Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan.
Lancet. 2018 Mar 10;391(10124):989-998. doi: 10.1016/S0140-6736(18)30315-5.
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA. Prognosis should be based on clinical observations and multimodal testing, with focus on no residual sedation.
在过去几十年中，由于院外和院内干预措施的进步，院外心脏骤停（OHCA）后的预后有所改善。约有一半初始为室性心动过速或心室颤动且自主循环恢复后处于昏迷状态而入院的 OHCA 患者，将存活并具有合理的神经功能状态出院。在本系列论文中，我们讨论了心脏骤停后综合征患者的院内管理。在大多数患者中，除常规重症监护外，最重要的院内干预措施是非昏迷和昏迷患者的持续积极治疗（包括在选定患者中进行循环支持）、核心温度降至 32-36°C 的目标温度管理至少 24 小时、立即进行冠状动脉造影术伴或不伴经皮冠状动脉介入治疗，以及将最终预后延迟至 OHCA 后至少 72 小时。预后应基于临床观察和多模态检查，重点是无残留镇静。
