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Enhanced post-cardiac arrest care significantly improved neurological outcomes
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According to a recent multicenter, prospective cohort study conducted in Japan, researchers found that more patients survived cardiac arrest without any neurological impairment after implementing improved, regional post-cardiac arrest care.
The new regional post-cardiac arrest care system was based on recommendations from the American Heart Association 2010 resuscitation guidelines.
Takashi Tagami
In 2010, the AHA guidelines recommended adding a fifth link — multidisciplinary postresuscitation care in a regional center — to the previous four outlined in the 2000 AHA Chain of Survival recommendations for patients who survived an out-of-hospital cardiac arrest. These included calling 9-1-1 for early access to emergency medical care; early CPR; early defibrillation; and early advanced CV life support.
Researchers examined records of 1,482 patients with cardiac arrest before changes in postresuscitation care (January 2006 to April 2008) and after (January 2009 to December 2010) in the Aizu region of Japan. The changes in care involved transporting the patients to a tertiary hospital that provided intensive care, including hemodynamic and respiratory management, therapeutic hypothermia and percutaneous coronary intervention.
Researchers found significantly more patients who survived an out-of-hospital cardiac arrest after implementation of the improved multidisciplinary postresuscitation system had a favorable neurological status when compared with those treated before the changes were made (51% vs. 19%).
Additionally, researchers reported significantly improved survival to hospital discharge after implementation of the new system (4.2% vs. 2.3%). Of those whose heartbeat was restored, 76% received therapeutic hypothermia after the changes vs. 11% before, and all intensive care unit patients received appropriate hemodynamic management by using advanced hemodynamic monitoring system after vs. 0% before.
One-month survival with a favorable neurological outcome among patients treated by emergency medical services providers also improved from 0.5% to 3%.
“Although there were concerns that the proportion of survivors with severe neurologic disability would increase, this did not occur,” Takashi Tagami, MD, PhD, lead author of the study and an assistant professor at Nippon Medical School in Tokyo, Japan, said in a press release. “These findings suggest that the ‘fifth link’ is associated with an increase in survival rate as well as improvement of quality of life among survivors.
“Post-cardiac arrest care requires a multidisciplinary approach to intensive care that is difficult to implement in a non-specialized hospital,” Tagami said. “This study indicates that the introduction of the regional resuscitation system of care, the ‘fifth link,’ made it possible to treat all potential survivors in the ICU of a specialized hospital.”
Disclosures: The researchers report no relevant financial disclosures.
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