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Meta-Analysis
. 2022 Nov;48(11):1513-1524.
doi: 10.1007/s00134-022-06821-y. Epub 2022 Sep 16.

Cardiac arrest and complications during non-invasive ventilation: a systematic review and meta-analysis with meta-regression

Amélie Rolle #  1   2 , Audrey De Jong #  1   3 , Elsa Vidal  1   2 , Nicolas Molinari  4 , Elie Azoulay  5 , Samir Jaber  6   7
Affiliations
Meta-Analysis

Cardiac arrest and complications during non-invasive ventilation: a systematic review and meta-analysis with meta-regression

Amélie Rolle et al. Intensive Care Med. 2022 Nov.

Abstract

Purpose: The aim of this study was to perform a systematic review and meta-analysis to investigate the incidence rate of cardiac arrest and severe complications occurring under non-invasive ventilation (NIV).

Methods: We performed a systematic review and meta-analysis of studies between 1981 and 2020 that enrolled adults in whom NIV was used to treat acute respiratory failure (ARF). We generated the pooled incidence and confidence interval (95% CI) of NIV-related cardiac arrest per patient (primary outcome) and performed a meta-regression to assess the association with study characteristics. We also generated the pooled incidences of NIV failure and hospital mortality.

Results: Three hundred and eight studies included a total of 7,601,148 participants with 36,326 patients under NIV (8187 in 138 randomized controlled trials, 9783 in 99 prospective observational studies, and 18,356 in 71 retrospective studies). Only 19 (6%) of the analyzed studies reported the rate of NIV-related cardiac arrest. Forty-nine cardiac arrests were reported. The pooled incidence was 0.01% (95% CI 0.00-0.02, I2 = 0% (0-15)). NIV failure was reported in 4371 patients, with a pooled incidence of 11.1% (95% CI 9.0-13.3). After meta-regression, NIV failure and the study period (before 2010) were significantly associated with NIV-related cardiac arrest. The hospital mortality pooled incidence was 6.0% (95% CI 4.4-7.9).

Conclusion: Cardiac arrest related to NIV occurred in one per 10,000 patients under NIV for ARF treatment. NIV-related cardiac arrest was associated with NIV failure.

Keywords: Cardiac arrest; Complications; ICU; Meta-analysis; Non-invasive ventilation.

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Conflict of interest statement

SJ reports receiving consulting fees from Drager, Medtronic, Fresenius, Baxter, Mindray and Fisher & Paykel. ADJ reports receiving consulting fees from Drager, Medtronic and Fisher & Paykel. EA has received fees from Gilead Sciences, Alexion, Astellas, MSD and Drager. No potential conflicts of interest relevant to this article were reported for the other authors.

Figures

Fig. 1
Fig. 1
Flow chart of the study. Between 1981 and 2020, we identified 2632 articles using the search strategy. A total of 308 studies were included (138 RCTs, 99 observational prospective, 71 observational retrospective), 19 (6%) studies reported a NIV-related cardiac arrest and 289 (94%) studies did not report a NIV-related cardiac arrest. NIV non-invasive ventilation
Fig. 2
Fig. 2
Forest plot of the pooled incidence of NIV-related cardiac arrest for acute respiratory failure treatment among 19 studies reporting NIV-related cardiac arrest with calculation of pooled incidence among the 308 studies assessed. Among the 1729 patients under NIV with assessed NIV-related cardiac arrests, 49 cardiac arrests were reported. The pooled incidence among all the studies included (reporting and not reporting cardiac arrests) was 0.01% (95% CI 0.00–0.02, I2 = 0% (0–15%)). The pooled incidence among the 19 studies reporting cardiac arrests was 2.6% (95% CI 1.9–3.4, I2 = 0% (0–49%)). NIV non-invasive ventilation
Fig. 3
Fig. 3
Number of NIV complication events related to NIV and hospital mortality in RCTs (n = 138) and non-RCTs (n = 170). This histogram shows the number of events of severe complications related to NIV according to the study design (two groups: RCTs, n = 138 in color blue and non-RCTs, n = 170 in color red). The cardiac arrest absolute number was 15 (31%) and 34 (69%) for RCTs and non-RCTs, respectively, the NIV failure absolute number was 1346 (31%) and 3025 (69%) for RCTs and non-RCTs, respectively, and the hospital mortality absolute number was 946 (12%) and 7027 (88%) for RCTs and non-RCTs, respectively. No statistical differences were found between the two groups for all complications. RCT randomized controlled trial, Non-RCT non-randomized controlled trial, NIV non-invasive ventilation, NS non-significant
Fig. 4
Fig. 4
Pooled incidence by year for 1000 patients with NIV-related cardiac arrest, NIV failure and hospital mortality over time (from 1981 to 2020) in RCTs (n = 138) and non-RCTs (n = 170). A Pooled incidence by year with 10,000 patients with NIV-related cardiac arrest over time (from 1981 to 2020) in RCTs (n = 138) and non-RCTs (n = 170). This spaghetti plot shows the number of events expressed in the pooled incidence of NIV-related cardiac arrest according to study design (two groups: RCTs in color blue and non-RCTs in color red) for each year from 1981 to 2020, for 1000 patients under NIV. With the package “metafor”, we used the inverse method to calculate each pooled incidence for NIV-related cardiac arrest for each year in the two groups RCTs versus non-RCTs. Then we plotted the data with the package “Ggplot2” and the function “ggparcoord” to add the line between each point representing the pooled incidence. The study effect (RCTs versus non-RCTs) and time effect were not significant. RCT randomized controlled trial, non-RCT non-randomized controlled trial, NIV non-invasive ventilation. B Pooled incidence by year for 1000 patients with NIV failure over time (from 1981 to 2020) in RCTs (n = 138) and non-RCTs (n = 170). This spaghetti plot shows the number of events expressed in the pooled incidence of NIV failure according to study design (two groups: RCTs in color blue and non-RCTs in color red) for each year from 1981 to 2020, for 1000 patients under NIV. With the package “metafor”, we used the inverse method to calculate each pooled incidence for NIV failure for each year in the two groups RCT versus non-RCTs. Then we plotted the data with the package “Ggplot2” and the function “ggparcoord” to add the line between each point representing the pooled incidence. The study effect (RCTs versus non-RCTs) and time effect were not significant. RCT randomized controlled trial, non-RCT non-randomized controlled trial, NIV non-invasive ventilation, NS non-significant. C Pooled incidence by year for 1000 patients with hospital mortality over time (from 1981 to 2020) in RCTs (n = 138) and non-RCTs (n = 170). This spaghetti plot shows the number of events expressed in the pooled incidence of hospital mortality according to study design (two groups: RCTs in color blue and non-RCTs in color red) for each year from 1981 to 2020, for 1000 patients under NIV. With the package “metafor”, we used the inverse method to calculate each pooled incidence for mortality for each year in the two groups RCTs versus non-RCTs. Then we plotted the data with the package “Ggplot2” and the function “ggparcoord” to add the line between each point representing the pooled incidence. The study effect (RCTs versus non-RCTs) and time effect were not significant. RCT randomized controlled trial, non-RCT non-randomized controlled trial, NIV non-invasive ventilation, NS non-significant
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