| 标题： | 中国成人心脏骤停后综合征器械支持治疗临床实践指南 |
| title： | Chinese Clinical Practice Guidelines for the Device Therapy of Adult Post-Cardiac Arrest Syndrome |
| 版本： | 原创版 |
| version： | Original |
| 分类： | 标准指南 |
| classification： | Standard guideline |
| 领域： | 治疗 |
| field： | Treatment |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 急诊科、重症医学科、呼吸与危重症科、心脏内科、心脏外科医师及护理人员、全科医生及护理人员、从事成人心脏骤停后综合征治疗的教学及研究人员。 |
| Guide users： | Medical care personnel of Emergency Department, Critical Care Units, Respiratory and Critical Care Department, Cardiology Department and Cardiac Surgery Department, general medicine practitioners, researchers and teaching staff working on the treatment of PCAS. |
| 证据分级方法： | GRADE |
| Evidence grading method： | GRADE |
| 制定单位： | 中国成人心脏骤停后综合征器械支持治疗临床实践指南编写专家组 |
| Formulating unit： | Taskforce of Chinese Clinical Practice Guidelines for the Device Therapy of Adult Post-Cardiac Arrest Syndrome |
| 注册时间： | 2022-06-08 |
| Registration time： | |
| 注册编号： | IPGRP-2022CN318 |
| Registration number： | |
| 指南制订的目的： | 心脏骤停（cardiac arrest, CA）时全身组织器官发生严重缺血、缺氧，炎症因子释放，产生各种代谢产物，ROSC后发生再灌注损伤，导致机体出现多器官功能紊乱或障碍，称为心脏骤停后综合征（post-cardiac arrest syndrome, PCAS）。在中国，CA发生率约40.7/10万（95%CI ：38.1/10万 ~43.3/10万），总体复苏成功率只有4.0%，在院外心脏骤停（out-of-hospital cardiac arrest，OHCA）患者中，出院存活率更是仅有1%。PCAS与CA患者预后密切相关，是影响复苏患者存活率的独立危险因素。越来越多的研究证据表明，在ROSC后进行积极干预可明显改善PCAS患者的生存率及神经功能预后。2010 年更新的《美国心脏协会心肺复苏和心血管急救指南》将“生存链”增加第五个环节即心肺复苏后综合治疗，针对PCAS提出改善组织器官灌注、治疗原发病、预防再发心脏骤停等治疗措施。2020年《美国心脏协会心肺复苏和心血管急救指南》更新时再次强调，复苏后治疗是“生存链”的重要一环，并建议通过全面的、结构化的、多学科的合作以实现最佳的治疗效果。参考2020年国际复苏联络委员会国际共识——心肺复苏和心血管急救治疗建议，欧洲复苏委员会和欧洲重症监护医学学会于2021年更新了《复苏后治疗指南》。为指导和规范我国临床医师对PCAS的诊疗过程中器械支持治疗的认识和使用，因此，亟需采用循证医学方法构建出我国人口背景下的PCAS器械支持治疗临床实践指南，以指导和规范我国PCAS治疗过程中器械支持治疗的临床诊疗决策。 |
| Purpose of the guideline： | Post-cardiac arrest syndrome (PCAS) is a syndrome of multiple organ dysfunction after the return of spontaneous circulation (ROSC), mainly caused by the reperfusion injury and eruption of inflammation factors after systematic ischemia and hypoxia during cardiac arrest (CA). In China, the incidence of CA is about 40.7 (95%CI: 38.1~ 43.3) per 100,000, only with an overall resuscitation rate of 4.0%. Among patients with out-of-hospital cardiac arrest (OHCA), the survival rate at discharge is barely 1%. PCAS is closely related to the prognosis of CA patients and is an independent risk factor for the survival rate of resuscitation. Increasing evidence suggests that efficient interventions after ROSC can significantly improve the survival rate and neurological prognosis of PCAS patients.2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care updated a fifth key link to the chain of survival, namely the comprehensive treatment after cardiopulmonary resuscitation, which proposed therapeutic management for PCAS, such as improving organ perfusion, treating primary diseases and preventing recurrent cardiac arrest. 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care also emphasized that post-resuscitation treatment is an important component of the chain of survival, suggesting comprehensive, structured and multidisciplinary cooperation for optimal treatment of PCAS. European Resuscitation Council and European Society of Intensive Care Medicine updated guidelines on post-resuscitation care in 2021, based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. To guide and standardize the usage of device therapy in adult PCAS patients in China, evidence-based clinical practice guidelines are needed for post-resuscitation care and clinical decisions. |
