Circulation. 2024 Oct 29;150(18):e316-e327. doi: 10.1161/CIR.0000000000001282. Epub 2024 Sep 19.
People who experience out-of-hospital cardiac arrest often require care at a regional center for continued treatment after resuscitation, but many do not initially present to the hospital where they will be admitted. For patients who require interfacility transport after cardiac arrest, the decision to transfer between centers is complex and often based on individual clinical characteristics, resources at the presenting hospital, and available transport resources. Once the decision has been made to transfer a patient after cardiac arrest, there is little direct guidance on how best to provide interfacility transport. Accepting centers depend on transferring emergency departments and emergency medical services professionals to make important and nuanced decisions about postresuscitation care that may determine the efficacy of future treatments. The consequences of early care are greater when transport delays occur, which is common in rural areas or due to inclement weather. Challenges of providing interfacility transfer services for patients who have experienced cardiac arrest include varying expertise of clinicians, differing resources available to them, and nonstandardized communication between transferring and receiving centers. Although many aspects of care are insufficiently studied to determine implications for specific out-of-hospital treatment on outcomes, a general approach of maintaining otherwise recommended postresuscitation care during interfacility transfer is reasonable. This includes close attention to airway, vascular access, ventilator management, sedation, cardiopulmonary monitoring, antiarrhythmic treatments, blood pressure control, temperature control, and metabolic management. Patient stability for transfer, equity and inclusion, and communication also must be considered. Many of these aspects can be delivered by protocol-driven care.
经历院外心脏骤停的人通常需要在区域中心接受治疗，以继续治疗复苏后的疾病，但许多人最初不会到他们将被收治的医院就诊。对于心脏骤停后需要进行医院间转运的患者，在中心之间进行转运的决策是复杂的，通常基于个体临床特征、就诊医院的资源和可用的转运资源。一旦决定在心脏骤停后转运患者，就几乎没有直接的指导如何最好地提供医院间转运。接受中心取决于转运急诊科和急救医疗服务专业人员，以便就可能决定未来治疗效果的复苏后护理做出重要而微妙的决策。在发生转运延迟时，早期护理的后果更大，这种情况在农村地区或恶劣天气下很常见。为经历心脏骤停的患者提供医院间转运服务的挑战包括临床医生的专业知识不同、可用资源不同以及转运和接收中心之间的沟通不规范。尽管许多护理方面的研究不足，无法确定对特定院外治疗结果的影响，但在医院间转运期间保持否则推荐的复苏后护理的一般方法是合理的。这包括密切关注气道、血管通路、呼吸机管理、镇静、心肺监测、抗心律失常治疗、血压控制、体温控制和代谢管理。还必须考虑患者的转运稳定性、公平性和包容性以及沟通。许多这些方面可以通过基于协议的护理来提供。
