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병원 밖 심정지 환자에서 조기 관상동맥조영술 시행과 생존 퇴원율 향상

Early coronary angiography in patients with out-of-hospital cardiac arrest and improved survival discharge rate

대한응급의학회지 2020년 31권 2호 p.127 ~ 134
천수민 ( Chun Su-Min ) - Keimyung University Dongsan Medical Center Department of Emergency Medicine

이상훈 ( Lee Sang-Hun ) - Keimyung University Dongsan Medical Center Department of Emergency Medicine
전재천 ( Jeon Jae-Cheon ) - Keimyung University Dongsan Medical Center Department of Emergency Medicine
최우익 ( Choi Woo-Ik ) - Keimyung University Dongsan Medical Center Department of Emergency Medicine
진상찬 ( Jin Sang-Chan ) - Keimyung University Dongsan Medical Center Department of Emergency Medicine

Abstract


Objective: Coronary angiography (CAG) is an important procedure in post-resuscitated patients with out of hospital cardiac arrest (OHCA). On the other hand, the timing of CAG is still controversial. This study investigated the relationship between electrocardiogram, cardiac enzyme, echocardiographic findings, and early coronary angiography (ECAG).

Method: The medical records of OHCA patients from January 2014 to December 2018 were reviewed retrospectively. The total patients who underwent CAG for OHCA caused by cardiac origin were 48. They were divided into two groups according to survival discharge. The ECAG was defined as the time from reporting 119 to the CAG within two hours. The following items in the two groups were also analyzed: the prehospital factors, such as witnessed arrest, bystander cardiopulmonary resuscitation, shockable rhythm, and arrest to return of spontaneous circulation time; and the hospital factors, such as the timing of CAG, ST-segment elevation or depression in the electrocardiogram, troponin-I elevation, and transthoracic echocardiography findings.

Results: Twenty-seven patients out of 48 patients with OHCA (56.3%) underwent ECAG. In the survival group (n=35), ECAG incidence was significantly higher than the death group (n=24 [68.6%] vs. n=3 [23.1%], P=0.008) and the adjusted odds ratio of ECAG for predicting survival discharge was 10.69 (95% confidence interval, 1.7-68.8).

Conclusion: In this retrospective study, the patients applied with ECAG showed a better prognosis in the survival discharge rate than the patients with delayed CAG.

키워드

Coronary angiography; Cardiac arrest; Electrocardiography
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