Christian Storm1,2, Christoph Leithner3, Alexander Krannich1, Jose I Suarez2,4,5,6, Robert D Stevens2,4,5,6,7. 1. Department of Nephrology and Intensive Care Medicine, Charité University, Berlin, Germany. 2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Neurology, Charité University, Berlin, Germany. 4. Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 5. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 6. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. 7. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
OBJECTIVES: Recent research has demonstrated value in selected therapeutic and prognostic interventions delivered to patients following cardiac arrest. The aim of this work was to determine if the implementation of a structured care pathway, which combines different interventions, could improve outcomes in survivors of cardiac arrest. DATA SOURCES: PubMed and review of citations in retrieved articles. STUDY SELECTION: Randomized trials and prospective observational studies conducted in adult cardiac arrest patients, which evaluated the impact on outcome of a structured care pathway, defined as an organized set of interventions designed specifically for postcardiac arrest patients. DATA EXTRACTION: Data collected included study characteristics and methodologic quality, populations enrolled, interventions that were part of the cardiac arrest structured care pathway, and outcomes. The principal outcome was favorable functional status defined as a Cerebral Performance Category score of 1-2 at or after hospital discharge. DATA SYNTHESIS: The systematic search retrieved 481 articles of which nine (total, 1,994 patients) were selected for systematic review, and six (1,422 patients) met criteria for meta-analysis. Interventions in the care pathways included early coronary angiography with or without percutaneous coronary intervention (eight studies), targeted temperature management (nine studies), and protocolized management in the ICU (seven studies). Neurologic prognostication was not a part of any of the structured pathways. Meta-analysis found significantly higher odds of achieving a favorable functional outcome in patients who were treated in a structured care pathway, when compared with standard care (odds ratio, 2.35; 95% CI, 1.46-3.81). CONCLUSIONS: Following cardiac arrest, patients treated in a structured care pathway may have a substantially higher likelihood of favorable functional outcome than those who receive standard care. These findings suggest benefit of a highly organized approach to postcardiac arrest care, in which a cluster of evidence-based interventions are delivered by a specialized interdisciplinary team. Given the overall low certainty of evidence, definitive recommendations will need confirmation in additional high-quality studies.
OBJECTIVES: Recent research has demonstrated value in selected therapeutic and prognostic interventions delivered to patients following cardiac arrest. The aim of this work was to determine if the implementation of a structured care pathway, which combines different interventions, could improve outcomes in survivors of cardiac arrest. DATA SOURCES: PubMed and review of citations in retrieved articles. STUDY SELECTION: Randomized trials and prospective observational studies conducted in adult cardiac arrestpatients, which evaluated the impact on outcome of a structured care pathway, defined as an organized set of interventions designed specifically for postcardiac arrestpatients. DATA EXTRACTION: Data collected included study characteristics and methodologic quality, populations enrolled, interventions that were part of the cardiac arrest structured care pathway, and outcomes. The principal outcome was favorable functional status defined as a Cerebral Performance Category score of 1-2 at or after hospital discharge. DATA SYNTHESIS: The systematic search retrieved 481 articles of which nine (total, 1,994 patients) were selected for systematic review, and six (1,422 patients) met criteria for meta-analysis. Interventions in the care pathways included early coronary angiography with or without percutaneous coronary intervention (eight studies), targeted temperature management (nine studies), and protocolized management in the ICU (seven studies). Neurologic prognostication was not a part of any of the structured pathways. Meta-analysis found significantly higher odds of achieving a favorable functional outcome in patients who were treated in a structured care pathway, when compared with standard care (odds ratio, 2.35; 95% CI, 1.46-3.81). CONCLUSIONS: Following cardiac arrest, patients treated in a structured care pathway may have a substantially higher likelihood of favorable functional outcome than those who receive standard care. These findings suggest benefit of a highly organized approach to postcardiac arrest care, in which a cluster of evidence-based interventions are delivered by a specialized interdisciplinary team. Given the overall low certainty of evidence, definitive recommendations will need confirmation in additional high-quality studies.
Authors: Stephen Pfeiffer; Matthew Zackoff; Katelyn Bramble; Lindsey Jacobs; Kristen Ruehlmann; Erika L Stalets; Ken Tegtmeyer; Maya Dewan Journal: Pediatr Qual Saf Date: 2021-03-10
Authors: Jun Wei Yeo; Zi Hui Celeste Ng; Amelia Xin Chun Goh; Jocelyn Fangjiao Gao; Nan Liu; Shao Wei Sean Lam; Yew Woon Chia; Gavin D Perkins; Marcus Eng Hock Ong; Andrew Fu Wah Ho Journal: J Am Heart Assoc Date: 2021-12-20 Impact factor: 6.106
Authors: Jens Nee; Roland Koerner; Daniel Zickler; Tim Schroeder; Philipp Enghard; Lutz Nibbe; Dietrich Hasper; Robert Buder; Christoph Leithner; Christoph J Ploner; Kai-Uwe Eckardt; Christian Storm; Jan M Kruse Journal: Scand J Trauma Resusc Emerg Med Date: 2020-09-23 Impact factor: 2.953
Authors: Pedro Kurtz; Christian Storm; Marcio Soares; Fernando Bozza; Carolina B Maciel; David M Greer; Leonardo S L Bastos; Ulisses Melo; Bruno Mazza; Marcelo S Santino; Roberto Seabra Lannes; Ana Paula Pierre de Moraes; Joel Tavares Passos; Giulliana Martines Moralez; Robson Correa Santos; Maristela Medeiros Machado; Saulo Fernandes Saturnino; Ciro Leite Mendes; Arthur Oswaldo Vianna; Jorge Salluh Journal: Crit Care Explor Date: 2021-07-14