Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.
Cardiovascular Research Institute, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany.
Sci Rep. 2021 Nov 18;11(1):22522. doi: 10.1038/s41598-021-02027-2.
In-hospital cardiac arrest (IHCA) is associated with poor outcomes. There are currently no standards for cardiac arrest teams in terms of member composition and task allocation. Here we aimed to compare two different cardiac arrest team concepts to cover IHCA management in terms of survival and neurological outcomes. This prospective study enrolled 412 patients with IHCA from general medical wards. From May 2014 to April 2016, 228 patients were directly transferred to the intensive care unit (ICU) for ongoing resuscitation. In the ICU, resuscitation was extended to advanced cardiac life support (ACLS) (Load-and-Go [LaG] group). By May 2016, a dedicated cardiac arrest team provided by the ICU provided ACLS in the ward. After return of spontaneous circulation (ROSC), the patients (n = 184) were transferred to the ICU (Stay-and-Treat [SaT] group). Overall, baseline characteristics, aetiologies, and characteristics of cardiac arrest were similar between groups. The time to endotracheal intubation was longer in the LaG group than in the SaT group (6 [5, 8] min versus 4 [2, 5] min, p = 0.001). In the LaG group, 96% of the patients were transferred to the ICU regardless of ROSC achievement. In the SaT group, 83% of patients were transferred to the ICU (p = 0.001). Survival to discharge did not differ between the LaG (33%) and the SaT (35%) groups (p = 0.758). Ultimately, 22% of patients in the LaG group versus 21% in the SaT group were discharged with good neurological outcomes (p = 0.857). In conclusion, we demonstrated that the cardiac arrest team concepts for the management of IHCA did not differ in terms of survival and neurological outcomes. However, a dedicated (intensive care) cardiac arrest team could take some load off the ICU.
院内心搏骤停（IHCA）与不良预后相关。目前，在心脏骤停团队成员构成和任务分配方面尚无标准。在这里，我们旨在比较两种不同的心脏骤停团队概念，以涵盖 IHCA 管理方面的生存和神经功能结局。这项前瞻性研究纳入了来自普通内科病房的 412 例 IHCA 患者。2014 年 5 月至 2016 年 4 月，228 例患者直接转入重症监护病房（ICU）进行持续复苏。在 ICU 中，复苏扩展至高级心脏生命支持（ACLS）（即 Load-and-Go [LaG] 组）。到 2016 年 5 月，由 ICU 提供的专门心脏骤停团队在病房内提供 ACLS。自主循环恢复（ROSC）后，患者（n=184）被转入 ICU（Stay-and-Treat [SaT] 组）。总体而言，两组间基线特征、病因和心脏骤停特征相似。LaG 组的气管插管时间长于 SaT 组（6 [5, 8] min 比 4 [2, 5] min，p=0.001）。在 LaG 组中，无论 ROSC 是否实现，96%的患者均被转入 ICU。在 SaT 组中，83%的患者被转入 ICU（p=0.001）。两组的出院生存率无差异（LaG 组为 33%，SaT 组为 35%，p=0.758）。最终，LaG 组 22%的患者与 SaT 组 21%的患者出院时神经功能良好（p=0.857）。总之，我们证明了管理 IHCA 的心脏骤停团队概念在生存和神经功能结局方面没有差异。然而，专门的（重症监护）心脏骤停团队可以为 ICU 减轻一些负担。
