Acil Servise Arrest Nedeniyle Getirilen Hastalarda İlk Tespit Edilen Kardiyak Ritmin Sağkalım Üzerine Olan Etkisinin Araştırılması

Abstract

ÖZ Amaç: Kardiyopulmoner arrest, dolaşım ve solunum fonksiyonlarının aniden durması sonucu dokulara yetersiz oksijen taşınması durumudur. Bu çalışmada kardiyopulmoner arrest ile başvuran hastalarda arrest nedenlerini ve başlangıç kardiyak ritminin hasta sağkalımına etkisini araştırmayı amaçladı. Gereç ve Yöntem: Geriye dönük olarak yapılan bu çalışmaya, hastane içi ve hastane dışı kardiyak arrest geçiren ve acil servisimize başvuran 1126 hastadan dışlama kriterleri sonrasında 1009'u dahil edildi. Hastaların demografik özelliklerinin yanı sıra başlangıç ritimleri ve mortalite durumları değerlendirildi. Bulgular: Hastaların klinik sonuçları ile başlangıç kardiyak ritimleri arasında anlamlı bir ilişki vardı (p<0.001). Başlangıçta kalp ritmi asistoli olan hastalarda mortalite oranı (%77,1) daha yüksekti. Yatan hastalarda asidoz oranı daha yüksek iken, ölümlü hastalarda travma oranı daha yüksekti (p<0.001). Kalp ritmi dönen hastalarda ST elevasyonu, ölenlerde sağ dal bloğu daha fazlaydı ancak bunlar istatistiksel olarak anlamlı değildi. Sonuç: Arrest hastalarında ilk ritim analizi, özellikle şoklanabilir ritimler olan ventriküler fibrilasyon ve nabızsız ventriküler taşikardinin saptanmasında çok önemlidir ve erken tanı ve müdahale ile hasta sağkalımı artar.

Keywords

• Kardiyopulmoner arrest
• kardiyak ritim
• mortalite

Investigation of the Effect of Initial Cardiac Rhythm on Survival in Patients Admitted with Cardiopulmonary Arrest to the Emergency Department

Abstract

Objective: Cardiopulmonary arrest is the condition of insufficient oxygen delivery to tissues as a result of sudden cessation of circulatory and respiratory functions. This study aimed to investigate the causes of arrest in patients admitted with cardiopulmonary arrest and the effect of initial cardiac rhythm on patient survival. Material and Methods: Out of 1126 patients who had an in-hospital and out-of-hospital cardiac arrest and were admitted to our emergency department, 1009 patients were included in this retrospective study following the exclusion criteria. In addition to the demographic characteristics of patients, their initial rhythms and mortality states were assessed. Results: There was a significant relationship between patients’ clinical outcomes and initial cardiac rhythms (p<0.001). The mortality rate (77.1%) was higher in patients whose initial cardiac rhythm was asystole. While the rate of acidosis was higher in inpatients the rate of trauma was higher in mortal patients (p<0.001). ST elevation was higher in patients whose cardiac rhythm returned and right bundle branch block was higher in those who died, however, these were not statistically significant. Conclusion: The initial rhythm analysis in arrest patients is crucial specifically in the detection of ventricular fibrillation and pulseless ventricular tachycardia which are shockable rhythms and patient survival increases with early diagnosis and intervention.

Keywords

• Cardiopulmonary arrest
• cardiac rhythm
• mortality

Thanks

We would like to thank the ED staff of Kayseri Training and Research Hospital.

References

1. 1. Nolan JP, Soar J, Perkins GD. Cardiopulmonary resuscitation. BMJ. 2012;345:e6122.
2. 2. Ornato JP. Sudden Cardiac Death. In: Tintinalli JE, Ma OJ, Yealy DM, Merckler GD, Stapczynski JS, Cline DM TS, editor. Tintinalli’s Emergency Medicine. 9th ed. New York: McGraw-Hill; 2020. p. 53–63.
3. 3. Meaney PA, Bobrow BJ, Mancini ME et al. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417–35.
4. 4. Wyckoff MH, Singletary EM, Soar J et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Team. Resuscitation. 2021;169:229–311.
5. 5. Perkins GD, Gräsner J-T, Semeraro F et al. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation [Internet]. 2021;161:1–60. https://www.sciencedirect.com/science/article/pii/S0300957221000551
6. 6. Panchal AR, Berg KM, Hirsch KG et al. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines. Circulation. 2019;140(24):e881–94.
7. 7. Edelson DP, Sasson C, Chan PS et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the. Circulation. 2020 ;141(25):e933–43.
8. 8. Soar J, Böttiger BW, Carli P et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021 ;161:115–51.

9. 9. Cournoyer A, Cossette S, Potter BJ et al. Prognostic impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest. Resuscitation [Internet]. 2019;140:43–9. https://www.sciencedirect.com/science/article/pii/S0300957219301601
10. 10. Mader TJ, Nathanson BH, Millay S, Coute RA, Clapp M, McNally B. Out-of-hospital cardiac arrest outcomes stratified by rhythm analysis. Resuscitation. 2012;83(11):1358–62.
11. 11. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000. Jama. 2002;288(23):3008–13.
12. 12. Roberts D, Landolfo K, Light RB, Dobson K. Early Predictors of Mortality for Hospitalized Patients Suffering Cardiopulmonary Arrest. Chest [Internet]. 1990;97(2):413–9. https://www.sciencedirect.com/science/article/pii/S0012369215406828
13. 13. Majewski D, Ball S, Bailey P, Bray J, Finn J. Long-term survival among OHCA patients who survive to 30 days: Does initial arrest rhythm remain a prognostic determinant? Resuscitation [Internet]. 2021;162:128–34. https://www.sciencedirect.com/science/article/pii/S0300957221000885
14. 14. Balan P, Hsi B, Thangam M et al. The cardiac arrest survival score: A predictive algorithm for in-hospital mortality after out-of-hospital cardiac arrest. Resuscitation [Internet]. 2019;144:46–53. https://www.sciencedirect.com/science/article/pii/S0300957219306173
15. 15. Thompson LE, Chan PS, Tang F et al. Long-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation(®). Resuscitation. 2018 Feb;123:58–64.
16. 16. Høybye M, Stankovic N, Lauridsen KG, Holmberg MJ, Andersen LW, Granfeldt A. Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes. Resuscitation [Internet]. 2021;165:50–7. https://www.sciencedirect.com/science/article/pii/S0300957221002215
17. 17. Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation [Internet]. 2000;44(1):7–17. https://www.sciencedirect.com/science/article/pii/S0300957299001550
18. 18. Virani SS, Alonso A, Aparicio HJ et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743.
19. 19. Nolan JP, Sandroni C, Böttiger BW et al. European resuscitation council and European society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation. 2021;161:220–69.
20. 20. Kim Y-J, Min S-Y, Lee DH et al. The role of post-resuscitation electrocardiogram in patients with ST-segment changes in the immediate post-cardiac arrest period. JACC Cardiovasc Interv. 2017;10(5):451–9.
21. 21. McFadden P, Reynolds JC, Madder RD, Brown M. Diagnostic test accuracy of the initial electrocardiogram after resuscitation from cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization: A systematic review and meta-analysis. Resuscitation [Internet]. 2021;160:20–36. https://www.sciencedirect.com/science/article/pii/S0300957221000022
22. 22. Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med [Internet]. 2021;12(4):695–723. https://doi.org/10.1007/s41999-021-00454-y
23. 23. Jerkeman M, Sultanian P, Lundgren P et al. Trends in survival after cardiac arrest: a Swedish nationwide study over 30 years. Eur Heart J [Internet]. 2022 Dec 7;43(46):4817–29. https://doi.org/10.1093/eurheartj/ehac414
24. 24. Wiberg S, Holmberg MJ, Donnino MW et al. Age-dependent trends in survival after adult in-hospital cardiac arrest. Resuscitation [Internet]. 2020;151:189–96. https://www.sciencedirect.com/science/article/pii/S0300957220301192
25. 25. Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009. Resuscitation. 2013 Sep;84(9):1255–60.
26. 26. Jenkins DH, Cioffi WG, Cocanour CS et al. Position statement of the Coalition for National Trauma Research on the National Academies of Sciences, Engineering and Medicine report, a national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury. J Trauma Acute Care Surg. 2016;81(5):816–8.