Christoph Adler1, Christian Paul2, Guido Michels3, Roman Pfister3, Anton Sabashnikov4, Jochen Hinkelbein5, Simon Braumann3, Llija Djordjevic4, Ralf Blomeyer2, Andrea Krings2, Bernd W Böttiger5, Stephan Baldus3, Robert Stangl2. 1. Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Cologne, Germany; Department of Emergency Medicine, Fire Department City of Cologne, Cologne, Germany. Electronic address: Christoph.adler@uk-koeln.de. 2. Department of Emergency Medicine, Fire Department City of Cologne, Cologne, Germany. 3. Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Cologne, Germany. 4. Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. 5. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany.
Abstract
BACKGROUND: Overall prognosis in patients with out-of-hospital cardiac arrest (OHCA) remains poor, especially when return of spontaneous circulation (ROSC) cannot be achieved at the scene. It is unclear if rapid transport to the hospital with ongoing cardiopulmonary resuscitation (CPR) improves outcome in patients with refractory OHCA (rOHCA). The aim of this study was to evaluate the effect of a novel fast track algorithm (FTA) in patients with rOHCA. METHODS: This prospective single-center study analysed outcome in rOHCA patients treated with FTA. Historical patients before FTA-implementation served as controls. rOHCA was defined as: persistent shockable rhythm after three shocks and 300mg of amiodarone or persistent non-shockable rhythm and continuous CPR for 10min without ROSC after exclusion of treatable arrest causes. RESULTS: 110 consecutive patients with rOHCA (mean age 56±14 years) were included. 40 patients (36%) were treated with FTA, 70 patients (64%) served as historical controls. Pre-hospital time was significantly shorter after FTA implementation (69±18 vs. 79±24min, p=0.02). Favourable neurological outcome (defined as cerebral performance categories Score 1 or 2) was significantly more frequent in FTA patients (27.5% vs. 11.4%, p=0.038). FTA-implementation showed a trend towards improved mortality (70.0% vs. 82.9%, p=0.151). Extracorporeal Life Support was similar between the two groups. CONCLUSION: Our study suggests that a rapid transport algorithm with ongoing CPR is feasible, improves neurological outcome and may improve survival in carefully selected patients with rOHCA.
BACKGROUND: Overall prognosis in patients with out-of-hospital cardiac arrest (OHCA) remains poor, especially when return of spontaneous circulation (ROSC) cannot be achieved at the scene. It is unclear if rapid transport to the hospital with ongoing cardiopulmonary resuscitation (CPR) improves outcome in patients with refractory OHCA (rOHCA). The aim of this study was to evaluate the effect of a novel fast track algorithm (FTA) in patients with rOHCA. METHODS: This prospective single-center study analysed outcome in rOHCA patients treated with FTA. Historical patients before FTA-implementation served as controls. rOHCA was defined as: persistent shockable rhythm after three shocks and 300mg of amiodarone or persistent non-shockable rhythm and continuous CPR for 10min without ROSC after exclusion of treatable arrest causes. RESULTS: 110 consecutive patients with rOHCA (mean age 56±14 years) were included. 40 patients (36%) were treated with FTA, 70 patients (64%) served as historical controls. Pre-hospital time was significantly shorter after FTA implementation (69±18 vs. 79±24min, p=0.02). Favourable neurological outcome (defined as cerebral performance categories Score 1 or 2) was significantly more frequent in FTApatients (27.5% vs. 11.4%, p=0.038). FTA-implementation showed a trend towards improved mortality (70.0% vs. 82.9%, p=0.151). Extracorporeal Life Support was similar between the two groups. CONCLUSION: Our study suggests that a rapid transport algorithm with ongoing CPR is feasible, improves neurological outcome and may improve survival in carefully selected patients with rOHCA.
Authors: Jessika Stefanie Kreß; Marc Rüppel; Hendrik Haake; Jürgen Vom Dahl; Sebastian Bergrath Journal: Anaesthesist Date: 2021-04-08 Impact factor: 1.041
Authors: Urs Pietsch; David Reiser; Volker Wenzel; Jürgen Knapp; Mario Tissi; Lorenz Theiler; Simon Rauch; Lorenz Meuli; Roland Albrecht Journal: Scand J Trauma Resusc Emerg Med Date: 2020-07-25 Impact factor: 2.953