Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Vascular Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
BMC Emerg Med. 2024 Aug 2;24(1):140. doi: 10.1186/s12873-024-01060-4.
Out of hospital cardiac arrest (OHCA) is a major public health problem with substantial mortality rates worldwide. Genetic diseases and primary electrical disorders are the most common etiologies at younger ages, while ischemic heart disease and cardiomyopathies are common causes at older ages. Despite improvement in prevention and treatment in recent years, OHCA is still a major cause of cardiovascular death.
We report prospective data regarding etiology, characteristics, clinical course, and outcomes of patients with OHCA who were admitted to a tertiary care center intensive cardiac care unit (ICCU) between 2020-2023.
A total of 92 patients admitted after OHCA were included in the cohort. Mean age was 63.8 ± 13.8 years and 75 (82%) were males. The most common etiology of OHCA was acute coronary syndrome (ACS) in 54 (59%) patients, of whom 46 (85%) patients had ST elevation myocardial infarction and 8 (15%) had non-ST elevation myocardial infarction. During hospitalization, 42 (46%) patients underwent targeted temperature management and 13 (14%) received mechanical circulatory support. Interestingly, 77 (84%) patients underwent coronary angiography, while only 51 (55%) received percutaneous coronary intervention (PCI). Neurologic status was favorable in 49 (53%) patients with Cerebral Performance Category score of 1-2. Overall, mortality rates were relatively low, with 15 (16%) in-hospital deaths and 24 (26%) deaths at 30-day follow-up.
Although ACS was the most common etiology for OHCA, only 55% of patients underwent PCI. Most OHCA patients admitted to the ICCU survived hospitalization and were discharged. Increased awareness, public education, worldwide registries, and specific evidence-based guidelines for the treatment of OHCA patients may lead to improved outcomes for these patients who often carry poor prognoses.
院外心脏骤停（OHCA）是一个全球性的重大公共卫生问题，其死亡率居高不下。在年轻患者中，遗传疾病和原发性电异常是最常见的病因，而在老年患者中，缺血性心脏病和心肌病则较为常见。尽管近年来在预防和治疗方面有所改善，但 OHCA 仍然是心血管死亡的主要原因。
我们报告了 2020 年至 2023 年间，在一家三级心脏重症监护病房（ICCU）接受治疗的 OHCA 患者的病因、特征、临床病程和结局的前瞻性数据。
共有 92 例 OHCA 后入院的患者纳入该队列。平均年龄为 63.8±13.8 岁，75 例（82%）为男性。OHCA 的最常见病因是急性冠脉综合征（ACS），在 54 例（59%）患者中，46 例（85%）患者为 ST 段抬高型心肌梗死，8 例（15%）为非 ST 段抬高型心肌梗死。在住院期间，42 例（46%）患者接受了目标温度管理，13 例（14%）接受了机械循环支持。有趣的是，77 例（84%）患者接受了冠状动脉造影，而只有 51 例（55%）接受了经皮冠状动脉介入治疗（PCI）。神经功能状态良好的患者有 49 例（53%），其脑功能状态评分（Cerebral Performance Category score）为 1-2。总的来说，住院期间死亡率相对较低，15 例（16%）患者死亡，30 天随访时 24 例（26%）患者死亡。
尽管 ACS 是 OHCA 最常见的病因，但只有 55%的患者接受了 PCI。大多数被收入 ICCU 的 OHCA 患者存活并出院。提高认识、公众教育、全球登记处以及针对 OHCA 患者的具体循证治疗指南，可能会改善这些预后不良的患者的结局。
