Post-resüsitatif Bakımda Yatakbaşı Ultrasonografinin Rolü

Yıl 2026, Cilt: 8 Sayı: 1 , 43 - 46 , 31.03.2026

Ömer Jaradat

https://izlik.org/JA69SL76YD

Öz

Amaç: Bu sunum, spontan dolaşımın geri dönüşü (ROSC) sonrası post-resüsitatif bakımda yatakbaşı ultrasonografinin (POCUS) kullanım alanlarını ve önemini vurgulamayı amaçlamaktadır.
Gereç ve Yöntem: Kardiyak arrest sonrası sağkalım, hızlı müdahale ve resüsitasyon sonrası bakımın kalitesine bağlıdır. ROSC sağlansa bile, post-resüsitatif dönemdeki yönetim, hasta sonlanımlarını doğrudan etkiler. Bu bildiri, kardiyak arrest sonrası POCUS kullanımına ilişkin güncel literatür ve uluslararası kılavuzlar taranarak hazırlanmıştır.
Bulgular: POCUS, ROSC sonrası geri döndürülebilir nedenlerin (kardiyak tamponad, pulmoner emboli, pnömotoraks, hipovolemi) saptanmasında yüksek tanısal doğruluk sağlar. Ekokardiyografi ile post-arrest miyokard disfonksiyonu (PAMD) ve bölgesel duvar hareket kusurları (RWMA) değerlendirilebilir; ancak RWMA’nın akut koroner sendrom için spesifik olmadığı unutulmamalıdır. Hemodinamik yönetimde, sıvı yanıtı ve toleransının tahmininde POCUS yol göstericidir; pozitif sıvı dengesi mortalite ile ilişkilidir. USG kılavuzluğunda santral venöz kateterizasyon komplikasyonları %70 oranında azaltır. Akciğer USG, mekanik ventilasyon ayarlarının (PEEP, inspiratuar basınç) optimizasyonuna yardımcı olur. Transkraniyal Doppler, serebral kan akımını değerlendirir; ilk 72 saatte prognostik değeri sınırlıyken, 5-7. günde yüksek akım hızları kötü prognozla ilişkilidir.
Sonuç: POCUS, post-resüsitatif bakımda tanısal ve yönetimsel süreçlerin ayrılmaz bir parçasıdır. Multimodal ve akılcı kullanımı, kardiyak arrest sonrası hasta sonlanımlarını iyileştirme potansiyeline sahiptir.

Anahtar Kelimeler

Point-of-care ultrasound , cardiac arrest , post-resuscitation care , echocardiography , lung ultrasound

Etik Beyan

Bu kongre bildirisi için etik kurul onay gerekmemektedir.

Destekleyen Kurum

Bu kongre bildirisi herhangi bir fon desteği almamıştır.

Teşekkür

Bu bildiri, 12-14 Şubat 2026 tarihleri arasında Konya'da düzenlenen 2. Uluslararası Acil Akademik Tıp Kongresi'nde sunulmuştur.

The Role of Point-of-care Ultrasound in Post-resuscitation Care

https://izlik.org/JA69SL76YD

Öz

Objective: This presentation aims to highlight the utility and importance of point-of-care ultrasound (POCUS) in post-resuscitation care following the return of spontaneous circulation (ROSC).
Material and Method: Survival after cardiac arrest depends on rapid intervention and the quality of post-resuscitation care. Even after achieving ROSC, management during the post-resuscitation period directly influences patient outcomes. This conference proceeding was prepared by scanning the current literature and international guidelines on the use of POCUS after cardiac arrest.
Results: POCUS provides high diagnostic accuracy in identifying reversible causes after ROSC, including cardiac tamponade, pulmonary embolism, pneumothorax, and hypovolemia. Echocardiography allows assessment of post-arrest myocardial dysfunction (PAMD) and regional wall motion abnormalities (RWMA); however, RWMA is not specific for acute coronary syndrome. In hemodynamic management, POCUS helps predict fluid responsiveness and tolerance; positive fluid balance is associated with increased mortality. Ultrasound guidance reduces central venous catheterization complications by up to 70%. Lung ultrasound aids in optimizing mechanical ventilation settings (PEEP, inspiratory pressure). Transcranial Doppler evaluates cerebral blood flow; while its prognostic value is limited in the first 72 hours, high flow velocities on days 5-7 correlate with poor outcomes.
Conclusion: POCUS is an integral part of diagnostic and management processes in post-resuscitation care. Its multimodal and rational use has the potential to improve patient outcomes after cardiac arrest.

Anahtar Kelimeler

Yatakbaşı ultrasonografi , kardiyak arrest , post-resüsitatif bakım , ekokardiyografi , akciğer ultrasonu

Kaynakça

• Latsios G, Sanidas E, Velliou M, Nikitas G, Bounas P, Parisis C, et al. Cardiac arrest: Pre-hospital strategies to facilitate successful resuscitation and improve recovery rates. World J Cardiol. 2025;17:100782. DOI: 10.4330/wjc.v17.i1.100782.
• Wong A, Vignon P, Robba C. How I use ultrasound in cardiac arrest. Intensive Care Med. 2023;49(12):1531-4. DOI: 10.1007/s00134-023-07249-8.
• Long B, Adrian RJ, Gottlieb M. Emergency medicine updates: Point-of-care ultrasound in cardiac arrest. Am J Emerg Med. 2026;99:176-87. DOI: 10.1016/j.ajem.2025.09.021.
• Ávila-Reyes D, Acevedo-Cardona AO, Gómez-González JF, Echeverry-Piedrahita DR, Aguirre-Flórez M, Giraldo-Diaconeasa A. Point-of-care ultrasound in cardiorespiratory arrest (POCUS-CA): narrative review article. Ultrasound J. 2021;13(1):46. DOI: 10.1186/s13089-021-00249-5.
• Savastano S, Baldi E, Schnaubelt S, Auricchio A. Post resuscitation ST-segment elevation: When a few minutes make the difference between a class I and a class III indication for immediate coronary angiography. Resuscitation. 2023;192:109971. DOI: 10.1016/j.resuscitation.2023.109971.
• Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-862. DOI: 10.1161/CIR.0000000000001309.
• Mauriello A, Marrazzo G, Del Vecchio GE, Ascrizzi A, Roma AS, Correra A, et al. Echocardiography in Cardiac Arrest: Incremental Diagnostic and Prognostic Role during Resuscitation Care. Diagnostics. 2024;14(18):2107. DOI: 10.3390/diagnostics14182107.
• 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. Resuscitation. 2021;161:220-69. DOI: 10.1016/j.resuscitation.2021.02.012.
• Elfwén L, Hildebrand K, Schierbeck S, Sundqvist M, Ringh M, Claesson A, et al. Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients. Resuscitation. 2019;142:16-22. DOI: 10.1016/j.resuscitation.2019.06.282.
• Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:33-9. DOI: 10.1016/j.resuscitation.2016.09.018.
• Imazio M, De Ferrari GM. Cardiac tamponade: an educational review. Eur Heart J Acute Cardiovasc Care. 2021;10(1):102-9. DOI: 10.1177/2048872620939341.
• Gonzalez MS, Basnight MA, Appleton CP. Experimental pericardial effusion: relation of abnormal respiratory variation in mitral flow velocity to hemodynamics and diastolic right heart collapse. J Am Coll Cardiol. 1991;17(1):239-48. DOI: 10.1016/0735-1097(91)90735-s.
• Pérez C, Diaz-Caicedo D, Almanza Hernández DF, Moreno-Araque L, Yepes AF, Carrizosa Gonzalez JA. Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. J Clin Med. 2024;13(18):5344. DOI: 10.3390/jcm13185344.
• Comess KA, DeRook FA, Russell ML, Tognazzi-Evans TA, Beach KW. The incidence of pulmonary embolism in unexplained sudden cardiac arrest with pulseless electrical activity. Am J Med. 2000;109(5):351-6. DOI: 10.1016/s0002-9343(00)00506-0.
• Beshara M, Bittner EA, Goffi A, Berra L, Chang MG. Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies. Crit Care. 2024;28(1):328. DOI: 10.1186/s13054-024-05102-y.
• Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract. 2012;2012:503254. DOI: 10.1155/2012/503254.
• Fletcher DJ, Boller M. Fluid Therapy During Cardiopulmonary Resuscitation. Front Vet Sci. 2021;7:625361. DOI: 10.3389/fvets.2020.625361.
• Didier J, Murris J, Schopper H, Guérin E, Flajoliet N, Amiot M, et al. Fluid balance after cardiac arrest: Any impact on outcome? Insights from the MIMIC IV database. Resusc Plus. 2025;25:101037. DOI: 10.1016/j.resplu.2025.101037.
• Renaudier M, Lascarrou JB, Chelly J, Lesieur O, Bourenne J, Jaubert P, et al. Fluid balance and outcome in cardiac arrest patients admitted to intensive care unit. Crit Care. 2025;29(1):152. DOI: 10.1186/s13054-025-05391-x.
• Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, et al. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015;3(3):40. DOI: 10.3978/j.issn.2305-5839.2015.02.11.
• Lopes NLG, Amaral VH, Minozzi MS, Guazzelli Pitta Madureira P, Zagne Braz L, da Hora Passos R. Lung ultrasound in the management of mechanical ventilation in pediatric critical care: a narrative review. Front Pediatr. 2025;13:1630918. DOI: 10.3389/fped.2025.1630918.
• Bianchini A, Pintus L, Vitale G, Mazzotta E, Felicani C, Zangheri E, et al. Lung Ultrasound in Mechanical Ventilation: A Purposive Review. Diagnostics. 2025;15(7):870. DOI: 10.3390/diagnostics15070870.
• Lau VI, Arntfield RT. Point-of-care transcranial Doppler by intensivists. Crit Ultrasound J. 2017;9(1):21. DOI: 10.1186/s13089-017-0077-9.
• Meunier J, Engrand N, Saulnier P, Deye N, Landais M, Cariou A, et al. Transcranial Doppler goal-directed therapy after cardiac arrest (GOODYEAR): a feasibility study. Resusc Plus. 2025;25:101001. DOI: 10.1016/j.resplu.2025.101001.
• Reichenbach A, Alteheld L, Henriksen J, Nakstad ER, Andersen GØ, Sunde K, et al. Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes. Front Neurol. 2023;14:1222401. DOI: 10.3389/fneur.2023.1222401.
• Sayed MS, Radi AMAE, Mohamed MF, Eltaher AF. Predicting the neurological outcome in survivors of cardiopulmonary resuscitation by transcranial Doppler measurement values. Egypt J Crit Care Med. 2025;12:11. DOI: 10.1007/s44349-025-00023-3.