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Adherence to post-cardiac arrest care guidelines and impact on survival and neurological outcome
Giulia Merigo1,2, Fabiana Madotto2, Aurora Magliocca1
1Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Insights
This study evaluated post-cardiac arrest (CA) care guidelines over 14 years. Improved adherence to guidelines, especially in hemodynamic management, was observed, though survival and neurological outcomes showed no significant change.
Area of Science:
- Critical Care Medicine
- Cardiology
- Neurology
Background:
- Post-cardiac arrest (CA) care guidelines (GLs) were introduced in 2010 and updated in 2015 and 2021.
- The impact of these evolving GLs on patient outcomes remains under-investigated.
- This study aims to evaluate the effect of three consecutive post-CA GLs on survival and neurological recovery over 14 years.
Purpose of the Study:
- To comprehensively assess the impact of successive post-cardiac arrest (CA) care guidelines on patient survival and neurological recovery.
- To compare the implementation and outcomes associated with the 2010, 2015, and 2024 post-CA GLs.
- To identify predictors of survival and favorable neurological outcome following CA resuscitation.
Main Methods:
- A retrospective cohort study of adult patients resuscitated from CA and admitted to the ICU from 2011 to 2024.
- Patients were stratified into three cohorts based on the prevailing GL (GL2010, GL2015, GL2024).
- Adherence to GL recommendations was assessed across seven key areas, and logistic regression with LASSO selection was used to evaluate outcomes.
Main Results:
- Survival to ICU discharge increased from 39.5% to 53.9%, and favorable neurological outcome improved from 30.9% to 42.7% across the cohorts.
- Adherence to GL recommendations significantly improved, particularly in hemodynamic management (32.0% to 77.3%), temperature control (60.6% to 94.4%), and general ICU management (56.3% to 77.6%).
- Adherence to hemodynamic recommendations was independently associated with improved survival (OR=2.20).
Conclusions:
- Implementation of updated post-CA care guidelines led to improved adherence, especially in hemodynamic management.
- While statistically significant improvements in survival or neurological outcomes were not observed, sustained guideline-based care shows potential value.
- Further research may be needed to fully elucidate the long-term impact of evolving post-CA care protocols.
Background:
Post-cardiac arrest (CA) care guidelines (GLs) have been introduced in 2010 and periodically updated every 5 years since then (in 2015 and 2021). However, the impact of these GLs on patients' outcome remains underexplored. The aim of this study was to comprehensively evaluate and compare the impact of implementation of three consecutive post-CA GLs over 14 years, on patients' survival and neurological recovery.
Methods:
This retrospective cohort study included adult patients resuscitated from CA and admitted to the intensive care unit (ICU) between 2011 and 2024. Patients were stratified into three cohorts based on the GL in use (GL2010, GL2015, and GL2024). Adherence to GL recommendations was assessed across seven macro-areas: coronary angiography, haemodynamic, ventilation, temperature control, general ICU management, multimodal neuroprognostication, and seizure control. Predictors of survival and favourable neurological outcome at ICU discharge were evaluated using multivariate logistic regression with LASSO selection. Outcome up to 6 months was also evaluated.
Results:
A total of 275 patients were included over the 14-year period. Survival to ICU discharge increased from 39.5% in cohort 1 to 53.9% in cohort 3, together with favourable neurological outcome that improved from 30.9 to 42.7%. Adherence to GL recommendations significantly improved across most domains, particularly in haemodynamic management (from 32.0% in cohort 1 to 77.3% in cohort 3), temperature control (from 60.6 to 94.4%), and general ICU management (from 56.3 to 77.6%). Among all interventions, adherence to haemodynamic recommendations was independently associated with improved survival (OR = 2.20, 95% CI: 1.01-4.86).
Conclusions:
Following the implementation of updated post-CA care GLs, adherence to recommendations improved, particularly in haemodynamic management. Although no statistically significant improvements in survival or neurological outcomes were observed, these findings highlight the potential value of sustained GL-based care.
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