Ali Fuat ERDEM, Havva KOCAYİGİT, Gürkan DEMİR, Kezban ÖZMEN SÜNER

Postkardiyak Arrest Sendromunda Hedeflenen Sıcaklık Yönetimi: tek merkez deneyimi

Çalışmamızdaki amacımız yoğun bakım ünitemizde uygulanmış olan Hedeflenen Sıcaklık Yönetimi (HSY) tedavisinin sonuçlarını retrospektif olarak analiz etmektir. Bu amaçla etik kurul onayının ardından, Ocak 2017-Aralık 2019 tarihleri arasında Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi Anestezi Yoğun Bakım Ünitesi'nde HSY uygulanan hastaların demografik verileri, kardiyopulmoner resusitasyon öyküsü, yoğun bakım takip süreci ve yoğun bakım sonlanımları incelendi. Daha sonra bu parametrelerin mortalite üzerindeki etkisi regresyon analizi kullanılarak değerlendirildi. Çalışma kriterlerini karşılayan 47 hastanın verileri analiz edildi. Hastaların yaş ortalaması 50 ± 16 olduğu ve 14 (% 29,8) hastanın kadın olduğu saptandı. CPR süresi ortalama 22.35 ± 16.08 dakika idi ve 35 (% 74.5) hastada arreste tanıklık eden birinin olduğu, 25 (% 53.2) hastanın hastane içinde arrest olduğu ve 13 (% 27.7) hastada ilk muayenede şok verilebilir ritim olduğu gözlendi. Sonuç olarak hastaların % 60'ının ex olduğu, % 20'sinin bakım hastası olarak, %20'sinin de ayaktan taburcu edildiği belirlendi. Yaş, akut böbrek yetmezliği gelişimi, gerekli vazopressör, yüksek APACHE skorları ve hastanede kalış süresi mortalite için bağımsız risk faktörleri olarak bulundu.

Anahtar Kelimeler:

kardiyak arrest, yoğun bakım, hedeflenen sıcaklık yönetimi

Targeted Temperature Management in Postcardiac Arrest Syndrome: A Single-Center Experience with 47 Patients

Our aim in this study is to retrospectively analyze the results of Targeted Temperature Management (TTM) treatment in our intensive care unit. Following the ethics committee's approval, the demographic data, cardiac arrest history, the follow-up process, and the final status of patients who were applied TTM in Sakarya University Training and Research Hospital Anesthesia Intensive Care Unit between January 2017 and December 2019 were recorded. Then, the effect of these parameters on mortality was evaluated using regression analysis. Data of 47 patients who met the study criteria were analyzed. The mean age of the patients was 50 ± 16 and 14 (29.8%) patients were female. The duration of cardiopulmonary resuscitation (CPR) was 22.35 ± 16.08 minutes, 35 (74.5%) patients had a witness to arrest, 25 (53.2%) patients were arrested in the hospital, and 13 (27.7%) patients had shockable rhythm. It was determined that 60% of the patients died, 20% of them were care patients with poor neurological outcomes and 20% of them were discharged outpatient with good neurological outcomes. Age, development of acute renal failure, requiring vasopressor, high APACHE scores, and length of hospital stay were found to be independent risk factors for mortality.

Keywords:

Cardiac arrest intensive care, targeted temperature management, mortality.,

PDF

___

Stub D, Bernard S, Duffy SJ, Kaye DM. Post cardiac arrest syndrome: a review of therapeutic strategies. Circulation. 2011;123(13):1428-1435.
Nolan JP, Neumar RW, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation. 2008;79(3):350-379.
Clifton W. Callaway, Chair; Michael W. Donnino; Ericka L. Fink; Romergryko G. Geocadin;Eyal Golan; Karl B. Kern; Marion Leary; William J. Meurer; Mary Ann Peberdy; Trevonne M. Thompson; Janice L. Zimmerman. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Part 8: Post–Cardiac Arrest Care. Circulation 2015;132[suppl 1]:465-82.
İnal MA, Ural SG, Çakmak HŞ, Arslan M, Polat R. Approach to Perioperative Hypothermia by Anaesthesiology and Reanimation Specialist in Turkey: A Survey Investigation. Turk J Anaesthesiol Reanim. 2017 Jun;45(3):139-145. doi: 10.5152/TJAR.2017.81567. Epub 2017 Feb 1. PMID: 28752003; PMCID: PMC5512391.
Stub D, Bernard S, Duffy SJ, Kaye DM. Post cardiac arrest syndrome: a review of therapeutic strategies. Circulation. 2011;123(13):1428-1435.
Vaahersalo, J., Hiltunen, P., Tiainen, M., Oksanen, T., Kaukonen, K.-M., Pettilä, V. Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Medicine, 2013:39(5), 826–837.
Schenone AL, Cohen A, Patarroyo G, Harper L, Wang X, Shishehbor MH et al. Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation. 2016;108:102-110.
Gündeniz A, Tabakoğlu E, Özdemir L, Tokuç B, Çevirme L, Hatipoğlu O, ve ark. Solunum Yoğun Bakım Hastalarında Mortalite Oranları ve İlişkili Faktörlerin Belirlenmesi. Toraks Dergisi 2007;8:79-84.
Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet 2008;371:1955-1969.
Granberg B, McGillis E, Solbiati M; Gruppo di Autoformazione Metodologica (GrAM), Therapeutic induced hypothermia does not improve the prognosis of out-of-hospital cardiac arrest patients. Intern Emerg Med. 2014;9(6):677-9.
Hakim, S. M., Ammar, M. A., and Reyad, M. S. (2018). Effect of therapeutic hypothermia on survival and neurological outcome in adults suffering cardiac arrest: a systematic review and meta-analysis. Minerva Anestesiol. 84, 720–730.
Wagner SR 4th, Lanier WL. Metabolism of glucose, glycogen, and high energy phosphates during complete cerebral ischemia. A comparison of normoglycemic, chronically hyperglycemic diabetic, and acutely hyperglycemic nondiabetic rats. Anesthesiology. 1994 Dec;81(6):1516-26. doi: 10.1097/00000542-199412000-00028. PMID: 7992921.
F Cicekci, AU Uca, I Kara, I Kara Study of Cerebral Performance Categories Based on Initial Rhythm and Resuscitation Time Following In-Hospital Cardiac Arrest in a State Hospital in Turkey- Hosp Pract Res. 2018 May;3(2):44-49.
Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of safety and adverse effects in the practice of therapeutic hypothermia. Am J Emerg Med. 2018 Oct;36(10):1886-1894. doi: 10.1016/j.ajem.2018.07.024. Epub 2018 Jul 11. PMID: 30017685.
Kızılaslan D, Erdoğan C, Çiftçi B, Ekinci M. Detailed Therapeutic Hypothermia Protocol After Cardiac Arrest. J Turk Soc Intens Care 2019;17:231-233.