35 KB219 KB25 KB192920262008Knafelj, RihardNoč, MarkoPloj, TomRadšel, PeterStojić, Milena6 straništevilka:6/7letnik:77str. 441-446ISSN:1318-0347COBISSID:24526809URN:URN:NBN:SI:doc-RT5KTQOWslSlovensko zdravniško društvoZdravniški vestnikAngioplastika transluminalna, perkutana, koronarnaAngioplasty, Transluminal, Percutaneous Coronarycardiovascular diseaseCoronary ArteriosclerosisHeart Arresthipotermijakardiovaskularne bolezniKoronarna arteriosklerozaMiddle AgeMiokardni infarktMyocardial InfarctionSrce, zastojsrčni infarktsrčni zastojSrednja letatherapyTreatment OutcomezdravljenjeZdravljenje, izidBlaga hipotermija in perkutana koronarna intervnecija pri zdravljenju bolnika s predbolnišničnim zastojem srca zaradi akutnega srčnega infarkta| Mild induced hypothermia and percutaneous coronary intervebntion in the treatment of patient with prehospital cardiac arrest due to acute myocardial infarction|Background Coronary artery disease is the most common cause of sudden cardiac death. More then 50% of patients die before reaching the hospital and at discharge survival rates remain as low as 5%. High mortality is mainly due to a cardiovascular collapse and ischemic brain injury. According to current guidelines percutaneous coronary intervention (PCI) is a golden standard in treatment of myocardial infarction with ST elevation (STEMI). As for now, the only well-documented therapeutic modality for prevention of ischemic brain injury is mild induced hypothermia (MIH). Methods At Center for Internal Intensive Medicine (KOIIM) both procedures (MIH and PCI) are being combined incomatose survivors in whom STEMI is likely since late 2003. Results We report on a 48-year old male who suffered out-of-hospital cardiac arrest one hour after onset of chest pain. Bystander basic life support was not provided.On arrival of prehospital emergency medical team ventricular fibrillation (VF) was documented. Following chest compression and defibrillation spontaneous circulation was established. 12-lead EKG revealed STEMI. Since patient remained comatose despite successful re-establishment of spontaneous circulation MIH was immediately started. Upon hospital admission urgent coronary angiography and successful primary percutaneous intervention were performed. Because of impending cardiogenic shock intra-aortic balloon pump was inserted. Hypothermia with target body temperature between 32 and 34 degrees C was maintained for 24 hours. Standard intensive care procedures wereemployed. The patient survived hospital discharge without any neurologicaldeficit and lives normal life without any symptoms of left ventricular dysfunction for more than 250 days. Discussion Early aggressive and combined treatment of comatose survivors with sudden cardiac arrest due toSTEMI proves to be safe, feasible and efficient in preventing neurological damageIzhodišča Koronarna ateroskleroza je najpogostejši vzrok nenadne srčne smrti. Več kot 50% bolnikov umre pred prihodom v bolnišnico, do odpusta iz bolnišnice jih preživi okoli 5%. Ciljna organa, ki odločata o preživetju bolnika, sta nedvomno srce in centralno živčevje. Sodobne smernice za zdravljenje miokardnega infarkta z dvigom spojnice ST (STEMI) narekujejo čimprejšnjo primarno perkutano koronarno intervencijo (PCI). Edini ukrep, ki vzgodnjem poreanimacijskem obdobju lahko zmanjša stopnjo možganske okvare, je blaga sistemska hipotermija (MIH). Metode Na Kliničnem oddelku za interno intenzivno medicino (KOIIM) pri nezavestnih bolnikih po uspešnem oživljanju redno uporabljamo inducirano hipotermijo. Metodo kombiniramo z urgentno koronarografijo pri bolnikih, kjer obstaja velika verjetnost koronarne bolezni, še zlasti če sumimo, da je povod nenadne srčne smrti akutna ishemija miokarda. Rezultati V prispevku prikazujemo primer 48-letnega moškega, pri katerem je eno uro po začetku prsne bolečine prišlo do nenadnega srčnega zastoja na terenu. Do prihoda ekipe nujne medicinske pomoči, ki je ugotovila fibrilacijo prekatov (VF), laiki temeljnih postopkov oživljanja (TPO) niso izvajali. Po kratkotrajni zunanji masaži srca in defibrilaciji se je vzpostavil stabilni sinusni ritem s tipnimi pulzi. 12-kanalni EKG je pokazal STEMI spodnje in zadnje stene. Ker je bolnik kljub vzpostavitvi spontanega obtoka ostal nezavesten, so že na terenu pričeli s hlajenjem. Takoj po prihoduv bolnišnico smo opravili urgentno koronarografijo in uspešno primarno perkutano koronarno intervencijo ter zaradi začetnega kardiogenega šoka vstavili aortno balonsko črpalko. Telesno temperaturo smo še 24 ur vzdrževali med 32 in 34°C ter nadaljevali intenzivno zdravljenje po splošno sprejetih načelih. (Izvleček prekinjen pri 2000 znakih)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo