Dillon David G, Montoy Juan Carlos C, Bosson Nichole, Toy Jake, Kidane Senai, Ballard Dustin W, Gausche-Hill Marianne, Donofrio-Odmann Joelle, Schlesinger Shira A, Staats Katherine, Kazan Clayton, Morr Brian, Thompson Kristin, Mackey Kevin, Brown John, Menegazzi James J
Department of Emergency Medicine University of California Davis California USA.
Department of Emergency Medicine University of California San Francisco California USA.
J Am Coll Emerg Physicians Open. 2024 Nov 5;5(6):e13321. doi: 10.1002/emp2.13321. eCollection 2024 Dec.
In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.
在院外心脏骤停（OHCA）患者恢复自主循环（ROSC）后，院前再次骤停是影响生存的重大障碍。迄今为止，关于成功复苏导致ROSC后至急诊科交接前的院前紧急医疗服务（EMS）管理的指导数据有限。ROSC后护理包括多方面的方法，包括血流动力学优化、气道管理、氧合和通气。我们试图制定一套基于证据、以目标为导向的护理方案，针对ROSC后即刻的特定重要参数，目标是降低再次骤停的发生率并改善生存结果。在此，我们描述这套以目标为导向的护理方案的基本原理和制定过程，加利福尼亚州的几家EMS机构将采用该方案。我们召集了一组EMS专家，包括EMS医疗主任、质量改进官员、数据管理人员、教育工作者、EMS临床医生、急诊医学临床医生和复苏研究人员，以制定一套在ROSC后即刻在现场应用的以目标为导向的护理方案。这套护理方案包括为院前人员提供的关于识别即将发生的再次骤停、血流动力学优化、通气策略、气道管理以及在转运开始前诊断潜在病因的指导。
