Kardiyopulmoner resüsitasyon uygulanan olguların son beş yıllık değerlendirilmesi
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Date
2013
Authors
Çimen, İlker
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda, kardiyopulmoner resüsitasyon (KPR) uygulanan olguları, inceleyerek demografik özelliklerilerinin, KPR sonuçlarının ve prognoz ile ilişkili faktörlerin değerlendirilmesini amaçladık. Uludağ Üniversitesi Sağlık Uygulamaları Araştırma Merkezi Hastanesinde, ocak 2007-2011 tarihleri arasında KPR uygulanan 3335 olgu, etik kurul onayı alındıktan sonra retrospektif olarak incelendi. Veriler, KPR formlarından, hasta dosyalarından ve Avicenna işletim sisteminden elde edildi. Olgulardan 98'i, verilerin eksikliği nedeniyle çalışma dışı bırakıldı, 2240'ına bir kez, 424'üne birden fazla KPR uygulanan 2664 hasta (1074 kadın, 1590 erkek) toplam 3237 olgu incelendi. Hastaların yaş dağılımı 1 gün-97 yaş arasında değişmekteydi. 1546 (%47.8) olguya yoğun bakım alanlarında, 1449 (%44.8) olguya klinik alanlarında KPR uygulandı. 1201 (%37.3) olguya gündüz (08.00-16.00 saatleri), 2036 (%62.7) olguya gece (16.00-08.00 saatleri) saatlerinde KPR uygulandı. Primer hastalık dağılımında kanserlerin [1004 (%37.7) olgu], yandaş hastalık dağılımında solunumsal problemlerin [454 (%17) olgu], arrest nedeni olarak ise hipotansiyonun [1681 (%52.3) olgu] birinci sırada olduğu gözlendi. KPR ekibi gelmeden önce 140 (%4.3) olguya yeterli temel yaşam desteği (TYD) uygulanmadığı görüldü. KPR ekibinin (mavi kod) arrest alanına ulaşma ve devir alma süresi 1.81±1.04 dakika, devir alımı takiben defibrilasyon süresi 0.68±1.09 dakika bulundu. Asistoli 2648 (%82.3) olguda arrest sırasında en sık gözlenen ritimdi. Havayolu yönetiminde çoğunlukla endotrakeal entübasyon uygulandığı gözlendi. Monitörize alanlarda arrest öncesi inotrop kullanımı, monitörize olmayan alanlardan yüksek bulundu (p<0.001). KPR uygulanması öncesinde 331 (%10.4) olguda antiaritmik ajan kullanımı mevcuttu. Monitörize alanlarda KPR başlama süresi, ileri yaşam desteği (İYD) başlanma süresi monitörize olmayan alanlara göre daha kısa bulundu (p<0.001). KPR sonrası 626 (%19.5) olguda spontan dolaşımın geri döndüğü (SDGD) bulundu. KPR sonrası SDGD?de kadın, erkek cinsiyet arasında fark bulunmadı (p=0.565). Monitörize alanlarda KPR uygulanan 1740 olgu ile monitörize olmayan alanlarda KPR uygulanan 1497 olguda SDGD arasında fark bulunmadı (p=0.837). SDGD, hastalarda şok uygulanabilir ritimler fazla idi (p<0.001). Antiaritmik kullanan olgularda SDGD kullanmayan olgulardan yüksek bulundu (p<0.001). Gece ve gündüz uygulanan KPR'lerde SDGD arasında fark gözlenmedi (p=0.822). SDGD'den sonra yaşam süresi 576 dakika (min. 48 dk. - maks. 90.22 gün) olarak bulundu. Mavi kod aranmasından sonra 21 (%0.6) olguda TYD yeterli iken, 3216 (%99.4) olguda TYD, İYD ve uzun dönem yaşam desteği gerekli olmuştur. SDGD sonrası 41 (%6.5) olgu taburcu edildi. Sonuç olarak, çalışmamızda hem spontan dolaşımın geri dönmesinde, hem de taburculukta mavi kod gelmeden önce yapılanların, kardiyak arrest ritminin ve arrest olmadan önce antiaritmik ajan kullanımın etken olduğu saptanmıştır.
Our aim was to evaluate demographic characteristics, factors effecting to prognose and outcome after in-hospital cardiopulmonary resuscitation (CPR). In this study 3335 cardiac arrest patients were analyzed retrospectively at Uludag University Medical Faculty Training and Research Hospital between January 2007-2011 after approval of the ethics committee. The data were obtained from forms, hospital records and Patient Information Management System (Avicenna). Ninety-eight patients were excluded from the study due to lack of data. Totaly 3237 cardiac arrest forms were analyzed. CPR applied in 424 of 2664 patients more than once, in 2240 of patients just once, (1074 female, 1590 male). The age distribution of the patients ranged from 1 day-97 years. Arrival time of CPR team (blue code) to the arrest area and taking over the resuscitation was 1.81±1.04 minute and following defibrillation time was 0.68±1.09 minute. Most resuscitation attempts were performed in intensive care unit (1546, 47.8%) and rest of (1449, 44.8%) the patient were resuscitated at the clinical areas. Time of arrest was split into two categories; (1201,37.3%) occured between 08.00-16.00h, (2036, 62.7%) between 16.00-08.00h. The distribution of the most common cause of cardiac arrest was cancers (1004, 37.7%) for primary disease and respiratory problems (454, 17%) for co-morbid disease and hypotension was the most common reason (1681, 52.3%) for cardiac arrest. Inadequate basic life support (BLS) was applied to 140 (4.3%) patients before CPR team arrived. Asystole was the most common primary arrhythmia (2648, 82.3%). For the airway safety endotracheal intubation was most performed technique. The incidence of inotropic agents at monitorized areas was found higher than non-monitorized areas (p<0.001). Three hundred thirthy one (10.4%) patient had continuous intravenous infusion of antiarrhythmic agents before cardiac arrest. After cardiac arrest basic life support (BLS) and advanced life support (ALS) was performed earlier in monitorized areas than non-monitorized areas (p<0.001). Two thousand five hundred ninety (80.5%) resuscitated patients died immediately. Of the 626/3216 (19.5%) patient survived initially [return of spontaneous circulation (ROSC)]. There was no difference between male and female gender (p=0.565), monitorized areas (1740, 53.8%) and non-monitorized areas (1497, 46.2%) regarding ROSC (p=0.837). ROSC was higher in shockable rhythms (p<0.001) and in patients who had continuous intravenous infusion of antiarrhythmic agents before cardiac arrest than others (p<0.001). There was no difference in ROSC, between day and night time CPR (p=0.822). The average survival was 576 minutes (48 minutes-90.22 days). BLS was succesful in 21 (0.6%) patients, 3216 (99.4%) patients required advanced life support and/or long-term life support. A total of 41 (6.5%) patients were discharged from hospital alive. In conclusion, in this study three factors were found to be significant predictors of ROSC and survival to discharge; efficient basic life support before blue code arrived, cardiac arrest rhythm and continuous intravenous infusion of antiarrhythmic agents before cardiac arrest.
Our aim was to evaluate demographic characteristics, factors effecting to prognose and outcome after in-hospital cardiopulmonary resuscitation (CPR). In this study 3335 cardiac arrest patients were analyzed retrospectively at Uludag University Medical Faculty Training and Research Hospital between January 2007-2011 after approval of the ethics committee. The data were obtained from forms, hospital records and Patient Information Management System (Avicenna). Ninety-eight patients were excluded from the study due to lack of data. Totaly 3237 cardiac arrest forms were analyzed. CPR applied in 424 of 2664 patients more than once, in 2240 of patients just once, (1074 female, 1590 male). The age distribution of the patients ranged from 1 day-97 years. Arrival time of CPR team (blue code) to the arrest area and taking over the resuscitation was 1.81±1.04 minute and following defibrillation time was 0.68±1.09 minute. Most resuscitation attempts were performed in intensive care unit (1546, 47.8%) and rest of (1449, 44.8%) the patient were resuscitated at the clinical areas. Time of arrest was split into two categories; (1201,37.3%) occured between 08.00-16.00h, (2036, 62.7%) between 16.00-08.00h. The distribution of the most common cause of cardiac arrest was cancers (1004, 37.7%) for primary disease and respiratory problems (454, 17%) for co-morbid disease and hypotension was the most common reason (1681, 52.3%) for cardiac arrest. Inadequate basic life support (BLS) was applied to 140 (4.3%) patients before CPR team arrived. Asystole was the most common primary arrhythmia (2648, 82.3%). For the airway safety endotracheal intubation was most performed technique. The incidence of inotropic agents at monitorized areas was found higher than non-monitorized areas (p<0.001). Three hundred thirthy one (10.4%) patient had continuous intravenous infusion of antiarrhythmic agents before cardiac arrest. After cardiac arrest basic life support (BLS) and advanced life support (ALS) was performed earlier in monitorized areas than non-monitorized areas (p<0.001). Two thousand five hundred ninety (80.5%) resuscitated patients died immediately. Of the 626/3216 (19.5%) patient survived initially [return of spontaneous circulation (ROSC)]. There was no difference between male and female gender (p=0.565), monitorized areas (1740, 53.8%) and non-monitorized areas (1497, 46.2%) regarding ROSC (p=0.837). ROSC was higher in shockable rhythms (p<0.001) and in patients who had continuous intravenous infusion of antiarrhythmic agents before cardiac arrest than others (p<0.001). There was no difference in ROSC, between day and night time CPR (p=0.822). The average survival was 576 minutes (48 minutes-90.22 days). BLS was succesful in 21 (0.6%) patients, 3216 (99.4%) patients required advanced life support and/or long-term life support. A total of 41 (6.5%) patients were discharged from hospital alive. In conclusion, in this study three factors were found to be significant predictors of ROSC and survival to discharge; efficient basic life support before blue code arrived, cardiac arrest rhythm and continuous intravenous infusion of antiarrhythmic agents before cardiac arrest.
Description
Keywords
Kardiyopulmoner resüsitasyon, Spontan dolaşımın geri dönmesi, Defibrilasyon, Temel yaşam desteği, İleri yaşam desteği, Cardiopulmonary resuscitation, Return of spontaneous circulation, Defibrillation, Basic life support, Advanced life support
Citation
Çimen, İ. (2013). Kardiyopulmoner resüsitasyon uygulanan olguların son beş yıllık değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.