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RETROSPECTIVE EVALUATION OF POST-CPR PATIENTS IN INTENSIVE CARE AFTER IN-HOSPITAL CARDIAC ARREST

Yıl 2022, Cilt: 1 Sayı: 1, 35 - 43, 16.03.2022

Öz

Introduction: The intensive care process begins with the return of spontaneous circulation after cardiac arrest. Depending on the severity of post-cardiac arrest syndrome, many patients may require multi-organ support, and the treatments applied have significant effects on neurological outcomes. Our study aimed to evaluate the neurological outcomes and intensive care mortality of patients with spontaneous circulation after in-hospital cardiac arrest.

Material/Method: Patients who developed in-hospital cardiac arrest between 2014 and 2020 were followed up in our anesthesia intensive care unit after spontaneous circulation returned were evaluated retrospectively. After CPR in our intensive care unit, we followed the patients up under our treatment protocol. Demographic data of the 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 intensive care database.

Results: We analyzed files of 49 patients with complete records. The mean age of the patients was 67.43 ±19.9 years, 46.9% (n:23) were female, and 53.1% (n:26) were male. The most common comorbidity was HT, with 36.6% (n:18). The mean APACHE II score was 28.52 ± 9.8. GCS was <8 at the time of hospitalization in 87.8% (n:43) of the patients. When the seventy-second hour GCS was evaluated, 75.4% (n:37) of the patients had a GCS <8, 20.3% (n:10) had a GCS of 9-12, and 4% (n:4) had a GCS of 13. The mean intensive care unit stay was 10.12±9.6 days. 55.1% (n:27) of the patients died. 44.9% (n:22) were discharged from the intensive care unit with a mean GCS of 12±3.4. 31.8% (n:7) of the patients were discharged with spontaneous tracheostomy breathing or a home ventilator.

Conclusion: In our study, the rate of discharge from the intensive care unit after in-hospital cardiac arrest was 44.9%, which is in conformance with the literature. There is a need for legal regulations, and national guidelines for transferring from tertiary intensive care to rehabilitation units for patients predicted to have a poor neurological prognosis after resuscitation and in a permanent vegetative state.

Kaynakça

  • Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015. Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202-222. doi:10.1016/j. resuscitation.2015.07.018
  • 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
  • Randhawa VK, Grunau BE, Debicki DB, et al. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins. Can J Cardiol. 2018;34(2):156-167. doi:10.1016/j.cjca.2017.11.013
  • Grasner J-T, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021:1-19. doi:10.1016/j.resuscitation.2021.02.007
  • Perkins GD, Jacobs IG, Nadkarni VM, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: A statement for healthcare professionals from a task force of the international liaison committee. Circulation. 2015;132(13):1286-1300. doi:10.1161/CIR.0000000000000144
  • Pareek N, Kordis P, Beckley-Hoelscher N, et al. A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2. Eur Heart J. 2020;41(47):4508-4517. doi:10.1093/eurheartj/ehaa570
  • Mak M, Moulaert VRM, Pijls RW, Verbunt JA. Measuring outcome after cardiac arrest: Construct validity of Cerebral Performance Category. Resuscitation. 2016;100:6-10. doi:10.1016/j.resuscitation.2015.12.005
  • Hirlekar G, Karlsson T, Aune S, et al. Survival and neurological outcome in the elderly after in- hospital cardiac arrest. Resuscitation. 2017. doi:10.1016/j.resuscitation.2017.07.013
  • 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(November 2018):21-28. doi:10.1016/j.resuscitation.2019.01.034
  • 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(March):77-84. doi:10.1016/j. resuscitation.2020.04.002
  • Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi:10.1007/s00134-021-06548-2
  • Nolan JP, Sandronic C, Bottiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation. 2021:1-50. doi:https://doi.org/10.1016/j. resuscitation.2021.02.012
  • Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA - J Am Med Assoc. 2019;321(12):1200-1210. doi:10.1001/jama.2019.1696.In-Hospital

HASTANE-İÇİ KARDİYAK ARREST SONRASI YOĞUN BAKIMDA İZLENEN POST-KPR HASTALARIN RETROSPEKTİF DEĞERLENDİRİLMESİ

Yıl 2022, Cilt: 1 Sayı: 1, 35 - 43, 16.03.2022

Öz

Giriş- Amaç: Kardiyak arrest sonrası spontan dolaşımın geri dönüşüyle birlikte hastanın yoğun bakım süreci başlar. Post kardiyak arrest sendromun ciddiyetine bağlı olarak birçok hastaya çoklu organ desteği gerekebilmekte ve uygulanan tedavilerin nörolojik sonuçlar üzerine önemli etkileri olmaktadır. Çalışmamızda hastane içi gelişen arrest sonrası spontan dolaşım sağlanan hastaların nörolojik sonuçları ve yoğun bakım mortalitesinin değerlendirilmesi amaçlandı.

Gereç- Yöntem: 2014-2020 yılları arasında hastane içi kardiyak arrest gelişen ve spontan dolaşım döndükten sonra Anestezi yoğun bakım ünitemizde izlenen hastalar retrospektif olarak değerlendirildi. Yoğun bakımımızda KPR sonrası hastalar tedavi protokolümüze uygun olarak izlendi. Yoğun Bakım veri tabanımız üzerinden hastalara ait demografik veriler, Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Glaskow koma skorları (GKS), yoğun bakımda kalış süresi ve mortaliteleri kaydedildi.

Bulgular: Kayıtları eksiksiz olan 49 hasta incelendi. Hastaların yaş ortalaması 67,43±19.9, % 46,9’u (n:23) kadın, % 53,1’i (n:26) erkekti. Komorbidite % 36,6 ile (n:18) en sık HT idi. Ortalama APACHE II skoru 28.52±9.8 saptandı. Hastaların % 87,8’sinde (n:43) yatış sırasında GKS <8 in altında idi. Yetmiş ikinci saat GKS değerlendirildiğinde hastaların % 75,4’ünde (n:37) GKS <8, % 20,3’ünde (n:10) GKS 9-12 arası, % 4’ünde ise (n:4) GKS 13 idi. Ortalama yoğun bakım yatış süresi 10,12±9,6 gündü. Hastaların % 55,1’i (n:27) eksitus, % 44,9’u (n:22) ortalama GKS 12±3,4 ile yoğun bakımdan taburcu edildi. Hastaların % 31,8’i (n:7) trakeostomili spontan solunumda veya ev tipi ventilatörle taburcu edildi.

Sonuç: Araştırmamızda hastane içi kardiyak arrest sonrası yoğun bakımdan taburculuk oranı % 44.9 idi ve literatür ile benzerdi. Resüsitasyon sonrasında kötü nörolojik prognoza sahip olacağı öngörülen ve/veya kalıcı vejetatif durumdaki hastalar için III. Basamak yoğun bakımdan rehabilitasyon ünitelerine nakil için yasal düzenlemelere ve ulusal kılavuzlara ihtiyaç duyulmaktadır.

Kaynakça

  • Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015. Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202-222. doi:10.1016/j. resuscitation.2015.07.018
  • 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
  • Randhawa VK, Grunau BE, Debicki DB, et al. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins. Can J Cardiol. 2018;34(2):156-167. doi:10.1016/j.cjca.2017.11.013
  • Grasner J-T, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021:1-19. doi:10.1016/j.resuscitation.2021.02.007
  • Perkins GD, Jacobs IG, Nadkarni VM, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: A statement for healthcare professionals from a task force of the international liaison committee. Circulation. 2015;132(13):1286-1300. doi:10.1161/CIR.0000000000000144
  • Pareek N, Kordis P, Beckley-Hoelscher N, et al. A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2. Eur Heart J. 2020;41(47):4508-4517. doi:10.1093/eurheartj/ehaa570
  • Mak M, Moulaert VRM, Pijls RW, Verbunt JA. Measuring outcome after cardiac arrest: Construct validity of Cerebral Performance Category. Resuscitation. 2016;100:6-10. doi:10.1016/j.resuscitation.2015.12.005
  • Hirlekar G, Karlsson T, Aune S, et al. Survival and neurological outcome in the elderly after in- hospital cardiac arrest. Resuscitation. 2017. doi:10.1016/j.resuscitation.2017.07.013
  • 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(November 2018):21-28. doi:10.1016/j.resuscitation.2019.01.034
  • 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(March):77-84. doi:10.1016/j. resuscitation.2020.04.002
  • Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi:10.1007/s00134-021-06548-2
  • Nolan JP, Sandronic C, Bottiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation. 2021:1-50. doi:https://doi.org/10.1016/j. resuscitation.2021.02.012
  • Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA - J Am Med Assoc. 2019;321(12):1200-1210. doi:10.1001/jama.2019.1696.In-Hospital

Ayrıntılar

Birincil Dil Türkçe
Konular Acil Tıp, Yoğun Bakım
Bölüm Orijinal Makaleler
Yazarlar

Y. Levent UĞUR Bu kişi benim 0000-0003-3167-3139

Murat ÖZÇELİK Bu kişi benim 0000-0001-6906-7500

Şule ÖZBİLGİN 0000-0002-2940-8988

Bahar KUVAKİ 0000-0002-5160-0634

Necati GÖKMEN 0000-0003-1835-4133

Yayımlanma Tarihi 16 Mart 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 1 Sayı: 1

Kaynak Göster

AMA UĞUR YL, ÖZÇELİK M, ÖZBİLGİN Ş, KUVAKİ B, GÖKMEN N. HASTANE-İÇİ KARDİYAK ARREST SONRASI YOĞUN BAKIMDA İZLENEN POST-KPR HASTALARIN RETROSPEKTİF DEĞERLENDİRİLMESİ. TJR. Mart 2022;1(1):35-43.