Kardiyopulmoner Resüsitasyon Başarısını Etkileyen Faktörlerin Retrospektif Olarak İncelenmesi

Abstract

Kardiyopulmoner resüsitasyon (KPR) uygulanan hastalarda sağkalımı etkileyen faktörleri belirlemek amacıyla yapılan çalışmamızda, bir yıl içinde hastanemizde KPR uygulanan 1576 hastaya ait 1995 KPR kayıt formu incelendi. Çalışmaya 18 yaş altı hastalar ve birden fazla KPR uygulananların ilk resüsitasyonları dışındaki veriler alınmadı. Geriye kalan 1228 hastanın dosya ve KPR formlarındaki hasta özellikleri, KPR ile ilgili bilgiler ve laboratuvar parametreleri kaydedildi. Spontan dolaşımın geri dönüşü (SDGD), ilk 24 ve 48 saatlik sağkalım üzerine etkileri araştırıldı. İstatistiksel analizde tek ve çok değişkenli lojistik regresyon analizi kullanıldı. Hastaların %37,9’u kadın, %62,1’i erkek olup, yaş ortalaması 64,0±14,1 yıl idi. SDGD oranı %32,41, ilk 24 ve 48. saat sağkalım oranları sırasıyla %8,15 ve %7,46 olarak bulundu. SDGD’yi etkileyen bağımsız risk faktörleri arasında yatış süresi, yoğun bakım ve acil serviste arrest, sepsis, metastaz, karaciğer yetmezliği, solunum depresyonu ve ventriküler fibrilasyon/nabızsız ventriküler taşikardi ilk ritmi yer aldı. İlk 24 ve 48 saatte mortalite oranları yoğun bakımda arrest (OR=3,01 ve 4,57), yüksek SAPS II (Simplified Acute Physiology Score II) skoru, yüksek GOFAR (Good Outcome Following Attempted Resuscitation) ve PAR (Prognosis After Resuscitation) skorlarıyla ilişkilendirildi. Sonuç olarak, hastane içi KPR’de sağkalım tahmininde SAPS II, GOFAR ve PAR skorlarının kullanılabileceği, yoğun bakımda arrestin sağkalımı olumsuz etkilediği saptandı.

Keywords

• Kardiyak arrest
• Kardiyopulmoner resüsitasyon
• Prognostik faktörler
• Skorlama sistemleri
• Sağkalım

A Retrospective Analysis of Factors Affecting the Success of Cardiopulmonary Resuscitation

Abstract

In our study conducted to determine the factors affecting survival in patients undergoing cardiopulmonary resuscitation (CPR), 1995 CPR record forms belonging to 1576 patients who underwent CPR in our hospital within one year were examined. Patients under the age of 18 were excluded from the study, as were resuscitation data of patients who underwent more than one CPR, except for their first resuscitation. Patient characteristics, characteristics related to CPR implementation, and laboratory parameters were recorded from the files and CPR registration forms of the remaining 1,228 patients. The effects of all these data on return of spontaneous circulation (ROSC) and survival in the first 24 and 48 hours after CPR were investigated. Univariate and multivariate logistic regression analyses were used for statistical evaluation. It was determined that 37.9% of the patients were female and 62.1% were male, with a mean age of 64.0±14.1 years. The ROSC rate was found to be 32.41%, while survival rates at the first 24 and 48 hours were 8.15% and 7.46%, respectively. In determining the ROSC rate, length of stay, arrest in the intensive care unit (ICU) and emergency room, sepsis, metastasis, liver failure, presence of respiratory depression, ventricular fibrillation/pulseless ventricular tachycardia in the first rhythm were determined as independent risk factors. Mortality rates in the first 24 and 48 hours were associated with arrest in the ICU (OR=3.01 and 4.57), high Simplified Acute Physiology Score II (SAPS II) score, high Good Outcome Following Attempted Resuscitation (GOFAR) and Prognosis After Resuscitation (PAR) scores. In conclusion, it was determined that SAPS II, GOFAR and PAR scores could be used to predict survival in in-hospital CPR, and that, the occurrence of arrest in the intensive care unit has an adverse effect on survival.

Keywords

• Cardiac arrest
• Cardiopulmonary resuscitation
• Prognostic factors
• Scoring systems
• Survival

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