Background: Epinephrine is administered to increase coronary perfusion pressure during advanced life support and promote short‐term survival. Recent cardiopulmonary resuscitation (CPR) guidelines recommend an epinephrine dosing interval of 3 to 5 minutes during resuscitation; however, scientific evidence supporting this recommendation is lacking. Therefore, we aimed to investigate the hemodynamic effects of repeated epinephrine doses during CPR by monitoring augmented blood pressure after its administration in a swine model of cardiac arrest. Methods and Results: A secondary analysis of data from a published study was performed using a swine cardiac arrest model. The epinephrine dose was fixed at 1 mg, and the first dose of epinephrine was administered after no‐flow and low‐flow times of 2 minutes and 8 minutes, respectively, and subsequently administered every 4 minutes. Four cycles of dosing intervals were defined because a previous study was terminated 26 minutes after the induction of ventricular fibrillation. Augmented blood pressures and corresponding timelines were determined. Augmented blood pressure trends following cycles and the epinephrine effect duration were also monitored. Among the 140 CPR cycles, the augmented blood pressure after epinephrine administration was the highest during the first cycle of CPR and decreased gradually with further cycle repetitions. The epinephrine effect duration did not differ between repeated cycles. The maximum blood pressure was achieved 78 to 97 seconds after epinephrine administration. Conclusions: Hemodynamic augmentation with repeated epinephrine administration during CPR decreased with cycle progression. Further studies are required to develop an epinephrine administration strategy to maintain its hemodynamic effects during prolonged resuscitation.

Some cases of plaster ingestion include the occurrence of gastrointestinal obstruction that requires surgery. To date, there are no reports on the treatment of plaster lesions in the mouth. A 50-year-old woman was referred to the emergency department after intentionally drinking a solution of approximately 100 g of plaster powder in 250 mL of water, 3 hours earlier. On arrival, the patient was alert but unable to speak because the plaster had hardened in her mouth. Hardened plaster was also found in her stomach. There was no evidence of acute gastrointestinal obstruction on abdominal computed tomography; we therefore decided to perform surgical observation. The intraoral plaster lesions were successfully removed using forceps, and the plaster bezoar was successfully eliminated without surgical treatment. The present case shows that not all patients with plaster poisoning require surgery; the patient’s conditions, such as gastrointestinal obstruction, should indicate the course of treatment.

Background/Objectives: Multiple organ failure is the main cause of mortality in severely injured patients who survive the early post-trauma phase. Myeloperoxidase and delta neutrophil indices may serve useful markers for the early diagnosis of an inflammatory condition. We aimed to ascertain the use of these indices for predicting multiple organ failure after a major trauma. Methods: A retrospective study was performed based on a level I trauma center database that included trauma patients with an injury severity score of >15 points. Organ function was evaluated according to the sequential organ failure assessment score within at least 48 h of admission and the myeloperoxidase and delta neutrophil indices, which were measured every morning. Results: A total of 96 patients were included in this study. Compared with the non-multiple-organ-failure group, the multiple organ failure group had similar myeloperoxidase indices but a significantly higher delta neutrophil index. Multivariate logistic regression analysis revealed no significant difference in the predictive power among the post-trauma multiple organ failure models that included various factors, although model 7, which combined the sequential organ failure assessment score and the myeloperoxidase and delta neutrophil indices, tended to have the maximum predictive power. Conclusions: Early delta neutrophil index (DNI) values and the composite model incorporating SOFA, absolute MPXI, and DNI each demonstrated moderate ability to predict multiple organ failure after major trauma. Prospective multicenter studies that include granular treatment variables are warranted to validate these biomarkers and to explore whether their incorporation into real-time decision tools can improve outcomes.

The 2025 Korean advanced life support guidelines were updated using a structured evidence evaluation process informed by recent randomized controlled trials and systematic reviews. The guideline development group prioritized patient-important outcomes and assessed the certainty of the evidence to formulate graded recommendations. For drug administration during adult cardiac arrest, intravenous access is the preferred initial route, with intraosseous access recommended when intravenous access cannot be rapidly established. Epinephrine remains the recommended vasopressor. Routine administration of vasopressin, either alone or in combination with corticosteroids, is not recommended for in-hospital or out-of-hospital cardiac arrest. In the absence of specific indications, the routine use of buffering agents and calcium is discouraged owing to insufficient evidence of their benefits and potential harm. Defibrillation recommendations were refined based on emerging evidence. In adults with refractory ventricular fibrillation or pulseless ventricular tachycardia after multiple unsuccessful defibrillation attempts, vector change or double sequential defibrillation may be considered in selected settings when performed by experienced teams with appropriate equipment. Airway management guidelines recommend cricothyroidotomy as a rescue technique when conventional airway management strategies fail. For patients receiving cardiopulmonary resuscitation while on mechanical ventilation, specific ventilator settings during chest compressions are recommended to optimize ventilation and minimize interference with high-quality cardiopulmonary resuscitation. The guidelines also address cardiopulmonary resuscitation–induced consciousness, allowing the cautious use of sedatives and/or analgesic agents when awareness interferes with resuscitation quality or safety. Overall, the guidelines emphasize evidence-based practice and individualized clinical decision-making.

The 2025 update of the Korean guidelines for cardiac arrest under special circumstances incorporates new evidence and expert consensus to clarify when clinicians should modify standard resuscitation algorithms. For cardiac arrest caused by acute hyperkalemia, the guidelines suggest administering intravenous insulin with glucose; however, current evidence remains insufficient to recommend for or against routine use of sodium bicarbonate or calcium. In suspected pulmonary embolism–related cardiac arrest, thrombolytic therapy may be considered. In confirmed cases, thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy may be appropriate, despite very low certainty of evidence. For opioid-related cardiac arrest, current evidence does not support the routine administration of naloxone in addition to standard advanced life support; however, naloxone may be administered when it is unclear whether the patient is in true cardiac arrest. The guidelines also emphasize managing cardiac arrest in the prone position. If the patient is intubated and immediate repositioning is unsafe or impractical, prone cardiopulmonary resuscitation and defibrillation may be attempted using invasive arterial pressure or end-tidal carbon dioxide monitoring to guide the timing of repositioning. Immediate supination is strongly recommended for non-intubated patients. Additional updates address drowning, severe hypothermia, pregnancy, anaphylaxis, and cardiac arrest during interventional procedures, underscoring the importance of early correction of reversible causes, appropriate airway strategies, and timely consideration of extracorporeal life support in selected cases. Overall, the 2025 recommendations highlight cautious, etiology-directed interventions and explicitly grade recommendation strength and certainty to support context-sensitive clinical decision-making in high-risk and resource-variable settings.

Background: We aimed to investigate the association between acute carbon monoxide (CO) poisoning and the risk of internal malignancies, including hematologic malignancies. Methods: The study population was derived from the National Health Insurance Service (NHIS) database of Korea between 2002 and 2022. Adults diagnosed with CO poisoning and controls were included. Demographics, socioeconomic statuses, lifestyle factors, and comorbidity profiles of participants were retrieved from the NHIS database. Covariates potentially associated with disease outcomes were selected based on the available literature and biological plausibility, balanced between the two cohorts using inverse probability of treatment weighting, and applied to adjust multivariable models. Results: Overall, 42,874 patients with CO poisoning and 905,285 controls were included; both cohorts comprised 44.3% females. The mean age of the CO poisoning and controls was 51.5 and 50.9 years, respectively. Patients with CO poisoning had a 1.02-fold increase in the overall risk of malignancy (a 1.03-fold increase in solid organ malignancies and a 0.71-fold decrease in hematologic malignancies) compared with controls. The risk of internal malignancy was increased in the oral cavity (adjusted hazard ratio, 1.33; 95% confidence intervals, 1.19–1.49), lungs (1.39; 1.33–1.46), bone (1.68; 1.23–2.30), cervix (1.32; 95% CI, 1.17–1.49), and kidneys (1.14; 1.04–1.24). Conversely, the risk of internal malignancies was decreased in the thorax (0.59; 0.45–0.77), anus (0.14; 0.06–0.34), uterus (0.71; 0.60–0.82), ovaries (0.59; 0.45–0.77), prostate (0.89; 0.84–0.95), Hodgkin lymphoma (0.35; 0.20–0.61), non-Hodgkin lymphoma (0.67; 0.59–0.75), and multiple myeloma (0.36; 0.30–0.43). Conclusions: CO poisoning was associated with the development of internal malignancies.