Öz
Giriş
Hastane içi pediyatrik kardiyak arrest (HİKA), yüksek morbidite ve mortalite ile ilişkilidir, ancak hayatta kalmayı etkileyen faktörler tam olarak ortaya konulmamıştır. Çalışmanın amacı, kardiyopulmoner resüsitasyon (CPR) süresi, ilk ritim ve arrest lokasyonuna odaklanarak HİKA’da acil ve kısa vadeli hayatta kalmayı etkileyen faktörleri değerlendirmektir.
Yöntemler
Bu geriye dönük kohort çalışması, 2013 ile 2022 yılları arasında Suudi Arabistan’ın Cidde kentindeki King Faisal İhtisas Hastanesi & Araştırma Merkezi’ne başvuran, 1 gün ile 14 yaş arası HİKA’lı 365 hastayı içerdi. CPR süresi, ilk ritim ve arrest lokasyonu gibi önemli resüsitasyon değişkenleri analiz edildi. Birincil sonuçlar, spontan dolaşımın geri dönüşü (ROSC) ve 28 günlük sağkalımdı. Komorbiditeler ve ROSC sonrası organ yetmezliği dahil olmak üzere demografik ve klinik veriler kaydedildi. Çok değişkenli lojistik regresyon ile bağımsız sağkalım belirleyicileri tanımlandı.
Bulgular
Yirmi sekiz günlük hayatta kalma oranı %25,2 idi. Uzun CPR süresi, düşük ROSC ve 28 günlük hayatta kalma oranı ile bağlantılıydı [olasılık oranı (OO)=1,11/dakika; p<0,001]. ROSC için medyan CPR süresi 7 dakika iken, ROSC elde edilemediğinde bu süre 27 dakikaydı (p<0,001). On beş dakikadan uzun süren CPR’nin ROSC ile sonuçlanma olasılığı yüksekti ve bu durumun tahmin doğruluğu %82 idi, yani olguların %82’sinde doğru bir şekilde tespit edildi (p<0,001). Acil serviste (AS) HİKA, ROSC başarısızlığı ile ilişkiliydi (OO=4,12; p=0,006). Başlangıçtaki bradikardi, asistoli veya nabızsız elektriksel aktiviteye göre daha iyi hayatta kalma ile ilişkiliydi (p=0,031). CPR süresi ile ROSC sonrası organ yetmezliği arasında anlamlı bir ilişki yoktu (p>0,05).
Sonuç
CPR süresi, başlangıç ritmi ve arrest lokasyonu, pediyatrik HİKA’da acil ve 28 günlük hayatta kalma oranını önemli ölçüde etkilemektedir. Bu bulgular, özellikle uzun süreli CPR gerektiren AS arrestleri için, ritimlere özgü optimize edilmiş resüsitasyon stratejilerinin gerekliliğini desteklemektedir. Gelecekteki araştırmalar, CPR süresini kısaltmak ve hayatta kalma oranını artırmak için stratejiler üzerinde durmalıdır.
Anahtar Kelimeler: Kardiyopulmoner resüsitasyon, hastane içi pediyatrik kardiyak arrest, hayatta kalma oranları
Kaynakça
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