Evaluation of the factors affecting mortality after cardiac arrest - do lactate and procalcitonin concentrations have any implications?

OBJECTIVE: Mortality and morbidity rates are very high in patients admitted to the Intensive Care Unit (ICU) after cardiac arrest. In this study, we aimed to determine the mortality rates, risk factors, and predictive factors for mortality in post-cardiac arrest patients admitted to the ICU. PATIENTS AND METHODS: Following approval from the Ethics Committee, we conducted a retrospective review of patient files for individuals over the age of 18 who received treatment for cardiac arrest in the ICU from January 2017 to June 2020. Demographic data of the patients, comorbidities, arrest location, etiology of arrest, duration of hospitalization, CPR duration, APACHE 2 scores, pH and HCO3 measurements in initial blood gases, lactate levels (1st, 6th, 12th, 24th hour), change in lactate levels (24-1), rate of lactate change, procalcitonin (PRC) levels (1st and 24th hour), change in PRC levels (24-1), rate of PRC change, and blood glucose levels were recorded. The patients were divided into two groups (survivors and non-survivors groups). RESULTS: 151 patients were included in the study. pH and HCO3 levels were lower in the non-survivors group than in the survivors group. Initial PRC levels were similar in both groups, but the 24th-hour PRC levels were higher, and the changes in PRC levels in the first 24 hours were greater in the non-survivors group. The lactate changes in the first 24 hours were higher in the non-survivors group. The receiver operating characteristic (ROC) curve showed that the HCO3 levels, 1st-, 6th-, 12th-, and 24th-hour lactate levels, and changes in lactate levels had predictability for mortality. In logistic regression analysis, we found that high 24th-hour lactate levels and changes in lactate levels were independent risk factors for mortality. CONCLUSIONS: Considering PRC and lactate levels, along with clinical examination and laboratory findings, may improve the accuracy of determining the prognosis of patients experiencing cardiac arrest.

Effect of ultrasound-guided bilateral erector spinae plane block for postoperative analgesia in patients undergoing multilevel posterior spinal instrumentation.

OBJECTIVE: Patients undergoing spinal fusion surgery suffer from severe postoperative pain. The study aims to investigate the effectiveness of ultrasound-guided erector spinae plane block in alleviating pain following multilevel spinal fusion with instrumentation. PATIENTS AND METHODS: Forty-two patients, who were in classes I-II-III according to the American Society of Anesthesiologists (ASA) classification and were scheduled for lumbar spinal fusion surgery, were randomly divided at a ratio of 1:1 into the erector spinae plane block (ESPB) group and the control group. While an erector spinae plane block was applied before surgery in the ESPB group, no block was involved in the control group. A patient-controlled analgesia pump containing morphine was attached to each patient after surgery. The primary outcome was the amount of morphine used in 24 hours. The secondary outcomes included pain scores and rescue analgesia requirements at different time points. RESULTS: The 24-hour morphine consumption level of the ESPB group was significantly lower than that of the control group (p=0.005). Pain intensity, which was assessed using The Numerical Rating Scale (NRS), was found to be significantly lower in the ESPB group (p<0.05). NRS scores of the two groups were similar at the 12th and 24th hours (respectively, p=0.097 and p=0.157). While rescue analgesia was administered to 71.4% of the patients in the control group, it was administered to 28.6% of those in the ESPB group. The difference between the groups was significant (p=0.005). CONCLUSIONS: Ultrasound-guided bilateral erector spinae plane block in multilevel spinal fusion surgery with instrumentation alleviates severe postoperative pain and reduces opioid consumption.