Síndrome Posparada cardíaca

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Presentado en Cochabamba - Bolivia sobre el Síndrome post parada cardica "quinto eslabón en la RCP".

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  • VIII SIMPOSIO DE MEDICINA INTERNA
  • Durante la fase inmediata, al ingreso del paciente en la UTI o en el departamento de urgencias del hospital, una vez asegurada la vía aérea y conseguida una estabilización inicial, debemos proceder a una valoración inicial y establecer, al mismo tiempo, la monitorización para poder Breve historia clínica en la que se busque activamente antecedente de dolor torácico o causa obvia de parada cardiorespiratorio no cardíaca. PC de causa claramente no cardíaca. PC de causa posible cardiaca isquémica. PC de causa probable cardíaca isquémica. PC de causa claramente cardiaca isquémica. La valoración del estado de consciencia mediante la escala de coma de Glasgow. Monitorización. desarrollar una optimización guiada por objetivos.
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  • Síndrome Posparada cardíaca

    1. 2. Cochabamba - Bolivia 2011 Dr. Roberto E. Gutiérrez Dorado Medicina Crítica y Terapia Intensiva
    2. 4. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63– 81.
    3. 5. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–56.
    4. 6. Peberdy MA, Kaye W, Ornatto JP. Post-resuscitation care: Is it the missing link in the Chain of Survival? Resuscitation. 2005;64:135–7.
    5. 7. Negovsky VA. The second step in resuscitation the treatment of the ‘post-resuscitation disease’. Resuscitation 1972;1:1—7. Negovsky VA. Postresuscitation disease. Crit Care Med. 1988;16:942—6. Vladimir A. Negovsky (1909-2003)
    6. 8. Neumar RW , Nolan JP , et al. A consensus statement from the International Liaison Committee on Resuscitation, pathophysiology, treatment, and prognostication. Circulation. 2008;118:2452–83.
    7. 9. Nolan JP, et al. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee. Resuscitation. 2008;79:350–79.
    8. 11. <ul><li>Fase inmediata: los primeros 20 min tras la RCE. </li></ul><ul><li>Fase precoz: desde los 20 min hasta las 6–12 h. </li></ul><ul><li>Fase intermedia: desde las 6–12 hasta las 72 h. </li></ul><ul><li>Fase de recuperación: a partir de las 72 h. </li></ul><ul><li>Fase de rehabilitación: desde el alta hospitalaria. </li></ul>Nolan JP, et al. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee. Resuscitation. 2008;79:350–79. Neumar RW , Nolan JP , et al. A consensus statement from the International Liaison Committee on Resuscitation, pathophysiology, treatment, and prognostication. Circulation. 2008;118:2452–83.
    9. 13. Jones AE, Shapiro NI, Kilgannon JH, Trzeciak S. Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: A systematic review. Resuscitation.2008;77:26–9.
    10. 14. D.F. Gaieski et al. Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest . Resuscitation 80 (2009) 418–424
    11. 15. D.F. Gaieski et al. Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest . Resuscitation 80 (2009) 418–424
    12. 16. H. Martín-Hernández, J.B. López-Messa, J.L. Pérez-Vela, R. Molina-Latorre, A. Cárdenas-Cruz, A. Lesmes-Serrano, J.A. Álvarez-Fernández, F. Fonseca-San Miguel, L.M. Tamayo-Lomas y P. Herrero-Ansolai, miembros del Comité Directivo del Plan Nacional de RCP de la SEMICYUC. Manejo del síndrome posparada cardíaca (DOCUMENTO DE CONSENSO) . Med Intensiva. 2010;34(2):107–126
    13. 20. Kilgannon JH, Roberts BW, Reihl LR, Chansky ME , Jones AE , Dellinger RP, et al. Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in- hospital mortality. Resuscitation. 2008;79:410–6.
    14. 21. Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, Parrillo JE, Trzeciak S; Emergency Medicine Shock Research Network Investigators. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010; 303:2165–2171.
    15. 22. Nadine Cueni-Villoz et al, Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest . Crit Care Med 2011; 39:000–000
    16. 24. Ka Wai Cheung, Robert S. Green, Kirk D. Magee. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients . Can J Emerg Med 2006;8(5):329-37
    17. 25. Ka Wai Cheung, Robert S. Green, Kirk D. Magee. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients . Can J Emerg Med 2006;8(5):329-37
    18. 26. 60 - 50 - 40 - 30 - 20 - 10 - 0 - 39 % 55 % The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. NEJM 2002;346:549-556 60 - 50 - 40 - 30 - 20 - 10 - 0 - Bernard, S.A. et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. NEJM 2002;346:557-563 Normotermia Hipotermia 26 % 49 % Normotermia Hipotermia P = 0,046 P = 0,009
    19. 27. Polderman, D. H. et al. Induced hypothermia improves neurological outcome in asystolic patients with out-of-hospital cardiac arrest. Circulation 2003;108:IV-581 90 - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 - 0 - Grupo control Grupo de hipotermia 20 % 78 % 41 % 56 % Glasgow de 15 en la UTI Mortalidad a 6 meses
    20. 28. Laver SR, Padkin A, Atalla A, Nolan JP. Therapeutic hypothermia after cardiac arrest: A survey of practice in intensive care units in the United Kingdom. Anaesthesia. 2006;61:873–7.
    21. 29. ¿Cuando? ¿Durante cuánto tiempo? ¿Hasta qué temperatura? y ¿A qué velocidad? ¿Cómo monitorizar la temperatura?
    22. 30. La administración de cristaloides 30–40 ml/kg e nfriados a 4 ºC. (SFL 0,9% o solución RL). + Bolsas de hielo Técnicas de superficie. Técnicas endovasculares. Se recomienda a 0,25 – 0,5 ºC por hora.
    23. 31. Michael Holzer, M.D. Targeted Temperature Management for Comatose Survivors of Cardiac Arrest . N Engl J Med 2010;363:1256-64 .
    24. 34. Sistema intravascular Coolgard Alsius®
    25. 35. Anna Finley Caulfield, et al, Comparison of Cooling Techniques to Treat Cardiac Arrest Patients with Hypothermia . Stroke Research and Treatment Volume 2011, Article ID 690506, 6 pages doi:10.4061/2011/690506
    26. 36. Andreas Schneider, Bernd W. Böttiger, Erik Popp. Cerebral Resuscitation After Cardiocirculatory Arrest . Anesth Analg 2009;108:971–9
    27. 37. Muerte neuronal retardada, después de la isquemia cerebral global Neuronas piramidales del hipocampo (Ratas) después de 10 minutos de isquemia cerebro transitoria. HIP CA1 24 Horas 36 Horas 48 Horas CA1 CA3 DG
    28. 38. 10 min. 1 h. 6 h. HT local cabeza. HT Sistémica. Emanuela Keller, Regina Mudra, Christoph Gugl, Martin Seule, Susanne Mink, Juerg Fröhlich. Theoretical evaluations of therapeutic systemic and local cerebral hypothermia . Journal of Neuroscience Methods Volume 178, April 2009, 345-349 HT local cuello.
    29. 39. Wolfgang Weihs, Alexandra Schratter, Fritz Sterz,∗, Andreas Janata, Sandra Högler, Michael Holzer, Udo M. Losert, Harald Herkner, Wilhelm Behringer. The importance of surface area for the cooling efficacy of mild therapeutic hypothermia . Resuscitation 82 (2011) 74–78
    30. 40. Maaret Castrén. Intra-Arrest Transnasal Evaporative Cooling A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness) . Circulation. 2010;122:729-736.
    31. 41. Florence Dumas, et al. Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest : Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry . Circ Cardiovasc Interv 2010;3;200-207
    32. 42. Bernd W. Böttiger, Et al. for the TROICA Trial Investigators and the European Resuscitation Council Study Group* . Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 2008;359:2651–62. 9;53:409–15.
    33. 43. Matthias Götberg. A Pilot Study of Rapid Cooling by Cold Saline and Endovascular Cooling Before Reperfusion in Patients With ST-Elevation Myocardial Infarction . Circ Cardiovasc Interv. 2010;3:400-407.
    34. 44. L.M. Batista et al. Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest . Resuscitation 81 (2010) 398–403
    35. 45. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196–204.
    36. 46. Michael Holzer, M.D. Targeted Temperature Management for Comatose Survivors of Cardiac Arrest . N Engl J Med 2010;363:1256-64.
    37. 47. Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia mediated alterations on the cytochrome P450 enzyme system. Crit Care Med. 2007;35:2196–204.
    38. 48. Wijdicks EFM, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidencebased review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 67:203-10.
    39. 49. G. Bryan Young, M.D. Neurologic Prognosis after Cardiac Arrest . N Engl J Med 2009;361:605-11 .
    40. 50. Dion Stub, Stephen Bernard, Stephen J. Duffy and David M. Kaye. Post Cardiac Arrest Syndrome: A Review of Therapeutic Strategies . Circulation 2011;123;1428-1435 .
    41. 51. <ul><li>C. Binks, R. E. Murphy, R. E. Prout, S. Bhayani, C. A. Griffiths, T. Mitchell, A. Padkin and J. P. Nolan. Therapeutic hypothermia after cardiac arrest implementation in UK intensive care units. Anaesthesia, 2010, 65, pages 260–265. </li></ul>El uso de hipotermia terapéutica por 208 ICUs. Los valores en número (proporción)

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