Kaan Kırali, Atakan Erkılınç, Rezzan Deniz Acar, Gökhan Alıcı, Mustafa Emre Gürcü, Pınar Karaca Baysal, Şeyhmus Külahçıoğlu, Nihal Özdemir, Cem Doğan, Serdar Fidan

Akut koroner sendroma bağlı gelişen hastane içi kardiyak arrestte ekstrakorporeal kardiyopulmoner resüsitasyon

Amaç: Bu çalışmada hastane içi kardiyak arrest görülen hastalarda ekstrakorporeal kardiyopulmoner resüsitasyonun sağkalım ve nörolojik sonuçlar üzerindeki etkisi araştırıldı. Çalışma planı: Ocak 2018 - Aralık 2020 tarihleri arasında akut koroner sendrom sonrası hastane içi kardiyak arrest nedeniyle veno-arteriyel ekstrakorporeal membran oksijenasyon desteği kullanılarak ekstrakorporeal kardiyopulmoner resüsitasyon ile tedavi edilen toplam 22 hasta (17 erkek, 5 kadın; ort. yaş: 52.8±9.0 yıl; dağılım, 32-70 yıl) retrospektif olarak incelendi. Hastalar veno-arteriyel ekstrakorporeal membran oksijenasyonundan ayrılan (n=13) ve ayrılmayanlar (n=9) olmak üzere iki grupta ele alındı. Hastaların demografik verileri, konvansiyonel kardiyopulmoner resüsitasyon başlangıcındaki kalp ritimleri, anjiyografik ve girişimsel sonuçları, sağkalım ve ekstrakorporeal kardiyopulmoner resüsitasyon öncesi ve sonrasında nörolojik sonuçları kaydedildi. Bulgular: Eşlik eden hastalıklar ve başlangıç laboratuvar test değerleri açısından her iki grup arasında anlamlı bir fark yoktu. Ayrılan gruptaki hastaların %92'sinde altta yatan ritim ventriküler fibrilasyon iken, ayrılamayan gruptaki hastaların %67'sinde kardiyak ritim yoktu (p=0.125). Ortalama sol ventrikül ejeksiyon fraksiyonundaki düzelme ayrılan grupta anlamlı düzeyde daha belirgindi (sırasıyla, %36.5±12.7'e kıyasla %21.1±7.4; p=0.004). Tüm hastalarda veno-arteriyel ekstrakorporeal membran oksijenasyonundan ayrılma oranı %59.1 olmakla birlikte, nörolojik sekel olmayan sağ kalanların hastaneden taburcu edilme oranı %36.4 idi. Sonuç: Hastane içi kardiyak arrest, konvansiyonel kardiyopulmoner resüsitasyon yoluyla anında hayat kurtarıcı müdahale gerektiren önemli ve acil bir durumdur. Başarısız olunursa, altta yatan etiyoloji veya ritim bozukluklarından bağımsız olarak, ekstrakorporeal kardiyopulmoner resüsitasyon başlatılmalıdır. Etkili konvansiyonel kardiyopulmoner resüsitasyon, beyin ve vücut hipoperfüzyonunu önlemek için zorunludur

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

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