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The impact of a clinical protocol in the management of the resuscitated cardiac arrest patients
Session:
Painel 7 -Doença Coronária 2
Speaker:
Joana Brito
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.1 Acute Cardiac Care – Resuscitation
Session Type:
Posters
FP Number:
---
Authors:
Joana Brito; Inês Aguiar Ricardo; P. Carrilho Ferreira; Joana Rigueira; João Pedro Ribeiro Agostinho; Rafael Santos; Nelson P. Cunha; Tiago Graça Rodrigues; Pedro Silvério António; Sara Couto Pereira; Beatriz Silva; Pedro Alves Da Silva; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong> It is common to apply protocol strategies to standardize the approach and reduce errors in situations of cardiorespiratory arrest (CRA).</p> <p><strong>Purpose:</strong> To evaluate the differences in patients (pts) submitted to coronary angiography (CA) in the context of CRA before and after the in-hospital implementation of a protocol for the orientation of complementary exams / therapy after CRA.</p> <p><strong>Methods:</strong> Retrospective single-center study of consecutive pts submitted to CA by CRA between January 2015 and July 2018. Demographic, clinical, electrocardiographic and angiographic data were evaluated. The results were obtained using the Tstudent test and the chi-square test. The group referenced to CA was compared before and after the application of a diagnostic/ therapeutic orientation algorithm. This protocol was initiated in November 2017 and suggests CA in <2h after hospital admission in pts with CRA in probable context of infarction, with defibrillating rhythm (DR) CRA of unknown cause and nondefibrillating rhythm CRA (NDR) with previously known coronary disease (CAD) (after exclusion of other causes); and in <24h in pts with NDR CRA without known CAD (after exclusion of other causes).</p> <p><strong>Results:</strong> 121 Pts (63.2 ± 13 years, 76% men) were included. The majority of CRA were extra-hospital (58.4%) and RD (69.4%). The most frequent cause was infarction (65.4%), most of type 1 (59.5%) and ST elevation (36.4%). On average the pts were submitted to CAT 1,3 ± 3 days after CRA. They performed 85 CA before protocol implementation and 36 after. The pts included in the protocol presented more advanced ages (median 71 vs 63 years, p = 0.018); (p = 0.004), more CRA in NDR (p = 0.003), lower prevalence of sinus rhythm after CRA (p = 0.033) and higher prevalence of atria fibrilation (p = 0.004). There was a tendency for cerebrovascular disease (p = 0.085) and a higher prevalence of CRA duration above the median (11 min) (p = 0.073). In this group of pts, there was a higher mortality (52.8 vs 29.9%, p = 0.019), a lower tendency for CAD (p = 0.064), with a similar angioplasty rate between the two groups.</p> <p><strong>Conclusion:</strong> After the institution of this protocol it seems that more patients are submitted to coronariography that may not benefit from the intervention because they tend to have less CAD. The evaluation of pts who underwent CA under the protocol revealed that it did not lead to a better prognosis and was associated with higher mortality, probably because it included pts without CAD and with more complex causes of CRA.</p>
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