Department of Nephrology and Intensive Care Medicine, Charité University, Berlin, Germany.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Crit Care Med. 2019 Aug;47(8):e710-e716. doi: 10.1097/CCM.0000000000003827.
Recent research has demonstrated value in selected therapeutic and prognostic interventions delivered to patients following cardiac arrest. The aim of this work was to determine if the implementation of a structured care pathway, which combines different interventions, could improve outcomes in survivors of cardiac arrest.
PubMed and review of citations in retrieved articles.
Randomized trials and prospective observational studies conducted in adult cardiac arrest patients, which evaluated the impact on outcome of a structured care pathway, defined as an organized set of interventions designed specifically for postcardiac arrest patients.
Data collected included study characteristics and methodologic quality, populations enrolled, interventions that were part of the cardiac arrest structured care pathway, and outcomes. The principal outcome was favorable functional status defined as a Cerebral Performance Category score of 1-2 at or after hospital discharge.
The systematic search retrieved 481 articles of which nine (total, 1,994 patients) were selected for systematic review, and six (1,422 patients) met criteria for meta-analysis. Interventions in the care pathways included early coronary angiography with or without percutaneous coronary intervention (eight studies), targeted temperature management (nine studies), and protocolized management in the ICU (seven studies). Neurologic prognostication was not a part of any of the structured pathways. Meta-analysis found significantly higher odds of achieving a favorable functional outcome in patients who were treated in a structured care pathway, when compared with standard care (odds ratio, 2.35; 95% CI, 1.46-3.81).
Following cardiac arrest, patients treated in a structured care pathway may have a substantially higher likelihood of favorable functional outcome than those who receive standard care. These findings suggest benefit of a highly organized approach to postcardiac arrest care, in which a cluster of evidence-based interventions are delivered by a specialized interdisciplinary team. Given the overall low certainty of evidence, definitive recommendations will need confirmation in additional high-quality studies.
最近的研究表明，在心脏骤停后对患者进行特定的治疗和预后干预具有价值。本研究旨在确定实施综合不同干预措施的结构化护理路径是否可以改善心脏骤停幸存者的预后。
PubMed 以及检索到的文章中的参考文献。
纳入评估结构化护理路径（定义为针对心脏骤停后患者设计的一系列干预措施）对预后影响的成年心脏骤停患者的随机试验和前瞻性观察性研究。
收集的数据包括研究特征和方法学质量、纳入的人群、作为心脏骤停结构化护理路径一部分的干预措施以及结局。主要结局为出院时或出院后良好的功能状态，定义为神经功能预后评分（Cerebral Performance Category score）为 1-2 分。
系统检索共获得 481 篇文章，其中 9 篇（共 1994 例患者）进行了系统评价，6 篇（共 1422 例患者）符合荟萃分析的纳入标准。护理路径中的干预措施包括早期有或无经皮冠状动脉介入治疗的冠状动脉造影（8 项研究）、目标温度管理（9 项研究）以及 ICU 中的方案化管理（7 项研究）。神经预后预测不是任何结构化路径的一部分。荟萃分析发现，与标准治疗相比，在结构化护理路径中治疗的患者实现良好功能结局的可能性显著更高（比值比，2.35；95%置信区间，1.46-3.81）。
心脏骤停后，接受结构化护理路径治疗的患者比接受标准治疗的患者更有可能获得良好的功能结局。这些发现表明，对心脏骤停后护理采取高度组织化的方法具有益处，其中由专门的跨学科团队提供一组基于证据的干预措施。鉴于证据总体质量较低，还需要在更多高质量研究中证实这些结论。
