European Resuscitation Council Guidelines for Resuscitation ... - CPR

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18 de 0ctubre de 2010 www.elsuapdetodos.com1360 H.-R. Arntz et al. / Resuscitation 81 (2010) 1353–1363• Requiring the catheterization laboratory to be ready within20 min• Having an attending cardiologists always at the hospital• Providing real-time data feedback• Fostering senior management commitment• Encouraging a team-based approachIf PPCI cannot be accomplished within an adequate timeframe,independent of the need for emergent transfer, then immediatefibrinolysis should be considered unless there is a contraindication.For those patients with a contraindication to fibrinolysis, PCI shouldstill be pursued despite the delay, rather than not providing reperfusiontherapy at all. For those STEMI patients presenting in shock,primary PCI (or coronary artery bypass surgery) is the preferredreperfusion treatment. Fibrinolysis should only be considered ifthere is a substantial delay to PCI.Triage and inter-facility transfer for primary PCIThe risk of death, reinfarction or stroke is reduced if patientswith STEMI are transferred promptly from community hospitals totertiary care facilities for PPCI [82,94,95]. It is less clear whetherimmediate fibrinolytic therapy (in- or out-of-hospital) or transferfor PPCI is superior for younger patients presenting with anteriorinfarction and within a short duration of
Anti-arrhythmicsThere is no evidence to support the use of anti-arrhythmic prophylaxisafter ACS. Ventricular fibrillation (VF) accounts for mostof the early deaths from ACS; the incidence of VF is highest in thefirst hours after onset of symptoms. This explains why numerousstudies have been performed with the aim of demonstrating theprophylactic effect of antiarrhythmic therapy [107]. The effects ofantiarrhythmic drugs (lidocaine, magnesium, disopyramide, mexiletine,verapamil, sotalol, and tocainamide) given prophylacticallyto patients with ACS have been studied. Prophylaxis with lidocainereduces the incidence of VF but may increase mortality [108]. Routinetreatment with magnesium in patients with AMI does notimprove mortality. Arrhythmia prophylaxis using disopyramide,mexiletine, verapamil, or other anti-arrhythmics given within thefirst hours of an ACS does not improve mortality. Therefore prophylacticanti-arrhythmics are not recommended.Angiotensin-converting enzyme inhibitors and angiotensinreceptor blockersOral ACE inhibitors reduce mortality when given to patientswith AMI with or without early reperfusion therapy. The beneficialeffects are most pronounced in patients presenting with anteriorinfarction, pulmonary congestion or left ventricular ejectionfraction
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European Resuscitation Council Guidelines for Resuscitation ... - CPR

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