Title Nove spoznaje i postupci u kardiopulmonalnoj reanimaciji
Title (english) New insights and procedures in cardiopulmonary resuscitation
Author Sara Periš
Mentor Dinko Tonković (mentor)
Committee member Slobodan Mihaljević (predsjednik povjerenstva)
Committee member Daniela Bandić Pavlović (član povjerenstva)
Committee member Dinko Tonković (član povjerenstva)
Granter University of Zagreb School of Medicine (Cabinet for First Aid) Zagreb
Defense date and country 2022-07-15, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Emergency Medicine
Abstract Iznenadni srčani arest je treći vodeći uzrok smrti u Europi. Godišnja incidencija OHCA-e u Europi iznosi između 67 i 170 bolesnika na 100,000 stanovnika, a stopa preživljavanja nakon otpusta iz bolnice iznosi u prosjeku 8%. Godišnja incidencija IHCA-e u Europi vodi se između 1,5-2,8 osoba na 1000 bolničkih prijema, dok je šansa za preživljenjem do otpusta/30 dana 15-34%. Osnovno održavanje života stavlja naglasak na prepoznavanje aresta i što ranije započinjanje reanimacije te potiče ranu defibrilaciju korištenjem AVD-a. Svi pružatelji KPR-a trebaju provoditi kompresije prsnog koša, a oni koji su educirani i sposobni trebaju kombinirati kompresije prsnog koša s umjetnim disanjem u omjeru 30:2. Napredno održavanje života na prvo mjesto stavlja kontinuirane kompresije prsnog koša visoke kvalitete s minimalnim pauzama i ranu defibrilaciju upotrebom samoljepljivih elektroda. Endotrahealna intubacija najnapredniji je način uspostave i održavanja dišnog puta. Valnom kapnografijom se potvrđuje i kontinuirano kontrolira položaj tubusa te kvaliteta KPR-a. Uspješnom reanimacijom dolazi do uspostave povratka spontane cirkulacije poslije prolongirane ishemije čitavog tijela. Prolongirana ishemija i reperfuzija uzrokuju globalno oštećenje tkiva i organa. Postreanimacijski sindrom (PCAS) je kombinacija patofizioloških zbivanja poslije srčanog aresta koja uključuje ozljedu mozga, disfunkciju miokarda, sustavni ishemijsko-reperfuzijski odgovor i perzistentnu precipitirajuću patologiju. Postreanimacijska skrb započinje neposredno nakon uspostave povratka spontane cirkulacije, a liječenje postreanimacijskog sindroma podrazumijeva zbrinjavanje multiplih organskih sustava, optimizaciju oksigenacije i ventilacije, hemodinamskih i metaboličkih varijabli te ciljanu kontrolu temperature. Cilj liječenja je potpuni neurološki oporavak, a postreanimacijska prognoza temelji se na multimodalnom pristupu koji uključuje klinički pregled, neurofiziološke pretrage, mjerenje serumskih biomarkera i neuroradiološke metode. Osim mjerenja neurološkog ishoda bitni su problemi koji prate pacijente nakon otpusta iz bolnice, a uključuju kognitivne, emocionalne i fizičke probleme te umor. Sukladno tome, potrebna je funkcionalna provjera fizičkih, kognitivnih i emocionalnih oštećenja prije otpusta pacijenta iz bolnice te kontrolni pregled unutar tri mjeseca u svrhu procjene potrebe za daljnjom rehabilitacijom.
Abstract (english) Sudden cardiac arrest is the third leading cause of death in Europe. The annual incidence of OHCA in Europe is between 67 and 170 patients per 100,000 inhabitants, and the survival rates at hospital discharge are on average 8%. The annual incidence of IHCA in Europe is between 1,5 and 2,8 people per 1000 hospital admissions, while survival rates at 30 days/hospital discharge range from 15% to 34%. Basic life support puts emphasis on recognizing arest and starting resuscitation as early as possible and promotes early defibrillation using AED. All providers of CPR should carry out chest compressions, and those who are educated and capable should combine chest compressions with rescue breathing in a ratio of 30:2. Advanced life support prioritizes high-quality continuous chest compressions with minimal interruptions and early defibrillation using self-adhesive electrodes. Endotracheal intubation is the most advanced way to establish and maintain the airway. Wave capnography confirms and continuously monitors the position of the tube and the quality of CPR. Successful resuscitation leads to the establishment of the return of spontaneous circulation after prolonged ischemia of the entire body. Prolonged ischemia and reperfusion cause global damage to tissues and organs. Post-cardiac arrest syndrome (PCAS) is a combination of pathophysiological events after cardiac arest that include brain injury, myocardial dysfunction, systemic ischemic-reperfusion response and persistent precipitating pathology. Post-resuscitation care begins immediately after the return of spontaneous circulation is established, and treatment of post-cardiac arrest syndrome includes the management of multiple organic systems, optimization of oxygenation and ventilation, hemodynamic and metabolic variables, and targeted temperature control. The goal of the treatment is a complete neurological recovery, and the post-resuscitation prognosis is based on a multimodal approach that includes clinical examination, neurophysiological tests, measurement of serum biomarkers and neuroradiological methods. In addition to measuring the neurological outcome, problems that accompany patients after discharge from the hospital are essential, including cognitive, emotional and physical problems and fatigue. Accordingly, a functional assessments of physical, cognitive and emotional impairments is required before discharging the patient from the hospital and a follow-up within three months in order to identify the need for further rehabilitation.
Keywords
kardiopulmonalna reanimacija
postreanimacijski sindrom
postreanimacijska skrb
Keywords (english)
cardiopulmonary resuscitation
post-cardiac arrest syndrome
post-resuscitation care
Language croatian
URN:NBN urn:nbn:hr:105:758410
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2023-01-27 10:04:45