Department of Cardiac Anesthesia at Queen Alia Heart Institute (QAHI), Amman, Jordan.
Department of Cardiac Surgery at Queen Alia Heart Institute (QAHI), Amman, Jordan.
Med Arch. 2021 Apr;75(2):149-153. doi: 10.5455/medarh.2021.75.149-153.
In the early postoperative period after cardiac surgery the heart may be temporarily dysfunctional and prone to arrhythmias due to the phenomenon of myocardial stunning, vasoplegic syndrome, systemic inflammatory response syndrome (SIRS), electrolyte disturbances, operative trauma and myocardial edema. Most cases of cardiac arrest after cardiac surgery are reversible.
To analyse the factors that may influence the outcome of cardiac arrest after adult and pediatric cardiac surgery.
Retrospective analysis that included cardiac surgical procedures (886 adult and 749 pediatric patients) performed during the 18 month period of this study at Queen Alia Heart Institute/ Amman, Jordan. All cardiac arrest events were recorded and analysed. Data was collected on Utstein style templates designed for the purpose of this study. The outcome of cardiac arrest is examined as an early outcome (ROSC or lethal outcome) and late outcome (full recovery, recovery with complications, or in-hospital mortality). Factors that may influence the outcome of cardiac arrest were recorded and statistically analysed. Ethical committee approval obtained.
The overall mortality rate was 3.3%. Cardiac arrest occurred in 114 patients (6.97%). The age of patients ranged from 5 days to 82 years and constituted 66 pediatric and 48 adult patients. Most pediatric cardiac arrests manifested as non-shockable rhythms (77%). Most in-hospital cardiac arrests occurred in the intensive care unit (86.5%). The majority of patients were mechanically ventilated at the time of occurrence of arrest (62.5% and 54.5% in adult and pediatric patients, respectively). Average time of cardiopulmonary resuscitation was 32.24 minutes. Overall, CA survival was 20% higher in the paediatric sub-group (full recovery rate of 51.5%). Neurological injury was slightly lower in pediatric than adult cardiac arrest survivals. (2% vs. 3%).
Shockable rhythms are more common in adult cardiac arrest, while non-shockable rhythms are more frequent in the pediatric sub-population. Hemodynamic monitoring, witnessed-type of cardiac arrest, non-interrupted cardiac massage, and early recognition of cardiac tamponade are the factors associated with higher rates of survival.
心脏手术后的早期，由于心肌顿抑、血管麻痹综合征、全身炎症反应综合征（SIRS）、电解质紊乱、手术创伤和心肌水肿等现象，心脏可能暂时功能失调并容易发生心律失常。大多数心脏手术后的心脏骤停是可以逆转的。
分析可能影响成人和儿科心脏手术后心脏骤停结果的因素。
回顾性分析包括在本研究期间的 18 个月内在约旦安曼的 Queen Alia 心脏研究所进行的心脏手术程序（886 例成人和 749 例儿科患者）。记录并分析所有心脏骤停事件。数据是根据为此研究设计的乌斯滕风格模板收集的。心脏骤停的结果被检查为早期结果（ROSC 或致死结果）和晚期结果（完全恢复、有并发症恢复或住院死亡率）。记录并统计分析可能影响心脏骤停结果的因素。获得伦理委员会批准。
总体死亡率为 3.3%。114 例患者（6.97%）发生心脏骤停。患者年龄从 5 天到 82 岁，包括 66 例儿科患者和 48 例成人患者。大多数儿科心脏骤停表现为非可电击节律（77%）。大多数院内心脏骤停发生在重症监护病房（86.5%）。大多数患者在发生骤停时正在机械通气（成人和儿科患者分别为 62.5%和 54.5%）。心肺复苏的平均时间为 32.24 分钟。总体而言，儿科亚组的 CA 存活率（完全恢复率为 51.5%）高 20%。儿科与成人心脏骤停幸存者的神经损伤略低（2%比 3%）。
可电击节律在成人心脏骤停中更为常见，而非可电击节律在儿科亚群中更为常见。血流动力学监测、目击型心脏骤停、不间断的心脏按摩以及早期识别心脏压塞是与更高生存率相关的因素。
