Early goal-directed management after out-of-hospital cardiac arrest: lessons from a certified cardiac arrest centre.

IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Birgit Markus, Nikolaos Patsalis, Charlotte Müller, Georgios Chatzis, Leona Möller, Rosita Rupa, Simon Viniol, Susanne Betz, Bernhard Schieffer, Julian Kreutz
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引用次数: 0

Abstract

Background: Despite continuous advances in post-resuscitation management, the outcome after out-of-hospital cardiac arrest (OHCA) is limited. To improve the outcome, interdisciplinary cardiac arrest centres (CACs) have been established in recent years, but survival remains low, and treatment strategies vary considerably in clinical and geographical aspects. Here we analysed a strategy of in-hospital post-resuscitation management while evaluating the outcome.

Methods: A broad spectrum of pre- and in-hospital parameters of 545 resuscitated patients admitted to the Cardiac Arrest Center of the University Hospital of Marburg between January 2018 and December 2022 were retrospectively analysed. Inclusion criteria were ≥18 years, resuscitation by emergency medical services, and non-traumatic cause of OHCA.

Results: In the overall patient cohort, the survival rate to hospital discharge was 39.8% (n = 217/545), which is 50.7% higher than in the EuReCa-TWO registry. A total of 77.2% of the survivors had CPC status 1 or 2 (favourable neurological outcome) before and after therapy. A standardized 'therapy bundle' for in-hospital post-resuscitation management was applied to 445 patients who survived the initial treatment in the emergency department. In addition to basic care (standardized antimicrobial therapy, adequate anticoagulation, targeted sedation, early enteral, and parenteral nutrition), it includes early whole-body CT (n = 391; 87.9%), invasive coronary diagnostics (n = 322; 72.4%), targeted temperature management (n = 293; 65.8%), and if indicated, mechanical circulatory support (n = 145; 32.6%), and appropriate neurological diagnostics.

Conclusions: Early goal-directed post-resuscitation management in a well-established and highly frequented CAC leads to significantly higher survival rates. However, our results underline the need for a broader standardization in post-resuscitation management to ultimately improve the outcome.

院外心脏骤停后的早期目标导向管理:一家认证心脏骤停中心的经验。
背景:尽管复苏后管理不断进步,但院外心脏骤停(OHCA)后的治疗效果有限。为了改善预后,近年来成立了跨学科的心脏骤停中心(CACs),但存活率仍然很低,而且治疗策略在临床和地域方面也有很大差异。在此,我们分析了院内复苏后的管理策略,同时对结果进行了评估:方法:我们对马尔堡大学医院心脏骤停中心(MCAC)在2018年1月1日至2022年12月12日期间收治的545名复苏患者的一系列院前和院内参数进行了回顾性分析。纳入标准为:年龄≥18岁、由急救医疗服务部门复苏、非创伤性原因导致的OHCA:在整个患者队列中,出院存活率为 39.8%(n = 217/545),比 EuReCa-TWO 登记的存活率高 50.7%。77.2%的幸存者在治疗前后的CPC状态均为1或2(良好的神经功能预后)。对 445 名在急诊科接受初步治疗后存活的患者采用了标准化的 "治疗捆绑 "进行院内复苏后管理。除了基本护理(标准化抗菌治疗、适当的抗凝、有针对性的镇静、早期肠内和肠外营养)外,还包括早期全身 CT(391 人;87.9%)、侵入性冠状动脉诊断(322 人;72.4%)、有针对性的体温管理(293 人;65.8%),如果有必要,还包括机械循环支持(145 人;32.6%)和适当的神经系统诊断:结论:在条件完善、就诊率高的 CAC 中进行早期目标明确的复苏后管理可显著提高存活率。然而,我们的研究结果强调,需要对复苏后管理进行更广泛的标准化,以最终改善结果。
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来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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