Yoğun bakım ünitesinde takip edilen kardiyopulmoner resüsitasyon sonrası hastaların değerlendirilmesi: Bir yıllık retrospektif analiz.

Öz

Amaç: Kardiyopulmoner resüsitasyon (KPR) sonrası hastalar kritik bir hasta grubudur. Günümüzde tedavi seçenekleri ve kılavuzların gelişmesine rağmen bu hastalarda mortalite ve morbidite oranları hala yüksektir. Yoğun Bakım Ünitesine (YBÜ) kabul edilen KPR sonrası hastalar için tanımlayıcı veriler elde etmeyi amaçladık. Gereç ve Yöntemler: KPR sonrası hastaların demografik verileri, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II) ve Glasgow koma skorları (GKS), yoğun bakımda kalış süreleri ve ölüm oranları hastanemiz veri tabanı üzerinden kayıt altına alındı. Bulgular: Çalışma süresi boyunca 78 hasta değerlendirildi.Hastaların yaş ortalaması 75,01±9,6 yıl olup 42'si (%53,84) kadındı.Yoğun bakım ünitesine kabulde ortalama APACHE II skoru 21,15 ± 7,2, ortalama GKS 8,29 ± 2,4 idi.Hastaların %96,15'inde yandaş hastalık mevcuttu ve 35 hastada 3 ve daha fazla yandaş hastalık mevcuttu.vYoğun bakımda 26 hasta hayatta kalırken 52 hasta hayatını kaybetti. Ölen hastalarda APACHE II skorları ve laktat düzeyi daha yüksek, buna karşın GKS skoru ise daha düşüktü.. Sonuç: KPR sonrası hastalarda yüksek mortalite oranları rapor edilmiştir. Bu hastalar için prognostik olduğu öne sürülen birçok faktör vardır. Ölen hastalarımızda laktat düzeyi ve APACHE II skoru daha fazla, GCS skoru ise daha düşüktü.

Anahtar Kelimeler

• Kardiyopulmoner arest
• Yoğun bakım
• Mortalite Oranı.

Evaluation of post cardiopulmonary resuscitation patıents followed in intensive care unit: A one-year retrospective analysis.

Öz

Aim: Post Cardiopulmonary Resuscitation (CPR) patients are a critical patient group. Despite the development of treatment options and guidelines, mortality and morbidity rates in these patients are still high. We aimed to obtain a descriptive data for post CPR patients admitted to Intensive Care Unit (ICU). Material and Methods: This single-center, retrospective observational study was conducted in the mix ICU’s at the Karabuk University Hospital in Karabuk, Turkey, from Jan 2023 to Jan 2024. Demographic data of the post-CPR patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Glasgow coma scores (GCS), length of stay in the ICU and mortality were recorded through our hospital database. Results: During the study period,78 patients were evaluated. The mean age of the patients was 75.01 ± 9.6 years, and 42 of them were female (53.84%). The mean APACHE II scores on ICU admission was 21.15 ± 7.2, and mean GKS was 8.29 ± 2.4. Comorbid disease was present in 96.15% of the patients, and 35 patients had 3 or more comorbid diseases. Twenty-six patients survived whereas 52 died in ICU. APACHE II scores and. the lactate level were higher, whereas GCS score was lower in nonsurvivors. Conclusion: High mortality rates have been reported for post CPR patients. There are many factors that have been suggested to be prognostic for these patients. In our died patients, the lactate level and their APACHE II score were higher and their GCS scores were lower.

Anahtar Kelimeler

• Cardiopulmonary arrest
• Intensive care
• Mortality Rate.

Kaynakça

1. Nolan JP, Sandroni C, Böttiger BW, 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. doi:10.1007/s00134-021-06368-4
2. Lin Q, Zhang N, Zhu H. The relationship between the level of NMLR on admission and the prognosis of patients after cardiopulmonary resuscitation: a retrospective observational study. Eur J Med Res. 2023;28(1):424. doi:10.1186/s40001-023-01407
3. Geocadin RG, Callaway CW, Fink EL, et al. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2019;140(9):e517-e542. doi:10.1161/CIR.0000000000000702
4. Gräsner JT, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61-79. doi:10.1016/j.resuscitation.2021.02.007.
5. Uğur YL, Özçelik M, Özbilgin Ş, Kuvaki B, Gökmen N. hastane-içi kardiyak arrest sonrası yoğun bakımda izlenen post-kpr hastaların retrospektif değerlendirilmesi. TJR. Mart 2022;1(1):35-43.
6. Sandroni C, Ferro G, Santangelo S, et al. In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation. 2004;62(3):291-297. doi:10.1016/j.resuscitation.2004.03.020
7. Hirlekar G, Karlsson T, Aune S, et al. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation. 2017;118:101-106. doi:10.1016/j.resuscitation.2017.07.013
8. Nehme Z, Andrew E, Bernard S, Smith K. Sex differences in the quality-of-life and functional outcome of cardiac arrest survivors. Resuscitation. 2019;137:21-28. doi:10.1016/j.resuscitation.2019.01.034

9. Djärv T, Bremer A, Herlitz J, et al. Health-related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: A Swedish population-based registry study. Resuscitation.2020;151:77-84. doi:10.1016/j.resuscitation. 2020.04.002
10. 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. 2021;12(4):695-723. doi:10.1007/s41999-021-00454
11. Katircioglu K, Ayvat P, Gunturkun F. Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality. Braz J Anesthesiol. 2023;73(4):401-408. doi:10.1016/j.bjane.2021.03.013
12. Fabbri A, Marchesini G, Spada M, et al. Monitoring intervention programmes for out-of-hospital cardiac arrest in a mixed urban and rural setting. Resuscitation. 2006;71(2):180-187. doi:10.1016/j.resuscitation.2006.04.003
13. Andrew E, Nehme Z, Bernard S, Smith K. The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest. Resuscitation. 2017;110:42-47. doi:10.1016/j.resuscitation.2016.10.018
14. Martinell L, Nielsen N, Herlitz J, et al. Early predictors of poor outcome after out-of-hospital cardiac arrest. Crit Care. 2017;21(1):96. doi:10.1186/s13054-017-1677-2
15. Chen J, Mei Z, Wang Y, et al. A nomogram to predict in hospital mortality in post-cardiac arrest patients: a retrospective cohort study. Pol Arch Intern Med. 2023;133(1):16325. doi:10.20452/pamw.16325
16. Hsu SH, Kao PH, Lu TC, et al. Serum Lactate for Predicting Cardiac Arrest in the Emergency Department. J Clin Med. 2022;11(2):403. doi:10.3390/jcm11020403
17. Wang CH, Huang CH, Chang WT, et al. Monitoring of serum lactate level during cardiopulmonary resuscitation in adult in-hospital cardiac arrest. Crit Care. 2015;19(1):344. doi:10.1186/s13054-015-1058-7.