ABSTRACT
Objective:
In this study, it was aimed to evaluate the practices of physicians working in intensive care units about post-resuscitation care in patients whose spontaneous circulation returned with cardiopulmonary resuscitation.
Materials and Methods:
In this cross-sectional study, a web-based questionnaire containing 28 questions was applied to physicians working in an intensive care units.
Results:
A total of 118 specialist physicians participated in the study. The mean arterial pressure target after resuscitation was mostly (91.5%) 65-75 mmHg, and the most preferred inotropic agent was noradrenaline (81.2%). It was determined that 52.1% of the participants applied targeted temperature management and continued for 24 h. Neuroprognostic evaluation was performed after 24 h, and most commonly Glasgow coma scale (96.6%), pupillary and corneal reflexes (92.2%), and computerized brain tomography (60.3%) were used. However, it was observed that biomarkers and neurophysiological methods were used less frequently.
Conclusion:
In this study, it was observed that there were differences in practices according to hospital conditions in post-resuscitation care, but physicians generally followed international guidelines. Simultaneously, it is considered that in addition to the international guidelines, national guidelines are necessary in accordance with the conditions of our country, and training was needed for standard applications.
Keywords:
Intensive care, post-resuscitation care, questionnaire
References
1
Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Böttiger BW, 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;79:350-79.
2
Mongardon N, Dumas F, Ricome S, Grimaldi D, Hissem T, Pene F, et al. Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 2011;1:45.
3
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021;161:220-69.
4
Chamberlain D; Founding Members of the International Liaison Committee on Resuscitation. The International Liaison Committee on Resuscitation (ILCOR)-past and present: compiled by the Founding Members of the International Liaison Committee on Resuscitation. Resuscitation 2005;67:157-61.
5
Arıboğan A. Nefesle başlar yolculuk!: Kardiyopulmoner resüsitasyonda tarihsel bir gezinti. Turkish Journal of Resuscitation 2022;1:14-6.
6
Report of the Intensive Care National Audit and Research Centre (ICNARC), London, December 1995 to October 2005. Available from: URL: https://www.icnarc.org/our-audit/audits/cmp/reports
7
Grasner J-T, Herlitz J, Tjelmeland IBM, Wnent J, Masterson S, Lilja G, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation 2021;161:61-79.
8
Tütüncü-Kılıç N, Kuvaki B, Özbilgin Ş, İncesu M. Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesinde Mavi Kod Uygulamalarının Değerlendirilmesi. TJR 2022;1:19-34.
9
Gür A, Tekin E, Özlü İ, Bilgili MA, Kaptan HM. Acil Serviste Resüsitasyon Yapılan Hastaların Retrospektif Değerlendirilmesi: İki Yıllık Analiz. Van Tıp Derg 2021;28:421-7.
10
Sağlam Ö. Acil Serviste Bir Yıllık Sürede Kardiyopulmoner Resüsitasyon Yapılan Kardiyak Arrest Hastalarında Mortaliteyi Etkileyen Faktörler. Ankara Yıldırım Beyazıt Üniversitesi;2018.
11
Çiçekci F, Atıcı SS. Mavi Kod çağrısına bağlı kardiyo-pulmoner resüsitasyon uygulamaları sonuçlarının değerlendirilmesi. Genel Tıp Derg 2013;23:70-6.
12
Geri G, Passouant O, Dumas F, Bougouin W, Champigneulle B, Arnaout M, et al. Etiological diagnoses of out-of hospital cardiac arrest survivors admitted to the intensive care unit: Insights from a French registry. Resuscitation 2017;117:66-72.
13
Vahatalo JH, Huikuri HV, Holmstrom LTA, Kentta TV, Haukilahti MAE, Pakanen L, et al. Association of silent myocardial infarction and sudden cardiac death. JAMA Cardiol 2019;4:796-802.
14
Nestler DM, Noheria A, Haro LH, Stead LG, Decker WW, Scanlan-Hanson LN. et al. Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction protocol. Circ Cardiovasc Qual Outcomes 2009;2;508-13.
15
Gamper G, Havel C, Arrich J, Losert H, Pace NL, Müllner M, et al. Vasopressors for hypotensive shock. Cochrane Database Syst Rev 2016;2:CD003709.
16
Levy B, Clere-Jehl R, Legras A, Morichau-Beauchant T, Leone M, Frederique G, et al. Epinephrine versus norepinephrine for cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2018;72:173-82.
17
American Diabetes Association. 15. Diabetes care in the hospital: standards of medical care in diabetes-2019. Diabetes Care 2019;42:173-81.
18
Oksanen T, Skrifvars MB, Varpula T, Kuitunen A, Pettila V, Nurmi J, et al. Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med 2007;33:2093-100.
19
Investigators N-SS, Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012;367:1108-18.
20
Awad A, Taccone FS, Jonsson M, Forsberg S, Hollenberg J, Truhlar A, et al. Time to intra-arrest therapeutic hypothermia in out-of-hospital cardiac arrest patients and its association with neurologic outcome: a propensity matched subanalysis of the PRINCESS trial. Intensive Care Med 2020;46:1361-70.
21
Yokoyama H, Nagao K, Hase M, Tahara Y, Hazui H, Arimoto H, et al. Impact of therapeutic hypothermia in the treatment of patients with out-of-hospital cardiac arrest from the J-PULSE-HYPO study registry. Circ J 2011;75:1063-70.
22
Lee BK, Lee SJ, Jeung KW, Lee HY, Heo T, Min YI. Outcome and adverse events with 72-hour cooling at 32 0C as compared to 24-hour cooling at 33 0C in comatose asphyxial arrest survivors. Am J Emerg Med 2014;32:297-301.
23
Kirkegaard H, Soreide E, de Haas I, Pettila V, Taccone FS, Arus U, et al. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA 2017;318:341-50.
24
Lybeck A, Friberg H, Aneman A, Hassager C, Horn J, Kjaergaard J, et al. Prognostic significance of clinical seizures after cardiac arrest and target temperature management. Resuscitation 2017;114:146-51.
25
Seder DB, Sunde K, Rubertsson S, Money M, Stammet P, Riker RR, et al. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Crit Care Med 2015;43:965-72.
26
Marco CA, Schears RM. Prehospital resuscitation practices: a survey of prehospital providers. J Emerg Med 2003;24:101-6.
27
Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004;291:870-9.
28
Sandroni C, Nolan JP. Neuroprognostication after cardiac arrest in Europe: new timings and standards. Resuscitation 2015;90:A4-5.
29
Sandroni C, D'Arrigo S. Neurologic Prognostication: Neurologic Examination and Current Guidelines. Semin Neurol 2017;37:40-7.
