Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department
Introduction: Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insuffici...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2025-02-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.4103/singaporemedj.SMJ-2021-354 |
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| author | Jing Kai Jackie Lam Jen Heng Pek |
| author_facet | Jing Kai Jackie Lam Jen Heng Pek |
| author_sort | Jing Kai Jackie Lam |
| collection | DOAJ |
| description | Introduction:
Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insufficient well-established protocols for post-resuscitation care. We aimed to evaluate post-resuscitation care in the emergency department (ED) of adult (aged ≥16 years) OHCA patients with sustained ROSC and its associated neurologically intact survival.
Methods:
A retrospective review of electronic medical records was conducted for OHCA patients with sustained ROSC at the ED. Data including demographics, pre-hospital resuscitation, ED resuscitation, post-resuscitation care and eventual outcomes were analysed.
Results:
Among 921 OHCA patients, 85 (9.2%) had sustained ROSC at the ED. Nineteen patients (19/85, 22.4%) survived, with 13 (13/85, 15.3%) having intact neurology at discharge. Electrocardiogram and chest X-ray were performed in all OHCA patients, whereas computed tomography (CT) was performed inconsistently, with CT brain being most common (74/85, 87.1%), while CT pulmonary angiogram (6/85, 7.1%), abdomen and pelvis (4/85, 4.7%) and aortogram (2/85, 2.4%) were done infrequently. Only four patients (4.7%) had all five neuroprotective goals of normoxia, normocarbia, normotension, normothermia and normoglycaemia achieved in the ED. The proportion of all five neuroprotective goals being met was significantly higher (P = 0.01) among those with neurologically intact survival (3/13, 23.1%) than those without (1/72, 1.4%).
Conclusion:
Post-resuscitation care at the ED showed great variability, indicating gaps between recommended guidelines and clinical practice. Good quality post-resuscitation care, centred around neuroprotection goals, must be initiated promptly to achieve meaningful survival with intact neurology. |
| format | Article |
| id | doaj-art-6c7bc01f175542ef90d9ff7f570fed2d |
| institution | OA Journals |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-6c7bc01f175542ef90d9ff7f570fed2d2025-08-20T02:04:49ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352025-02-01662667210.4103/singaporemedj.SMJ-2021-354Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency departmentJing Kai Jackie LamJen Heng PekIntroduction: Out-of-hospital-cardiac-arrest (OHCA) is a major public health challenge and post-return-of-spontaneous-circulation (ROSC) goals have shifted from just survival to survival with intact neurology. Although post-ROSC care is crucial for survival with intact neurology, there are insufficient well-established protocols for post-resuscitation care. We aimed to evaluate post-resuscitation care in the emergency department (ED) of adult (aged ≥16 years) OHCA patients with sustained ROSC and its associated neurologically intact survival. Methods: A retrospective review of electronic medical records was conducted for OHCA patients with sustained ROSC at the ED. Data including demographics, pre-hospital resuscitation, ED resuscitation, post-resuscitation care and eventual outcomes were analysed. Results: Among 921 OHCA patients, 85 (9.2%) had sustained ROSC at the ED. Nineteen patients (19/85, 22.4%) survived, with 13 (13/85, 15.3%) having intact neurology at discharge. Electrocardiogram and chest X-ray were performed in all OHCA patients, whereas computed tomography (CT) was performed inconsistently, with CT brain being most common (74/85, 87.1%), while CT pulmonary angiogram (6/85, 7.1%), abdomen and pelvis (4/85, 4.7%) and aortogram (2/85, 2.4%) were done infrequently. Only four patients (4.7%) had all five neuroprotective goals of normoxia, normocarbia, normotension, normothermia and normoglycaemia achieved in the ED. The proportion of all five neuroprotective goals being met was significantly higher (P = 0.01) among those with neurologically intact survival (3/13, 23.1%) than those without (1/72, 1.4%). Conclusion: Post-resuscitation care at the ED showed great variability, indicating gaps between recommended guidelines and clinical practice. Good quality post-resuscitation care, centred around neuroprotection goals, must be initiated promptly to achieve meaningful survival with intact neurology.https://journals.lww.com/10.4103/singaporemedj.SMJ-2021-354emergencyout-of-hospital cardiac arrestresuscitationreturn of spontaneous circulationsurvival |
| spellingShingle | Jing Kai Jackie Lam Jen Heng Pek Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department Singapore Medical Journal emergency out-of-hospital cardiac arrest resuscitation return of spontaneous circulation survival |
| title | Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department |
| title_full | Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department |
| title_fullStr | Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department |
| title_full_unstemmed | Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department |
| title_short | Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department |
| title_sort | post resuscitation care of patients with return of spontaneous circulation after out of hospital cardiac arrest at the emergency department |
| topic | emergency out-of-hospital cardiac arrest resuscitation return of spontaneous circulation survival |
| url | https://journals.lww.com/10.4103/singaporemedj.SMJ-2021-354 |
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