Cardiac Arrest (CA), Post Cardiac Arrest Syndrome
Conditions
Keywords
cardiac arrest, post cardiac arrest syndrome, post resuscitation care, guidelines
Brief summary
The goal of this retrospective observational cohort study is to evaluate whether the progressive implementation of updated post-cardiac arrest care guidelines has improved survival and neurological recovery in adult patients admitted to the intensive care unit (ICU) after successful resuscitation from cardiac arrest. Cardiac arrest is one of the leading causes of death worldwide. More than half of patients successfully resuscitated from cardiac arrest die before hospital discharge, largely due to a complex condition known as Post-Cardiac Arrest Syndrome (PCAS), which affects the brain, heart, and all major organ systems. Over the past decade, the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have published updated post-resuscitation care guidelines in 2010, 2015, and 2021, introducing progressively refined treatment recommendations. However, no study has yet evaluated whether the local adoption of these evolving guidelines has translated into measurable improvements in patient outcomes over time. The main questions this study aims to answer are: * Has survival to ICU discharge improved across three successive guideline periods (2010, 2015, and 2021) in adult cardiac arrest patients admitted to the ICU? * Has neurological recovery at ICU and hospital discharge improved across the three guideline cohorts? * What is the local level of adherence to each set of guideline recommendations, and how does it relate to patient outcomes? * What is the impact of individual new interventions introduced by each guideline update on survival and organ function? * Do outcomes differ based on whether the cardiac arrest occurred outside or inside the hospital, or based on its underlying cause (cardiac, respiratory, metabolic, toxicological, or traumatic)? Researchers will compare three patient cohorts defined by the guideline period active at the time of ICU admission - Cohort A (January 2011-December 2015, treated according to 2010 guidelines), Cohort B (January 2016-March 2021, treated according to 2015 guidelines), and Cohort C (April 2021-April 2024, treated according to 2021 guidelines) - to determine whether progressive guideline implementation is associated with improved survival and neurological outcomes over time. Cohort A serves as the reference group. Participants in this study are adult patients (aged 18 years or older) who experienced cardiac arrest of any cause - whether in or out of hospital - were successfully resuscitated, and were subsequently admitted to ICU at the S. Chiara Hospital in Trento, Italy. Data are collected retrospectively from digitized medical records and cover clinical characteristics, cardiac arrest details, ICU treatments, laboratory and imaging findings, and patient outcomes including survival, length of stay, ventilator-free days, and neurological status at discharge (assessed using the Cerebral Performance Category scale). No interventions are performed as part of this study. Patient data are fully anonymized prior to analysis.
Interventions
OTHERpost-resuscitation care
This study focused on the real-world, bundled implementation of successive ERC-ESICM guideline frameworks - rather than evaluating any single intervention (e.g., targeted temperature management, coronary angiography timing, or neuroprognostication alone). While most existing trials isolate one treatment component, this study captures the cumulative clinical effect of progressively refined, comprehensive post-resuscitation care bundles as delivered in routine ICU practice across three distinct guideline eras (2010, 2015, 2021) over 14 years within a single center. This longitudinal, within-institution design controls for center-level variability, allowing direct comparison of guideline-driven practice evolution and its impact on survival and neurological recovery. No experimental intervention is applied; the exposure of interest is the guideline framework active at the time of each patient's ICU admission.
Sponsors
Azienda Sanitaria Universitaria Integrata del Trentino
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Resuscitated from cardiac arrest and subsequently admitted to the intensive care unit (ICU) * Age ≥18 years at the time of ICU admission * Out-of-hospital or in-hospital cardiac arrest * Cardiac arrest of any etiology, including cardiac, respiratory, metabolic, toxicological, and traumatic causes
Exclusion criteria
* Age \<18 years at the time of ICU admission (pediatric patients) * Not admitted to ICU
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intensive Care Unit (ICU) Survival | From cardiac arrest date to ICU discharge or death, up to 90 days | To evaluate ICU survival for patients resuscitated from cardiac arrest. |
| Neurological Recovery at ICU Discharge | From cardiac arrest date to ICU discharge or death, up to 90 days | ICU Survival with Cerebral Performance Category (CPC) score of 1 or 2 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital discharge status. | From cardiac arrest date to hospital discharge or death, up to 180 days | To evaluate hospital survival for patients resuscitated from cardiac arrest. |
| Post-Resuscitation Care Guideline Implementation. | From cardiac arrest date to ICU discharge or death, up to 90 days | To evaluate guideline-recommended intervention adherence. |
Countries
Italy
Outcome results
None listed