Post-resuscitation care of patients with return of spontaneous circulation after out-of-hospital cardiac arrest at the emergency department.
10.4103/singaporemedj.SMJ-2021-354
- Author:
Jing Kai Jackie LAM
1
;
Jen Heng PEK
Author Information
1. Department of Emergency Medicine, Sengkang General Hospital, Singapore.
- Publication Type:Journal Article
- MeSH:
Humans;
Out-of-Hospital Cardiac Arrest/mortality*;
Retrospective Studies;
Male;
Female;
Middle Aged;
Emergency Service, Hospital;
Cardiopulmonary Resuscitation/methods*;
Return of Spontaneous Circulation;
Aged;
Adult;
Treatment Outcome;
Electrocardiography;
Tomography, X-Ray Computed;
Aged, 80 and over
- From:Singapore medical journal
2025;66(2):66-72
- CountrySingapore
- Language:English
-
Abstract:
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.
