Travmatik ve Non-Travmatik Kardiyopulmoner Arrest Hastaların Kıyaslanması

Öz

Amaç: Bu çalışmada, acil servise travmatik ve non-travmatik nedenlerle kardiyopulmoner arrest olarak kabul edilen hastaların demografik özelliklerinin, laboratuvar bulgularının ve klinik süreçlerinin değerlendirilerek mortalite ile ilişkili faktörlerin belirlenmesi amaçlandı.
Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmaya üçüncü basamak bir acil servise kardiyopulmoner arrest ön tanısı ile kabul edilen hastalar dahil edildi. Hastalar arrest etiyolojisine göre travmatik ve non-travmatik nedenli olarak sınıflandırıldı. Demografik veriler, başvuru zamanı, arrest etiyolojisi, yoğun bakım yatış durumu, laboratuvar parametreleri (arteriyel kan gazı pH değeri ve serum laktat düzeyi) ile acil serviste bekleme süreleri hastane otomasyon sistemi üzerinden elde edildi.
Bulgular: Çalışmaya toplam 434 hasta dahil edildi. Hastaların 342’si (%78,8) acil serviste ölürken, 92’si (%21,2) yoğun bakıma yatırıldı. Ölen hastaların yaş ortalaması sağ kalan hastalara göre anlamlı derecede daha yüksek bulundu (p=0,033). Yoğun bakım mortalitesi %76,1 olarak saptandı. Ölen hastalarda başvuru anında ölçülen kan pH değerinin anlamlı derecede düşük (p=0,016) ve laktat düzeyinin anlamlı derecede yüksek olduğu (p=0,011) gözlendi. Arrest etiyolojisinin travmatik veya non-travmatik olması ile mortalite arasında istatistiksel olarak anlamlı ilişki saptanmadı (p>0,05). Yoğun bakıma yatan hastalarda kabul anında alınan kan pH ve laktat düzeylerinde medikal ve travmatik grup arasında anlamlı fark olmadığı görüldü (p>0,05).
Sonuç: Acil servise kardiyopulmoner arrest nedeniyle kabul edilen hastalarda ileri yaş, düşük pH ve yüksek laktat düzeyleri mortalite ile ilişkili önemli prognostik faktörlerdir. Arrest etiyolojisinin travmatik veya non-travmatik olması mortalite üzerinde istatistiksel olarak anlamlı bir fark göstermemiştir.

Anahtar Kelimeler

• acil servis
• kardiyopumoner arrest
• travma

Comparison of Traumatic and Non-Traumatic Cardiopulmonary Arrest Patients

Öz

Aim: This study aimed to evaluate the demographic characteristics, laboratory findings, and clinical processes of patients admitted to the emergency department with cardiopulmonary arrest due to traumatic and non-traumatic causes, and to identify factors associated with mortality.
Materials and Methods: In this retrospective, single-center study, patients admitted to a tertiary emergency department with a preliminary diagnosis of cardiopulmonary arrest were included. Patients were classified into traumatic and non- traumatic groups according to the etiology of arrest. Demographic data, time of admission, arrest etiology, intensive care unit admission status, laboratory parameters (arterial blood gas pH value and serum lactate level), and length of stay were obtained from the hospital automation system.
Results: A total of 434 patients were included in the study. Of these, 342 patients (78.8%) died in emergency department, while 92 patients (21.2%) were admitted to the intensive care unit. The mean age of non-survivors was significantly higher than that of survivors (p=0.033). Intensıve care unit mortality was found to be 76.1%. In patients who died, admission blood pH values were significantly lower (p=0.016), and lactate levels were significantly higher (p=0.011). No statistically significant association was found between mortality and arrest etiology (traumatic vs. non-traumatic) (p>0.05). No significant differences were observed in arterial blood pH and lactate levels at admission between medical and traumatic patients admitted to the intensive care unit (p>0.05).
Conclusion: Advanced age, low arterial pH, and elevated lactate levels were identified as important prognostic factors associated with mortality in patients admitted to the emergency department with cardiopulmonary arrest. Whether the etiology of the cardiopulmonary arrest was traumatic or non-traumatic did not show a statistically significant difference in mortality.

Anahtar Kelimeler

• cardiopulmonary arrest
• emergency department
• trauma

Kaynakça

1. Altınbilek E, Çalık M, Tümer M, Erdem AB, Öztürk D. Retrospective evaluation of patients undergoing cardiopulmonary resuscitation in the emergency department. J Acad Res Med. 2020;10(3):264-268.
2. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A. Implementation working group for the all-Japan utstein registry of the fire and disaster management agency. Nationwide public- access defibrillation in Japan. N Engl J Med. 2010;362(11):994- 1004.
3. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63- 81.
4. Kitamura T, Kiyohara K, Sakai T, Iwami T, Nishiyama C, Kajino K, et al. Epidemiology and outcome of adult out-of-hospital cardiac arrest of noncardiac origin in Osaka: A population-based study. BMJ Open. 2014;4(12):e006462.
5. Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales - A retrospective database analysis. Resuscitation. 2017;110:90-94.
6. Evans CC, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, et al. Resuscitation outcomes consortium I. Prehospital traumatic cardiac arrest: management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81(2):285-293.
7. Burstein B, Vallabhajosyula S, Ternus B, Barsness GW, Kashani K, Jentzer JC. The prognostic value of lactate in cardiac intensive care unit patients with cardiac arrest and shock. Shock. 2021;55(5):613- 619.
8. Jeong D, Shin SD, Shin TG, Lee GT, Park JE, Hwang SY, et al. Initial arterial pH predicts survival of out-of-hospital cardiac arrest in South Korea. Acute Crit Care. 2025;40(3):444-451.

9. Yosha HD, Tadele A, Teklu S, Melese KG. A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia. BMC Emerg Med. 2021;21(1):1–9.
10. Hunchak C, Teklu S, Meshkat N, Meaney C, Puchalski Ritchie L. Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia. BMC Res Notes. 2015;8:605.
11. Hiemstra B, Bergman R, Absalom AR, van der Naalt J, van der Harst P, de Vos R, et al. Long-term outcome of elderly out-of- hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis. 2018;12(12):341-349.
12. Nakamura F, Kajino K, Kitamura T, Daya MR, Ong ME, Matsuyama T, et al. CRITICAL Study investigators. Impact of age on survival of patients with out-of-hospital cardiac arrest transported to tertiary emergency medical institutions in Osaka, Japan. Geriatr Gerontol Int. 2019;19(11):1088-1095.
13. Stankovic N, Holmberg MJ, Høybye M, Granfeldt A, Andersen LW. Age and sex differences in outcomes after in-hospital cardiac arrest. Resuscitation. 2021;165:58-65.
14. Collie BL, Emami S, Lyons NB, Ramsey WA, O’Neil CF Jr, Meizoso JP, et al. Survival of in-hospital cardiopulmonary arrest in trauma patients. J Surg Res. 2024;298:379-384.
15. Gräsner JT, Wnent J, Lefering R, Herlitz J, Masterson S, Maurer H, et al. EuReCa-THREE Collaborator Group. European registry of cardiac arrest study THREE (EuReCa- THREE) - EMS response time influence on outcome in Europe. Resuscitation. 2025;7:110704.
16. Lee MHM, Chia MYC, Fook-Chong S, Shahidah N, Tagami T, Ryu HH, et al. Characteristics and outcomes of traumatic cardiac arrests in the pan-asian resuscitation outcomes study. Prehosp Emerg Care. 2023;27(8):978-986.
17. Wolthers SA, Jensen TW, Breindahl N, Milling L, Blomberg SN, Andersen LB, et al. Traumatic cardiac arrest - a nationwide Danish study. BMC Emerg Med. 2023;23(1):69.
18. Chen YC, Wu KH, Hsiao KY, Hung MS, Lai YC, Chen YS, et al. Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury. 2019;50(1):4-9.
19. Wallace SK, Abella BS, Shofer FS, Leary M, Agarwal AK, Mechem CC, et al. Effect of time of day on prehospital care and outcomes after out-of-hospital cardiac arrest. Circulation. 2013;127(15):1591-1596.
20. Khan AM, Kirkpatrick JN, Yang L, Groeneveld PW, Nadkarni VM, Merchant RM. American Heart Association’s Get With the Guidelines- Resuscitation (GWTG-R) Investigators. Age, sex, and hospital factors are associated with the duration of cardiopulmonary resuscitation in hospitalized patients who do not experience sustained return of spontaneous circulation. J Am Heart Assoc. 2014;3:e001044.
21. Oğuztürk H, Turtay MG, Tekin YK, Sarıhan E. A cardiac arrests in the emergency ward and our experiences on the cardiopulmonary resuscitation. Kafkas J Med Sci. 2011;1:114-117.
22. Patel NT, Carr CT, Hopson CM, Hwang CW. Lactate and pH as independent biomarkers for prognosticating meaningful post- out-of-hospital cardiac arrest outcomes: A systematic review and meta-analysis. J Clin Med. 2025;14(7):2244.
23. Callegari F, De Giorgio D, Merigo G, Cerrato M, Tinelli O, Magliocca A, et al. Association between early arterial pH, base excess and lactate and 24-h mortality and neurological outcomes after cardiac arrest and cardiopulmonary resuscitation: a translational study. Resusc Plus. 2026;28:101228.
24. Burša F, Pleva L. Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study. Scand J Trauma Resusc Emerg Med. 2014;22:11.
25. Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47(4):369-421.