by Storm, Christian;
Leithner, Christoph; Krannich, Alexander; Suarez, Jose I.; Stevens, Robert D.
Objectives: Recent research has demonstrated value in selected therapeutic and
prognostic interventions delivered to patients following cardiac arrest. The
aim of this work was to determine if the implementation of a structured care
pathway, which combines different interventions, could improve outcomes in
survivors of cardiac arrest.
Data Sources: PubMed and review of citations in retrieved
articles.
Study Selection: Randomized trials and prospective
observational studies conducted in adult cardiac arrest patients, which
evaluated the impact on outcome of a structured care pathway, defined as an
organized set of interventions designed specifically for postcardiac arrest
patients.
Data Extraction: Data collected included study
characteristics and methodologic quality, populations enrolled, interventions
that were part of the cardiac arrest structured care pathway, and outcomes. The
principal outcome was favorable functional status defined as a Cerebral
Performance Category score of 1–2 at or after hospital discharge.
Data Synthesis: The systematic search retrieved 481 articles
of which nine (total, 1,994 patients) were selected for systematic review, and
six (1,422 patients) met criteria for meta-analysis. Interventions in the care
pathways included early coronary angiography with or without percutaneous
coronary intervention (eight studies), targeted temperature management (nine
studies), and protocolized management in the ICU (seven studies). Neurologic
prognostication was not a part of any of the structured pathways. Meta-analysis
found significantly higher odds of achieving a favorable functional outcome in
patients who were treated in a structured care pathway, when compared with
standard care (odds ratio, 2.35; 95% CI, 1.46–3.81).
Conclusions: Following cardiac arrest, patients treated
in a structured care pathway may have a substantially higher likelihood of
favorable functional outcome than those who receive standard care. These
findings suggest benefit of a highly organized approach to postcardiac arrest
care, in which a cluster of evidence-based interventions are delivered by a
specialized interdisciplinary team. Given the overall low certainty of
evidence, definitive recommendations will need confirmation in additional
high-quality studies.
