Evidence-Based Approach to Out-of-Hospital Cardiac Arrest

Abstract

Purpose of review: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge.

Recent findings: Most common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients.

Summary: Clinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients.

Supplementary information: The online version contains supplementary material available at 10.1007/s11936-021-00924-3.

Keywords: COVID-19; CPR; Cardiac catheterization lab; Out-of-hospital cardiac arrest; Targeted temperature management.

Fig. 1

Algorithm of clinical factors available to aid in decision-making along the continuum of care of patients with out-of-hospital cardiac arrest. Obtained with permission from publisher of Catheterization and Cardiovascular Interventions [•].