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Published on: January 30, 2020
Evidence-Based Approach to Out-of-Hospital Cardiac Arrest
Mohammad Amin Kashef1, Amir S Lotfi2
1Hampden and Franklin County Cardiovascular Associates, Springfield, MA USA.
Insights
Out-of-hospital cardiac arrest (OHCA) management remains challenging, with neurological injury being a primary cause of death. Improving emergency response, CPR, defibrillation, and temperature management can enhance survival rates for OHCA patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) is a significant cause of mortality globally.
- Despite advancements in cardiac disease management, patient outcomes post-OHCA remain suboptimal.
- The COVID-19 pandemic has introduced novel complexities in managing OHCA cases.
Purpose of the Study:
- To review current management strategies for OHCA survivors.
- To present evidence-based treatments for OHCA.
- To identify existing knowledge gaps in OHCA care.
Main Methods:
- This is a review article, synthesizing existing literature.
- Information was gathered on OHCA management, treatments, and outcomes.
- Analysis focused on factors influencing survival and prognostication.
Main Results:
- Neurological injury, shock, and multiorgan failure are leading causes of death post-OHCA.
- Interventions such as improved EMS response, bystander CPR, early defibrillation, and targeted temperature management improve survival.
- Early cardiac catheterization, hemodynamic assessment, and mechanical support are recommended for specific patient groups.
- Prognostication tools aid clinical decision-making.
Conclusions:
- Clinical decision-making for OHCA patients is complex.
- There is a critical need for more randomized controlled trials to establish evidence-based guidelines for OHCA care.
- Balancing intervention benefits against the risk of futile treatment is essential.
Purpose Of Review:
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.
Recent Findings:
Most common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients.
Summary:
Clinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s11936-021-00924-3.
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