Çetin GEÇMEN, Muzaffer KAHYAOĞLU, Arzu KALAYCI, Abdulrahman NASER, Özge AKGÜN, Özkan CANDAN, Ahmet GÜNER, Mehmet ÇELİK, Can Yücel KARABAY, Akın İZGİ, Cevat KIRMA

Üçüncü Basamak Bir Merkezden Kardiyak Arrest Serisi

Giriş: Kardiyak arrest etkili kardiyopulmoner resüsitasyon (KPR) yapılmazsa ölümle sonuçlanan kardiyak fonksiyonların beklenmedik şekilde kaybolmasıdır. Ani kardiyak arrest olayın meydana geldiği yere bağlı olarak hastane içi ve dışı olarak sınıflandırılır. Hastalar ve Yöntem: Çalışmaya 2013-2016 yılları arasında kardiyak arrest tanısıyla hastane içi ve hastane dışı olmak üzere Koşuyolu Kalp Hastanesi Acil Servisine başvuran veya hasta yakını ya da ambulans yardımı ile tıbbi ekipmanla getirilen 18 yaş üstü 134 hasta dahil edilmiştir. Hastaların demografik özellikleri hastane veri tabanından sağlanmıştır. Bulgular: Çalışmaya 95 (%71) erkek, 39 (%29) kadın hasta olmak üzere toplam 134 hasta dahil edilmiştir. Yaş ortalaması 61.7 ± 14.6 olarak saptandı. Total 134 kardiyak arrestin 58’i hastane içi, 76’sı hastane dışı olarak saptanmıştır. KPR sonrası nabızlı elektriksel aktivite saptanan hastaların 35 (%64.8)’i hastane içi arrest, 19 (%35.2)’u hastane dışı arrest; nabızlı elektriksel aktivite sağlanamayan hastaların 23 (%28.7)’ü hastane içi arrest, 57 (%71.2)’si hastane dışı arrest olarak saptanmıştır (p< 0.001). Sonuç: Çalışmamızda kardiyak arrest nedeni olarak en sık nedenler; ST yükselmeli miyokart infarktüsü, konjestif kalp yetersizliği ve nedeni belirlenemeyen grup olarak belirlenmiştir. Geliş ritmi olarak en fazla asistol ritmi saptanmıştır. KPR sonrası nabızlı elektriksel aktivite sağlanan grupta saptanan ventriküler fibrasyon oranı nabızlı elektriksel aktivite sağlanamayan gruptakine göre daha yüksek oranda tespit edilmiş ve istatistiksel olarak anlamlı saptanmıştır. Çalışmamızda literatüre benzer olarak şoklanabilir ritim olanlarda nabızlı elektriksel aktivite sağlanma oranı daha fazla saptanmıştır.

Anahtar Kelimeler:

Kardiyak, arrest

Cardiac Arrest Registry at a Tertiary Center

Introduction: Cardiac arrest, which may result in death without an effective cardiopulmonary resuscitation (CPR), is the unexpected loss of cardiac functions. Sudden cardiac arrest is classified as in-hospital and out-of-hospital depending on the place where the event occurs. Patients and Methods: In this study, 134 patients (age, >18 years) who were admitted or were brought with the help of their relatives or in an ambulance and medical equipment to the Emergency Department of Kosuyolu Cardiac Hospital with the diagnosis of in-hospital or out-of-hospital cardiac arrest between 2013 and 2016 were enrolled. Demographic characteristics of the patients were obtained from the hospital database. Results: In total, 134 patients were included in this study. Of these, 95 (71%) were males and 39 (29%) were females. The mean patient age was 61.7 ± 14.6 years. In a total of 134 cardiac arrests, 58 were in-hospital and 76 were out-of-hospital. Among the patients who exhibited electrical activity with pulse after CPR, 35 (64.8%) experienced in-hospital cardiac arrest and 19 (35.2%) experienced out-of-hospital cardiac arrest, whereas among the patients who exhibited pulseless electrical activity after CPR, 23 (28.7%) experienced in-hospital cardiac arrest and 57 (71.2%) experienced out-of-hospital cardiac arrest (p< 0.001). Conclusion: The most common cause of cardiac arrest in our study cohort was myocardial infarction with ST segment elevation, followed by congestive heart failure and indefinite causes. Asystole was the most common rhythm at admission. The rate of ventricular fibrillation detected in the returning group was found to be higher than the non-returning group and the difference was statistically significant (p< 0.001). Similary to literature in our study, pulsatile electrical rhythm was found to be more prominent in pulsatile rhythms.

Keywords:

Cardiac, arrest,

PDF

___

1. Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015;95:1-80.
2. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, et al; Resuscitation Outcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423-31.
3. Sasson C, Rogers MA, Dahl J, Dahl J, Kellemann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63-81.
4. Martens P, Mullie A, Vanhaute O. Clinical status before and during cardiopulmonary resuscitation versus outcome in two consecutive databases. Eur J Emerg Med 1995;2:17-23.
5. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297e308.
6. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006;295:50e7.
7. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001;104:2158.
8. Rea TD, Pearce RM, Raghunathan TE, Lemaitre RN, Sotoodehnia N, Jouven X, et al. Incidence of out-of-hospital cardiac arrest. Am J Cardiol 2004;93:1455-60.
9. Kannel WB, Wilson PW, D’Agostino RB, Cobb J. Sudden coronary death in women. Am Heart J 1998;136:205.
10. Centers for Disease Control and Prevention (CDC). State-specific mortality from sudden cardiac death--United States, 1999. MMWR Morb Mortal Wkly Rep 2002;51:123.
11. Gillum RF. Sudden coronary death in the United States: 1980-1985. Circulation 1989;79:756.
12. Kannel WB, Doyle JT, McNamara PM, Quickenton P, Gordon T. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation 1975;51:606-13.
13. Rea TD, Eisenberg MS, Becker LJ, Murray JA, Hearne T. Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Circulation 2003;107:2780-5.
14. Akahane M, Ogawa T, Koike S, Tanabe S, Horiguchi H, Mizoguchi T, et al. The effects of sex on out-of-hospital cardiac arrest outcomes. Am J Med 2011;124:325-33.
15. Kim C, Fahrenbruch CE, Cobb LA, Eisenberg MS. Out-of-hospital cardiac arrest in men and women. Circulation 2001;104:2699.
16. Bougouin W, Mustafic H, Marijon E, Murad MH, Dumas F, Barbouttis A, et al. Gender and survival after sudden cardiac arrest: A systematic review and meta-analysis. Resuscitation 2015;94:55-60.
17. Kim C, Becker L, Eisenberg MS. Out-of-hospital cardiac arrest in octogenarians and nonagenarians. Arch Intern Med 2000;160:3439.
18. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.
19. Mozaffarian D, Anker SD, Anand I, Linker DT, Sullivan MD, Cleland JG, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation 2007;116:392-8.
20. Houmsse M, Franco V, Abraham WT. Epidemiology of sudden cardiac death in patients with heart failure. Heart Fail Clin 2011;7:147-55.
21. Bayés de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989;117:151.
22. Luu M, Stevenson WG, Stevenson LW, Baron K, Walden J. Diverse mechanisms of unexpected cardiac arrest in advanced heart failure. Circulation 1989;80:1675-80.
23. Kürkciyan I, Meron G, Sterz F, Janata K, Domanovits H, Holzer M, et al. Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 2000;160:1529-35.
24. Narang R, Cleland JG, Erhardt L, Ball SG, Coats AJ, Cowley AJ, et al. Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J 1996;17:1390-403.
25. Weaver WD, Cobb LA, Hallstrom AP, Fahrenbruch C, Copass MK, Ray R. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol 1986;7:752-7.
26. Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol 2000;86:610.
27. Gray WA, Capone RJ, Most AS. Unsuccessful emergency medical resuscitation--are continued efforts in the emergency department justified? N Engl J Med 1991;325:1393.
28. Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med 1997;337:301.
29. Bunch TJ, White RD, Gersh BJ, Shen WK, Hammill SC, Packer DL. Outcomes and in-hospital treatment of out-of-hospital cardiac arrest patients resuscitated from ventricular fibrillation by early defibrillation. Mayo Clin Proc 2004;79:613-9.
30. De Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI, Dalstra J, Daemen MJ, van Ree JW, et al. Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors. Heart 1998;79:356-61.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi