamine synthetase, leading to intracellular accumulation of ammonia, hyperammonemia is considered one of the main mechanisms of glufosinate ammonium toxicity in humans. However, whether hyperammonemia causes neurotoxicity has not yet been studied. Therefore, the purpose of this study was to determine whether the serum ammonia level is elevated before the development of neurotoxicity.

Risk of pre-existing hyponatremia and mortality in patients with traumatic brain injury across age groups.

Traumatic brain injurySodiumClinical outcomes.

Association Between Procalcitonin Level at 72 Hours After Cardiac Arrest and Neurological Outcomes in Cardiac Arrest Survivors.

The association between procalcitonin (PCT) level measured 72 hours after cardiac arrest (CA) and neurological outcomes is unknown. We aimed to examine the association of serial PCT levels up to 72 hours with neurological outcomes in patients who underwent targeted temperature management (TTM) after CA. This retrospective observational study included adult comatose patients with CA undergoing TTM (33℃ for 24 hours) at the Chonnam National University Hospital in Gwangju, Korea, between January 2018 and December 2020.

The Association Between Induction Rate and Neurologic Outcome in Patients Undergoing Targeted Temperature Management at 33°C.

To determine the association between the induction rate and 6-month neurologic outcomes in out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management (TTM). This retrospective observational study analyzed data prospectively collected from adult comatose OHCA survivors treated with TTM at the Chonnam National University Hospital in Gwangju, Korea, between October 2015 and December 2020. We measured the core body temperature (BT) through an esophageal probe and recorded it every 5 minutes throughout TTM.

Heat loss augmented by extracorporeal circulation is associated with overcooling in cardiac arrest survivors who underwent targeted temperature management.

We investigated the association of extracorporeal circuit-based devices with temperature management and neurological outcome in out-of-hospital cardiac arrest survivors who underwent targeted temperature management. Patients with extracorporeal membrane oxygenation and/or continuous renal replacement therapy were classified as the extracorporeal group. We calculated the cooling rate during the induction period and time-weighted core temperatures (TWCT) during the maintenance period.

The impact of prehospital endotracheal intubation on mortality in traumatic brain injury.

Introduction: Our study aimed to evaluate whether prehospital endotracheal intubation (ETI) affects the mortality of individuals who sustain traumatic brain injury (TBI) compared with bag-valve mask (BVM) ventilation, as well as to test the interaction effect of ETI on study outcome according to carbon dioxide level.

Methods: Our retrospective study involving patients who experienced TBI between January 2019 and December 2020. The main exposure variable was the prehospital airway management technique (ETI vs.

Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C.

We examined the association between variability in body temperature (BT) and water temperature (WT) during the maintenance period of targeted temperature management (TTM) and neurologic outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Adult (≥18 years), comatose OHCA survivors who underwent TTM at 33°C between October 2015 and December 2019 were included. We collected data on BT and WT recorded every minute during the TTM maintenance period.

Performance of Modified Early Warning Score (MEWS) for Predicting In-Hospital Mortality in Traumatic Brain Injury Patients.

The present study aimed to analyze and compare the prognostic performances of the Revised Trauma Score (RTS), Injury Severity Score (ISS), Shock Index (SI), and Modified Early Warning Score (MEWS) for in-hospital mortality in patients with traumatic brain injury (TBI). This retrospective observational study included severe trauma patients with TBI who visited the emergency department between January 2018 and December 2020. TBI was considered when the Abbreviated Injury Scale was 3 or higher.

The clinical role of serum albumin in Organophospate poisoning.

This retrospective study investigated whether the serum albumin (SA) concentration at presentation is associated with mortality and the mechanism underlying the association. This study enrolled 217 patients poisoned with organophosphate (OP). Hypoalbuminemia (albumin <3.