Chung HS, et al. J Korean Med Sci. 2020 Mar;35(19):e189. https://doi.org/10.3346/jkms.2020.35.e189

Nationwide and regional interventions can help improve bystander cardiopulmonary resuscitation (CPR) awareness, knowledge, and the willingness. Periodic community investigation will help monitor the effect. This study aimed to compare the experience of CPR education, CPR knowledge, and CPR willingness, during a 5-year interval. This is a pre and post study. Two surveys were done in February 2012 and December 2016. National and regional intervention including legislation promoting public involvement, standardizing CPR education programs, training CPR instructors, and installing supporting organizations were done at the period. In both surveys, respondents were selected via quota sampling in Daegu Metropolitan City and answered the survey through face-to-face interview. Respondents’ general demographic characteristics, CPR educational experience, CPR knowledge and CPR willingness were questioned. Total of 2141 respondents (1000 in 2012, 1141 in 2016) were selected. The percentage of respondents who received CPR education itself and recent education were higher after intervention compared to before intervention (36.2% vs. 55.1%, 16.9% vs. 30.1%, respectively). Correct knowledge of performing CPR seems to be improved overall (1.6% vs. 11.7%, odd ratio 14.28, 95% confidence interval 5.68–35.94). However, less respondents were willing to perform CPR on strangers (54.5% vs 35.0%). Nationwide and regional interventions to promote bystander CPR and CPR education were associated with increased CPR education experience and improved correct CPR knowledge in performing bystander CPR. Willingness to perform bystander CPR on family did not increase significantly and CPR willingness to strangers was decreased. Additional legal and technological measures should be implemented to promote bystander CPR.

The recent medical applications of deep-learning (DL) algorithms have demonstrated their clinical efficacy in improving speed and accuracy of image interpretation. If the DL algorithm achieves a performance equivalent to that achieved by physicians in chest radiography (CR) diagnoses with Coronavirus disease 2019 (COVID-19) pneumonia, the automatic interpretation of the CR with DL algorithms can significantly reduce the burden on clinicians and radiologists in sudden surges of suspected COVID-19 patients. The aim of this study was to evaluate the efficacy of the DL algorithm for detecting COVID-19 pneumonia on CR compared with formal radiology reports. This is a retrospective study of adult patients that were diagnosed as positive COVID-19 cases based on the reverse transcription polymerase chain reaction among all the patients who were admitted to five emergency departments and one community treatment center in Korea from February 18, 2020 to May 1, 2020. The CR images were evaluated with a publicly available DL algorithm. For reference, CR images without chest computed tomography (CT) scans classified as positive for COVID-19 pneumonia were used given that the radiologist identified ground-glass opacity, consolidation, or other infiltration in retrospectively reviewed CR images. Patients with evidence of pneumonia on chest CT scans were also classified as COVID-19 pneumonia positive outcomes. The overall sensitivity and specificity of the DL algorithm for detecting COVID-19 pneumonia on CR were 95.6%, and 88.7%, respectively. The area under the curve value of the DL algorithm for the detection of COVID-19 with pneumonia was 0.921. The DL algorithm demonstrated a satisfactory diagnostic performance comparable with that of formal radiology reports in the CR-based diagnosis of pneumonia in COVID-19 patients. The DL algorithm may offer fast and reliable examinations that can facilitate patient screening and isolation decisions, which can reduce the medical staff workload during COVID-19 pandemic situations.

Electrocardiogram (ECG) rhythms, particularly shockable rhythms, are crucial for planning cardiac arrest treatment. There are varying opinions regarding treatment guidelines depending on ECG rhythm types and documentation times within pre-hospital settings or after hospital arrivals. We aimed to determine survival and neurologic outcomes based on ECG rhythm types and documentation times. This prospective observational study of 64 emergency medical centers was performed using non-traumatic out-of-hospital cardiac arrest registry data between October 2015 and June 2017. From among 4,608 adult participants, 4,219 patients with pre-hospital and hospital ECG rhythm data were enrolled. Patients were divided into 3 groups: those with initial-shockable, converted-shockable, and never-shockable rhythms. Patient characteristics and survival outcomes were compared between groups. Further, termination of resuscitation (TOR) validation was performed for 6 combinations of TOR criteria confirmed in previous studies, including 2 rules developed in the present study. Total survival to discharge after cardiac arrest was 11.7%, and discharge with good neurologic outcomes was 7.9%. Survival to discharge rates and favorable neurologic outcome rates for the initial-shockable group were the highest at 35.3% and 30.2%, respectively. There were no differences in survival to discharge rates and favorable neurologic outcome rates between the converted-shockable (4.2% and 2.0%, respectively) and never-shockable groups (5.7% and 1.9%, respectively). Irrespective of rhythm changes before and after hospital arrival, TOR criteria inclusive of unwitnessed events, no pre-hospital return of spontaneous circulation, and asystole in the emergency department best predicted poor neurologic outcomes (area under the receiver operating characteristic curve of 0.911) with no patients classified as Cerebral Performance Category 1 or 2 (specificity = 1.000). Survival outcomes and TOR predictions varied depending on ECG rhythm types and documentation times within pre-hospital filed or emergency department and should, in the future, be considered in treatment algorithms and prognostications of patients with out-of-hospital cardiac arrest. ClinicalTrials.gov Identifier: NCT03222999.

Early defibrillation is crucial for the survival of patients with out-of-hospital cardiac arrest. This study aimed to examine the trends and associated factors regarding public awareness and willingness to use automated external defibrillators (AEDs) through citywide surveys. Three-round surveys were conducted in February 2012 (n=1,000), December 2016 (n=1,141), and December 2018 (n=1,001) among citizens in Daegu, South Korea, who were aged ≥19 years. The subjects were selected through a three-stage quota sampling. Awareness and willingness to use an AED were assessed in the three groups. The primary outcome was willingness to use AEDs. Of 3,142 respondents, 3,069 were eligible for analysis. The proportion of respondents who knew how to use AEDs increased from 4.7% in 2012 to 20.8% in 2018. Of the respondents in 2012, 2016, and 2018, 39.7%, 50.0%, and 43.2%, respectively, were willing to use an AED. Factors associated with willingness to use AEDs were male sex (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.10-1.75), cardiopulmonary resuscitation training experience in the previous 2 years (AOR, 1.80; 95% CI, 1.43-2.28), recognition of the Good Samaritan law (AOR, 1.45; 95% CI, 1.13-1.86), and awareness of how to use an AED (AOR, 4.40; 95% CI, 3.26-5.93). To increase willingness to use AEDs, education in AED use and the Good Samaritan law, along with re-education to maintain knowledge of AED use, should be considered.