Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care

Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society’s position statement on OHCA care, multiple ra...

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Veröffentlicht in:Canadian journal of cardiology 2024-04, Vol.40 (4), p.524-539
Hauptverfasser: van Diepen, Sean, Le May, Michel R., Alfaro, Patricia, Goldfarb, Michael J., Luk, Adriana, Mathew, Rebecca, Peretz-Larochelle, Maude, Rayner-Hartley, Erin, Russo, Juan J., Senaratne, Janek M., Ainsworth, Craig, Belley-Côté, Emilie, Fordyce, Christopher B., Kromm, Julie, Overgaard, Christopher B., Schnell, Gregory, Wong, Graham C.
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Sprache:eng
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Zusammenfassung:Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society’s position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA. In addition, prehospital trials have helped craft new expert opinions on antiarrhythmic strategies (amiodarone or lidocaine) and outline the potential role for double sequential defibrillation in patients with refractory cardiac arrest when equipment and training is available. Finally, we advocate for regionalized OHCA care systems with admissions to a hospital capable of integrating their post OHCA care with comprehensive on-site cardiovascular services and provide guidance on the potential role of extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest. We believe that knowledge translation through national harmonization and adoption of contemporary best practices has the potential to improve survival and functional outcomes in the OHCA population. La survie des patients ayant subi un arrêt cardiaque hors de l’hôpital (ACHH) demeure faible à la sortie de l’hôpital et d’importantes différences régionales dans les pratiques de traitement et les taux de survie ont été décrites. Depuis la publication en 2017 de l’énoncé de position de la Société cardiovasculaire du Canada sur les soins de l’ACHH, les nombreux essais contrôlés randomisés ont contribué à mieux définir les soins optimaux après l’arrêt cardiaque. Notre groupe de travail fournit des directives actualisées : sur le moment opportun du cathétérisme cardiaque des patients ayant un sus-décalage du segment ST et n’ayant pas de sus-décalage du segment ST ; qui reposent sur une stratégie révisée de régulation de la température axée sur la normothermie plutôt que l’hypothermie; la pression artérielle, les paramètres d’oxygénation et de ventilation; et sur le traitement des activités ryth
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2024.01.012