Cadiology intensive care in patients with out-of-hospital cardiac arrest or cardiogenic shock

Abstract

Background

Despite advances in therapy, mortality remains high after out-of-hospital cardiac arrest (OHCA) and cardiogenic shock (CS). While recent trials have improved CS care, OHCA management appears to have stagnated following neutral or negative results.

Objectives

To evaluate the Hannover Cardiac Resuscitation Algorithm (HaCRA) for standardized early diagnostic and therapeutic management of OHCA and CS patients prior to intensive care admission.

Methods

All OHCA and CS patients admitted under HaCRA underwent structured evaluation for ventilatory and circulatory support, including non-invasive imaging, cardiac catheterization with revascularization, mechanical circulatory support, therapeutic hypothermia, and invasive haemodynamic monitoring. A cardiology intensive care team supervised care from admission to intensive care.

Results

A total of 946 OHCA and 506 CS patients were treated. Mechanical circulatory support was required in 21 % of OHCA patients. Among CS patients receiving a micro-axial flow pump, 49 % had been resuscitated beforehand. OHCA mortality was 44 % overall, 33 % in shockable rhythms, and 61 % in non-shockable rhythms. Patients meeting inclusion criteria of the targeted temperature management (TTM)-trial had a mortality rate of 23 % with predominantly good neurological outcomes. CS patients requiring circulatory support had 52 % mortality, ranging from 35 % with micro-axial flow pump support to 59 % with biventricular support.

Conclusions

Implementation of HaCRA, coordinated by cardiology consultants trained in both interventional cardiology and intensive care, standardizes the management of OHCA and CS and may improve outcomes in these critically ill populations.