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revista de revista_saturacion (3).pptx
1. Revista de Revistas
MR2 Medicina Intensiva Oscar Aaron Horna Garcia
Centro Médico Naval Cirujano Mayor Santiago Tavara
2. INTRODUCCION
- 2015 European Resuscitation Council (ERC) y la European Society of Intensive Care Medicine (ESICM)
colaboraron para formar las primeras guias clinicas de cuidados postresuscitación
- 2020 se actualizan.
- Se consideran los siguientes tópicos
- Sindrome post arresto cardiaco
- Control de oxigenación y ventilación
- Objetivos hemodinámicos
- Reperfusión coronaria
- Temperatura
- Control de Convulsiones
- Pronóstico
- Rehabilitacion
- Resultados a largo plazo
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
3. 1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
4. Oxigenoteria en el Post arresto cardiaco… ¿qué
sabemos?
- Fisiopatológicamente ⇒ arresto cardiaco genera riesgo de daño cerebral hipoxico-isquémico
- El rol de los valores de O2 en sangre en este proceso es poco estudiado
- Hipoxia-isquemia cerebral es asociado a resultados malos
- Administrar más oxígeno debería ser más beneficioso… de otro lado los radicales de oxígeno.
- Existe diferencia en el efecto de los valores de oxigeno dependiendo del órgano estudiado
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
5. METODOS
- Estudio clinico, paralelo, multicéntrico randomizado
- 2 emergencias de 15 hospitales en 2 estados Australianos
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
6. PACIENTES
- Criterios de inclusión
- Mayor o igual de 18 años
- Vía aérea avanzada
- Causa de arresto cardiaco probablemente cadiaca
- Estar planificado ser trasladado a un hospital participante
- Exclusión
- Tener una causa no obvia no cardiaca de arresto cardiaco
- Sospecha de embarazo
- Orden de no reanimación
- Reciban oxigenoterapia en casa
- Randomizacion
- 1:1
- Grupo de 90-94% y grupo de 98-100%
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
7. 1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen
Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi:
10.1001/jama.2022.17701. PMID: 36286192;PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation.
2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
8. 1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
9. RESULTADOS
- Outcome primario ⇒ Alta hospitalaria
- Secundarios
- Rearresto e hipoxia
- Injuria Cardiaca
- Sobrevivencia post UCI (dias)
- Causa de muerte hospitalaria
- Resultado neurológico favorable
- Preespecificos secundarios
- 12m post calidad de vida
- Discapacidad
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
10. 1. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
11. 1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J,
Grantham H, Hein C, Masters S, Stub D, Perkins GD,
Dodge N, Martin C, Hopkins S, Cameron P; EXACT
Investigators. Effect of Lower vs Higher Oxygen
Saturation Targets on Survival to Hospital Discharge
Among Patients Resuscitated After Out-of-Hospital
Cardiac Arrest: The EXACT Randomized Clinical Trial.
JAMA. 2022 Nov 8;328(18):1818-1826. doi:
10.1001/jama.2022.17701. PMID: 36286192;PMCID:
PMC9608019.
12. FLUJO
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J,
Grantham H, Hein C, Masters S, Stub D, Perkins GD,
Dodge N, Martin C, Hopkins S, Cameron P; EXACT
Investigators. Effect of Lower vs Higher Oxygen
Saturation Targets on Survival to Hospital Discharge
Among Patients Resuscitated After Out-of-Hospital
Cardiac Arrest: The EXACT Randomized Clinical Trial.
JAMA. 2022 Nov 8;328(18):1818-1826. doi:
10.1001/jama.2022.17701. PMID: 36286192;PMCID:
PMC9608019.
13. DISCUSIÓN
- No diferencia significativa entre grupos
- Estudio limitado por la pandemia
- Se evidencia lo observado en animales, que la hiperoxia empeora los
resultados en paciente con sindrome post arresto cardiaco
- El estudio sugiere un posible daño con SatO2 90-94% pues es posible que
ello se deba el incremento de casos de hipoxia resultando en isquemia
cardiaca lo que resulta en nuevo rearresto sin ROSC
- 94-98%??
1. Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients
Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701. PMID: 36286192; PMCID: PMC9608019.
2. Kleinman ME, Perkins GD, Bhanji F, et al.. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Resuscitation. 2018;127:132-146. doi: 10.1016/j.resuscitation.2018.03.021
3. Kempster K, Howell S, Bernard S, et al.. Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021;166:21-30. doi: 10.1016/j.resuscitation.2021.07.003
4. Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393-1414. doi: 10.1007/s00134-021-06548-2
