Merigo Giulia, Madotto Fabiana, Magliocca Aurora, Florio Gaetano, Rosati Alessandra, Castagna Valentina, Pagliano Marco, Zanella Alberto, Panigada Mauro, Grasselli Giacomo, Ristagno Giuseppe
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Ann Intensive Care. 2025 Jul 2;15(1):88. doi: 10.1186/s13613-025-01508-1.
Post-cardiac arrest (CA) care guidelines (GLs) have been introduced in 2010 and periodically updated every 5 years since then (in 2015 and 2021). However, the impact of these GLs on patients' outcome remains underexplored. The aim of this study was to comprehensively evaluate and compare the impact of implementation of three consecutive post-CA GLs over 14 years, on patients' survival and neurological recovery.
This retrospective cohort study included adult patients resuscitated from CA and admitted to the intensive care unit (ICU) between 2011 and 2024. Patients were stratified into three cohorts based on the GL in use (GL2010, GL2015, and GL2024). Adherence to GL recommendations was assessed across seven macro-areas: coronary angiography, haemodynamic, ventilation, temperature control, general ICU management, multimodal neuroprognostication, and seizure control. Predictors of survival and favourable neurological outcome at ICU discharge were evaluated using multivariate logistic regression with LASSO selection. Outcome up to 6 months was also evaluated.
A total of 275 patients were included over the 14-year period. Survival to ICU discharge increased from 39.5% in cohort 1 to 53.9% in cohort 3, together with favourable neurological outcome that improved from 30.9 to 42.7%. Adherence to GL recommendations significantly improved across most domains, particularly in haemodynamic management (from 32.0% in cohort 1 to 77.3% in cohort 3), temperature control (from 60.6 to 94.4%), and general ICU management (from 56.3 to 77.6%). Among all interventions, adherence to haemodynamic recommendations was independently associated with improved survival (OR = 2.20, 95% CI: 1.01-4.86).
Following the implementation of updated post-CA care GLs, adherence to recommendations improved, particularly in haemodynamic management. Although no statistically significant improvements in survival or neurological outcomes were observed, these findings highlight the potential value of sustained GL-based care.
心脏骤停（CA）后护理指南（GLs）于2010年推出，此后每5年定期更新（2015年和2021年）。然而，这些指南对患者预后的影响仍未得到充分探索。本研究的目的是全面评估和比较连续14年实施的三个CA后GLs对患者生存和神经功能恢复的影响。
这项回顾性队列研究纳入了2011年至2024年间从CA复苏并入住重症监护病房（ICU）的成年患者。根据使用的GL（GL2010、GL2015和GL2024）将患者分为三个队列。在七个宏观领域评估对GL建议的依从性：冠状动脉造影、血流动力学、通气、体温控制、ICU综合管理、多模态神经预后评估和癫痫控制。使用带有LASSO选择的多变量逻辑回归评估ICU出院时生存和良好神经功能预后的预测因素。还评估了长达6个月的预后。
在14年期间共纳入275例患者。ICU出院生存率从第1队列的39.5%提高到第3队列中的53.9%，良好神经功能预后从30.9%提高到42.7%。在大多数领域，对GL建议的依从性显著提高，特别是在血流动力学管理方面（从第1队列的32.0%提高到第3队列的77.3%）、体温控制方面（从60.6%提高到94.4%）和ICU综合管理方面（从56.3%提高到77.6%）。在所有干预措施中，对血流动力学建议的依从性与生存率提高独立相关（OR = 2.20，95% CI：1.01 - 4.86）。
在实施更新的CA后护理GLs后，对建议的依从性有所提高，特别是在血流动力学管理方面。尽管在生存或神经功能预后方面未观察到统计学上的显著改善，但这些发现凸显了持续基于GL的护理的潜在价值。
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