A epidemiologia da parada cardiorrespiratória no serviço de emergência de um hospital universitário
Data
2015-04-29
Autores
Campanharo, Cassia Regina Vancini 
Orientadores
Atallah, Alvaro Nagib
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A parada cardiorrespiratória (PCR) é frequente e, mesmo com tratamentos de emergência eficientes, associa-se a prognósticos ruins. A identificação da epidemiologia desses casos pode auxiliar no desenvolvimento de estratégias para aperfeiçoar recursos físicos, humanos e materiais, melhorando a sobrevida e o prognóstico desses indivíduos. Objetivo: Caracterizar pacientes atendidos em PCR em um serviço de emergência e verificar quais as variáveis associaram-se ao óbito, à sobrevida e ao estado neurológico. Métodos: Estudo de coorte prospectivo realizado no serviço de emergência de um hospital universitário federal brasileiro. A amostra foi obtida sucessivamente entre os anos de 2011 e 2012, e foi composta por 285 pacientes acompanhados por 1 ano. Os critérios de inclusão foram pacientes atendidos em PCR no setor de emergências clínicas. A média de idade foi 66,3±17,2 anos, com predomínio de homens (55,8%) e brancos (71,9%). Se o paciente apresentasse mais de uma PCR, considerou-se o primeiro evento para compor a análise. Os dados foram coletados por enfermeiros treinados, por meio do in-hospital Utstein style. O nível de significância considerado foi 0,05. Resultados: Em relação às características da PCR, 76,5% ocorreram no intra-hospitalar e 88,7% foram presenciadas pela equipe de saúde ou por familiares. A insuficiência respiratória foi a causa imediata presumida mais comum (30,8%) e a atividade elétrica sem pulso (AESP) foi o ritmo inicial mais frequente (58,7%). As intervenções mais realizadas durante a ressuscitação cardiopulmonar (RCP) foram ventilações e compressões (100%), epinefrina (97,2%) e intubação (68,5%). A média de tempo desde o início da RCP até o primeiro choque foi de 10 minutos; até a realização da intubação, de 7 minutos; até a primeira dose de epinefrina, de 3,5 minutos; e até o término da RCP, de 19,2 minutos. Dentre a amostra deste estudo, 18,6% sobreviveram até as primeiras 24 horas após a PCR, sendo que, destes, 5,6% obtiveram alta hospitalar e 4,6% permaneceram vivos após 1 ano de seguimento. As infecções (31,1%) foram as principais causas de óbito. Após 1 ano de seguimento, pacientes com AESP como ritmo inicial de PCR apresentaram menores chances de sobreviver que aqueles com fibrilação ventricular (FV) (p=0,03), e pacientes com assistolia, menores chances de sobreviver que aqueles com AESP (p<0,00). Dos sobreviventes até 1 ano de seguimento (n=13), 53,8% apresentaram independência completa, 38,5% independência para as atividades de vida diária e 7,7% dependência moderada. Conclusão: A taxa de mortalidade da população estudada, após 1 ano de seguimento, foi alta. O ritmo cardíaco inicial da PCR foi a variável que melhor explicou a mortalidade. A AESP associou-se a maior mortalidade quando comparada à FV. Após 1 ano de seguimento, a maioria dos pacientes apresentou independência completa, sendo que a CPC não se associou às variáveis que poderiam ter influência na condição neurológica dos pacientes.
Background: Cardiac arrest (CA) is frequent and, even with efficient emergency treatment, it is associated with poor prognosis. The identification of the epidemiology of these cases may assist in developing strategies to improve physical, human and material resources, which may improve survival and prognosis of these individuals. Objective: To characterize patients with CA in the emergency department and to determine the variables associated with mortality, survival and neurological status. Methods: A prospective cohort study conducted in the emergency department of a Brazilian federal university hospital. The sample was successively obtained from 2011 to 2012 and comprised 285 patients followed up for 1 year. Inclusion criteria were patients with CA in the clinical emergency room. The mean age was 66.3±17.2 years, with a predominance of men (55.8%) and caucasian (71.9%). If a patient had more than one episode of CA, only the first episode were considered in the analysis. Data were collected by trained nurses through the in-hospital Utstein style. The level of significance was 0.05. Results: Regarding the CA characteristics, 76.5% occurred in-hospital and 88.7% were witnessed by health staff or family. Respiratory failure was the most common presumed immediate cause (30.8%) and pulseless electrical activity (PEA) was the most frequent initial rhythm (58.7%). The interventions most performed during cardiopulmonary resuscitation (CPR) were ventilations and compressions (100%), epinephrine (97.2%) and intubation (68.5%). The median interval between the CPR initiation until the first shock was 10 minutes; 7 minutes until intubation; 3.5 minutes until first epinephrine dose; and 19.2 minutes between the CPR initiation to CPR end. Of all patients, 39.6% had return of spontaneous circulation, 18.6% survived to the first 24 hours after the arrest, and of these 5.6% were discharged, and 4.6% were alive after 1 year of follow-up. Infections (31.1%) were the main cause of death. After 1-year follow-up, patients with PEA as the initial rhythm of CA showed lower chance of survival than those with ventricular fibrillation (VF) (p=0.03) and patients with asystole were less likely to survive than those with PEA (p<0.00). Of the survivors up to 1-year follow-up (n=13), 53.8% had complete independence, 38.5% independence for activities of daily living and 7.7% moderate dependence. Conclusion: After 1-year follow-up, the mortality rate of the studied population was high. The initial heart rate of CA was the variable that best explained the mortality. The PEA was associated with higher mortality when compared to FV. Most patients, after 1-year period of follow-up, showed complete independence, and the CPC was not associated with variables that may influence neurological condition of the patients.
Background: Cardiac arrest (CA) is frequent and, even with efficient emergency treatment, it is associated with poor prognosis. The identification of the epidemiology of these cases may assist in developing strategies to improve physical, human and material resources, which may improve survival and prognosis of these individuals. Objective: To characterize patients with CA in the emergency department and to determine the variables associated with mortality, survival and neurological status. Methods: A prospective cohort study conducted in the emergency department of a Brazilian federal university hospital. The sample was successively obtained from 2011 to 2012 and comprised 285 patients followed up for 1 year. Inclusion criteria were patients with CA in the clinical emergency room. The mean age was 66.3±17.2 years, with a predominance of men (55.8%) and caucasian (71.9%). If a patient had more than one episode of CA, only the first episode were considered in the analysis. Data were collected by trained nurses through the in-hospital Utstein style. The level of significance was 0.05. Results: Regarding the CA characteristics, 76.5% occurred in-hospital and 88.7% were witnessed by health staff or family. Respiratory failure was the most common presumed immediate cause (30.8%) and pulseless electrical activity (PEA) was the most frequent initial rhythm (58.7%). The interventions most performed during cardiopulmonary resuscitation (CPR) were ventilations and compressions (100%), epinephrine (97.2%) and intubation (68.5%). The median interval between the CPR initiation until the first shock was 10 minutes; 7 minutes until intubation; 3.5 minutes until first epinephrine dose; and 19.2 minutes between the CPR initiation to CPR end. Of all patients, 39.6% had return of spontaneous circulation, 18.6% survived to the first 24 hours after the arrest, and of these 5.6% were discharged, and 4.6% were alive after 1 year of follow-up. Infections (31.1%) were the main cause of death. After 1-year follow-up, patients with PEA as the initial rhythm of CA showed lower chance of survival than those with ventricular fibrillation (VF) (p=0.03) and patients with asystole were less likely to survive than those with PEA (p<0.00). Of the survivors up to 1-year follow-up (n=13), 53.8% had complete independence, 38.5% independence for activities of daily living and 7.7% moderate dependence. Conclusion: After 1-year follow-up, the mortality rate of the studied population was high. The initial heart rate of CA was the variable that best explained the mortality. The PEA was associated with higher mortality when compared to FV. Most patients, after 1-year period of follow-up, showed complete independence, and the CPC was not associated with variables that may influence neurological condition of the patients.
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Citação
CAMPANHARO, Cassia Regina Vancini. A epidemiologia da parada cardiorrespiratória no serviço de emergência de um hospital universitário. 2015. 116 f. Tese (Doutorado em Saúde Baseada em Evidências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.