HEDEFE YÖNELİK SICAKLIK YÖNETİMİYLE İYİLEŞTİRİLMİŞ SONUÇLAR (HSY): POST-KARDİYAK ARREST HASTALARDA KLİNİK ÖNEMİ

Yıl 2022, Cilt: 1 Sayı: 3, 119 - 138, 29.12.2022

Pelin Karaaslan , Cem Erdoğan , Deniz Kızılaslan Burcu Tunay , Yunus Oktay Atalay , Hüseyin Öz

Öz

Amaç
Kardiyopulmoner resüsitasyon (KPR) ve kardiyak arrest sonrası bakımdaki gelişmelere rağmen, hastane içi ve hastane dışı kardiyak arrest hastalarının sağ kalımı sırasıyla %15 ve %22 oranlarıyla hala düşüktür. Hedefe yönelik sıcaklık yönetiminin (TTM), hastane içinde veya dışında kardiyak arrest yaşayan hastaların nörolojik sonuçlarını iyileştirdiği gösterilmiştir. Bu retrospektif çalışmada, European Society of Intensive Care Medicine (ESICM) tarafından 2019 yılında en iyi TTM protokolü seçilen TTM protokolümüzün etkinliğini analiz etmeyi ve konvansiyonel ile mekanik TTM tekniklerini karşılaştırmayı amaçladık.

Yöntem
Bu retrospektif çalışmaya, başarılı bir resüsitasyondan sonraki ilk 6 saat içinde yoğun bakım ünitesine (YBÜ) kabul edilen erişkin hastalar dahil edilmiştir. Ocak 2013’ten Aralık 2017’ye kadar olan veriler hasta kayıtlarından toplandı. 18 yaşından küçük ve hipotermi süresi sonuna kadar hayatta kalamayan hastalar çalışma dışı bırakılmışlardır. Sıcaklık yönetiminin etkinliği için geleneksel TTM grubu (KH) ve TMS makine grubu karşılaştırıldı.

Bulgular
Dört yıllık bir süre boyunca, 1343 KPR sonrası hasta yoğun bakımda takip edildi. Bu 1343 hastanın %20,5’ine TTM tedavisi uygulandı. TTM hastalarının %62,04’ü (170) taburcu olup; %37,9’u (104) hayatını kaybederken; TTM tedavisi almayan hastaların sadece %27,44’ü (293) taburcu olabilmiştir. TTM hastalarının toplam sağ kalım oranları (KH ve TMS makine grubu) TTM uygulanmayan hastalara göre sırasıyla %62,04 ve %27,44 daha yüksekti (p<0,05). TMS makine grubu, KH grubundan (%66,4) daha iyi sağ kalım oranlarına sahipti. Ayrıca vücut sıcaklık değerlerinde dalgalanmalar TMS grubunda KH grubuna göre daha az gözlendi.

Sonuç
Kullanılan yöntemden bağımsız olarak başarılı bir KPR sonrası uygulanan TTM, sonuç üzerinde olumlu bir etkiye sahiptir. Önemli olan minimum dalgalanmalarla hedef sıcaklığı korumaktır. Standart bir protokol olmamasına rağmen, protokole dayalı bir TTM, kardiyak arrest sonrası hastalar için yararlı olabilir. Gelecekteki çalışmalar, TTM için en uygun protokolün geliştirilmesine yardımcı olabilir.

Anahtar Kelimeler

Kardiyak arrest, sıcaklık, yoğun bakım

IMPROVED OUTCOMES WITH TARGETED TEMPERATURE MANAGEMENT (TTM): CLINICAL SIGNIFICANCE FOR POST-CARDIAC ARREST PATIENTS

Öz

Objective
Despite advances in cardiopulmonary resuscitation (CPR) and post-cardiac arrest care, the survival of patients with in-hospital and out-of-hospital cardiac arrests are still low with the rates of 15% and 22%, respectively. Targeted temperature management (TTM) has been shown to improve neurologic outcome of patients who had either in or out-of-hospital cardiac arrests. In this retrospective study we aimed to analyze the effectiveness of our TTM protocol – chosen as the best TTM protocol by European Society of Intensive Medicine (ESICM) in 2019 and to compare conventional and mechanical TTM techniques.

Method
This retrospective study included adult post-CPR patients who were admitted to the intensive care unit (ICU) in the first 6 hours after a successful resuscitation. Data from January 2013 to December 2017 were collected from patients’ records. Patients younger than 18 years old and who could not survive till the end of hypothermia period were excluded. Conventional TTM group and TMS machine group were compared for the effectivity of temperature management.

Results
Over a 4-year period, 1343 post-CPR patients were followed up in ICU. Among these 1343 patients 20.5% were applied TTM treatment. While 62.04% (170) of TTM patients were discharged and 37.9% (104) have died; only 27.44% (293) of the patients who did not receive TTM treatment were discharged. Total survival rates of TTM patients (CH and TMS machine groups) were higher than the patients who were not applied TTM with the rate of 62.04% and 27.44% respectively (p<0.05). TMS machine group had better survival rates than CH group (66.4%). Also fluctuations of body temperature values were observed less in TMS group than CH Group.

Conclusion
TTM with no importance about the method being used, has a positive impact on outcome after a successful CPR. The important thing is maintaining the target temperature with minimal fluctuations. Although there is not a standard protocol, a protocol driven TTM may be useful for post cardiac arrest patients. Future studies may help improving an optimal protocol for TTM.

Anahtar Kelimeler

Cardiac Arrest, temperature, intensive care unit

Kaynakça

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