Kardiyak Arrest Hastalarında Odaklı Kardiyak Ultrasonografinin Değeri
Abstract
It is stated that cardiac standstill on sonographic evaluation is predictive for death in cardiac arrest patients. There are limited number of studies about sonographic evaluation predicting return of spontaneous circulation (ROSC). The aim of the study was to determine the value of categorized Ventricular Wall Motion (VMW) score in predicting ROSC. Patients presented with cardiac arrest or who developed cardiac arrest at Hacettepe University emergency department were enrolled in our study. Intraresuscitative Cardiac Ultrasonography (ICARUS) was performed during first 10 minutes of cardiopulmonary resuscitation (CPR) on rhythm/pulse check pauses every 2 minutes in less than 10 seconds time. Patients were evaluated for age, sex, cause of arrest, location of arrest, intubation performed in out-of-hospital arrests, initial rhythm, blood gas parameters (pH, pO2, pCO2, K+, lactate, HCO3-), and VMW scores obtained on sonographic assessment. 28 subjects were enrolled. Demographically, the study consisted of 13 (%46.4) females and 15 (%53.6) males with mean 67.6 ±16.89 (35-93). 16 of patients were out-of-hospital arrest and 13 of them were not witnessed. In 10 of 28 patients ROSC was sustained. 4 of 10 patients survived for less than 24 hours, 3 patients lived for at least 14 days, and 3 were dischared from hospital. Difference between ROSC sustained patients and exitus group in blood gas bicarbonate level and VMW scores were found statistically significant (p<0.05). The sum of VMW scores for each patient (called ICARUS points) was found statistically significant for predicting ROSC (p<0.001). ICARUS points were highly predictive of ROSC regardless of rhythm with 100% specificity, 90% sensitivity, positive predictive value of 100%, negative predictive value 100%, and area under curve on Receiver Operating Characteristics (ROC) analysis was 0.978, p<0.001 (%95 Confidence Interval, 0.929-1.00). ICARUS scoring performed by categorization of VMW is associated with ROSC regardless of rhythm. Serial evaluation of VMW on ICARUS is highly predictive of CPR outcome and so of survival.