Zunajbolnišnična obravnava refraktarne ventrikularne fibrilacije

(magistrsko delo)

Matjaž Vaupotič (Author), Matej Strnad (Mentor)

Abstract

Uvod: Zunajbolnišnični srčni zastoj zaradi refraktarne ventrikularne fibrilacije/tahikardije brez utripa (VF/pVT) ima visoko stopnjo umrljivosti in predstavlja izziv za zdravljenje. V magistrskem delu smo želeli predstaviti metode za zdravljenje refraktarne VF/pVT na terenu, ter ugotoviti njihove učinke na preživetje. Metodologija: Izveden je bil sistematični pregled literature v mednarodnih podatkovnih bazah: Pubmed, Science Direct, Google Učenjak ter Wiley Online Library. Vključili smo znanstvene članke v angleškem jeziku, ki obravnavajo izbrano temo, izdane v časovnem obdobju od januarja 2010 do decembra 2019 in se nanašajo na odraslo populacijo. Z metodo PRISMA smo prikazali potek pregleda literature. Rezultati: Metode, ki bi lahko izboljšale preživetje in nevrološki izhod bolnikov po srčnem zastojem zaradi refraktarne VF/pVT v prehospitalnem okolju, so: aplikacija ustreznih zdravil, dvojna zunanja defibrilacija, vzpostavitev zunajtelesnega krvnega obtoka (ECMO) na terenu in hiter transport bolnika med oživljanjem s pomočjo mehanske naprave za stiskanje prsnega koša do ustanove, ki lahko izvaja perkutano koronarno intervencijo med oživljanjem ali ECMO. Razprava in sklep: Vloga antiaritmikov pri zdravljenju VF/pVT ostaja nejasna. Beta blokatorji kažejo obetavno vlogo. Dvojnosekvenčna defibrilacija zaenkrat ne kaže statistično pomembnih izboljšav v preživetju bolnikov in ugodnih nevroloških izidov. Potrebno je jasno opredeliti, kdaj in pri kom jo uporabiti. Pravočasna vzpostavitev ECMO pri bolnikih v zunajbolnišničnem srčnem zastoju zaradi refraktarne VF/pVT lahko izboljša preživetje in nevrološki izid. Potrebujemo klinične poti in opredelitev, kateri bolniki so kandidati za hiter transport in invazivno oskrbo ter kdaj začeti z njo med oživljanjem.

Keywords

zunajbolnišnični srčni zastoj;antiaritmična zdravila;dvojnosekvenčna defibrilacija;zunajtelesni krvni obtok;

Data

Language:	Slovenian
Year of publishing:	2020
Typology:	2.09 - Master's Thesis
Organization:	UM MF - Faculty of Medicine
Publisher:	[M. Vaupotič]
UDC:	616.12-008.315-083.98(043.2)
COBISS:	33131779
Views:	639
Downloads:	133
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	English
Secondary title:	Management of out of hospital ventricular fibrillation
Secondary abstract:	Introduction: Out-of-hospital cardiac arrest (OHCA) due to refractory ventricular fibrillation/pulseless tachycardia (VF/pVT) has a high mortality rate and is challenging to treat. In the master's thesis we wanted to present methods for treating refractory VF/pVT in prehospital environment and to determine their effects on survival. Methodology: A systematic literature review was conducted in international databases: Pubmed, Science Direct, Google Scholar, and the Wiley Online Library. We included scientific articles in English addressing the selected topic, published between January 2010 and December 2019, which relate to the adult population. The PRISMA method was used to illustrate the progress of literature review. Results: Methods that could improve survival and neurological outcome of patients after OHCA due to refractory VF/pVT are: application of appropriate medicines, double external defibrillation, establishment of extracorporeal circulation (ECMO) in prehospital setting, and rapid transportation of patients during resuscitation using a mechanical chest compression device to an institution that can perform percutaneous coronary intervention during resuscitation or ECMO. Discussion and conclusion: Antiarrhythmics have unclear role in treatment of VF/pVT. Beta blockers show a promising role. Double-sequence defibrillation does not currently show statistically significant improvements in patient survival or favorable neurological outcomes. Clear definition, of when and with whom to use it, is needed. Timely establishment of ECMO in patients with OHCA due to refractory VF/pVT may improve survival and neurological outcome. We need to define which patients are candidates for rapid transport and invasive care, and when to start it during resuscitation.
Secondary keywords:	out-of-hospital cardiac arrest;antiarrhythmic drugs;double-sequential defibrillation;extracorporeal blood flow;Ventricular fibrillation;Cardiopulmonary resuscitation;Fibrilacija prekatov;Kardiopulmonarno oživljanje;
Type (COBISS):	Master's thesis/paper
Thesis comment:	Univ. v Mariboru, Fak. za zdravstvene vede
Pages:	V, 48 f.
ID:	11637366