Fire Science and Engineering (한국화재소방학회논문지)

Korean Institute of Fire Science and Engineering (한국화재소방학회)
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Out-of-Hospital Cardiac Arrest Response to a Pregnant Woman by the 119 Emergency Medical Service System: A Case Study

119구급대에 의한 병원 전 임산부 심장정지 소생환자 1례

  • Lee, Jae-Min (Department of Emergency Medical Technology, Gwangju Health University) ;
  • Hong, Soo-Mi (Department of Healthcare Management, Vision College of Jeonju) ;
  • An, Guk-Ki (Jeonju Wansan Fire Station) ;
  • Yun, Hyeong-Wan (Department of Emergency Medical Technology, Vision College of Jeonju)
  • 이재민 (광주보건대학교 응급구조과) ;
  • 홍수미 (전주비전대학교 보건행정학과) ;
  • 안국기 (전주완산소방서) ;
  • 윤형완 (전주비전대학교 응급구조과)
  • Received : 2019.12.02
  • Accepted : 2019.12.12
  • Published : 2020.02.28
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Abstract

When a pregnant woman experiences cardiac arrest, resuscitation is of the utmost importance. Cardiac arrest in pregnant women differs from cardiac arrest in the general population since both mother and fetus need to be taken into consideration. In the event of cardiac arrest, determining whether to deliver the baby is significant. Cardiopulmonary resuscitation is not always successful, and the survival rate depends on the speed and precision of the procedure. In this study, we focus on the case of a 30-year-old pregnant woman who experienced cardiac arrest and whose family was quick to perceive her condition and call the hospital. A witness performed initial cardiopulmonary resuscitation, while rescue workers performed the advanced procedure. In this case, the patient and baby received proper treatment and left the hospital after six days. It is extremely rare for a pregnant patient to achieve return of spontaneous circulation (ROSC) or receive advanced cardiac life support before reaching the hospital. However, the woman in question in this study achieved ROSC and received both cardiopulmonary resuscitation before reaching the hospital and advanced cardiac life support at the hospital. The specifics of the case are reported in the context of a literature review.

임신부에서 심정지가 발생하였을 때, 가장 중요한 것은 임신부를 소생시키는 것이다. 임신부에서의 심정지는 산모와 태아를 동시에 고려해야 한다는 점 때문에 일반적인 심정지와 다른 부분이 있다. 임신부 심정지 환자에서는 태아를 분만해야 하는지를 결정하는 것은 산모와 태아 모두를 위하여 매우 중요하다. 심폐소생술이 수행되더라도 임신부 심정지 환자가 모두 소생되는 것은 아니며, 얼마나 신속하고 정확하게 심폐소생술이 시행되었느냐에 따라 환자의 생존율이 결정된다. 임신부 심정지 환자는 30세 목격당시 보호자에 의한 빠른 인지와 신속한 신고 및 목격자 심폐소생술이 이루어져 졌으며 119구급대에 의한 전문소생술이 적용되었고, 환자와 태아 모두 적절한 치료 후 6일 만에 건강하게 퇴원한 사례이다. 병원 전 단계에서 임신부 환자가 자발순환회복(Return of spontaneous circulation, ROSC)되어 이송하는 경우와 전문심장구조술을 시행 하는 경우는 매우 드물다. 임신부 심정지가 발생하여 목격자에 의한 심폐소생술과 119구급대원에 의한 전문심장소생술로 현장에서 자발순환회복되어 생존퇴원한 1례를 경험하여 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. D. H. Lee, G. B. KIim, E. K. Eo and Y. J. Cheon, "Case Reports : A Case that Pregnant Woman was Performed Emergency Cesarian Section During CPR", The Korean Society of Emergency Medicine, Vol. 18, No. 1, pp. 80-83 (2007).
  2. H. J. Yoon, Y. D. Kim and Y. S. Jee, "Cardiac Arrest in a Pregnant Woman with Pregnancy-induced Hypertension - A Case Report -", Anesthesia and Pain Medicine, Vol. 11, No. 3, pp. 269-272 (2016). https://doi.org/10.17085/apm.2016.11.3.269
  3. J. E. Whitty, "Maternal Cardiac Arrest in Pregnancy", Clin Obstet Gynecol, Vol. 45, No. 2, pp. 377-392 (2002). https://doi.org/10.1097/00003081-200206000-00009
  4. S. Morris and M. Stacey, "Resuscitation in Pregnancy", BMJ, Vol. 327, pp. 1277-1279 (2003). https://doi.org/10.1136/bmj.327.7426.1277
  5. J. Sora, C. D. Deakin, J. P. Nolan, G. Abbas, A. Alfonzo, A. J. Handley, D. Lockey, G.D. Perkins et al., "European Resuscitation Council Huidelines for Resuscitation 2005 Section 7. Cardiac Arrest in Special Circumstance", Resuscitation, Vol. 67, pp. 135-70 (2005). https://doi.org/10.1016/j.resuscitation.2005.05.003
  6. R. W. Neumar, M. Shuster, C. W. Callaway, L. M. Gent, D. L. Atkins, F. Bhanji, S. C. Brooks, A. R. de Caen et al., "Part 1: Executive Summary. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, Vol. 132, pp. 315-367 (2015).
  7. L. B. Becker and P. E. Pepe, "Ensuring the Effectiveness of Community-wide Emergency Cardiac Care", Ann Emerg Med, Vol. 22, pp. 354-365 (1993). https://doi.org/10.1016/S0196-0644(05)80465-2
  8. F. Bhanji, A. J. Donoghue, M. S. Wolff, G. E. Flores, L. P. Halamek, J. M. Berman, E. H. Sinz and A. Cheng, "Part 14: Education. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, Vol. 132, pp. 561-573 (2015).
  9. D. K. Mauer, H. W. Gervais, W. F. Dick and G. A. Rees, "Cardiopulmonary Resuscitation (CPR) During Pregnancy. Working Group on CPR of the European Academy of Anaesthesiology, Europe, Vol. 10, No. 2, pp. 437-440 (1993).
  10. B. S. Selden and T. J. Burke, "Complete Maternal and Fetal Recovery after Prolonged Cardiac Arrest", Ann Emerg Med, Vol. 17, pp. 346-349 (1988). https://doi.org/10.1016/S0196-0644(88)80779-0
  11. J. E. Tintinalli, G. D. Kelen and J. S. Stapczynski, "Emergency Medicine", A Comprehensive Study Guide. 6th ed, New York McGraw-Hill, pp. 94-98 (2008).
  12. J. E. Tintinalli, G. D. Kelen and J. S. Stapczynski, "Emergency Medicine", American College of Emergency Physicians, McGraw-Hill, pp. 61-78 (2004).
  13. S. W. Lee and Y. S. Hong, "Cardiac Arrest in Emergency Department", The Korean Society of Emergency Medicine, Vol. 11, No. 2, pp. 176-190 (2000).
  14. NEMA, "Fire Fighting Administration Data and Statistics", pp. 276-280 (2009).
  15. O. D. Limmer, H. D. Grant and R. H. Murrary, "Emergency Care", Prentice Hall, pp. 402-417 (2009).
  16. Y. W. Jang, "Comparison of Needs and Importance of Pre-hospital First Aid Perceived by 119 Paramedics and Emergency Medical Personnel", Master Thesis, Graduate School of Nursing, Dong-A University (2006).
  17. Seoul National University College of Medicine, "Establishment of Clinical Practice Guidelines for Training Emergency Medical Service", pp. 195-210 (2007).
  18. K. K. Hee, "The First Responder's Retention of Knowledge and Skills of Cardiopulmonary Resuscitation", Gyeonggi College Journal, Vol. 29 (2001).
  19. K. Lee, S. D. Shin and J. K. Kim, "Appropriate Analysis of Emergency Medical Services on Site and in Transportation", Ministry of Health and Welfare, pp. 19-28, 106-109 (2009).
  20. H. J. Kim, Y. S. Kim, S. M. Kim and S. Chol, "In-hospital Utstein-style Evaluation of the CPCR Performed by ACLS Teams on Cardiac-arrest patients in a General Hospital", Journal of The Korean Society of Emergency of Medicine, Vol. 13, No. 4, pp. 450-458 (2000).
  21. H. S Lee, S. P. Chung, U. J. Kim, S. M. Chung, H. G. Kang and S. H. Kim, "Evaluation of in-Hospital Cardiac Arrest According to the in-Hospital Utstein Style", Journal of The Korean Society of Emergency of Medicine, Vol. 10, No. 1, pp. 70-71 (1999).
  22. Y. S. Park, Y. M. Kim and S. H, Kang, "Predictors of Survival from Out-of-Hospital Cardiac Arrest by Four Levels" Vol. 34, No. 2, pp. 484-513 (2014).
  23. S. Y. Shin and J. Y. Jeong, "The Comparison of Effectiveness in Prehospital Protocol Education on CardioPulmonary Resuscitation", Korea Academia-Industrial Cooperation Society, Vol. 10, No. 11, pp. 3418-3426 (2009). https://doi.org/10.5762/KAIS.2009.10.11.3418
  24. H. W Yun, J. M. Lee and J. Y. Jung, "Out-of- hospital Resuscitation if Cardiac Arrest by 119 Emergency Medical Service System", Fire Science and Engineering, Vol. 24, No. 5 pp. 142-149 (2010).
  25. H. W Yun, "A Case Study About Dementia Dignosis of Cardiac Arrest Patient Alived by ACLS on 119 EMS Field", J Korean Health & Fundamental Med Sci, Vol. 4, No. 3, pp. 136-142 (2011).
  26. Nation Fire Agency, "Special 119EMS (paramedic) standard Guidelines", pp. 85-100 (2019)