Birgit Markus, Nikolaos Patsalis, Charlotte Müller, Georgios Chatzis, Leona Möller, Rosita Rupa, Simon Viniol, Susanne Betz, Bernhard Schieffer, Julian Kreutz
{"title":"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。","authors":"Birgit Markus, Nikolaos Patsalis, Charlotte Müller, Georgios Chatzis, Leona Möller, Rosita Rupa, Simon Viniol, Susanne Betz, Bernhard Schieffer, Julian Kreutz","doi":"10.1093/ehjqcco/qcae032","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"707-718"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early goal-directed management after out-of-hospital cardiac arrest: lessons from a certified cardiac arrest centre.\",\"authors\":\"Birgit Markus, Nikolaos Patsalis, Charlotte Müller, Georgios Chatzis, Leona Möller, Rosita Rupa, Simon Viniol, Susanne Betz, Bernhard Schieffer, Julian Kreutz\",\"doi\":\"10.1093/ehjqcco/qcae032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":11869,\"journal\":{\"name\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"volume\":\" \",\"pages\":\"707-718\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjqcco/qcae032\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Quality of Care and Clinical Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ehjqcco/qcae032","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Early goal-directed management after out-of-hospital cardiac arrest: lessons from a certified cardiac arrest centre.
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.
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.