Ebook Prehospital management of acute STEMI: Part 2
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Ebook Prehospital management of acute STEMI: Part 2
Prehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2 an out-of-hospital cardiac arrest (OIICA) in the course of their Sl-segment elevation myocardial infarction (STEMĨ) represent a special subgroup of prehospital STEMI patients, hl spite of much progress 111 cardiopulmonary resuscitation (CPR), the overall survival rale of OTĨCA is low, with a long-t Ebook Prehospital management of acute STEMI: Part 2erm survival rate less than 7%.‘ It has been estimated that 90% of OHCAs are due to acute myocardial infarction.2"' Only tew data on patients with acuEbook Prehospital management of acute STEMI: Part 2
te STEMI and prehospital CPR are available.''-6 It has been estimated that 10% to 21% of STEM! patients need defibrillation and CPR.7-9 A recent regisPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2 needing prehospital CPR constitute a subgroup of patients at very high risk lor adverse events. The literature reports a high variability in outcomes 111 such patients due to differences in the definition of the event,Prehospital Management of Acute SltML Practical Approaches and International Stra Ebook Prehospital management of acute STEMI: Part 2tegies for Early Intervention © 2015 Joseph s. Alpert.132Prehospital Management of Acute STEM Iits etiology, and the method and timing of coronary repEbook Prehospital management of acute STEMI: Part 2
erfusion therapy.Because primary percutaneous coronary intervention (1TC1) and fibrinolysis have demonstrated good outcomes in the first, “golden” houPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2 reperfusion treatment.- 5 However, the role of coronary reperfusion strategies with thrombolysis or PCI in the subgroups of STEMI-OHCA patients remains unclear, although an excellent prognosis of patients with SI EMI has been globally reported in the last decade. The literature still gives controve Ebook Prehospital management of acute STEMI: Part 2rsial results, probably owing to limited sample-size studies, retrospective design, or noncomparative analysis between STEM1 patients with and withoutEbook Prehospital management of acute STEMI: Part 2
OHCA. Furthermore, the International Liaison Committee on Resuscitation (II.COR) concludes “there arc insufficient data to support or decline the rouPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2r OTICA patients include thrombolysis, PPCĨ. and/or adjunct therapies. The aim of this chapter IS to review the special characteristics of the STEMĨ-O1ĨCA population and discuss the state of the art tor the therapeutic strategies of OHCA in SI I ’M I patients.STEM 1-0 HCA-S PECIFIC POPULATION CHARAC Ebook Prehospital management of acute STEMI: Part 2TERISTICS AND PREDICTORS OF MORTALITYSTEM!-induced CA is mostly related to ventricular fibril-lation (VF). VF occurs at early stage of STEME and IS moEbook Prehospital management of acute STEMI: Part 2
st frequently oul-of-hospital. This explains the importanceChapter 6 Prehospital S IEMI Management of OHCA 133quickly in association with basic cardiaPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 21 patients needing prehospital CPR are younger (64 years vs. 66 years) and more frequently have anterior S i EMI or left bundle branch block (LBBB) compared with STEM I patients without prehospital CPR. Several factors have been identified as predictors of mortality: older age,14 male gender,1 asyst Ebook Prehospital management of acute STEMI: Part 2ole or pulseless electrical activity as initial heart rhythm,10,15 unwitnessed events, need for epinephrine,15 cardiac versus respiratory etiology ofEbook Prehospital management of acute STEMI: Part 2
CA,15 longer resuscitation time,16 and longer time to return of spontaneous circulation (ROSC).14 Predictors of mortality are important to optimize prPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2e regarding thrombolysis lòr OTICA sutlers from small-sample-size population, retrospective study designs, and lack of comparison of care and outcomes of STEM! patients with or without OHCA. On the basis of clinical reports, retrospective analysis, and some prospective studies, several studies demon Ebook Prehospital management of acute STEMI: Part 2strated high survival rate and improved outcome when thrombolysis was given during CPR.1?1E In contrast, in two large, randomized studies, no improvemEbook Prehospital management of acute STEMI: Part 2
ent of outcome was observed, although there was no increased incidence of bleeding.7-91 he use of fibrinolysis during CPR has to be considered in adulPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2xample where throm-134Prehospital Management of Acute STEM!that “fibrinolysis should be considered in adult patients with CA with proven or suspected pulmonary embolism. 1 here are insufficient data to support or refute the routine use of fibrinolysis in cardiac arrest from other causes.”12Safety Is Ebook Prehospital management of acute STEMI: Part 2sues and Bleeding RiskSeveral studies demonstrated the safety of thrombolytic therapy in patients with previous CPR.7-9 When thrombolytic agents are uEbook Prehospital management of acute STEMI: Part 2
sed, CPR has to be continued for more than 60 to 90 minutes after administration, rhe European guidelines highlight (hat while a fibrinolytic agent isPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2is effect in CPR showed an increase rate of Rose, 24-hour survival, discharge survival, and long-term neurologic function. • These results were not confirmed in the TROICA trial, which failed to demonstrate any beneficial effects of thrombolytic therapy.2'' Tn contrast, in the recent study by Koeth Ebook Prehospital management of acute STEMI: Part 2et al.,21 the patients who received a thrombolytic agent as coronary reperfusion therapy demonstrated a significantly reduced in-hospital mortality (3Ebook Prehospital management of acute STEMI: Part 2
6.8% vs. 58.2% in the no-reperfusion group) in survivors ofprehospilal resuscitation with STEM I.The risk of bleeding associated with thrombolytic thePrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2n demonstrated to increase the risk of intracranial bleeding.2'' Tn contrast, several studies with significant limitations demonstrated beneficial effects with improved outcome without any adverse events in terms ofbleeding complications, especially no increased fibrinolysis-induced hemorrhagic comp Ebook Prehospital management of acute STEMI: Part 2lications, even when thrombolytic therapy was associated with heparin.22 A lower rate of nonfatal stroke due to a preventive effect of brain microthroEbook Prehospital management of acute STEMI: Part 2
mbi with fibrinoly-Chapter 6 Prehospital S1EMI Management of ()H( A 135positive effects of targeted thrombolysis during CPR. confirming the results ofPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2gh the data may be con Hiding, the risks are still substantial enough that the indication for thrombolytic therapy during OIICA has to be considered on a case-by-case basis. The 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Rec Ebook Prehospital management of acute STEMI: Part 2ommendations reports that ‘Tontine administration of fibrin olytics for the treatment of in-hospital and out-of-hospital cardiac arrest is not recommeEbook Prehospital management of acute STEMI: Part 2
nded.”29ANGIOGRAPHY AND PPCI INOHCA PATIENTSSurvivors of OHCA may benefit from mechanical coronary reperfusion as a result of PCT. Early cooling alterPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2stituted rapidly,3021 but the optimal delay between cooling and PPC1 remains unclear. In all cases, angiography and/or PCI must not preclude or delay the strategy of therapeutic hypothermia.52Some clinical events, such as presence of chest pain before CA, history of established coronary artery disea Ebook Prehospital management of acute STEMI: Part 2se, and abnormal or doubtful ECG results that are signs of ongoing myocardial infarction, may be an indication for performing immediate angiography, aEbook Prehospital management of acute STEMI: Part 2
s these events are related to potential coronary occlusions. Angiography may also have a role because of difficulties in interpretation of the ECG aftPrehospital S1EMI Management in the Setting of Out-of-Hospital Cardiac ArrestEric WicL MD PhD and Rì trick Goldstein. MDINTRODUCTIONPatients who have Ebook Prehospital management of acute STEMI: Part 2of Acute STEMIresuscitation (88% as reported by Arntz Ct al.4). Obtaining an ECG early on, even with unstable cardiocirculatory conditions, may still contribute to optimizing the therapy, particularly when a time-sensitive therapeutic option is considered. Ebook Prehospital management of acute STEMI: Part 2Gọi ngay
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