Kashef Mohammad Amin, Lotfi Amir S
Hampden and Franklin County Cardiovascular Associates, Springfield, MA USA.
Division of Cardiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199 USA.
Curr Treat Options Cardiovasc Med. 2021;23(6):43. doi: 10.1007/s11936-021-00924-3. Epub 2021 May 10.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.
Most common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients.
Clinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients.
The online version contains supplementary material available at 10.1007/s11936-021-00924-3.
院外心脏骤停（OHCA）是主要的死亡原因。尽管心脏病管理有所改善，但OHCA的预后仍然很差。本综述的目的是提供有关OHCA幸存者管理、循证治疗以及当前知识空白的信息。
OHCA最常见的死亡原因是神经损伤，其次是休克和多器官功能衰竭。有预后评估工具可帮助进行临床决策。采取措施缩短紧急医疗服务（EMS）响应时间、鼓励旁观者进行心肺复苏（CPR）、早期除颤和目标温度管理可提高生存率。对于可电击心律且推测为心脏病因、ST段抬高、持续缺血或有血流动力学和电不稳定证据的患者，应考虑早期启动心脏导管实验室进行冠状动脉造影、血流动力学评估和机械循环支持。该领域缺乏随机对照试验，应权衡干预措施的益处与进行无效治疗的风险。新型冠状病毒肺炎（COVID-19）大流行给OHCA患者的护理带来了新挑战。
对OHCA患者进行临床决策具有挑战性。需要进行试验以提供关于OHCA患者护理的循证知识。
在线版本包含可在10.1007/s11936-021-00924-3获取的补充材料。
