Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM)
Por:
Jorge-Perez, P, Nikolaou, N, Donadello, K, Khoury, A, Behringer, W, Hassager, C, Boettiger, B, Sionis, A, Nolan, J, Combes, A, Quinn, T, Price, S, Grand, J
Publicada:
9 feb 2023
Ahead of Print:
1 dic 2022
Resumen:
Aims International guidelines give recommendations for the management of comatose out-of-hospital cardiac arrest (OHCA) survivors. We aimed to investigate adherence to guidelines and disparities in the treatment of OHCA in hospitals in Europe. Methods and results A web-based, multi-institutional, multinational survey in Europe was conducted using an electronic platform with a predefined questionnaire developed by experts in post-resuscitation care. The survey was disseminated to all members of the societies via email, social media, websites, and newsletters in June 2021. Of 252 answers received, 237 responses from different units were included and 166 (70%) were from cardiac arrest centres. First-line vasopressor used was noradrenaline in 195 (83%) and the first-line inotrope was dobutamine in 148 (64%) of the responses. Echocardiography is available 24/7 in 204 (87%) institutions. Targeted temperature management was used in 160 (75%) institutions for adult comatose survivors of OHCA with an initial shockable rhythm. Invasive or external cooling methods with feedback were used in 72 cardiac arrest centres (44%) and 17 (24%) non-cardiac arrest centres (P < 0.0003). A target temperature between 32 and 34 degrees C was preferred by 46 centres (21%); a target between 34 and 36 degrees C by 103 centres (52%); and <37.5 degrees C by 35 (16%). Multimodal neuroprognostication was poorly implemented and a follow-up at 3 months after discharge was done in 71 (30%) institutions. Conclusion Post-resuscitation care is not well established and varies among centres in European hospitals. Cardiac arrest centres have a higher coherence with guidelines compared with respondents from non-cardiac arrest centres. The overall inconsistency in approaches and deviation from recommendations could be a focus for improvement.
Filiaciones:
Jorge-Perez, P:
Canary Isl Univ Hosp, Dept Cardiol, San Cristobal la Laguna 38320, Santa Cruz de T, Spain
Nikolaou, N:
Konstantopouleio Gen Hosp, Cardiol Dept, Intens Cardiac Care Unit, Athens, Greece
Donadello, K:
Univ Verona, Dept Surg Dent Gynaecol & Paediat, Dept Anesthesia & Intens Care B, AOUI Univ Hosp Integrated Trust Verona,Policlin GB, Ple L Scuro, Verone, Italy
Khoury, A:
Besancon Univ Hosp, Dept Emergency Med & Crit Care, Besancon, France
Besancon Univ Hosp, INSERM CIC 1431, Besancon, France
Behringer, W:
Med Univ Vienna, Dept Emergency Med, Vienna, Austria
Hassager, C:
Univ Hosp Copenhagen, Rigshospitalet, Heart Ctr, Dept Cardiol, Copenhagen, Denmark
Boettiger, B:
Univ Hosp Cologne, Med Fac, Cologne, Germany
Univ Cologne, Cologne, Germany
European Resuscitat Council ERC, Natl Heart & Lung Inst, Niel, Belgium
German Resusc Council GRC, Amager Hvidovre Hosp, Dept Cardiol, Ulm, Germany
Sionis, A:
Univ Autonoma Barcelona, Hosp Sant Pau, Cardiol Dept, Intens Cardiac Care Unit,IIB Sant Pau, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Nolan, J:
Univ Warwick, Warwick Med Sch, Coventry, England
Royal United Hosp, Dept Anaesthesia & Intens Care Med, Bath, England
Combes, A:
Sorbonne Univ, Inst Cardiometab & Nutr, INSERM Unite Mixte Rech UMRS 1166, Paris, France
Sorbonne Univ, Hop Pitie Salpetriere, Assistance Publ Hop Paris, Inst Cardiometab & Nutr,Serv Med Intens Reanimat,I, Paris, France
Quinn, T:
Univ London, Kingston Univ & St Georges, London, England
Price, S:
Royal Brompton & Harefield Hosp, Dept Cardiol, London, England
Royal Brompton & Harefield Hosp, Dept Crit Care, London, England
Green Accepted, Bronze, All Open Access; Bronze
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