Scholz K H, Böttiger B W
Klinik für Kardiologie und Internistische Intensivmedizin/Chest Pain Unit - Medizinische Klinik I, St. Bernward Krankenhaus GmbH, Treibestr. 9, 31134, Hildesheim, Deutschland.
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland.
Herz. 2018 Sep;43(6):506-511. doi: 10.1007/s00059-018-4728-9.
In patients with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR), the prognosis is influenced by various factors. In the prehospital setting, the duration of ischemia from the time of onset of cardiac arrest to the beginning of effective resuscitation measures is by far the most critical and determining factor for outcome. This interval can be shortened by an increase in the rate of lay CPR measures. With respect to intrahospital follow-up care, a number of structural factors have a relevant influence on prognosis. According to the literature, case volume, size of the hospital and the number of post-OHCA patients treated per year also have a large influence on the further prognosis. The crucial factor here is the availability and permanent readiness of a catheterization laboratory with the possibility of an immediate coronary intervention. In OHCA patients with ST-segment elevation myocardial infarction (STEMI), the time passed until the reopening of the occluded infarcted vessel is of paramount importance for survival. The 24/7 around the clock availability of a catheterization laboratory is therefore one of the indispensable prerequisites for a cardiac arrest center (CAC). In addition, a number of technical, structural, and organizational arrangements must be implemented in the CAC clinics in order to fulfil the requirements for such a center. The certification of CACs is currently being implemented by the German Resuscitation Council (GRC) and the German Society of Cardiology (DGK). As an important aim the GRC and the medical societies involved are hoping to avoid misallocation of post-OHCA patients to the nearest hospital, which may not be a suitable center for the treatment of these patients. Future studies will show whether CACs can indeed comprehensively improve the prognosis of OHCA patients following successful prehospital resuscitation.
在院外心脏骤停（OHCA）且心肺复苏（CPR）后恢复自主循环（ROSC）的患者中，预后受多种因素影响。在院前环境中，从心脏骤停发作至有效复苏措施开始的缺血持续时间是迄今为止对预后最关键且起决定性作用的因素。通过提高非专业人员CPR措施的实施率可缩短这一间隔时间。关于院内后续护理，一些结构因素对预后有显著影响。根据文献，病例数量、医院规模以及每年治疗的OHCA后患者数量对进一步的预后也有很大影响。这里的关键因素是导管室的可用性及随时准备就绪状态，以便能够立即进行冠状动脉介入治疗。在患有ST段抬高型心肌梗死（STEMI）的OHCA患者中，直至闭塞梗死血管重新开通所经过的时间对生存至关重要。因此，导管室全天候24小时随时可用是心脏骤停中心（CAC）不可或缺的先决条件之一。此外，为满足此类中心的要求，CAC诊所必须实施一系列技术、结构和组织安排。目前德国复苏委员会（GRC）和德国心脏病学会（DGK）正在对CAC进行认证。GRC及相关医学协会的一个重要目标是避免将OHCA后患者错误分配到最近的医院，因为该医院可能并非治疗这些患者的合适中心。未来的研究将表明，CAC是否真的能全面改善院前复苏成功后OHCA患者的预后。
