Regionalization of postcardiac arrest care.

PURPOSE OF REVIEW: To discuss the concept and implementation of regionalized postcardiac arrest care.

RECENT FINDINGS: American Heart Association guidelines call for therapeutic hypothermia in patients who have return of spontaneous circulation but remain comatose after out-of-hospital cardiac arrest due to ventricular fibrillation. The real and perceived technical challenges of inducing, maintaining, and monitoring postarrest patients who have received induced hypothermia have limited its widespread use. In addition, recent data suggest that emergency primary coronary intervention may benefit those victims of out-of-hospital cardiac arrest with return of spontaneous circulation. However, most community hospitals lack consistent 24-h a day emergency percutaneous coronary intervention capability. Therefore, despite showing efficacy in clinical trials, these therapies remain underutilized in clinical practice, thus limiting their widespread use. The concept of regionalized specialty care has been used successfully for other time-sensitive illnesses such as major trauma and acute stroke. Evidence extrapolated from the trauma and stroke literature suggests that such a system of care would be well tolerated, feasible, and would improve outcomes after out-of-hospital cardiac arrest.

SUMMARY: It is feasible to implement a large system of care in which eligible postcardiac patients are triaged to centers capable of delivering standardized, state-of-the art postarrest care. Further research is warranted to determine the optimal design of such a system of care.