Text

Efektivitas Insersi Dini Pompa Balon Intra Aorta terhadap Mortalitas Pasien Pasca Henti Jantung Karena Sindrom Koroner Akut: Kajian terhadap Laktat, Interleukin-6, Beklin1, dan Kaspase-3 = The Effect of IABP Early Insertion on Mortality in Post Cardiac Arrest Patients with Acute Coronary Syndrome: A Study of Lactate, Interleukin-6, Beclin-1, and Caspase-3.

Kebutuhan akan dukungan sirkulasi mekanik secara dini untuk meningkatkan perfusi organ harus dipertimbangkan dalam manajemen pasien pasca henti jantung. Pompa Balon Intra-Aorta (PBIA) merupakan alat bantu sirkulasi mekanik yang paling mudah dipakai dan tersedia di negara berkembang seperti Indonesia. Tujuan penelitian ini adalah untuk mengetahui efektivitas insersi dini PBIA terhadap mortalitas pasien pasca henti jantung karena sindrom koroner akut (SKA). Penelitian uji klinis ini dilakukan pada pasca henti jantung karena SKA dilakukan RSJPDHK periode Oktober 2017–Desember 2018. Kriteria inklusi adalah semua pasien pasca henti jantung karena sindrom koroner akut, berusia 18–75 tahun. Kriteria eksklusi adalah terdapat riwayat stroke, pupil anisokor, sudah menggunakan PBIA sebelumnya, regurgitasi aorta, sindrom brugada dan congenital long QT. Pasien dirandomisasi menjadi kelompok pelakuan dan kontrol. Kelompok perlakuan diberikan intervensi insersi PBIA sedini mungkin dalam 3 jam pertama setelah sirkulasi spontan kembali. Pemeriksaan kadar interleukin-6, bersihan laktat efektif (BLE), beklin-1, kaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO2 diff, dan ScvO2 dilakukan di jam ke0 dan jam ke-6 pasca kembali sirkulasi spontan. Luaran primer yang dinilai adalah mortalitas rumah sakit. Luaran sekunder yang dinilai adalah perbaikan hemodinamik, marka apoptosis dan kemampuan prediksi beklin-1, kaspase-3, interleukin-6 dan laktat jam ke-0 terhadap kematian. Analisis regresi cox dilakukan untuk menilai kesintasan pasien di RS dengan prinsip intention-to treat. Sebanyak 60 pasien pasca henti jantung karena SKA, 30 di kelompok perlakuan dan 30 di kelompok kontrol diikutsertakan dalam penelitian ini. Mortalitas pada kelompok perlakuan adalah 18 (60%) pasien, sedangkan kontrol 17 (56,67%) pasien ([p = 0,793; hazard ratio 1,29; [IK] 95% 0,66–2,52). Tidak terdapat perbedaan kadar IL-6, BLE, beklin-1, kaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO2 diff, dan ScvO2 di jam ke-6 pasca SSK antara dua kelompok. Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA, sedangkan Beklin-1 tidak dapat memprediksi kematian. Simpulan: Pemasangan PBIA dini tidak memperbaiki mortalitas pasien SKA pasca henti jantung. Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA.
Kata kunci: henti jantung, PBIA


The need for mechanical circulatory support to improve organ perfusion may be considered in the management of post cardiac arrest syndrome patients. Intra Aortic Balloon Pump (IABP) is the most available and convenient used mechanical circulation aid especially in developing countries such as Indonesia. This study aimed to find out whether early insertion of IABP can reduce inhospital mortality, length of stay and death markers of cardiac arrest complicating acute myocardial infarction. A randomized trial conducted in National Cardiovascular Center Harapan Kita (NCCHK) Hospital from October 2017–December 2018. Inclusion criteria were all post cardiac arrest due to acute coronary syndrome (ACS) patients aged 18–75 years. Exclusion criteria were history of stroke, anisocoric pupil, previous IABP use, aortic regurgitation, brugada syndrome, and congenital long QT syndrome. The intevention group was given IABP inserted as early as possible in the first 3 hours after spontaneous circulation returned. Patients were randomized into two groups, intervention and controls. Assessment of interleukin-6, lactate clearence, beclin-1, caspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2 Diff, and ScvO2 was done in first hour and 6 hours after return of spontaneous circulation (ROSC). Primary outcome was in-hospital mortality. Secondary outcome was improved hemodynamics, apoptotic markers, and predictive ability of beclin-1, caspase-3, IL-6 and lactate in first hour after ROSC to mortality. Cox regression analysis was performed to assess in-hospital survival with the intention-to-treat principle. A total of 60 post cardiac arrest due to ACS patients, 30 in intervention group and 30 controls included in this study. In hospital mortality of intervention group vs control was 18 (60%) vs. 17 (56.67%) respectively ([p = 0.793; hazard ratio 1.29; [CI] 95% 0,66–2.52). There’s no difference in IL-6, lactate clearence, beclin-1, caspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2 Diff, and ScvO2 in 6 hours after ROSC between two groups. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients while beclin-1 does not. Conclusion: Early insertion of IABP is not improve mortality outcome of post cardiac arrest complicating acute myocardial infarction patients. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients.
Keywords: cardiac arrest, IABP