References
They think it’s all over-managing post cardiac arrest syndrome
Abstract
Return of spontaneous circulation (ROSC) is the first stage in the successful management of the cardiac arrest patient. The care that the patient receives during the immediate post-ROSC period, has a major impact on subsequent survival from out of hospital cardiac arrest (OHCA), particularly in terms of surviving to hospital discharge neurologically intact. For the first time, the 2010 Resuscitation Council (UK) (
This review will outline the guidance from the Resuscitation Council (UK) and the International Liaison Committee On Resuscitation (ILCOR) on the management of post cardiac arrest syndrome (PCAS) and how this can be practically implemented in the pre-hospital environment. interventions directly applicable to the pre-hospital phase until handover at the emergency department (ED) will be considered. In addition, specific guidance relating to the management of the ROSC patient in the pre-hospital phase of their care will be provided.
Since the release of the 2005 Resuscitation Council (UK) guidelines (Nolan J et al, 2006) there has been an emphasis on the active management of the physiological derangement that follows Return of Spontaneous Circulation (ROSC). This has occurred because despite increasing number of patients achieving ROSC, the number of patients leaving hospital neurologically intact has not increased by a similar magnitude (Nolan et al, 2007; 2008) As a result, clinicians are now focusing their attention on what is perceived to be the weak link in the ‘chain of survival’.
In 1966, Friedrich Wilhelm Ahnefeld coined the phrase ‘rescue chain concept’, which was the original German name for the ‘chain of survival’ (Baskett and Baskett, 2007). Since then, clinician have been striving to reduce the number of deaths from sudden cardiac arrest and with the clinical advancements that have been made in the intervening years, it would be logical to conclude that hospital discharge rates would have increased dramatically. However, survival rates to hospital discharge after OHCA are still only 7–10 % (Nolan et al, 2007, 2008). A review conducted in 2008 by The International Liaison Committee On Resuscitation (ILCOR), found considerable variation in patient management outcomes in the post cardiac arrest phase. They also identified that where protocols existed to standardize post resuscitation care across the multidisciplinary team, the institutions involved demonstrated improved outcomes (Nolan et al, 2008). More recently, the Department of Health has introduced a series of clinical performance indicators for ambulance trusts, including ROSC on arrival at hospital and survival to discharge following OHCA (Ambulance Statistics Team, 2011). This makes a review of treatment guidelines for the last link in the chain of survival, post resuscitation care, necessary.
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