Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Department of Anaesthesiology, Hannover Medical School, Hannover, Germany.
JACC Cardiovasc Interv. 2018 Sep 24;11(18):1811-1820. doi: 10.1016/j.jcin.2018.06.022.
This study sought to analyze the impact of mandatory therapeutic hypothermia and cardiac catheterization in the absence of overt noncardiac cause of arrest as part of the Hannover Cardiac Resuscitation Algorithm before intensive care admission.
Despite advanced therapies, out-of-hospital cardiac arrest (OHCA) is still associated with high mortality rates. Recently, the TTM (Target Temperature Management 33°C Versus 36°C After Out-of-Hospital Cardiac Arrest)-trial caused severe uncertainty about the efficacy of and need for therapeutic hypothermia. Furthermore, the role of early coronary angiography in OHCA survivors without ST-segment elevation remains undetermined.
In the HACORE (HAnnover Cooling REgistry) we investigated 233 consecutive patients (median age 64 [interquartile range: 53 to 74] years) with OHCA admitted to our institution between January 2011 and December 2015 who were treated according to the algorithm.
A total of 73% had ventricular fibrillation as primary rhythm. Return of spontaneous circulation was achieved after 20 (interquartile range: 10 to 30) min. Immediate percutaneous coronary angiography was performed in 96% and coronary angioplasty in 59% of all cases. ST-segment elevation was present in 47%. Critical coronary stenosis requiring percutaneous coronary intervention was present in 67% of patients with and 52% of patients without ST-segment elevation. Overall 30-day intrahospital mortality in this real-world registry was 37%. Patients in our local registry who matched the inclusion/exclusion criteria of the TTM-trial (n = 145) had a markedly lower 30-day mortality (27%) compared with the published trial (44%).
Standardized treatment of patients with OHCA following a strict protocol incorporating computed tomography, cardiac catheterization and revascularization, liberal use of active hemodynamic support in presence of shock, and mandatory therapeutic hypothermia results in mortality rates lower than previously reported.
本研究旨在分析在入住重症监护病房之前，强制性治疗性低温和心脏导管术在没有明显非心源性停搏原因的情况下作为汉诺威心脏复苏算法的一部分对院外心脏骤停（OHCA）的影响。
尽管有先进的治疗方法，院外心脏骤停（OHCA）仍然与高死亡率相关。最近，TTM（目标温度管理 33°C 与 OHCA 后 36°C）试验对治疗性低温的疗效和必要性产生了严重的不确定性。此外，在没有 ST 段抬高的 OHCA 幸存者中早期进行冠状动脉血管造影的作用仍不确定。
在 HACORE（汉诺威冷却登记处）中，我们调查了 2011 年 1 月至 2015 年 12 月期间我院收治的 233 例连续 OHCA 患者（中位数年龄 64 [四分位距：53 至 74] 岁），他们按照该算法进行治疗。
73%的患者存在原发性室颤。自主循环恢复发生在 20 分钟（四分位距：10 至 30 分钟）后。所有患者中立即进行了经皮冠状动脉造影术，其中 96%进行了冠状动脉血管成形术，59%进行了经皮冠状动脉介入治疗。47%的患者存在 ST 段抬高。需要经皮冠状动脉介入治疗的临界冠状动脉狭窄在有 ST 段抬高的患者中占 67%，在无 ST 段抬高的患者中占 52%。在这个真实世界的登记处，30 天院内死亡率为 37%。与 TTM 试验（n=145）的纳入/排除标准相匹配的本研究患者，30 天死亡率（27%）明显低于已发表的试验（44%）。
采用严格的协议（包括计算机断层扫描、心脏导管术和血运重建）对 OHCA 患者进行标准化治疗，在存在休克时广泛使用积极的血液动力学支持，并强制性进行治疗性低温治疗，可导致死亡率低于之前报道的死亡率。
