Management of Patients After Out of Hospital Cardiac Arrest
Management of Patients After Out of Hospital Cardiac Arrest
The outcome for patients after an out-of-hospital cardiac arrest (OHCA) has been poor over many decades and single interventions have mostly resulted in disappointing results. More recently, some regions have observed better outcomes after redesigning their cardiac arrest pathways. Optimised resuscitation and prehospital care is absolutely key, but in-hospital care appears to be at least as important. OHCA treatment requires a multidisciplinary approach, comparable to trauma care; the development of cardiac arrest pathways and cardiac arrest centres may dramatically improve patient care and outcomes. Besides emergency medicine physicians, intensivists and neurologists, cardiologists are playing an increasingly crucial role in the post-resuscitation management, especially by optimising cardiac output and undertaking urgent coronary angiography/intervention.
Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality and serious morbidity throughout many regions of the world. Although there have been major advances in resuscitation practice, the survival rate for patients with OHCA, with a few recent exceptions, has remained poor for over 30 years: most regions report a survival rate to hospital discharge of <10%. For many years, research has focused on optimising prehospital management, as described recently in this journal.
After return of spontaneous circulation (ROSC), the aim is to limit neurological disability by optimising cardiocerebral resuscitation. The optimum therapeutic strategy after ROSC for patients with OHCA remains unknown. Increasing evidence suggests that optimising post-resuscitation management using a standardised treatment protocol and a multidisciplinary strategy can significantly improve survival. With optimal post-resuscitation care, OHCA should no longer be perceived as a terminal event. In recent years, survival rates have started to improve significantly in some regions, probably because of multiple factors, which will be explored in this review. We will focus on the current status of post-resuscitation science and provide clinical guidance on the in-hospital management of patients with OHCA.
Abstract and Introduction
Abstract
The outcome for patients after an out-of-hospital cardiac arrest (OHCA) has been poor over many decades and single interventions have mostly resulted in disappointing results. More recently, some regions have observed better outcomes after redesigning their cardiac arrest pathways. Optimised resuscitation and prehospital care is absolutely key, but in-hospital care appears to be at least as important. OHCA treatment requires a multidisciplinary approach, comparable to trauma care; the development of cardiac arrest pathways and cardiac arrest centres may dramatically improve patient care and outcomes. Besides emergency medicine physicians, intensivists and neurologists, cardiologists are playing an increasingly crucial role in the post-resuscitation management, especially by optimising cardiac output and undertaking urgent coronary angiography/intervention.
Introduction
Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality and serious morbidity throughout many regions of the world. Although there have been major advances in resuscitation practice, the survival rate for patients with OHCA, with a few recent exceptions, has remained poor for over 30 years: most regions report a survival rate to hospital discharge of <10%. For many years, research has focused on optimising prehospital management, as described recently in this journal.
After return of spontaneous circulation (ROSC), the aim is to limit neurological disability by optimising cardiocerebral resuscitation. The optimum therapeutic strategy after ROSC for patients with OHCA remains unknown. Increasing evidence suggests that optimising post-resuscitation management using a standardised treatment protocol and a multidisciplinary strategy can significantly improve survival. With optimal post-resuscitation care, OHCA should no longer be perceived as a terminal event. In recent years, survival rates have started to improve significantly in some regions, probably because of multiple factors, which will be explored in this review. We will focus on the current status of post-resuscitation science and provide clinical guidance on the in-hospital management of patients with OHCA.
Source...