Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations☆,☆☆
Section snippets
Demographic FactorsACS-002A,ACS-002B
For patients with ACS, we evaluated whether any specific demographic factors (e.g., age, sex, race, weight) were associated with delayed treatment and classified these delays according to whether they occurred before or after hospital arrival.
Initial therapeutic interventions
Few studies have been published that directly address out-of-hospital or ED interventions for ACS. In some situations, extrapolation from in-hospital evidence was needed to provide some guidance for out-of-hospital and early ED management.
Reperfusion strategies
In the majority of patients, STEMI occurs as the result of a recent acute occlusion of a major epicardial coronary artery due to the disruption of atherosclerotic plaque and thrombus formation. Strategies aimed at restoring myocardial perfusion are an important part of the management of these patients. Restoring coronary blood flow and myocardial perfusion either by pharmacological (fibrinolytics) and/or mechanical therapy (PCI) has been demonstrated to improve outcomes in patients presenting
Additional medical therapy
Several additional medical therapies have been proposed for ACS patients with the goal of reducing complications from myocardial ischaemia, major adverse cardiac events, and ultimately long-term survival. Therapeutic options include antiarrhythmics, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and HMG-CoA reductase inhibitors (statins). The bulk of data available to determine the usefulness of these therapies has not been derived from patients in the prehospital or ED settings.
Healthcare system interventions for ACS
Several systems-related strategies have been developed to improve quality of care for patients with ACS and reduce reperfusion delays for patients with STEMI. Strategies exist for patients identified in the prehospital setting and in the ED. These strategies focus on the use of prehospital 12-lead ECG and time-saving strategies to facilitate early diagnosis and rapid treatment for patients with STEMI.
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Note from the writing group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (e.g., “Chest Pain Observation UnitsACS-005A”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.
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The European Resuscitation Council requests that this document be cited as follows: Bossaert L, O’Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K, on behalf of the Acute Coronary Syndrome Chapter Collaborators. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010;81:e175–e212.
We thank the following individuals for their collaborations on the worksheets contained in this chapter: William J. Brady, Teresa R. Camp-Rogers, Marc J. Claeys, Alan M. Craig, Russell Denman, Judith Finn, Chris Ghaemmaghami, Ian Jacobs, Michael C. Kurz, Dawn Yin Lim, Steve Lin, Venu Menon, Patrick Meybohm, Peter T. Morley, Dirk Mueller, Hiroshi Nonogi, Brian J. O’Neil, Joseph P. Ornato, Julian J. Owen, Valeria Rac, Hiromi Seo, Kimberly A. Skelding, Christian Spaulding, Nico R.Van de Veire, and Hiroyuki Yokoyama.
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Co-chairs and equal first co-authors.