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院外心脏骤停后患者的复苏与生存:一篇展示重症监护病房相关因素全貌的文献综述

Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors.

作者信息

Nikolovski Srdjan S, Lazic Aleksandra D, Fiser Zoran Z, Obradovic Ivana A, Tijanic Jelena Z, Raffay Violetta

机构信息

Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago Health Science Campus, Maywood, USA.

Emergency Medicine, Serbian Resuscitation Council, Novi Sad, SRB.

出版信息

Cureus. 2024 Feb 24;16(2):e54827. doi: 10.7759/cureus.54827. eCollection 2024 Feb.

Abstract

As an important public health issue, out-of-hospital cardiac arrest (OHCA) requires several stages of high quality medical care, both on-field and after hospital admission. Post-cardiac arrest shock can lead to severe neurological injury, resulting in poor recovery outcome and increased risk of death. These characteristics make this condition one of the most important issues to deal with in post-OHCA patients hospitalized in intensive care units (ICUs). Also, the majority of initial post-resuscitation survivors have underlying coronary diseases making revascularization procedure another crucial step in early management of these patients. Besides keeping myocardial blood flow at a satisfactory level, other tissues must not be neglected as well, and maintaining mean arterial pressure within optimal range is also preferable. All these procedures can be simplified to a certain level along with using targeted temperature management methods in order to decrease metabolic demands in ICU-hospitalized post-OHCA patients. Additionally, withdrawal of life-sustaining therapy as a controversial ethical topic is under constant re-evaluation due to its possible influence on overall mortality rates in patients initially surviving OHCA. Focusing on all of these important points in process of managing ICU patients is an imperative towards better survival and complete recovery rates.

摘要

作为一个重要的公共卫生问题,院外心脏骤停(OHCA)需要现场和入院后多个阶段的高质量医疗护理。心脏骤停后休克可导致严重的神经损伤,导致恢复效果不佳和死亡风险增加。这些特征使这种情况成为重症监护病房(ICU)中OHCA后住院患者需要处理的最重要问题之一。此外,大多数复苏后初期存活者患有潜在的冠状动脉疾病,这使得血运重建程序成为这些患者早期管理中的另一个关键步骤。除了将心肌血流量保持在令人满意的水平外,其他组织也不能被忽视,将平均动脉压维持在最佳范围内也是可取的。随着在ICU住院的OHCA后患者中使用目标温度管理方法,所有这些程序都可以在一定程度上简化,以降低代谢需求。此外,作为一个有争议的伦理话题,维持生命治疗的撤除由于其可能对OHCA初始存活患者的总体死亡率产生影响而不断受到重新评估。在管理ICU患者的过程中关注所有这些要点对于提高生存率和完全恢复率至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bebf/10962929/23d25f882762/cureus-0016-00000054827-i01.jpg

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