Acil serviste kardiyopulmoner resüsitasyon yapılan hastalarda kan gazı, END-tidal CO2 ve anamnez yardımı ile resüsitasyon süresi ve mortalite oranı tahmin edilebilir mi?
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Tarih
2022
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada kardiyopulmoner arrest olan hastalarda ölçülen ETCO2, hastanın anamnezi ve bulguları, verilen tedavi, kan gazındaki parametreleri ile mortaliteyi arttıran ve azaltan nedenleri, resüsitasyonun ne kadar süre yapılmasının gerektiği ve mortalitenin tahmin edilip edilemeyeceği hususlarının araştırılması amaçlanmıştır. Bu parametreler ışığında amaç, hastane içi ve hastane dışı arrest olan hastalarda, KPR süresini hesaplayarak; SDGD sağlanan hastalar ile exitus kabul edilen hastaların kıyaslanmasıyla hastaya özgü yapılması gereken ideal KPR süresi ile ilgili bilgi sahibi olmaktır. Yöntem: Çalışmaya acil servisimize başvuran 18 yaş ve üzeri, dışlama kriterlerini bulundurmayan ve çalışmaya katılma onamı alınmış 150 hasta dahil edildi. Çalışmamızda acile ayaktan gelen ya da ambulansla gelen hastalarda ve acil kritik bakımda takip edilen hastalarda yapılan KPR ele alınmıştır. Çalışmada hastalara yönelik herhangi bir girişimde bulunulmadı ve gözlemci olarak katılarak yapılan prospektif bir çalışmadır. Çalışmaya dahil edilme kriterlerini taşıyan tüm hastaların: Yaş, cinsiyet, komorbiditeleri, Hİ ve HD KPR süresi, monitördeki ilk arrest ritmi, defibrilatörün kaç kez kullanıldığı, arrest anında hastaya yapılan ilaçlar, entübasyonun yapılıp yapılmadığı, yapıldıysa kaçıncı dakikada yapıldığı, travmaya bağlı olup olmadığı, hastaneye ulaşım şekli, geri döndürülebilir neden varlığı, tanıklı olup olmadığı, entübasyon uygulandıktan sonra ölçülen ETCO2, hastanın tanısı/ön tanısı, hastanın spontan dolaşımının geri dönüp dönmediği ve 24 saat sonra yaşayıp yaşamadığı kayıt altına alındı. Hastalardan arrest öncesi ya da arrest anında alınan kan gazı parametreleri (pH, PCO2, HCO3, Laktat, Baz Açığı, Hg, COHb, K, Ca) not edildi. Araştırma sonucunda elde edilen veriler bilgisayar ortamında SPSS (Statistical Package for Social Sciences) 18.0 paket programı ile analiz edildi. Bulgular: HİKA olan 102 hasta ile HDKA olan 48 hasta ile yapılan çalışmada; HİKA olan grupta erkek oranı %59,8 iken, HDKA'da %70,8 idi. HİKA ve HDKA olan hastaların sırasıyla %28,3'ünde (n=53), %50'sinde (n=24) SDGD tespit edildi. 24 saat sonundaki yaşam oranlarına bakıldığında ise sırasıyla %13,7'sinde (n=14), %27,1'inde (n=13) ise SDGD tespit edildi. SDGD sağlanan hastaların hastane içi KPR, hastane dışı KPR, ve total hastada arrest süreleri sırasıyla 10,03±8,76, 26,04±15,38, 17,28±14,51 saptandı (İstatistiksel olarak anlamlı yüksek bulundu). 24 saat sonunda SDGD saptanan hastaların hastane içi KPR, hastane dışı KPR ve total hastada arrest süreleri sırasıyla; 5,29±5,58, 19,85±10,54, 12,29±11,03 saptandı (istatistiksel olarak anlamlı yüksek bulundu). HİKA ve HDKA olan hastaların toplamında 24 saat içinde mortal seyreden hastalara bakıldığında; COHb düşük olması, baz açığının artması, bikarbonatın düşük olması, Ph'nin düşük olması, laktat değerinin 8,25 mmol/L 'nin üstünde olması, baz açığının artması, adrenalinin 8,5 mg'dan fazla yapılması, KPR'nin 26,5 dakikadan fazla yapılması mortalite oranını belirgin arttırdığı tespit edildi. KPR yapılan hastalarda ETCO2 değerinin SDGD öngörüsü için sınır değeri 17,5 mmHg olarak hesaplanmıştır (AUC:0,85; sens:95,7; spes:68,3). Total çalışmamızdaki hastalarda; H iyonu fazlalığı olması, septik şok tanısı olması, NEA ritmi olması, yatan hasta grubunda olması mortaliteyi arttırmaktadır. Kardiyak tromboz varlığı, ilk arrest ritminin şoklanabilir olması, defibrilasyon sayısının fazla olması ise SDGD oranını arttırmaktadır. HDKA olan hastalarda tanıklı KA olması, hastanın hayatta kalma şansını arttırmaktadır. Sonuç: HİKA ile HDKA olan hastaların KPR seyirleri birbirinden farklılık seyretmek ile beraber bu hastaların mortalitesini öngörmede ETCO2 değeri, arrest olma ritmi, olası tanısı, komorbid hastalıkları, geri döndürülebilir nedenleri, tanıklı/tanıksız olması, entübasyon yapılma zamanı, kan gazındaki Ph, bikarbonat, laktat, baz açığı, CO, potasyum değerleri önem arz etmektedir. Ayrıca bu belirteçler yapılması gereken KPR süresi hakkında da bize yol gösterirler. Anahtar Kelimeler: Kardiyopulmoner Resüstasyon (KPR), Arrest, Hastane İçi Kardiyak Arrest, Hastane Dışı Kardiyak Arrest, Mortalite, Spontan Dolaşımın Geri Dönmesi, Geri Döndürülebilir Nedenler, End Tidal CO2, Kapnografi, Defibrilasyon
In this study, in patients with cardiopulmonary arrest, it was aimed to investigate relationship between the patient's anamnesis and findings, the treatment given, the parameters in blood gas, measured ETCO2 and the reasons that increase or decrease mortality, how long resuscitation should be done and whether mortality can be predicted. The aim is, in the light of these parameters, to calculate the duration of CPR in patients with in-hospital and out-of-hospital arrest; and to have information about the ideal CPR duration that should be done specifically for the patient by comparing the patients with ROSC and the patients died. Method: The study included 150 patients aged 18 years and older, who applied to our emergency department, did not meet the exclusion criteria, and consented to participate in the study. In our study, CPR performed in patients coming to the emergency room on an outpatient basis or by ambulance and in patients followed in the emergency critical care unit were examined. It is a prospective study with participation as an observer and no intervention was made for the patients in the study. All patients who met the inclusion criteria in the study: Age, gender, comorbidities, duration of in hospital and out of hospital CPR, first arrest rhythm on the monitor, how many times the defibrillator was used, drugs administered to the patient during the arrest, whether intubation was performed, if intubation was done in which minute, whether it was trauma related, the type of transportation to the hospital, the presence of a reversible cause, whether it was witnessed, the ETCO2 value measured after intubation, the diagnosis/pre-diagnosis of the patient, whether the patient's spontaneous circulation returned and whether he was alive after 24 hours were recorded. Blood gas parameters (pH, PCO2, HCO3, Lactate, Base Deficiency, Hg, COHb, K, Ca) taken from the patients before or during the arrest were noted. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results: In the study conducted with 102 patients with IHCA and 48 patients with OHCA; While the proportion of men in the group with IHCA was 59.8%, it was 70.8% in OHCA. ROSC was detected in 28.3% (n=53) and 50% (n=24) patients with IHCA and OHCA, respectively. Considering the survival rates at the end of 24 hours, ROSC was detected in 13.7% (n=14) and 27.1% (n=13), respectively. In-hospital CPR, out-of-hospital CPR, and total patient arrest times were found to be 10.03±8.76, 26.04±15.38, 17.28±14.51, respectively, in patients with ROSC (Statistically significant high was found). Considering the patients who died within 24 hours in total of patients with IHCA and OHKA; Low COHb, increased base deficit, low bicarbonate, low pH, lactate value above 8.25 mmol/L, increased base deficit, adrenaline more than 8.5 mg, performing CPR for more than 26.5 minutes significantly increased the mortality rate. The cut-off value for the prediction of ETCO2 value for ROSC in patients undergoing CPR was calculated as 17.5 mmHg. (AUC:0.85; sensitivity:95.7; specificity:68.3). In the patients in our total study; Excess H ions, diagnosis of septic shock, presence of NEA rhythm, and being in the inpatient group increase mortality. Presence of cardiac thrombosis, shockable first arrest rhythm, and high number of defibrillations increase the rate of ROSC. Having witnessed CA in patients with OHCA, increases the patient's chance of survival. Conclusion: Although the CPR process of patients with İHCA and OHCA is different from each other, in predicting the mortality of these patients; ETCO2 value, arrest rhythm, possible diagnosis, comorbid diseases, reversible causes, witnessing/unwitnessed, intubation time, pH in blood gas, bicarbonate, lactate, base deficit, COHb, potassium values are important. In addition, these markers guide us about the required CPR time. Keywords: Cardiopulmonary Resuscitation (CPR), Arrest, In-Hospital Cardiac Arrest, Out-of-Hospital Cardiac Arrest, Mortality, Reversal of Spontaneous Circulation, Reversible Causes, End Tidal CO2, Capnography, Defibrillation
In this study, in patients with cardiopulmonary arrest, it was aimed to investigate relationship between the patient's anamnesis and findings, the treatment given, the parameters in blood gas, measured ETCO2 and the reasons that increase or decrease mortality, how long resuscitation should be done and whether mortality can be predicted. The aim is, in the light of these parameters, to calculate the duration of CPR in patients with in-hospital and out-of-hospital arrest; and to have information about the ideal CPR duration that should be done specifically for the patient by comparing the patients with ROSC and the patients died. Method: The study included 150 patients aged 18 years and older, who applied to our emergency department, did not meet the exclusion criteria, and consented to participate in the study. In our study, CPR performed in patients coming to the emergency room on an outpatient basis or by ambulance and in patients followed in the emergency critical care unit were examined. It is a prospective study with participation as an observer and no intervention was made for the patients in the study. All patients who met the inclusion criteria in the study: Age, gender, comorbidities, duration of in hospital and out of hospital CPR, first arrest rhythm on the monitor, how many times the defibrillator was used, drugs administered to the patient during the arrest, whether intubation was performed, if intubation was done in which minute, whether it was trauma related, the type of transportation to the hospital, the presence of a reversible cause, whether it was witnessed, the ETCO2 value measured after intubation, the diagnosis/pre-diagnosis of the patient, whether the patient's spontaneous circulation returned and whether he was alive after 24 hours were recorded. Blood gas parameters (pH, PCO2, HCO3, Lactate, Base Deficiency, Hg, COHb, K, Ca) taken from the patients before or during the arrest were noted. The data obtained as a result of the research were analyzed in computer environment with the SPSS (Statistical Package for Social Sciences) 18.0 package program. Results: In the study conducted with 102 patients with IHCA and 48 patients with OHCA; While the proportion of men in the group with IHCA was 59.8%, it was 70.8% in OHCA. ROSC was detected in 28.3% (n=53) and 50% (n=24) patients with IHCA and OHCA, respectively. Considering the survival rates at the end of 24 hours, ROSC was detected in 13.7% (n=14) and 27.1% (n=13), respectively. In-hospital CPR, out-of-hospital CPR, and total patient arrest times were found to be 10.03±8.76, 26.04±15.38, 17.28±14.51, respectively, in patients with ROSC (Statistically significant high was found). Considering the patients who died within 24 hours in total of patients with IHCA and OHKA; Low COHb, increased base deficit, low bicarbonate, low pH, lactate value above 8.25 mmol/L, increased base deficit, adrenaline more than 8.5 mg, performing CPR for more than 26.5 minutes significantly increased the mortality rate. The cut-off value for the prediction of ETCO2 value for ROSC in patients undergoing CPR was calculated as 17.5 mmHg. (AUC:0.85; sensitivity:95.7; specificity:68.3). In the patients in our total study; Excess H ions, diagnosis of septic shock, presence of NEA rhythm, and being in the inpatient group increase mortality. Presence of cardiac thrombosis, shockable first arrest rhythm, and high number of defibrillations increase the rate of ROSC. Having witnessed CA in patients with OHCA, increases the patient's chance of survival. Conclusion: Although the CPR process of patients with İHCA and OHCA is different from each other, in predicting the mortality of these patients; ETCO2 value, arrest rhythm, possible diagnosis, comorbid diseases, reversible causes, witnessing/unwitnessed, intubation time, pH in blood gas, bicarbonate, lactate, base deficit, COHb, potassium values are important. In addition, these markers guide us about the required CPR time. Keywords: Cardiopulmonary Resuscitation (CPR), Arrest, In-Hospital Cardiac Arrest, Out-of-Hospital Cardiac Arrest, Mortality, Reversal of Spontaneous Circulation, Reversible Causes, End Tidal CO2, Capnography, Defibrillation
Açıklama
Anahtar Kelimeler
Kardiyopulmoner Resüstasyon (KPR), Arrest, Hastane İçi Kardiyak Arrest, Hastane Dışı Kardiyak Arrest, Mortalite, Cardiopulmonary Resuscitation (CPR), Arrest, In-Hospital Cardiac Arrest, Out-of-Hospital Cardiac Arrest, Mortality
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WoS Q Değeri
Scopus Q Değeri
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Künye
Hacımustafaoğlu, Ö. (2022). Acil serviste kardiyopulmoner resüsitasyon yapılan hastalarda kan gazı, END-tidal CO2 ve anamnez yardımı ile resüsitasyon süresi ve mortalite oranı tahmin edilebilir mi?. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
