TY - JOUR

T1 - Back to basics for out-of-hospital cardiac arrest

AU - Hansen, Carolina Malta

AU - Folke, Fredrik

AU - Granger, Christopher B.

PY - 2023

Y1 - 2023

N2 - Over the past 20 years, much effort has been put into advanced in-hospital care for patients resuscitated after out-of-hospital cardiac arrest (OHCA), including centralisation of care at dedicated cardiac arrest centres.1 Observational studies have reported better outcomes for patients treated at such centres than those treated at local hospitals.2 Large clinical trials have provided evidence that patients with OHCA (without cardiogenic shock or ST-elevation myocardial infarction [STEMI]) do not benefit from acute angiography, hypothermia, control or rigorous blood pressure or oxygenation control, and randomised clinical trial evidence supporting the use of mechanical support is still scarce.3, 4, 5, 6 Concurrently, the importance of multimodal neuroprognostication has become increasingly clear and, particularly, the value of allowing time for the patient to recover, to avoid premature termination of therapy. Still, the question that remains is whether patients who achieved return of sustained spontaneous circulation (ROSC) without STEMI after OHCA benefit from direct transport to specialised cardiac arrest centres as opposed to being taken to a closer local hospital with basic emergency and intensive care.

AB - Over the past 20 years, much effort has been put into advanced in-hospital care for patients resuscitated after out-of-hospital cardiac arrest (OHCA), including centralisation of care at dedicated cardiac arrest centres.1 Observational studies have reported better outcomes for patients treated at such centres than those treated at local hospitals.2 Large clinical trials have provided evidence that patients with OHCA (without cardiogenic shock or ST-elevation myocardial infarction [STEMI]) do not benefit from acute angiography, hypothermia, control or rigorous blood pressure or oxygenation control, and randomised clinical trial evidence supporting the use of mechanical support is still scarce.3, 4, 5, 6 Concurrently, the importance of multimodal neuroprognostication has become increasingly clear and, particularly, the value of allowing time for the patient to recover, to avoid premature termination of therapy. Still, the question that remains is whether patients who achieved return of sustained spontaneous circulation (ROSC) without STEMI after OHCA benefit from direct transport to specialised cardiac arrest centres as opposed to being taken to a closer local hospital with basic emergency and intensive care.

U2 - 10.1016/S0140-6736(23)01560-X

DO - 10.1016/S0140-6736(23)01560-X

M3 - Comment/debate

C2 - 37647927

AN - SCOPUS:85173237940

VL - 402

SP - 1300

EP - 1301

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10410

ER -