A systematic diagnostic and therapeutic approach for the treatment of patients after cardio-pulmonary resuscitation: a prospective evaluation of 212 patients over 5 years.
A literature on systematic treatment protocols for patients after resuscitation for cardiac arrest is lacking. We evaluated a systematic protocol, including ECG, echocardiogram, urgent cardiac catheterisation ("STEMI-like" workflow), CT scans, laboratory findings, IABP, hypothermia, and cMRI, prospectively over 5 years. The primary endpoint was the Cerebral Performance Category Scale (CPCS). During the period from January 2008 to December 2012, 212 patients were included. The mean age was 66.7 years, n = 151 (71.2 %) were male, mean time from the first medical contact to start of catheterisation was 76.6 min, and ventricular fibrillation (VF) was present in n = 99 (46.7 %). A significant coronary artery stenosis was seen in n = 130 (61.3 %), PCI was performed in n = 101 (47.6 %), an ACS was found in n = 100 (47.2 %), n = 91 patients (42.9 %) had another cardiac cause, an extra-cardiac cause was found in n = 12 (5.7 %, mostly a cerebral process), and in 9 patients (4.3 %), no cause was identifiable. A significant difference in mortality was found for patients with TIMI flow 2/3 vs. 0/1 (65.4 vs. 95.7 %, p < 0.01). The difference of intra-aortic balloon pumping vs. no pumping was not significant, performing hypothermia reduced mortality significantly (52.7 vs. 68.2 %, p = 0.04). The survival rate was n = 76 (35.9 %), a CPCS of 1/2 was reached in n = 68 pts (32.1 %), patients with ongoing resuscitation had a 100 % mortality (n = 41), and VF had a lower mortality (54.6 vs. 72.6 %, p < 0.01). A systematic algorithm may improve the outcome of patients after reanimation compared with classically reported outcomes. The data are hypothesis generating for further studies.
Department of Cardiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany. h.vonkorn@new.marienhaus-gmbh.de.
Hubertus
H
von Korn
Department of Cardiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Victor
V
Stefan
IMBEI, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.
Reyn
R
van Ewijk
Department of Cardiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Kamalesh
K
Chakraborty
Department of Cardiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Burkhard
B
Sanwald
Department of Cardiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Jan
J
Hemker
Department of Cardiology, University Hospital Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Ulrich
U
Hink
Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.
Marc
M
Ohlow
Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.
Bernward
B
Lauer
Department of Anesthesiology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Dierk
D
Vagts
Department of Gastroenterology, Hetzelstift, Stiftstr. 10, 67434, Neustadt, Germany.
Stefan
S
Gruene
Department of Cardiology, University Hospital Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Thomas
T
Münzel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
Resuscitation; Therapy and diagnosis