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揭示院外心脏骤停幸存者复苏后支持性护理的突破:一项叙述性综述

Unveiling Breakthroughs in Post-resuscitation Supportive Care for Out-of-Hospital Cardiac Arrest Survivors: A Narrative Review.

作者信息

Jagarlamudi Nikhil Sai, Soni Kriti, Ahmed Saima S, Makkapati Naga Sai Ram, Janarthanam Sujaritha, Vallejo-Zambrano Cristhian R, Patel Khushbu C, Xavier Roshni, Ponnada Praveen Kumar, Zaheen Iqra, Ehsan Muhammad

机构信息

Internal Medicine, NRI Medical College, Guntur, IND.

Internal Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Center, Pune, IND.

出版信息

Cureus. 2023 Sep 6;15(9):e44783. doi: 10.7759/cureus.44783. eCollection 2023 Sep.

Abstract

Survivors of out-of-hospital cardiac arrest (OHCA) experience significant mortality rates and neurological impairment, potentially attributed to the hypoxic-ischemic injury sustained amid the cardiac arrest episode. Post-resuscitation care plays a crucial role in determining outcomes for survivors of OHCA. Supportive therapies have proven to be influential in shaping these outcomes. However, targeting higher blood pressure or oxygen levels during the post-resuscitative phase has not been shown to offer any mortality or neurological benefits. In terms of maintaining hemodynamic instability after resuscitation, it is recommended to use norepinephrine rather than epinephrine. While extracorporeal cardiopulmonary resuscitation has shown promising results, targeted temperature management has been found ineffective in improving outcomes despite its previous potential. This review also investigates various challenges and barriers associated with the practical implementation of these supportive therapies in clinical settings. The review also highlights areas ripe for future research and proposes potential directions to further enhance post-resuscitation supportive care for OHCA survivors.

摘要

院外心脏骤停(OHCA)幸存者面临着较高的死亡率和神经功能障碍,这可能归因于心脏骤停期间遭受的缺氧缺血性损伤。复苏后护理对于决定OHCA幸存者的预后起着至关重要的作用。支持性治疗已被证明对这些预后有影响。然而,在复苏后阶段将血压或氧水平目标设定得更高并未显示出对死亡率或神经功能有任何益处。在复苏后维持血流动力学不稳定方面,建议使用去甲肾上腺素而非肾上腺素。虽然体外心肺复苏已显示出有前景的结果,但尽管目标温度管理此前具有潜力,但已发现其在改善预后方面无效。本综述还调查了在临床环境中实际实施这些支持性治疗所面临的各种挑战和障碍。该综述还强调了未来研究的成熟领域,并提出了进一步加强OHCA幸存者复苏后支持性护理的潜在方向。

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In-hospital mode of death after out-of-hospital cardiac arrest.院外心脏骤停后的院内死亡模式。
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