Northern Health, Epping, 185 Cooper St., Epping, 3076, Victoria, Australia.
Northern Health, Epping, 185 Cooper St., Epping, 3076, Victoria, Australia; Deakin University, School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, Geelong, Australia.
Aust Crit Care. 2017 Nov;30(6):299-305. doi: 10.1016/j.aucc.2016.12.001. Epub 2016 Dec 16.
There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based.
The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation.
A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes.
The four major findings were: (i) use of fraction of inspired oxygen (FiO) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission.
Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required.
循证复苏后护理与生存和出院时的功能状态之间存在明确的关系。澳大利亚复苏委员会（ARC）建议采用方案驱动的护理方法，以提高心脏骤停后的生存机会。医疗保健提供者有义务确保复苏后方案驱动的护理是及时和基于证据的。
本研究旨在检查在从自发循环恢复后 24 小时内，对从急诊科入院的重症监护病房患者进行复苏后护理的最佳实践指南的依从性，这些患者经历了院外或急诊科心脏骤停并存活下来。
在澳大利亚墨尔本的两家卫生服务机构对符合心脏骤停幸存者标准的患者的病历进行了回顾性审核。审核的标准是：主要心脏骤停特征、氧合和通气管理、心血管护理、神经护理和患者结局。
主要发现有四项：（i）在复苏后管理的前 24 小时内，使用 1.0 的吸入氧分数（FiO）和高氧血症很常见；（ii）心脏护理存在差异，及时进行 12 导联心电图检查，大多数患者的收缩压（SBP）大于 100mmHg，但延迟转移到心脏导管实验室；（iii）神经护理不理想，高血糖的发生率很高，几乎有 50%的患者未能提供治疗性低温；（iv）在住院期间死亡率与住院期间前 24 小时的复苏后护理的特定元素之间存在关联。
需要制定跨越整个患者治疗过程的基于证据的、具体情况的复苏后护理指南。依赖国家指南并不一定能转化为当地的基于证据的护理，因此迫切需要采取策略来确保有效实施指南。
