European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Nov 2020
ReviewThe cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause - aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM).
Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. ⋯ This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.
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Eur Heart J Acute Cardiovasc Care · Nov 2020
Multicenter Study Observational StudyAn observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA).
Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. ⋯ Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.
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Eur Heart J Acute Cardiovasc Care · Nov 2020
Observational StudyManagement of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial.
Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. ⋯ An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.
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Eur Heart J Acute Cardiovasc Care · Nov 2020
Randomized Controlled Trial Multicenter StudyRole of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial.
Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. ⋯ This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.
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Eur Heart J Acute Cardiovasc Care · Nov 2020
Cancer is not associated with higher short or long-term mortality after successful resuscitation from out-of-hospital cardiac arrest when adjusting for prognostic factors.
As the prevalence of malignancies in the general population increases, the odds of an out-of-hospital cardiac arrest (OHCA) patient having a history of cancer likewise increases, and the impact on post-cardiac arrest care and mortality is not well known. We aimed to investigate 30-day and 1-year mortality after successful resuscitation in patients with cancer prior to OHCA compared with OHCA patients without a previous cancer diagnosis. ⋯ Cancer prior to OHCA was not associated with higher mortality in patients successfully resuscitated from OHCA when adjusting for confounders. Cancer prior to OHCA should be used with caution when performing prognostication after OHCA.