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Meta-Analysis
. 2022 Jun 1;7(6):633-643.
doi: 10.1001/jamacardio.2022.0795.

Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis

Simon A Amacher  1   2 , Chantal Bohren  2 , René Blatter  2 , Christoph Becker  2   3 , Katharina Beck  2 , Jonas Mueller  2 , Nina Loretz  2 , Sebastian Gross  2 , Kai Tisljar  1 , Raoul Sutter  1   4 , Christian Appenzeller-Herzog  4   5 , Stephan Marsch  1   4 , Sabina Hunziker  2   4
Affiliations
Meta-Analysis

Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis

Simon A Amacher et al. JAMA Cardiol. .

Abstract

Importance: Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce.

Objective: To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA.

Data sources: A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021.

Study selection: Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol.

Data extraction and synthesis: Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed.

Main outcomes and measures: The primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA.

Results: The search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results.

Conclusions and relevance: In this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sutter reported holding stock in Novartis, Roche, Alcon, and Johnson & Johnson and receiving grants from UCB Pharma outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curves for Patient Survival
Below the x-axis, the number at risk for the individual time points with number of deaths (in parentheses) are reported. ICU indicates intensive care unit; OHCA, out-of-hospital cardiac arrest.
Figure 2.
Figure 2.. Kaplan-Meier Survival Curve for Patients Surviving to Hospital Discharge or 30 Days After Out-of-Hospital Cardiac Arrest Stratified by Initial Cardiac Arrest Rhythm
Figure 3.
Figure 3.. Forest Plot Summarizing Overall Survival Rates After Hospital Discharge Stratified by Follow-up Category
See this image and copyright information in PMC

Comment in

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