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Kebutuhan akan dukungan sirkulasi mekaniksecara diniuntuk meningkatkan perfusi organ harus dipertimbangkandalam 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 diniPBIA terhadap mortalitas pasien pasca henti jantungkarena sindrom koroner akut (SKA).

Penelitian uji klinis yang melibatkan 60 pasieninidilakukan pada pasca henti jantung karena SKA di dilakukan RSJPDHKperiodeOktober 2017–Desember 2018K.Kriteria inklusi adalah semua pasien pasca henti jantung karena sindrom koroner akut, berusia 18–75 tahun.Kriteria eksklusi adalah terdapat riwayat strokeberdasarkan anamnesis, pupil anisokor, sudah menggunakan PBIA sebelumnya, regurgitasi aorta, sindrom brugada dan congenital long QT.Pasien dirandomisasi menjadi kelompok pelakuan dan kontrol.. Pasien dibagi menjadi dua kelompok yaitu perlakuan (n= 30) dan kontrol (n =30). 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 ke-0 dan jam ke-6 pasca kembali sirkulasi spontan.Luaran primer yang dinilai adalah mortalitas rumah sakit.,Luaransekunder yang dinilai adalahperbaikan hemodinamik, dan marka apoptosisdan kemampuanprediksi beklin-1, kaspase-3, interleukin-6 dan laktat jam ke-0 terhadap kematian. Analisisregresi cox dilakukan untuk menilai kesintasan pasien di RSdengan prinsip intention-to treat.

Sebanyak 60 pasien pasca henti jantung karena SKA, 30 di kelompok perlakuan dan 30 di kelompok kontroldiikutsertakan dalam penelitian ini.Mortalitas pada kelompok perlakuan adalah 18 (60%) pasien, sedangkan pada kelompok kontrol adalah 17 (56,67%) pasien.  ([p=0,793; hazard ratio 1,29; [IK] 95% 0,66–2,52). Tidak terdapat perbedaan kadar IL-6, BLE, beclinbeklin-1, caspasekaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO₂ diff, dan ScvO₂di 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 tidakmemperbaiki mortalitas pasien SKA pasca henti jantung. .Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA.

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The need formechanical circulatory support to improve organ perfusion may be considered inthemanagement 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.¹This study aimed to find out whether early insertion of IABP can reduce in-hospital 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, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2 Diff, and ScvO2 was done in first hour and 6 hours afterreturn 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, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO₂Diff, and ScvO₂in 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 improvemortality outcome of post cardiac arrest complicating acute myocardial infarctionpatients. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients.

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"Penyakit jantung koroner (PJK) menyebabkan ketidakseimbangan suplai dan kebutuhan metabolik miokard dalam melakukan fungsi sirkulasi dan homeostasis. Baku emas terapi PJK adalah bedah pintas arteri koroner (BPAK). Prosedur BPAK dengan mesin pintas jantung paru (PJP) dapat mencetuskan cedera miokard tingkat selular sehingga memerlukan aplikasi proteksi miokard. Glutamin adalah asam amino conditionally essential yang berperan dalam proteksi miokard dengan membentuk energi selama periode iskemia, tetapi belum teruji penggunaannya pada pasien dengan fraksi ejeksi rendah. Padahal, pasien fraksi ejeksi (EF) rendah lebih rentan terhadap cedera miokard, sehingga glutamin diharapkan dapat memberi proteksi. Penelitian menggunakan desain double blind randomized controlled trial di Instalasi Bedah Jantung Dewasa RSJPDHK Jakarta pada bulan Januari–Agustus 2021 dengan subjek penelitian 60 pasien sesuai kriteria inklusi dan eksklusi. Alokasi random subjek untuk memilih 30 pasien mendapatkan 500 mL glutamin 0,5 g/kg dalam NaCl 0,9% sebagai kelompok intervensi (glutamin), dan 30 pasien mendapatkan NaCl 0,9% sebanyak 500 mL sebagai kelompok kontrol selama 24 jam pertama. Pengukuran yang dilakukan meliputi kadar glutamin plasma, kadar α-KG, myocardial injury score, indeks apoptosis, ekspresi anti-kardiak troponin I, kadar troponin I, EF, indeks jantung dan kadar laktat. Dua subjek drop out sehingga analisis dilakukan terhadap 58 subjek. Efek proteksi miokard glutamin terlihat pada kadar troponin I, laktat plasma, dan myocardical injury score yang lebih rendah pada kelompok glutamin, serta ekspresi anti-kardiak troponin I jaringan apendiks atrium kanan jantung setelah mesin PJP dilepas lebih tinggi dibandingkan kontrol. Tidak didapatkan perbedaan bermakna indeks apoptosis jaringan apendiks atrium kanan, fraksi ejeksi pasca-operasi, penggunaan vasoaktif dan inotropik pasca-operasi, durasi penggunaan ventilator dan durasi perawatan intensif pasca-operasi pada kedua kelompok. Simpulan: Pemberian preoperatif glutamin 0,5 g/kg secara intravena dalam 24 jam pertama memiliki efek proteksi miokard pada pasien BPAK elektif dengan EF rendah yang menggunakan mesin PJP.

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Coronary heart disease (CHD) causes a myocardial metabolic supply and demand imbalance in performing circulatory and homeostatic functions. The gold standard treatment of CHD is coronary artery bypass graft (CABG). The CABG procedure with a cardiopulmonary bypass (CPB) machine can trigger myocardial injury at cellular level due to ischemia and reperfusion. Glutamine is a conditionally essential amino acid in the human body which has a role as myocardial protector through energy production during myocardial ischemia. However, its application has not been tested in low ejection fraction (EF) patients. Meanwhile, patients with low EF are more vulnerable to myocardial injury. Thus, glutamine administration was expected to provide myocardial protection. The study was a double-blind, randomized controlled trial design and was performed at the Adult Cardiac Surgery Installation of the National Cardiovascular Center Harapan Kita, Jakarta from January to August 2021 with a sample size of 60 patients meeting the inclusion and exclusion criteria. Subjects were randomly allocated into intervention (glutamine): 30 patients were administered a solution of glutamine 0.5 g/kg dissolved in 0.9% NaCl up to 500 mL in total volume and control group; 30 patients were administered 500 mL of 0.9% NaCl, both over a period of the first 24 hours. Parameters measured include plasma glutamine levels, α-KG levels, myocardial injury scores, apoptotic index, anti-cardiac troponin I expression, troponin I levels, EF, cardiac index and lactate levels. Two samples were dropped out; hence 58 patients were analyzed in this study. Myocardial protective effects of glutamine are observed in plasma troponin I, lactate levels, and myocardial injury score of right atrial appendage tissue, which were significantly lower in the glutamine group and higher anti-cardiac troponin I expression of right atrial appendage tissue in the glutamine group. Apoptotic index of right atrial appendage tissue, postoperative ejection fraction, postoperative use of vasoactive and inotropic, ventilator time, and duration of intensive care showed no significant differences in both groups. Conclusion: Preoperative administration of intravenous glutamine 0.5 g/kg in the first 24 hours has a cardioprotective effect in low EF patients underwent elective on-pump CABG."