Herzog Eyal, Aziz Emad F, Kukin Marrick, Steinberg Jonathan S, Mittal Suneet
Division of Cardiology-Cardiac Care Unit, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
Crit Pathw Cardiol. 2009 Mar;8(1):1-6. doi: 10.1097/HPC.0b013e318198c904.
Sudden cardiac death is one of the leading causes of death in the United States, accounting for an estimate 350,000 deaths each year. The US Congress passed a resolution in late September 2008 designating October as "National Sudden Cardiac Arrest Awareness Month." In an effort to raise awareness for preventing unnecessary deaths because of sudden cardiac death, the resolution "calls upon the people of the United States to observe this month with appropriate programs and activities." The response from our institute was to develop a novel pathway named ESCAPE-which is an evidence-based novel pathway for low Ejection fraction and Sudden Cardiac death Awareness and Prevention Eligibility. The main objective of this program is to demonstrate that implementing a simple novel pathway for primary prevention of sudden cardiac arrest leads to an increase in the number of patients with low ejection fraction (<or=35%) referred for implantable cardioverter defibrillators therapy. The key difference of our pathway compared with prior reported algorithms is that it is initiated at imaging laboratories. The registry will consist of consecutive patients presenting to our imaging laboratories (the echocardiography, the nuclear, and the cardiac catheterization laboratories). The ESCAPE pathway defines patients' management based upon 3 key parameters: left ventricular ejection function, heart failure functional class, and an evidence of a prior myocardial infarction or coronary artery disease. We hope that this new novel pathway will help to bridge the gap between the complex guidelines and the actual clinical practice and will help to save many lives.
心脏性猝死是美国主要的死亡原因之一，每年估计导致35万人死亡。2008年9月底，美国国会通过了一项决议，将10月定为“全国心脏性猝死意识月”。为提高对预防因心脏性猝死导致的不必要死亡的认识，该决议“呼吁美国人民通过适当的项目和活动来纪念这个月”。我们机构的回应是开发一种名为ESCAPE的新途径——这是一种基于证据的针对低射血分数以及心脏性猝死意识与预防资格的新途径。该项目的主要目标是证明实施一种简单的心脏性猝死一级预防新途径会使因植入式心脏复律除颤器治疗而转诊的低射血分数（≤35%）患者数量增加。我们的途径与先前报道的算法相比的关键差异在于它在影像实验室启动。该登记将包括连续就诊于我们影像实验室（超声心动图、核医学和心导管实验室）的患者。ESCAPE途径基于三个关键参数定义患者的管理：左心室射血功能、心力衰竭功能分级以及既往心肌梗死或冠状动脉疾病的证据。我们希望这条新的途径将有助于弥合复杂指南与实际临床实践之间的差距，并有助于挽救许多生命。
