RESUMO
RESUMO Objetivo: Analisar o perfil clínico de pacientes com parada cardiorrespiratória intra-hospitalar, seu atendimento e evolução, com registro baseado no estilo Utstein. Métodos: Estudo observacional, prospectivo e longitudinal em ambiente de terapia intensiva de pacientes com parada cardiorrespiratória incluídos durante 1 ano. Resultados: Foram 89 pacientes, com média de idade de 59,0 anos, 51,6% homens, submetidos às manobras de ressuscitação cardiopulmonar. Os episódios ocorreram no período diurno em 64,6% dos casos. A assistolia/bradiarritmia foi o ritmo inicial mais frequente (42,7%). A maior parte dos que apresentaram retorno à circulação espontânea evoluiu com parada cardiorrespiratória recorrente, principalmente nas primeiras 24 horas (61,4%). As médias dos tempos foram de 10,3 dias entre a internação e ocorrência de parada cardiorrespiratória; 0,68 minutos entre a parada cardiorrespiratória e ressuscitação cardiopulmonar; 7,1 minutos entre a parada cardiorrespiratória e a desfibrilação; 16,3 minutos de duração da ressuscitação cardiopulmonar. Houve associação entre sexo e duração da ressuscitação cardiopulmonar (19,2 minutos nas mulheres versus 13,5 minutos nos homens; p = 0,02), duração da ressuscitação cardiopulmonar e retorno à circulação espontânea (10,8 minutos versus 30,7 minutos; p < 0,001), entre cardiopatia e a idade (60,6 anos versus 53,6; p < 0,001). A sobrevida imediata após a parada cardiorrespiratória foi de 71% e, até a alta hospitalar e no sexto mês após a alta, de 9% e de 6%, respectivamente. Conclusão: O principal ritmo inicial detectado foi a assistolia/bradiarritmia com curto intervalo entre a parada cardiorrespiratória e a reanimação, porém com desfibrilação tardia. Mulheres apresentaram maior tempo de reanimação. Houve baixa taxa de sobrevida hospitalar.
ABSTRACT Objective: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Mortalidade Hospitalar , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Fatores de Tempo , Bradicardia/epidemiologia , Fatores Sexuais , Taxa de Sobrevida , Estudos Prospectivos , Estudos Longitudinais , Resultado do Tratamento , Parada Cardíaca/fisiopatologia , Parada Cardíaca/mortalidade , Pessoa de Meia-IdadeRESUMO
OBJECTIVE:: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. METHODS:: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. RESULTS:: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. CONCLUSIONS:: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.
Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Mortalidade Hospitalar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bradicardia/epidemiologia , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Fundamento: as síndromes coronarianas agudas (SCA) são as maiores causadoras de morte no Brasil e no mundo e estão associadas a fatores de risco comuns. Objetivo: identificar os fatores de risco em pacientes internados com o diagnóstico de SCA no Centro de Terapia Intensiva (CTI) de um hospital privado. Métodos: estudo transversal, com abordagem quantitativa, realizado no CTI de um hospital privado no município de Contagem, entre julho e dezembro de 2008. Foram pesquisados todos os pacientes admitidos nessa unidade com o diagnóstico de SCA. A identificação das variáveis estatisticamente significativas foi calculada por meio da odds ratio e do teste qui-quadrado, considerando-se significativo p ≤ 0,05. Resultados: dos 47 pacientes estudados, 57,5% eram do gênero masculino. A média aritmética de idade foi de 59,5 anos. A prevalência encontrada na população estudada foi: dislipidemia 46,8%, hipertensão arterial 85,1%, diabetes mellitus 34%, tabagismo 37%, sedentarismo 74,5%, obesidade 38,3%, história familiar positiva 55,3% e internação prévia 46,8%. Entre faixa etária e hipertensão arterial (p=0,001), constatou-se que quanto mais avançada a idade do paciente, mais alta a chance dele ser hipertenso. Verificou-se que 32 (68%) pacientes eram sedentários e hipertensos (p=0,02; OR 6.10). Nos pacientes do gênero masculino a chance dos sedentários também serem hipertensos subiu para 12 vezes (p=0,01; OR 12.0). Conclusão: a hipertensão arterial e o sedentarismo foram os fatores de risco de mais ocorrência. Esses achados enfatizam a necessidade de adequar os hábitos de vida da população para prevenir as SCAs.(AU)
Background: Acute coronary syndromes (ACS) are the major cause of death in Brazil and the world, and are associated with common risk factors. Objective: To identify risk factors in patients admitted with the diagnosis of ACS in the Intensive Care Unit (ICU) of a private hospital. Methods: Cross-sectional study with a quantitative approach, performed in the ICU of a private hospital in Contagem City, between July and December 2008. We searched all patients admitted to the unit with the diagnosis of ACS. The identification of statistically significant variables was calculated using odds ratio and chi-square test, considering significant p ≤ 0.05. Results: Out of the 47 patients studied, 57.5% were male gender and 42.5% were female. The arithmetic average age was 59.5 years. The prevalence in this studied population was: dyslipidemia 46.8%, hypertension 85.1%, diabetes mellitus 34%, smoking 37%, sedentary lifestyle 74.5%, obesity 38.3%, positive family history 55.3% and previous hospitalization 46.8%. Between age and hypertension (p = 0,001) was found that the more advanced the age of the patient, the greater the chance of being hypertensive. It was found that 32 (68%) of patients are sedentary and hypertensive (p = 0,02; OR 6.10). In male gender patients the chance increases to 12 times of the sedentary ones also be hypertensive (p = 0,01; OR 12.0). Conclusion: Hypertension and sedentary lifestyle were the risk factors of higher occurrence. These findings emphasize the need to adapt the lifestyle of the population to prevent ACS.(AU)