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GEBEDE BEKLENMEYEN KARDİYAK ARREST VE HEDEFE YÖNELİK SICAKLIK YÖNETİMİ

Yıl 2022, Cilt: 1 Sayı: 2, 105 - 112, 17.08.2022

Öz

Gebelikte tahmin edilen kardiyopulmoner arrest sıklığı yılda 30.000 hamilelikte 1 olarak görülmektedir. Gebede kardiyak arrest en zorlu durumlardan biridir. Erişkindeki kardiyopulmoner resüsitsyona benzer olmakla birlikte uygulamada bazı özellikli yanları vardır. Nadir görülüyor olmasına karşın hızlı hareket etmeyi gerektiren bir durumdur, çünkü aynı anda iki canlı tehlike altındadır. Kardiyopulmoner arrest gerçekleştiğinde yüksek kalitede başarılı kardiyopulmoner resüsitasyon (KPR), 4-5 dakika içinde infantın doğurtulması gereklidir.

Bu olguda daha önceden bilinmeyen dilate kardiyomiyopatisi olan gebede, gebeliğin ağırlaştırdığı kalp yetersizliğine bağlı olarak litotomi pozisyonunda rutin gebelik muayenesi sırasında gelişen beklenmedik kardiyopulmoner arrestteki KPR yönetimi ve resüsitasyon sonrası dönemde uygulanan hedefe yönelik sıcaklık yönetiminden söz ettik.

Kaynakça

  • Department of Health, Welsh Office, Scottish Office Department of Health, Department of Health and Social Services, Northern Ireland. Why mothers die. Report on confidential enquiries into maternal deaths in the United Kingdom, 2000—2002. London: The Stationery Office; 2004.)
  • Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac arrest in pregnancy: a scien- tific statement from the America Heart Association. Circulation 2015;132:1747.
  • McLennan C, Minn M. Antecubital and femoral venous pressure in normal and toxemic pregnancy. Am J Obstet Gynecol 1943;45:568–91.
  • Kerr MG. The mechanical effects of the gravid uterus in late pregnancy. J Obstet Gynaecol Br Commonw 1965;72:513– 29.
  • McLennan C, Minn M. Antecubital and femoral venous pressure in normal and toxemic pregnancy.Am J Obstet Gynecol. 1943; 45:568–591.
  • Ueland K, Novy MJ, Peterson EN, Metcalfe J. Maternal cardiovascular dynamics, IV: the influence of gestational age on the maternal cardiovascular response to posture and exercise.Am J Obstet Gynecol. 1969; 104:856–864.
  • Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy.Best Pract Res Clin Obstet Gynaecol. 2013; 27:791–802.
  • San-Frutos L, Engels V, Zapardiel I, Perez-Medina T, Almagro-Martinez J, Fernandez R, Bajo-Arenas JM. Hemodynamic changes during pregnancy and postpartum: a prospective study using thoracic electrical bioimpedance.J Matern Fetal Neonatal Med. 2011; 24:1333–1340.
  • Carbillon L, Uzan M, Uzan S. Pregnancy, vascular tone, and maternal hemodynamics: a crucial adaptation.Obstet Gynecol Surv. 2000; 55:574–581.
  • Palmer SK, Zamudio S, Coffin C, Parker S, Stamm E, Moore LG. Quantitative estimation of human uterine artery blood flow and pelvic blood flow redistribution in pregnancy.Obstet Gynecol. 1992; 80:1000–1006.
  • Ray P, Murphy GJ, Shutt LE. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth 2004;93:428—39.
  • Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardio- vascular system. Int J Cardiol 2005;98:179—89.
  • Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J; ERC Special Circumstances Writing Group Collaborators. Resuscitation. 2021 Apr;161:152-219.
  • Vanden Hoek TL,Morrison LJ, Shuster M, et al. Part12: Cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122(Suppl 3): S829–61.
  • Holmes S, Kirkpatrick IDC, Zelop CM, et al. MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation. Am J Obstet Gynecol 2015;213:401.e1-5.
  • Nanson J, Elcock D, Williams M, et al. Do physiological changes in pregnancy change defibrillation energy requirements? Br J Anaesth 2001;87:237–9.
  • C.W. Yancy, M. Jessup, B. Bozkurt, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol, 62 (16) (2013), pp. e147-e239
  • S.C. Siu, M. Sermer, J.M. Colman, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation, 104 (5) (2001), pp. 515-521
  • J. Grewal, S.C. Siu, H.J. Ross, et al. Pregnancy outcomes in women with dilated cardiomyopathy. J Am Coll Cardiol, 55 (1) (2009), pp. 45-52.
  • HACA Study group. Mild therapeutic hypothermia to improve the neurlogic outcome after cardiac arrest. N Engl J Med 2002; 346:549-556.
  • Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out of hospital cardiac arrest with induced hyhothermia. N Engl J Med 2002; 346:557-563.
  • Holzer M. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346:549-556.
  • Nolan JP, Sandroni C, Andersen LW, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Lilja G, Morley PT, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone FS, Soar J. Nolan JP, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Resuscitation. 2022 Mar;172:229-236.
  • Rittenberger JC, Kelly E, Jang D, et al. Succesful outcome utilizing hypothermia after cardiac arrest. Crit Care Med 2008; 36:1354-1356.
  • Wible EF, Kass JS, Lopez GA. A report of fetal demise during therapeutic hypothermia after cardiac arrest. Neurocrit Care 2010; 13:239-242.
  • Chauhan A, Musunuru H, Donnino M, et al. The use of therapeutic hypothermia after cardiac arrest in a pregnant patient. Ann Emerg Med 2012; 60:786-789.
  • Nielsen N, et al. Targeted temperature management at 33 vs 36 C after cardiac arrest. N Engl J Med 2013;369:2197- 2206.

UNEXPECTED CARDIAC ARREST IN PREGNANT PATIENT AND MANAGEMENT OF TARGETED TEMPERATURE MANAGEMENT

Yıl 2022, Cilt: 1 Sayı: 2, 105 - 112, 17.08.2022

Öz

The estimated frequency of cardiopulmonary arrest during pregnancy is 1 in 30,000 pregnancies per year. Cardiac arrest in pregnancy is one of the most challenging situations. Although it is similar to cardiopulmonary resuscitation in adults, it has some peculiarities in practice. Although it is rare, it is a situation that requires quick action because two living things are in danger at the same time. When cardiopulmonary arrest occurs, high-quality successful cardiopulmonary resuscitation (CPR) requires delivery of the infant within 4-5 minutes.

In this case, we mentioned about CPR management in unexpected cardiopulmonary arrest developed during routine pregnancy examination in the lithotomy position due to heart failure aggravated by pregnancy in a pregnant woman with previously unknown dilated cardiomyopathy and targeted temperature management in the post-resuscitation period.

Kaynakça

  • Department of Health, Welsh Office, Scottish Office Department of Health, Department of Health and Social Services, Northern Ireland. Why mothers die. Report on confidential enquiries into maternal deaths in the United Kingdom, 2000—2002. London: The Stationery Office; 2004.)
  • Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac arrest in pregnancy: a scien- tific statement from the America Heart Association. Circulation 2015;132:1747.
  • McLennan C, Minn M. Antecubital and femoral venous pressure in normal and toxemic pregnancy. Am J Obstet Gynecol 1943;45:568–91.
  • Kerr MG. The mechanical effects of the gravid uterus in late pregnancy. J Obstet Gynaecol Br Commonw 1965;72:513– 29.
  • McLennan C, Minn M. Antecubital and femoral venous pressure in normal and toxemic pregnancy.Am J Obstet Gynecol. 1943; 45:568–591.
  • Ueland K, Novy MJ, Peterson EN, Metcalfe J. Maternal cardiovascular dynamics, IV: the influence of gestational age on the maternal cardiovascular response to posture and exercise.Am J Obstet Gynecol. 1969; 104:856–864.
  • Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy.Best Pract Res Clin Obstet Gynaecol. 2013; 27:791–802.
  • San-Frutos L, Engels V, Zapardiel I, Perez-Medina T, Almagro-Martinez J, Fernandez R, Bajo-Arenas JM. Hemodynamic changes during pregnancy and postpartum: a prospective study using thoracic electrical bioimpedance.J Matern Fetal Neonatal Med. 2011; 24:1333–1340.
  • Carbillon L, Uzan M, Uzan S. Pregnancy, vascular tone, and maternal hemodynamics: a crucial adaptation.Obstet Gynecol Surv. 2000; 55:574–581.
  • Palmer SK, Zamudio S, Coffin C, Parker S, Stamm E, Moore LG. Quantitative estimation of human uterine artery blood flow and pelvic blood flow redistribution in pregnancy.Obstet Gynecol. 1992; 80:1000–1006.
  • Ray P, Murphy GJ, Shutt LE. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth 2004;93:428—39.
  • Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardio- vascular system. Int J Cardiol 2005;98:179—89.
  • Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J; ERC Special Circumstances Writing Group Collaborators. Resuscitation. 2021 Apr;161:152-219.
  • Vanden Hoek TL,Morrison LJ, Shuster M, et al. Part12: Cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122(Suppl 3): S829–61.
  • Holmes S, Kirkpatrick IDC, Zelop CM, et al. MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation. Am J Obstet Gynecol 2015;213:401.e1-5.
  • Nanson J, Elcock D, Williams M, et al. Do physiological changes in pregnancy change defibrillation energy requirements? Br J Anaesth 2001;87:237–9.
  • C.W. Yancy, M. Jessup, B. Bozkurt, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol, 62 (16) (2013), pp. e147-e239
  • S.C. Siu, M. Sermer, J.M. Colman, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation, 104 (5) (2001), pp. 515-521
  • J. Grewal, S.C. Siu, H.J. Ross, et al. Pregnancy outcomes in women with dilated cardiomyopathy. J Am Coll Cardiol, 55 (1) (2009), pp. 45-52.
  • HACA Study group. Mild therapeutic hypothermia to improve the neurlogic outcome after cardiac arrest. N Engl J Med 2002; 346:549-556.
  • Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out of hospital cardiac arrest with induced hyhothermia. N Engl J Med 2002; 346:557-563.
  • Holzer M. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346:549-556.
  • Nolan JP, Sandroni C, Andersen LW, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Lilja G, Morley PT, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone FS, Soar J. Nolan JP, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Resuscitation. 2022 Mar;172:229-236.
  • Rittenberger JC, Kelly E, Jang D, et al. Succesful outcome utilizing hypothermia after cardiac arrest. Crit Care Med 2008; 36:1354-1356.
  • Wible EF, Kass JS, Lopez GA. A report of fetal demise during therapeutic hypothermia after cardiac arrest. Neurocrit Care 2010; 13:239-242.
  • Chauhan A, Musunuru H, Donnino M, et al. The use of therapeutic hypothermia after cardiac arrest in a pregnant patient. Ann Emerg Med 2012; 60:786-789.
  • Nielsen N, et al. Targeted temperature management at 33 vs 36 C after cardiac arrest. N Engl J Med 2013;369:2197- 2206.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Acil Tıp, Yoğun Bakım
Bölüm Olgu Sunumları
Yazarlar

Süha Bozbay Bu kişi benim 0000-0002-7161-5163

Oktay Demirkiran 0000-0003-1319-9381

Yayımlanma Tarihi 17 Ağustos 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 1 Sayı: 2

Kaynak Göster

AMA Bozbay S, Demirkiran O. GEBEDE BEKLENMEYEN KARDİYAK ARREST VE HEDEFE YÖNELİK SICAKLIK YÖNETİMİ. TJR. Ağustos 2022;1(2):105-112.