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HASTANE İÇİ KARDİYAK ARREST SONRASI ERİŞKİNLERDE KARDİYOPULMONER RESÜSİTASYON SONUCUNU ETKİLEYEN FAKTÖRLERİN ANALİZİ

Yıl 2023, Cilt: 2 Sayı: 3, 84 - 93, 26.12.2023

Öz

Amaç
Hastane içinde gelişen kardiyak arrestlerde mortaliteyi etkileyen birçok faktör mevcuttur. Bu çalışmada amacımız hastanemizde erişkinlerde yapılan kardiyopulmoner resüsitasyon (KPR) sırasında hastanın hayatta kalmasını etkileyen faktörleri incelemek, hastanemizde yapılan resüsitasyon yönetimi ve kayıt sistemleri hakkında fikir sahibi olmaktır.

Yöntem
01.01.2021 ve 31.07.2023 tarihleri arasında kardiyopulmoner resüsitasyon uygulanmış 18 yaş üstü 1421 hasta hastane kayıt sistemlerinden retrospektif olarak taranarak çalışmaya dahil
edildi. Hastalar yaşayan ve yaşamayan olarak iki gruba ayrıldı. Tüm hastaların yaş, cinsiyet, KPR süresi, kullanılan adrenalin miktarı, hastanede kalış süresi, KPR yapılma yeri ve zamanı (gece-gündüz) gibi demografik ve klinik parametreler ve Charlson Komorbidite İndeksleri hesaplanarak, gruplar
arasındaki istatistiksel farklar değerlendirildi.

Bulgular
1421 kardiyak arrest gelişmiş olan hastadan, 70'inde (%4,9) spontan solunumun veya dolaşımın geri döndüğü belirlenerek, yoğun bakım ünitesine sevk edilirken, 1351 hasta (%95,1) eksitus letalis olarak kabul edilmiştir. Demografik veriler ve komorbidite açısından gruplar benzer bulundu. Gece resüsitasyon uygulanan, yoğun bakım ünitesinde müdahale edilen, resüsitasyon uygulama süresi fazla olan, daha yüksek miktarda adrenalin kullanılmış hastalarda ölüm oranı daha yüksek bulundu.

Sonuç
Sonuç olarak; KPR performansını arttırmak için hastane erken uyarı sistemlerinin kurulması, tüm personelin temel ve ileri yaşam desteği konusunda eğitilmesinin sağlanması, hastane kayıt sistemlerinin geliştirilmesi ve bu konuda hizmet içi eğitimin arttırılması gerektiği düşüncesindeyiz.

Kaynakça

  • Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support. Resuscitation. Published online November 2020:A35-A79.
  • Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ et al. The American College of Emergency Physicians. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7 th edition.2011; Chapter 12. Sudden Cardiac Death; 63-67.
  • Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990; 263:1106-1113.
  • Martinez JP. Prognosis in cardiac arrest. Emerg Med Clin North Am. 2012; 30(1):91-103.
  • Charlson ME, Pompei P, Ales KL, MacKenzie R. A new metod of classifying prognostic comorbidity in longitudinal studies: development y validation. J Chron Dis 1987; 40:373–83.
  • Sandroni C, Nolan J, Cavallaro F, Antonelli M. Inhospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(1):237–45.
  • Pembeci K, Yildirim A, Turan E, Buget M, Camci E, Senturk M, Tugrul M, Akpir K. Assessment of the success of cardiopulmonary resuscitation attempts performed in a Turkish university hospital. Resuscitation. 2006;68(2):221-9.
  • Araç, S. , Zengin, Y. , İçer, M. , Gündüz, E. , Dursun, R. , Durgun, H. , Üstündağ, M. ,Orak, M. , Kuyumcu, M. & Güloğlu, C. (2021). Acil Serviste Kardiyopulmoner Resüsitasyon Yapılan Hastaların Değerlendirilmesi; Retrospektif Çalışma . Abant Tıp Dergisi , 10 (1) , 140-151.
  • Petrie DA, De Maio V, Stiell IG, Dreyer J, et al. Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support - defibrillation system, OPALS study. CJEM. 2001;3(3):186-92.
  • Herlitz J, Engdahl J, Svensson L. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J. 2005;149(1):61–6.
  • 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.
  • Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, Berg RA; National Registry of Cardiopulmonary Resuscitation Investigators. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008;299(7):785-92.
  • Wang C, Gao Y, Liu Y, Ying Y, Li C, Li Q, Chai Y. Analysis of factors influencing cardiopulmonary resuscitation and survival outcome in adults after in-hospital cardiac arrest: a retrospective observational study. Chin Med J 2022;135:2875–2877.
  • Nallamothu, B. K., Guetterman, T. C., Harrod, M., Kellenberg, J. E., Lehrich, J. L., Kronick, S. L., Krein, S. L., Iwashyna, T. J., Saint, S., & Chan, P. S. (2018). How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation, 138(2), 154–163.

ANALYSIS OF FACTORS AFFECTING CARDIOPULMONARY RESUSCITATION OUTCOME IN ADULTS IN-HOSPITAL CARDIAC ARREST

Yıl 2023, Cilt: 2 Sayı: 3, 84 - 93, 26.12.2023

Öz

Objective
There are many factors affecting mortality in hospital arrests.
Our aim in this study is to examine the factors affecting the patient’s survival during cardiopulmonary resuscitation (CPR) performed in adults in our hospital and to have an idea about the resuscitation management and recording systems in our hospital.

Method
A total of 1,421 patients over 18 who underwent cardiopulmonary resuscitation between 01.01.2021 and 31.07.2023 were retrospectively scanned from hospital registry systems and included in the study. Patients were divided into two groups: surviving and non-surviving. Demographic and clinical
parameters of all patients, such as age, gender, comorbidity, duration of CPR, amount of adrenaline used, length of hospital stay, place and time of CPR (day and night), and Charlson Comorbidity Statistical differences between groups were
evaluated by calculating their indices.

Results
Among 1421 patients who developed cardiac arrest, 70 (4.9%) were referred to the intensive care unit after it was determined that spontaneous breathing or circulation had returned, while 1351 patients (95.1%) were accepted as exitus letalis. The groups were similar in terms of demographic data and comorbidities. The mortality rate was found to be higher in patients who were resuscitated at night, who were treated in the intensive care unit, who had longer resuscitation times, and who used more elevated amounts of adrenaline.

Conclusion
In conclusion, in order to increase CPR performance, hospital early warning systems should be established, all personnel should be trained in basic and advanced life support, hospital registry systems should be developed and in-service training on this subject should be increased.

Kaynakça

  • Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support. Resuscitation. Published online November 2020:A35-A79.
  • Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ et al. The American College of Emergency Physicians. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7 th edition.2011; Chapter 12. Sudden Cardiac Death; 63-67.
  • Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990; 263:1106-1113.
  • Martinez JP. Prognosis in cardiac arrest. Emerg Med Clin North Am. 2012; 30(1):91-103.
  • Charlson ME, Pompei P, Ales KL, MacKenzie R. A new metod of classifying prognostic comorbidity in longitudinal studies: development y validation. J Chron Dis 1987; 40:373–83.
  • Sandroni C, Nolan J, Cavallaro F, Antonelli M. Inhospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(1):237–45.
  • Pembeci K, Yildirim A, Turan E, Buget M, Camci E, Senturk M, Tugrul M, Akpir K. Assessment of the success of cardiopulmonary resuscitation attempts performed in a Turkish university hospital. Resuscitation. 2006;68(2):221-9.
  • Araç, S. , Zengin, Y. , İçer, M. , Gündüz, E. , Dursun, R. , Durgun, H. , Üstündağ, M. ,Orak, M. , Kuyumcu, M. & Güloğlu, C. (2021). Acil Serviste Kardiyopulmoner Resüsitasyon Yapılan Hastaların Değerlendirilmesi; Retrospektif Çalışma . Abant Tıp Dergisi , 10 (1) , 140-151.
  • Petrie DA, De Maio V, Stiell IG, Dreyer J, et al. Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support - defibrillation system, OPALS study. CJEM. 2001;3(3):186-92.
  • Herlitz J, Engdahl J, Svensson L. Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J. 2005;149(1):61–6.
  • 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.
  • Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, Berg RA; National Registry of Cardiopulmonary Resuscitation Investigators. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008;299(7):785-92.
  • Wang C, Gao Y, Liu Y, Ying Y, Li C, Li Q, Chai Y. Analysis of factors influencing cardiopulmonary resuscitation and survival outcome in adults after in-hospital cardiac arrest: a retrospective observational study. Chin Med J 2022;135:2875–2877.
  • Nallamothu, B. K., Guetterman, T. C., Harrod, M., Kellenberg, J. E., Lehrich, J. L., Kronick, S. L., Krein, S. L., Iwashyna, T. J., Saint, S., & Chan, P. S. (2018). How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation, 138(2), 154–163.

Ayrıntılar

Birincil Dil Türkçe
Konular Anesteziyoloji
Bölüm Orijinal Makaleler
Yazarlar

Zuhal ÇAVUŞ 0000-0002-7588-5240

Döndü GENÇ MORALAR 0000-0002-4229-4903

Veysel DİNÇ 0000-0003-2718-5212

Oğuz ÖZAKIN 0000-0001-5138-1606

Fatma KORKAN Bu kişi benim 0000-0002-9446-9955

İsa BADUR 0000-0002-0306-4259

Yayımlanma Tarihi 26 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 2 Sayı: 3

Kaynak Göster

AMA ÇAVUŞ Z, GENÇ MORALAR D, DİNÇ V, ÖZAKIN O, KORKAN F, BADUR İ. HASTANE İÇİ KARDİYAK ARREST SONRASI ERİŞKİNLERDE KARDİYOPULMONER RESÜSİTASYON SONUCUNU ETKİLEYEN FAKTÖRLERİN ANALİZİ. TJR. Aralık 2023;2(3):84-93.