CARDIAC ARREST

PADA SETTING
Pembimbing:ICU
dr. Tommy Nugroho,
SpAn

Disusun oleh :
Jessica Kristianto 201806010054
Resley Ongga Mulia 201806010069
Angeline Asehan 201806010101
Amelia Prasetyadi 201906010087
Valencia Shirleen 201906010173
 CONTENTS

01 03 05
Morbiditas dan Deteksi dini Prognosis
Mortalitas dan tindakan post
02 04 cardiac arrest
Faktor risiko Respon/
Tindakan definitif
 01
MORBIDITAS DAN
MORTALITAS
 Morbiditas
● Insiden pasti Cardiac Arrest terkait perwatan
di ICU → belum diketahui pasti
● Sistematik review oleh Efendijev et al → di
ICU terjadi 5,6-78,1 Cardiac Arrest per
1000 admission.
● Southmead Hospital, Bristol → 25 kejadian
Cardiac Arrest per 1000 admission.

● Belanda → 4,6% pasien di ICU terkena

Cardiac Arrest

Cook, James, and Matt Thomas. “Cardiac Arrest in ICU.” Journal of the Intensive Care Society 18, no. 2 (May 2017): 173–173.
Mandigers, Loes, Fabian Termorshuizen, Nicolette F. de Keizer, Diederik Gommers, Dinis dos Reis Miranda, Wim J.R. Rietdijk, and Corstiaan A. den Uil. “A Nationwide Overview of 1-Year
Mortality in Cardiac Arrest Patients Admitted to Intensive Care Units in the Netherlands between 2010 and 2016.” Resuscitation 147 (February 2020): 88–94.
Mortalitas
● Eropa → Mortalitas pasien
dengan Cardiac arrest di ICU
53-66%
 02
FAKTOR RISIKO
DAN ETIOLOGI
 AHA Journals
2011

Modi Simon, Krahn Andrew D. Sudden Cardiac Arrest Without Overt Heart Disease. Circulation. 2011 Jun 28;123(25):2994–3008.
 AHA Journals
2011

Modi Simon, Krahn Andrew D. Sudden Cardiac Arrest Without Overt Heart Disease. Circulation. 2011 Jun 28;123(25):2994–3008.
Modi Simon, Krahn Andrew D. Sudden Cardiac Arrest Without Overt Heart Disease. Circulation. 2011 Jun 28;123(25):2994–3008.
Armstrong RA, Kane C, Oglesby F, Barnard K, Soar J, Thomas M. The incidence of cardiac arrest in the intensive care unit: A systematic review and meta-analysis. J
Madhavan M,
Friedman P,
Lennon R, Prasad
A, White R,
Chenni S, et al.
Implantable
Cardioverter‐
Defibrillator
Therapy in
Patients With
Ventricular
Fibrillation out of
Hospital Cardiac
Arrest Secondary
to Acute Coronary
Syndrome. Journal
of the American
Heart Association.
2015 Feb 23;4.
 ICU-CA
(~0,5-5%)

Peningkatan derajat keparahan

penyakit

Pasca Riwayat Penyakit Kesiapan

Pembedahan Jantung dan Paru perawat
22,4/1000 24,4-78,5%;13,3-39,7%
Aminuddin. Analisis faktor yang berhubungan dengan kesiapan perawat dalam menangani cardiac arrest di ruangan ICCU dan ICU RSU Anutapura Palu. Jurnal keperawatan Soedirman.2013

Armstrong RA, Kane C, Oglesby F, Barnard K, Soar J, Thomas M. The incidence of cardiac arrest in the intensive care unit: A systematic review and meta-analysis. J Intensive Care Soc. 2019 May;20(2):144–54.

Lee H-K, Lee H, No J-M, Jeon Y-T, Hwang J-W, Lim Y-J, et al. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand. 2013 Jul;57(6):784–92.
 Kesiapan
perawat

Pengetahuan Pelatihan Fasilitas

Analisis Bivariat
chi square

Aminuddin. Analisis faktor yang berhubungan dengan kesiapan perawat dalam menangani cardiac arrest di ruangan ICCU dan ICU RSU Anutapura Palu. Jurnal
 Kesiapan
Pengetahuan
perawat

Aminuddin. Analisis faktor yang berhubungan dengan kesiapan perawat dalam menangani cardiac arrest di ruangan ICCU dan ICU RSU Anutapura Palu. Jurnal
 Kesiapan
Fasilitas
perawat

Aminuddin. Analisis faktor yang berhubungan dengan kesiapan perawat dalam menangani cardiac arrest di ruangan ICCU dan ICU RSU Anutapura Palu. Jurnal
 Kesiapan
Pelatihan
perawat

Aminuddin. Analisis faktor yang berhubungan dengan kesiapan perawat dalam menangani cardiac arrest di ruangan ICCU dan ICU RSU Anutapura Palu. Jurnal
● Hasil penelitian ini menunjukkan bahwa partisipasi dari
pelatihan penanganan cardiac arrest setiap 6 bulan sekali
dapat meningkatkan kemampuan praktikal dan
pengetahuannya
● Tingkat pengetahuan juga berpengaruh terhadap performa
Wolfe H, Zebuhr C, Topjian AA, Nishisaki A, Niles DE, Meaney PA, et al. Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes. Crit Care Med.
2014 Jul;42(7):1688–95.
 03
DETEKSI DINI
 DETEKSI DINI

● Probable Cause
○ 40% → Respiratory failure
○ 34% → Cardiac failure
○ 26% → Syok

● 73,3% → ROSC after CPR

● Survival Rate
○ 43,5% → 24 jam
○ 24,4% → 1 bulan
○ 20,6% → 3 bulan

Lee H-K, Lee H, No J-M, Jeon Y-T, Hwang J-W, Lim Y-J, et al. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand. 2013.
 DETEKSI DINI

● Gejala: nyeri dada, dyspnea, palpitasi

● ICU → bedside monitor
○ TTV (TD, SpO2, RR, HR, T)
○ Waveform: EKG
● 95% → alarm (88% → false positive)

Chugh SS. Early identification of risk factors for sudden cardiac death. Nat Rev Cardiol. 2010.
Drew BJ, et al. Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive
Intensive Care Unit Patients. PLOS ONE. 2014.
 DETEKSI DINI

Drew BJ, et al. Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients. PLOS ONE. 2014.
 DETEKSI DINI

Drew BJ, et al. Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients. PLOS ONE. 2014.
 04
RESPON/TINDAKAN DEFINITIF
 Respon Terhadap Cardiac Arrest

Pada setting di rumah sakit health care provider akan melakukan :

● Memastikan safety
● Check respon pasien
● Menyiapkan team resusitasi
● Dilakukan pengecekan nadi dan napas (<10 detik)
● Mempersiapkan automated external defibrillator (AED) and alat-alat emergensi
● Mulai CPR dan lakukan defibrillasi apabila defibrillator sudah tersedia
TINDAKAN UNTUK CARDIAC ARREST PADA ORANG DEWASA
2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An
Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
 TINDAKAN UNTUK CARDIAC ARREST PADA ANAK-ANAK

Duff J, Topjian A, Berg M, Chan M, Haskell S, Joyner B et al. 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138(23) .

Duff J, Topjian A, Berg M, Chan M, Haskell S, Joyner B et al. 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138(23) .

 05
PROGNOSIS DAN TINDAKAN
POST CARDIAC ARREST
IMMEDIATE POST-CARDIAC ARREST CARE ALGORITHM
Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the
European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202‐222. doi:10.1016/j.resuscitation.2015.07.018
 PROGNOSIS
Faktor yang menentukan prognosis :
- Penyebab henti jantung (co. overdosis, kardiomiopati)
- Adanya komorbiditas (co. metastasis kanker, demensia)
- Penilaian henti jantung dan kardiovaskular
- Penilaian neurologis

Prediktor prognosis buruk :

- Refleks pupil (-) dalam 72 jam → paling akurat
- Refleks kornea (-) dalam 72 jam
- Respons motorik (-) / ekstensi terhadap nyeri dalam 72 jam → GCS M≤2
- Myoclonic status epilepticus (MSE) → CNS injury
- Bilateral absence of cortical SSEPs (N20 response) pada hari ke 1-3
(electrophysiology)
- Serum neuron-specific enolase > 33 μg/L pada hari ke 1-3 (biomarker)

Nickson D, Nickson D. Prognosis After Cardiac Arrest • LITFL • CCC Differential Diagnosis. Life in the Fast Lane • LITFL • 2020
Sandroni, C., D’Arrigo, S. & Nolan, J.P. Prognostication after cardiac arrest. Crit Care 22, 150 (2018). https://doi.org/10.1186/s13054-018-2060-7
Sandroni C, Geocadin RG. Neurological prognostication after cardiac arrest. Curr Opin Crit Care. 2015;21(3):209‐214. doi:10.1097/MCC.0000000000000202
 PROGNOSIS
Kurang bermanfaat :
- Tidak dilakukan CPR > 8 menit
- Waktu untuk ROSC > 30 menit
- Durasi koma anoxic > 72 jam
- Perubahan gelombang epileptiform pada EEG

Prediktor untuk prognosis baik :

- Refleks batang otak pulih dalam 48 jam (oculocephalic, papillary, corneal)
- Respons pulih dalam 24 jam
- Usia muda

Nickson D, Nickson D. Prognosis After Cardiac Arrest • LITFL • CCC Differential Diagnosis. Life in the Fast Lane • LITFL • 2020
Sandroni, C., D’Arrigo, S. & Nolan, J.P. Prognostication after cardiac arrest. Crit Care 22, 150 (2018). https://doi.org/10.1186/s13054-018-2060-7
Sandroni C, Geocadin RG. Neurological prognostication after cardiac arrest. Curr Opin Crit Care. 2015;21(3):209‐214. doi:10.1097/MCC.0000000000000202
Randhawa VK, Grunau BE, Debicki DB, et al. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins. Can J Cardiol.
2018;34(2):156‐167. doi:10.1016/j.cjca.2017.11.013
THANKYOU