Amerika\u2019da her y\u0131l 359.400 adet hastane d\u0131\u015f\u0131 kardiyak arrest vakas\u0131 geli\u015fmektedir. Her ne kadar temel ya\u015fam deste\u011fi ve ileri ya\u015fam deste\u011fi (\u0130YD) konusunda e\u011fitimlerin say\u0131 ve kalitesi artt\u0131r\u0131l\u0131yor olsa da \u015foklanamaz ritme sahip hastalarda sonlan\u0131m genellikle k\u00f6t\u00fc seyretmektedir. \u015eoklanamaz ritimlerdeki kardiyak arrest hastalar\u0131n\u0131n tedavisinde temel nokta, potansiyel olarak geri d\u00f6nd\u00fcr\u00fclebilir altta yatan nedenlerin erken d\u00fczeltilmesidir. Son zamanlarda bak\u0131m odakl\u0131 ekokardiyografi (EKO), d\u00fczeltilebilir kardiyak arrest nedenleri, sonlan\u0131m tahmini ve res\u00fcsitasyon karar\u0131n\u0131n sonland\u0131r\u0131lmas\u0131na yard\u0131mc\u0131 olmak i\u00e7in kullan\u0131lmaya ba\u015flanm\u0131\u015ft\u0131r. Res\u00fcsitasyon s\u0131ras\u0131nda odaklanm\u0131\u015f EKO ile potansiyel nedenleri ara\u015ft\u0131rmak i\u00e7in \u00e7e\u015fitli protokoller ve \u00e7al\u0131\u015fmalar \u00f6nerilmi\u015ftir. Bu \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131, standartla\u015ft\u0131r\u0131lmam\u0131\u015f protokoller ve heterojen \u00e7al\u0131\u015fma pop\u00fclasyonlar\u0131 nedeniyle kar\u0131\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. K\u0131sa vadeli sonu\u00e7lar\u0131 \u00f6nceden tahmin etmesi ve res\u00fcsitasyon sonland\u0131rma karar\u0131na yard\u0131mc\u0131 olabilece\u011fi d\u00fc\u015f\u00fcncesi ile bak\u0131m odakl\u0131 EKO kullan\u0131m\u0131na artan bir ilgi duyulmaktad\u0131r. Bu derlemenin amac\u0131, kardiyak arrest olan hastalarda k\u0131sa vadeli sonu\u00e7lar\u0131n tahmininde bak\u0131m odakl\u0131 EKO\u2019nin do\u011frulu\u011funun nicel bir de\u011ferlendirmesini yapmakt\u0131r. \u00a0<\/p>\r\n\r\n\r\n\r\n
Meta-analizde, genel bibliyografik veri tabanlar\u0131 (PubMed ve EMBASE) “EKO” ve “Kardiyopulmoner res\u00fcsitasyon” terimi i\u00e7in Temmuz 2016’ya kadar ara\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Birincil olarak “Acil EKO”, “Odaklanm\u0131\u015f EKO De\u011ferlendirme”, “Kritik Bak\u0131m Ultrasonu” ve “Ultrason” ve “EKO” konular\u0131n\u0131 i\u00e7eren arama sonu\u00e7lar\u0131 daha sonra ilgili n\u00fcfus i\u00e7in \u00e7apraz kontrol edilmi\u015f ve “Kardiyopulmoner Res\u00fcsitasyon”, “CPR”, “Hastane \u00d6ncesi Bak\u0131m” ve “\u0130leri Ya\u015fam Deste\u011fi” terimleri kullan\u0131larak sadece insan \u00e7al\u0131\u015fmalar\u0131nda k\u0131s\u0131tlanarak yay\u0131n tarihi ve \u00fclke ayr\u0131m\u0131 yapmaks\u0131z\u0131n tekrar aranm\u0131\u015ft\u0131r. Hastane \u00f6ncesi veya acil serviste kardiyak arrest geli\u015fen eri\u015fkin hastalarda transtorasik odaklanm\u0131\u015f EKO ile de\u011ferlendirilen klinik \u00e7al\u0131\u015fmalar dahil edilmi\u015ftir. \u00c7al\u0131\u015fman\u0131n spontan dola\u015f\u0131m\u0131n geri d\u00f6n\u00fc\u015f\u00fc (SDGD), hastane yat\u0131\u015f\u0131nda sa\u011fkal\u0131m ve taburculukta sa\u011f kal\u0131m olarak belirlenen res\u00fcsitasyon sonu\u00e7lar\u0131ndan en az birini rapor ediyor olmas\u0131 istenmi\u015ftir.<\/p>\r\n\r\n\r\n\r\n
Veriler, genel \u00e7al\u0131\u015fma \u00f6zellikleri, \u00e7al\u0131\u015fma tasar\u0131m\u0131, ayarlar\u0131, hasta \u00f6zellikleri, sonograf\u0131n deneyimi, ultrason transd\u00fcseri tipi, sonografik tarama protokolleri, res\u00fcsitasyonun sonland\u0131r\u0131lma kriterleri, ba\u015flang\u0131\u00e7 kardiyak ritmi, \u00e7e\u015fitli sonlan\u0131mlar\u0131n tan\u0131m\u0131 ve klinik seyir i\u00e7in gerekli olan niceliksel veriler i\u00e7in 2*2 g\u00f6zl\u00fc tablolar elde edilerek yorumlanm\u0131\u015f. Duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck verilerinin birden \u00e7ok \u00e7iftini bildiren \u00e7al\u0131\u015fmalarda, en y\u00fcksek Youden indeksiyle (duyarl\u0131l\u0131k + \u00f6zg\u00fcll\u00fck -1) tutarl\u0131 verileri kullan\u0131lm\u0131\u015f. Se\u00e7ilmi\u015f \u00e7al\u0131\u015fmalar\u0131n meta-analizlerinden \u00f6nce metodolojik kalitesini de\u011ferlendirmek i\u00e7in Tan\u0131 Do\u011fruluk \u00d6l\u00e7e\u011fi Kalite De\u011ferlendirmesi (QUADAS) kullan\u0131larak \u00f6nyarg\u0131 riski ile ili\u015fkili olabilecek \u00e7al\u0131\u015fma tasar\u0131mlar\u0131n\u0131n, pop\u00fclasyonun, endeks testlerinin ve referans standartlar\u0131n \u00f6zelliklerini de\u011ferlendirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n
SDGD, hastane yat\u0131\u015f\u0131nda sa\u011fkal\u0131m ve taburculukta sa\u011f kal\u0131m gibi farkl\u0131 sonlan\u0131mlar\u0131n havuzlanmas\u0131 ile duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck ve pozitif ve negatif olas\u0131l\u0131k oranlar\u0131 % 95 g\u00fcven aral\u0131\u011f\u0131 (GA) ile hesaplanm\u0131\u015f. Acil serviste sa\u011fkal\u0131m olarak bildirilen hastalar\u0131 hastane yat\u0131\u015f\u0131nda sa\u011fkal\u0131m grubu i\u00e7erisine dahil etmi\u015fler. Sonu\u00e7 tan\u0131m\u0131ndaki de\u011fi\u015fikli\u011fin \u00f6zet tahminler \u00fczerindeki etkisini belirlemek i\u00e7in bir duyarl\u0131l\u0131k analizi yap\u0131lm\u0131\u015f. \u00d6zet etki tahminleri t\u00fcretmek i\u00e7in iki de\u011fi\u015fkenli bir model kullan\u0131lm\u0131\u015f. Hassasiyeti \u00f6zde\u015fli\u011fe g\u00f6re \u00e7izen ve e\u011fri alt\u0131ndaki alan\u0131 hesaplayan hiyerar\u015fik bir \u00f6zet \u00f6zelligi al\u0131c\u0131 \u00e7al\u0131\u015fma karakteristi\u011fi e\u011frisi olu\u015fturulmu\u015f. \u00c7al\u0131\u015fman\u0131n heterojenlik derecesini I2 testi ile de\u011ferlendirilmi\u015f. Yay\u0131n yanl\u0131l\u0131\u011f\u0131n\u0131n varl\u0131\u011f\u0131 ve etkisi, Egger testlerinin bir kombinasyonu kullan\u0131larak incelenmi\u015f.<\/p>\r\n\r\n\r\n\r\n
Taramada 961 \u00e7al\u0131\u015fmaya rastlanm\u0131\u015f, 928\u2019i ba\u015fl\u0131k ve \u00f6zet b\u00f6l\u00fcm\u00fcnden elenmi\u015f, 33 \u00e7al\u0131\u015fma ileri ara\u015ft\u0131rmaya al\u0131nm\u0131\u015f ve bunlardan uygun kriterleri sa\u011flayan 15 \u00e7al\u0131\u015fma derlemeye dahil edilmi\u015f. Bu 15 \u00e7al\u0131\u015fmada spontan kardiyak hareket varl\u0131\u011f\u0131 tespiti ile ortaya \u00e7\u0131kan sonu\u00e7lar\u0131n do\u011frulu\u011fu de\u011ferlendirilmi\u015f. Ba\u015far\u0131l\u0131 res\u00fcsitasyonun \u00f6l\u00e7\u00fct\u00fc SDGD varl\u0131\u011f\u0131, hastaneye yat\u0131\u015fta sa\u011f kal\u0131m ve taburculukta sa\u011f kal\u0131m olarak belirlenmi\u015f. De\u011ferlendirmeye al\u0131nan 15 \u00e7al\u0131\u015fmada 1965 kardiyak arrest hastas\u0131 de\u011ferlendirilmi\u015f. On \u00e7al\u0131\u015fma acil serviste, 3 \u00e7al\u0131\u015fma hastane \u00f6ncesi d\u00f6nemde 2 \u00e7al\u0131\u015fma hem hastane \u00f6ncesi her ikisinde yap\u0131lm\u0131\u015f. \u00c7al\u0131\u015fmalar\u0131n ikisi travmatik yedisi travmatik olmayan hastalarda kalanlar ise kar\u0131\u015f\u0131k pop\u00fclasyonda yap\u0131lm\u0131\u015f. Yedi \u00e7al\u0131\u015fmada deneyimli EKO uygulay\u0131c\u0131s\u0131 kullan\u0131lm\u0131\u015f. Nab\u0131z kontrol zaman\u0131 sonografik de\u011ferlendirme zaman\u0131 olmu\u015f ve subkostal, apikal, parasternal pencerelerden de\u011ferlendirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n
Kardiyak arrest hastalar\u0131nda ba\u015far\u0131l\u0131 res\u00fcsitasyon sonu\u00e7lar\u0131 de\u011ferlendirilmeye al\u0131nm\u0131\u015f. Sekiz \u00e7al\u0131\u015fmada ROSC varl\u0131\u011f\u0131,\u00a0 7 \u00e7al\u0131\u015fmada hastaneye yat\u0131\u015fta sa\u011f kal\u0131m ve 2 \u00e7al\u0131\u015fmada hastaneden taburculukta sa\u011f kal\u0131m sonu\u00e7 olarak kullan\u0131lm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n
Alt\u0131 \u00e7al\u0131\u015fmada kardiyopulmoner res\u00fcsitasyon s\u0131ras\u0131nda odaklanm\u0131\u015f EKO yapmak i\u00e7in yap\u0131land\u0131r\u0131lm\u0131\u015f bir protokol \u00f6nerilmi\u015f. Kalp subkostal, apikal ve parasternal pencerelerden perikardiyal bo\u015fluk, inferior vena kava (hacim durumu), sa\u011f ventrik\u00fcl (kontraksiyon, \u00e7ap \u00f6l\u00e7\u00fcm\u00fc, p\u0131ht\u0131 varl\u0131\u011f\u0131) a\u00e7\u0131s\u0131ndan de\u011ferlendirilmi\u015f. Ek olarak plevral kayma hareketinin de\u011ferlendirilmesi ile pn\u00f6motoraks ara\u015ft\u0131r\u0131lm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n
Te\u015fhis do\u011frulu\u011funa y\u00f6nelik \u00e7al\u0131\u015fmalar\u0131n kalite de\u011ferlendirmesi yap\u0131lm\u0131\u015f, genel olarak, \u00e7al\u0131\u015fmalar\u0131n metodolojik kalitesi iyi bulunmu\u015f. \u00c7al\u0131\u015fma tipleri prospektif \/ retrospektif kohort dizaynlar\u0131 ve randomize olmayan kontroll\u00fc \u00e7al\u0131\u015fmay\u0131 i\u00e7ermekteymi\u015f. \u00c7al\u0131\u015fmalar\u0131n \u00e7o\u011funda referans standart veya k\u00f6rle\u015ftirme i\u015flemi belirtilmemi\u015f, ancak SDGD sonu\u00e7lar\u0131n\u0131n belirlenmesi ya da hastaneye yat\u0131\u015f veya hastaneden taburcu olma sa\u011fkal\u0131m\u0131 objektif olarak verilmi\u015f ve ilk EKO bulgular\u0131ndan etkilenmemi\u015f. Dolay\u0131s\u0131yla, kurulu\u015f \u00f6nyarg\u0131 riskinin az oldu\u011fu d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015f.<\/p>\r\n\r\n\r\n\r\n
On be\u015f \u00e7al\u0131\u015fmada sonlan\u0131m tahmini do\u011frulu\u011fu spontan kardiyak hareketin saptanmas\u0131 ile de\u011ferlendirilmi\u015f. SDGD i\u00e7in tahmini toplanm\u0131\u015f duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck s\u0131ras\u0131yla 0.95 (% 95 GA: 0.72-0.99) ve 0.80 (% 95 GA: 0.63-0.91), havuzlanm\u0131\u015f pozitif olas\u0131l\u0131k oran\u0131 4.8 (% 95 GA: 2.5-9.4) ve negatif olas\u0131l\u0131k oran\u0131 0.06 (% 95 CI: 0.01-0.39), ROC e\u011frisi alt\u0131ndaki alan 0.93 bulunmu\u015f. Ara analiz sonu\u00e7lar\u0131 i\u00e7in (Hastaneye yat\u0131\u015fta sa\u011fkal\u0131m) spontan kardiyak hareket varl\u0131\u011f\u0131n\u0131n duyarl\u0131l\u0131\u011f\u0131 0.90 (% 95 GA: 0.83-0.94), \u00f6zg\u00fcll\u00fc\u011f\u00fc 0.78 (% 95 GA: 0.64-0.88), pozitif olas\u0131l\u0131k oran\u0131 4.1 (% 95 CI: 2.3-7.4) ve negatif olas\u0131l\u0131k oran\u0131 0.13 (% 95 GA: 0.07-0.24) bulunmu\u015f. Her iki sonlan\u0131m i\u00e7in de y\u00fcksek duyarl\u0131l\u0131k ve orta \u00f6zg\u00fcll\u00fckte bulunan sonu\u00e7lar, spontan kardiyak hareketin olmamas\u0131n\u0131n hayatta kalmay\u0131 d\u0131\u015flamada y\u00fcksek \u00f6ng\u00f6r\u00fcde oldu\u011funu ve spontan kardiyak hareketin pozitif olmas\u0131n\u0131n ise hayatta kalmay\u0131 desteklemede orta \u00f6ng\u00f6r\u00fcde oldu\u011fu bildirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n
Bu sistematik derlemede, res\u00fcsitasyonda bak\u0131m odakl\u0131 EKO\u2019nin rol\u00fcn\u00fcn esas olarak res\u00fcsitasyon sonucunun tahmini ve potansiyel olarak tedavi edilebilen nedenlerin erken belirlenmesi oldu\u011fu g\u00f6sterilmi\u015f. EKO\u2019de spontan kardiyak hareketin bulunmamas\u0131 d\u00fc\u015f\u00fck negatif olas\u0131l\u0131k oran\u0131na sahip ve res\u00fcsitasyonun sonland\u0131r\u0131lmas\u0131na karar vermede yard\u0131mc\u0131 olabilir, y\u00fcksek negatif olas\u0131l\u0131k oran\u0131na sahip oldu\u011funda ise res\u00fcsitasyonun durdurulmas\u0131na karar verdiricidir. Res\u00fcsitasyonda yatak ba\u015f\u0131 odaklanm\u0131\u015f EKO\u2019nin ba\u015fl\u0131ca avantajlar\u0131 ger\u00e7ek zamanl\u0131 olmas\u0131, h\u0131zl\u0131 de\u011ferlendirme sa\u011flamas\u0131 ve ay\u0131r\u0131c\u0131 tan\u0131 yelpazesini daralt\u0131p h\u0131zl\u0131 tedavinin sa\u011flanmas\u0131na yard\u0131mc\u0131 olmas\u0131d\u0131r. Bunun yan\u0131nda res\u00fcsitatif \u00e7aban\u0131n yan\u0131t\u0131n\u0131 h\u0131zl\u0131ca de\u011ferlendirmeye olanak sa\u011flar. Dezavantaj olarak, sonografinin yap\u0131lmas\u0131 ve sonu\u00e7lar\u0131n yorumlanmas\u0131nda ustal\u0131k sahibi olmak gereklili\u011fidir. E\u011fer uygulay\u0131c\u0131 e\u011fitimi yetersiz ise \u0130YD s\u00fcrecine m\u00fcdahale etme olas\u0131l\u0131\u011f\u0131 vard\u0131r.<\/p>\r\n\r\n\r\n\r\n
Blyth ve ark. taraf\u0131ndan ger\u00e7ekle\u015ftirilen bir \u00f6nceki meta-analizle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda; bu derleme yakla\u015f\u0131k \u00fc\u00e7 kat\u0131 kadar hasta (1695 vs 568) i\u00e7ermektedir. Blyth’in \u00e7al\u0131\u015fmas\u0131, SDGD tahmini i\u00e7in duyarl\u0131l\u0131\u011f\u0131 0.92 (% 95 CI: 0.85-0.95) ve \u00f6zg\u00fcll\u00fc\u011f\u00fc 0.80 (% 95 GA: 0.76-0.84) bildirmi\u015f. Dahil edilen \u00e7al\u0131\u015fmalar\u0131n say\u0131s\u0131n\u0131n artmas\u0131yla iki sonlan\u0131ma y\u00f6nelik bir alt grup analizi yap\u0131lmas\u0131 sa\u011flanm\u0131\u015f. Blyth’in meta-analizi ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda bak\u0131m odakl\u0131 EKO i\u00e7in SDGD’n\u00fc \u00f6ng\u00f6rmek i\u00e7in benzer \u00f6zg\u00fcll\u00fck (0.80,% 95 GA: 0.63-0.91), ancak daha y\u00fcksek bir duyarl\u0131l\u0131k (0.95,% 95 GA: 0.72-0.99) bulunmu\u015f. Hastaneye yat\u0131\u015fta sa\u011fkal\u0131m\u0131 \u00f6ng\u00f6rmede ise duyarl\u0131l\u0131k (0.90,% 95 GA: 0.83-0.94), SDGD\u2019den daha d\u00fc\u015f\u00fck bulunmu\u015f. Uzun s\u00fcreli sa\u011fkal\u0131m\u0131n, bak\u0131m kalitesine ve komplikasyonlara ba\u011fl\u0131 \u00e7e\u015fitli fakt\u00f6rlerle birle\u015fti\u011fi, bu nedenle, ilk EKO bulgular\u0131na dayanarak kolayca tahmin edilemeyece\u011fi tart\u0131\u015f\u0131lm\u0131\u015ft\u0131r. Her iki sonu\u00e7 i\u00e7in d\u00fc\u015f\u00fck havuzlanm\u0131\u015f negatif olas\u0131l\u0131k oran\u0131 (SDGD: 0.06,% 95 GA: 0.01-0.39; hastaneye yat\u0131\u015fta sa\u011fkal\u0131m: 0.13,% 95 GA: 0.07-0.24), bak\u0131m odakl\u0131 EKO\u2019de spontan kardiyak hareketin bulunmamas\u0131n\u0131n res\u00fcsitasyonun ba\u015far\u0131s\u0131zl\u0131\u011f\u0131n\u0131 \u00f6ng\u00f6rmek ve \u00f6n test olas\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fck hastalarda res\u00fcsitasyonun sonland\u0131r\u0131lmas\u0131na yol g\u00f6stermek i\u00e7in g\u00fcvenilir oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. Bunun aksine, pozitif olas\u0131l\u0131k oran\u0131 spontan kardiyak hareketin varl\u0131\u011f\u0131n\u0131n SDGD ve sa\u011fkal\u0131m\u0131 kesin olarak tahmin etmedi\u011fini ileri s\u00fcrmektedir. De\u011ferlendirmeye al\u0131nm\u0131\u015f t\u00fcm \u00e7al\u0131\u015fmalar i\u00e7erisinde Tomruk ve ark. herhangi bir saptanm\u0131\u015f kardiyak hareket i\u00e7in en d\u00fc\u015f\u00fck duyarl\u0131l\u0131\u011f\u0131 (% 26) bildirmi\u015flerdir. 149 hastay\u0131 kapsayan bir \u00e7al\u0131\u015fmada b\u00f6ylesine b\u00fcy\u00fck bir tutars\u0131zl\u0131k, tek ba\u015f\u0131na \u015fans d\u0131\u015f\u0131nda alternatif a\u00e7\u0131klamalar yap\u0131lmas\u0131n\u0131 gerektirmektedir. D\u00fc\u015f\u00fck duyarl\u0131l\u0131k, tek subkostal g\u00f6r\u00fc\u015f kullan\u0131m\u0131 veya odaklanm\u0131\u015f sonografide yetersiz e\u011fitim nedeniyle tan\u0131sal yanl\u0131\u015fl\u0131k ile a\u00e7\u0131klanabilir. Breitkreutz ve ark. taraf\u0131ndan yap\u0131lan hastane \u00f6ncesi d\u00f6nemde res\u00fcsitasyon yap\u0131lan arrest hastalar\u0131n\u0131 i\u00e7eren \u00e7al\u0131\u015fmada ise y\u00fcksek yanl\u0131\u015f negatif oran g\u00f6r\u00fclmektedir. Bu durum i\u00e7in, hastane \u00f6ncesi d\u00f6nemde ta\u015f\u0131nabilir sonografi spontan kardiyak hareketi do\u011frulukla saptayamayabilir ya da erken d\u00f6nemde EKO\u2019de spontan kardiyak hareketin olmamas\u0131 halen daha SDGD sa\u011flanabilme \u015fans\u0131na sahip olabilir \u015feklinde yorum getirilmi\u015ftir. Ancak bu varsay\u0131m\u0131 do\u011frulamak i\u00e7in daha ileri \u00e7al\u0131\u015fmalar gereklili\u011fi vurgulanm\u0131\u015ft\u0131r.<\/p>\r\n\r\n\r\n\r\n
Bu derlemenin sonu\u00e7lar\u0131 hem g\u00fc\u00e7l\u00fc hem de zay\u0131f y\u00f6nleri \u0131\u015f\u0131\u011f\u0131nda yorumlanmal\u0131d\u0131r. Mevcut derleme, res\u00fcsitasyonda bak\u0131m odakl\u0131 EKO\u2019nin kullan\u0131m\u0131 i\u00e7in \u00f6nerilen protokolleri \u00f6zetleyen ilk derlemedir. Bu \u00e7al\u0131\u015fma ayn\u0131 zamanda, bak\u0131m odakl\u0131 EKO ile sonu\u00e7 tahmini i\u00e7in g\u00fcncellenmi\u015f bir havuzlanm\u0131\u015f do\u011fruluk tahmini sa\u011flamaktad\u0131r. Bu \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131 tarama protokollerinin standartla\u015ft\u0131r\u0131lmas\u0131n\u0131 kolayla\u015ft\u0131rabilir. Buna ek olarak, g\u00fcncellenmi\u015f \u00f6zet do\u011fruluk indeksleri, bak\u0131m odakl\u0131 EKO\u2019nin res\u00fcsitasyon sonland\u0131rmas\u0131n\u0131 belirlemedeki yararl\u0131l\u0131\u011f\u0131n\u0131 teyit etmektedir. Bununla birlikte, \u00e7al\u0131\u015fma baz\u0131 zay\u0131f y\u00f6nler de ta\u015f\u0131maktad\u0131r. \u0130lk olarak, bu derlemeye dahil edilen \u00e7al\u0131\u015fmalar\u0131n hi\u00e7birinde bak\u0131m odakl\u0131 EKO\u2019nin sonlan\u0131m\u0131 iyile\u015ftirdi\u011fine dair bir veri yoktur. Bu nedenle, ultrason g\u00f6\u011f\u00fcs kompresyonlar\u0131nda kesintiye neden olmayacak \u015fekilde yap\u0131lmal\u0131d\u0131r. \u0130kincisi, ultrason operat\u00f6re ba\u011f\u0131ml\u0131d\u0131r, uygulay\u0131c\u0131n\u0131n raporlama e\u011fitim seviyesinin eksikli\u011fi, sonu\u00e7lar\u0131n farkl\u0131 seviyelerde raporland\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. \u00c7o\u011fu ara\u015ft\u0131rman\u0131n temel e\u011fitimle hekimler taraf\u0131ndan yap\u0131ld\u0131\u011f\u0131n\u0131 ve bu nedenle sonu\u00e7lar\u0131n ileri d\u00fczeydeki \u00e7al\u0131\u015fanlara genellenemeyece\u011fini varsay\u0131lm\u0131\u015ft\u0131r. \u00dc\u00e7\u00fcnc\u00fc olarak tarama protokolleri aras\u0131nda, tarama zaman\u0131 (bir defal\u0131k ilk de\u011ferlendirme ve s\u00fcrekli de\u011ferlendirme) ve pencereleri (tekli subkostal g\u00f6r\u00fcn\u00fcm vs. \u00e7oklu g\u00f6r\u00fcn\u00fcmler) gibi g\u00fc\u00e7l\u00fc heterojenlik bulunmu\u015f; dolay\u0131s\u0131yla do\u011fruluk indeksleri kardiyak arrestin geri d\u00f6nd\u00fcr\u00fclebilir nedenlerini saptamak i\u00e7in havuzlanamam\u0131\u015ft\u0131r. Bu nedenle, acil durumlarda geri d\u00f6n\u00fc\u015f\u00fcml\u00fc arrest nedenlerini te\u015fhis etmek i\u00e7in bak\u0131m odakl\u0131 EKO kullan\u0131m\u0131 sadece a\u00e7\u0131klay\u0131c\u0131 bilgilerle desteklenmektedir ve g\u00fcncel bak\u0131m standard\u0131n\u0131 de\u011fi\u015ftirmek i\u00e7in yeterli olmayabilir. D\u00f6rd\u00fcnc\u00fc olarak, hastalar\u0131n arrest \u00f6zellikleri (Travmatik \/ travmatik olmayan, kalp durmas\u0131 yeri), spontan kardiyak hareketin belirlenmesinde kriter olan EKO sonu\u00e7lar\u0131n\u0131n (organize kalp hareketi) ve yap\u0131lan m\u00fcdahalelerin heterojenli\u011finin fark\u0131nda olmak gerekir. Be\u015fincisi, do\u011frulamada \u00f6nyarg\u0131 riski vard\u0131r. \u0130YD\u2019ne m\u00fcdahale etmese de, bak\u0131m odakl\u0131 EKO sonu\u00e7lar\u0131, res\u00fcsitasyon \u00e7abas\u0131n\u0131n sona erdirilmesi karar\u0131n\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fcde etkileyecektir. Prospektif \u00e7al\u0131\u015fmalar, ilk EKO sonras\u0131 res\u00fcsitatif \u00e7abalar\u0131n belli bir s\u00fcre (\u00f6rne\u011fin 15 dakika) devam ettirilmesi ve res\u00fcsitasyon uygulay\u0131c\u0131lar\u0131n\u0131n EKO sonu\u00e7lara k\u00f6r olmas\u0131 sa\u011flanarak bu \u00f6nyarg\u0131lardan ar\u0131nd\u0131r\u0131labilir.<\/p>\r\n\r\n\r\n\r\n
Mevcut literat\u00fcr, bak\u0131m odakl\u0131 EKO\u2019nin sonu\u00e7lar\u0131 \u00f6ng\u00f6rmek ve kardiyak arrest hastalar\u0131nda d\u00fczeltilebilir nedenleri belirlemek i\u00e7in kullan\u0131labilece\u011fini \u00f6nermektedir. \u00c7al\u0131\u015fman\u0131n bulgular\u0131, EKO\u2019de spontan kardiyak hareketin yoklu\u011funun hayatta kalma olas\u0131l\u0131\u011f\u0131n\u0131 \u00f6nemli derecede d\u00fc\u015f\u00fcrd\u00fc\u011f\u00fcn\u00fc ve res\u00fcsitasyon sonland\u0131rma karar\u0131n\u0131n al\u0131nmas\u0131na yard\u0131mc\u0131 oldu\u011funu g\u00f6stermektedir. \u015eu an itibariyle, bu sistematik g\u00f6zden ge\u00e7irme klinik \u00f6nerilere ili\u015fkin en iyi mevcut kan\u0131t olarak kabul edilebilir.\u00a0<\/p>\r\n\r\n\r\n\r\n
Tsou, Po-Yang et al.,\u00a0Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis.\u00a0Resuscitation , Volume 114 , 92 – 99.<\/em> https:\/\/doi.org\/10.1016\/j.resuscitation.2017.02.021<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":" Giri\u015f Amerika\u2019da her y\u0131l 359.400 adet hastane d\u0131\u015f\u0131 kardiyak arrest vakas\u0131 geli\u015fmektedir. Her ne kadar temel ya\u015fam deste\u011fi ve ileri ya\u015fam deste\u011fi…<\/p>\n","protected":false},"author":1599,"featured_media":4145,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,12],"tags":[43,10026],"class_list":["post-2176","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-eko","tag-kpr"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1599"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2176"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2176\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/4145"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2176"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2176"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}