Báo cáo y học: Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest...
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Báo cáo y học: "Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest" Available online http://ccforum.com/content/11/6/235ReviewClinical review: Beyond immediate survival from resuscitation –long-term outcome considerations after cardiac arrestDilshan Arawwawala and Stephen J BrettDepartment of Anaesthesia and Intensive Care Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UKCorresponding author: Stephen J Brett, stephen.brett@imperial.ac.ukPublished: 6 December 2007 Critical Care 2007, 11:235 (doi:10.1186/cc6139)This article is online at http://ccforum.com/content/11/6/235© 2007 BioMed Central LtdAbstract resuscitation practice, and/or subsequent medical intervention.A substantial body of literature concerning resuscitation fromcardiac arrest now exists. However, not surprisingly, the greater With greater numbers of patients now surviving for longerpart concerns the cardiac arrest event itself and optimising survivaland outcome at relatively proximal time points. The aim of this periods, survival alone may be an inadequate assessment ofreview is to present the evidence base for interventions and thera- resuscitation and post-resuscitation care. A more suitablepeutic strategies that might be offered to patients surviving the tool may be assessment of quality of life (QOL) after hospitalimmediate aftermath of a cardiac arrest, excluding components of discharge. This requires an understanding of the psycho-resuscitation itself that may lead to benefits in long-term survival. In social impact of cardiac arrest and its sequelae on theaddition, this paper reviews the data on long-term impact, physical survivor and associated family members.and neuropsychological, on patients and their families, revealing aburden that is often underestimated and underappreciated. Asgreater numbers of patients survive cardiac arrest, outcome The aim of this review is to present the evidence base formeasures more sophisticated than simple survival are required. interventions and therapeutic strategies that might be offered to patients surviving the immediate aftermath of an OOHCAIntroduction (excluding components of resuscitation itself) which may leadSurvival to a particular time after an ‘index’ cardiac arrest to benefits in long-term survival. In addition, this paperevent, as recommended by the Utstein guidelines [1], is the reviews the data on long-term impact, both physical andmost commonly reported outcome measure for resuscitation, neuropsychological, on patients and their families.with hospital discharge and 1-year survival often reported. MethodologyExcessive mortality risk is greatest within the first year afterarrest and, after 2 years, approaches that of an age- and Search terms recommended by the American Heart Associa-gender-matched population [2]. A retrospective review of in- tion [8] and International Liaison Committee on Resuscitationhospital mortality identified neurological injury as the mode of (ILCOR) were used. These were used by working partiesearly death in two thirds of out-of-hospital cardiac arrest evaluating evidence for the ILCOR 2005 Consensus(OOHCA) patients admitted to intensive care. Cardiovascular statement [9].death and multi-organ failure death accounted for theremainder [3]. A number of studies have investigated survival An electronic search of the literature by means of PubMedrates at greater than 1 year and how survival following was conducted using MeSH (Medical Subject Heading) mainOOHCA has changed over time. Such studies suggest that search terms ‘heart arrest’ or ‘cardiopulmonary resuscitation’.longer-term survival figures are improving [4-7]. This may ...