Title Srčani zastoj nekardiogenog porijekla Title (english) Noncardiogenic cardiac arrest Author Ana Katić Mentor Tomislav Radočaj (mentor) Committee member Marinko Vučić (predsjednik povjerenstva) Committee member Dinko Tonković (član povjerenstva) Committee member Tomislav Radočaj (član povjerenstva) Granter University of Zagreb Defense date and country 2024-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Srčani zastoj uzrokovan je izostankom odgovarajuće mehaničke aktivnosti srca, čime dolazi do zastoja cirkulacije i neizbježne smrti pacijenta ukoliko se ne pristupi reanimaciji. Iako većinom kardiogene etiologije, srčani zastoj može biti i nekardiogenog porijekla. Nekardiogeni uzroci većinom su reverzibilni, što znači da njihovo pravodobno prepoznavanje i liječenje dovodi do povratka spontane cirkulacije i prekida srčanog zastoja pacijenta. Smjernice Europskog vijeća za reanimatologiju u svojem ALS (engl. Advanced Life Support) algoritmu preporučaju korištenje mnemotehnike „4H i 4T“ za prepoznavanje nekardiogenih uzroka, gdje četiri H označavaju hipoksiju, hipovolemiju, hipokalemiju i hiperkalemiju te hipotermiju i hipertermiju. Četiri T označavaju tamponadu, tenzijski pneumotoraks, trombozu, tj. plućnu emboliju i trombozu koronarne arterije te toksine. Hipoksija je najčešći uzrok srčanog zastoja u pedijatrijskoj populaciji. Nastaje većinom zbog asfiksije, a prethodi mu predarestni period progresivnog pogoršanja kardiopulmonalne funkcije. Srčani zastoj zbog hipovolemije viđa se uglavnom u politraumatiziranih pacijenata zbog velikog gubitka krvi. Ključ liječenja je zaustavljanje krvarenja i brza nadoknada volumena otopinama i krvnim pripravcima. Hiperkalemija i hipokalemija najčešći su elektrolitski poremećaji koji uzrokuju srčani zastoj, a česti su u pacijenata s oštećenom bubrežnom funkcijom. Hipotermija nije toliko česta, a pacijenti sa srčanim zastojem uslijed hipotermije imaju vrlo dobro preživljenje i neurološke ishode budući da hipotermija djeluje protektivno na mozak. Zastoj srca uslijed hipertermije također se ne događa često, no za anesteziologa je važno pažnju obratiti na sklonost pacijenta malignoj hipertermiji, hipermetaboličkoj reakciji skeletnih mišića na primjenu inhalacijskih anestetika i sukcinilkolina. Tamponada srca i tenzijski pneumotoraks događaju se uglavnom tijekom ozljeda i trauma, a srčani zastoj uzrokuju mehaničkom opstrukcijom protoka krvi pa su standardni reanimacijski postupci bez liječenja ovih uzroka često uzaludni. Plućna embolija i tromboza koronarne arterije najčešći su uzroci srčanog zastoja, a zahtijevaju hitan transport pacijenta u bolnicu gdje je moguće liječenje. Srčani zastoj uzrokovan toksinima nastaje zbog direktnog toksičnog djelovanja na srce ili poremećaja elektrolita, a najčešće je uzrokovan predoziranjem opioidima, benzodiazepinima u kombinaciji s alkoholom i tricikličkim antidepresivima.
Abstract (english) Cardiac arrest is caused by the absence of appropriate mechanical activity of the heart, resulting in a cessation of circulation and inevitable death if resuscitation is not initiated. Although it is mostly of cardiogenic etiology, cardiac arrest can also be noncardiogenic. Noncardiogenic causes are mostly reversible, meaning that timely recognition and treatment can lead to the return of spontaneous circulation and cessation of cardiac arrest. The European Resuscitation Council guidelines in their ALS (Advanced Life Support) algorithm recommend the use of the mnemonic "4H and 4T" to recognize noncardiogenic causes, where the four H's stand for hypoxia, hypovolemia, hypo- and hyperkalemia, and hypo- and hyperthermia. The four T's are tamponade, tension pneumothorax, thrombosis, i.e., pulmonary embolism and coronary artery thrombosis, and toxins. Hypoxia is the most common cause of cardiac arrest in the pediatric population. It mostly occurs due to asphyxia and is preceded by a pre-arrest period of progressive worsening of cardiopulmonary function. Cardiac arrest due to hypovolemia is mostly seen in trauma patients due to significant blood loss. The key to treatment is stopping the bleeding and quickly replacing volume with solutions and blood products. Hyperkalemia and hypokalemia are the most common electrolyte disturbances causing cardiac arrest and are frequent in patients with impaired renal function. Hypothermia is not as common, but patients with cardiac arrest due to hypothermia have very good survival and neurological outcomes since hypothermia has a protective effect on the brain. Hyperthermia is also uncommon, but it is important for anesthesiologists to pay attention to the patient's susceptibility to malignant hyperthermia, a hypermetabolic reaction of skeletal muscles to inhalation anesthetics and succinylcholine. Cardiac tamponade and tension pneumothorax mostly occur during injuries and traumas, causing cardiac arrest through mechanical obstruction of blood flow, so standard resuscitation procedures without treating these causes are often futile. Pulmonary embolism and coronary artery thrombosis are the most common causes of cardiac arrest and require urgent transport of the patient to a hospital where treatment is possible. Cardiac arrest caused by toxins occurs due to direct toxic effects on the heart or electrolyte disturbances and is most commonly caused by overdose of opioids, benzodiazepines in combination with alcohol, and tricyclic antidepressants.
Keywords
nekardiogeni srčani zastoj
reanimacija
reverzibilni uzroci
Keywords (english)
noncardiogenic cardiac arrest
resuscitation
reversible causes
Language croatian URN:NBN urn:nbn:hr:105:751579 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-07-08 16:42:08
