Prehosp Emerg Care. 2021 Mar-Apr;25(2):191-195. doi: 10.1080/10903127.2020.1754979. Epub 2020 May 1.
Up to 44% of out-of-hospital cardiac arrest (OHCA) patients will rearrest in the immediate post-return of spontaneous circulation (post-ROSC) period, and rearrest is associated with decreased survival. Cardiac arrest guidelines are often equivocal regarding what post-ROSC care should be provided in the prehospital setting and when hospital transport should be initiated. Prehospital protocols must balance the benefit of time-dependent hospital-based care with the risk of early rearrest. We sought to describe current prehospital protocols for post-ROSC care in the treatment of OHCA.
A single trained abstractor systematically reviewed a purposeful sample of prehospital protocols for adult non-traumatic cardiac arrest from the United States using an standardized data abstraction form. Protocols were either stand-alone or integrated into intra-arrest care. Exclusion criteria were non-911 ground transport agencies and protocols not revised since the 2015 American Heart Association guideline update. All protocols were publicly available via the Internet. Data abstraction was conducted in May 2019. Measures of interest were counted and summarized. Proportions and 95% confidence intervals were calculated.
We identified and reviewed 82 prehospital protocols from 46 states and the District of Columbia. Seven protocols were excluded due to the revision date, leaving 75 protocols included in the study. Six protocols (8%; CI 3.7-16%) provide no guidance on prehospital post-ROSC care. 12-lead electrocardiogram (ECG) acquisition (63/75 [84%; CI 73-91%]) and transport to percutaneous coronary intervention-capable hospitals (55/75 [73%; CI 62-83%]) are common, although not ubiquitous. Of those that do require a 12-lead ECG, 40% [CI 27-54%] required the presence of an ST-elevation myocardial infarction to inform their transport decision. Only 9 (12%; CI 6.4-22%) provide any guidance on when to initiate transport post-ROSC, with 4 (5%; CI 2-13%) requiring a post-ROSC stabilization period prior to transport.
Prehospital treatment and transport protocols for post-ROSC care are highly variable across the United States.
多达 44%的院外心脏骤停 (OHCA) 患者在自主循环恢复 (ROSC) 后即刻会再次发生心脏骤停，而再次心脏骤停与生存率降低有关。心脏骤停指南通常对院外复苏后应提供何种 ROSC 护理以及何时开始医院转运存在分歧。院前方案必须平衡时间依赖性院内治疗的益处与早期再次心脏骤停的风险。我们旨在描述目前 OHCA 治疗中 ROSC 后护理的院前方案。
一名受过专门培训的摘要员使用标准化数据提取表格，系统地审查了来自美国的针对成人非创伤性心脏骤停的特定院前方案的有针对性样本。方案要么是独立的，要么整合到心搏骤停护理中。排除标准是非 911 地面转运机构和自 2015 年美国心脏协会指南更新以来未修订的方案。所有方案均可通过互联网公开获得。数据提取于 2019 年 5 月进行。感兴趣的措施被计数并进行总结。计算了比例和 95%置信区间。
我们确定并审查了来自 46 个州和哥伦比亚特区的 82 个院前方案。由于修订日期，有 7 个方案被排除在外，研究中纳入了 75 个方案。6 个方案（8%；95%CI3.7-16%）没有提供院外 ROSC 后护理的指导。12 导联心电图（ECG）采集（63/75 [84%；95%CI73-91%]）和转运至经皮冠状动脉介入治疗能力医院（55/75 [73%；95%CI62-83%]）是常见的，尽管并非普遍存在。在那些确实需要 12 导联 ECG 的方案中，40%[95%CI27-54%]要求存在 ST 段抬高型心肌梗死才能告知其转运决策。只有 9 个（12%；95%CI6.4-22%）提供了有关何时在 ROSC 后开始转运的任何指导，其中 4 个（5%；95%CI2-13%）要求在转运前进行 ROSC 后稳定期。
美国各地的 ROSC 后治疗和转运方案差异很大。
