Meta-Analysis

. 2019 Dec 4:367:l6373.

doi: 10.1136/bmj.l6373.

Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

Shannon M Fernando^{1

2}, Alexandre Tran^{3

4}, Wei Cheng⁵, Bram Rochwerg^{6

7}, Monica Taljaard^{3

5}, Christian Vaillancourt^{2

3

5}, Kathryn M Rowan⁸, David A Harrison⁸, Jerry P Nolan^{9

10}, Kwadwo Kyeremanteng^{11

5}, Daniel I McIsaac^{3

5

12}, Gordon H Guyatt^{7

13}, Jeffrey J Perry^{2

3

5}

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada sfernando@qmed.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Intensive Care National Audit and Research Centre, London, UK.
⁹ Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
¹⁰ Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹³ Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 31801749
PMCID: PMC6891802
DOI: 10.1136/bmj.l6373

Meta-Analysis

Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

Shannon M Fernando et al. BMJ. 2019.

. 2019 Dec 4:367:l6373.

doi: 10.1136/bmj.l6373.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada sfernando@qmed.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Intensive Care National Audit and Research Centre, London, UK.
⁹ Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
¹⁰ Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
¹³ Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 31801749
PMCID: PMC6891802
DOI: 10.1136/bmj.l6373

Abstract

Objective: To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest.

Design: Systematic review and meta-analysis.

Data sources: Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database.

Study selection criteria: English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest.

Data extraction: PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence.

Results: The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival.

Conclusion: Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest.

Systematic review registration: PROSPERO CRD42018104795.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig 1**
Flowchart summarising evidence search and study selection

**Fig 2**
Forest plots showing pre-arrest factors and associated odds of survival after in-hospital cardiac arrest. Factors shown are male sex, age, history of malignancy and congestive heart failure. *30 day mortality

**Fig 3**
Forest plots showing pre-arrest factors and associated odds of survival after in-hospital cardiac arrest. Factors shown are history of chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus, and diagnosis of acute coronary syndrome and sepsis. *30 day mortality

**Fig 4**
Forest plots showing intra-arrest factors and associated odds of survival after in-hospital cardiac arrest. Factors shown are witnessed arrest, monitored patient, and arrest during daytime hours. *30 day mortality

**Fig 5**
Forest plots showing intra-arrest factors and associated odds of survival after in-hospital cardiac arrest. Factors shown are initial shockable rhythm, intubation during resuscitation, and duration of resuscitation longer than 15 minutes. *30 day mortality

See this image and copyright information in PMC

References

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Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

Affiliations

Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical