Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

Abstract Introduction This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA). Methods We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i.e. vascular access and cardiac arrest. There were no limitations implemented in the search strategy. We selected studies comparing IO versus IV access in neurological or survival outcomes after OHCA. Favourable neurological outcome at hospital discharge was pre-specified as the primary outcome. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Time to intervention, defined as time interval from call for emergency medical services to establishing vascular access or administering medications, was hypothesized to be a potential outcome moderator and examined in subgroup analysis with meta-regression. Results Nine retrospective observational studies involving 111,746 adult OHCA patients were included. Most studies were rated as high quality according to Newcastle-Ottawa Scale. The pooled results demonstrated no significant association between types of vascular access and the primary outcome (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.33; I2, 95%). In subgroup analysis, time to intervention was noted to be positively associated with the pooled OR of achieving the primary outcome (OR: 3.95, 95% CI, 1.42–11.02, p: 0.02). That is, when the studies not accounting for the variable of “time to intervention” in the statistical analysis were pooled together, the meta-analytic results between IO access and favourable outcomes would be biased toward inverse association. No obvious publication bias was detected by the funnel plot. Conclusions The meta-analysis revealed no significant association between types of vascular access and neurological outcomes at hospital discharge among OHCA patients. Time to intervention was identified to be an important outcome moderator in this meta-analysis of observation studies. These results call for the need for future clinical trials to investigate the unbiased effect of IO use on OHCA CPR.

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Impact of Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation with Out-of-Hospital Cardiac Arrest: A Systemic Review and Meta-Analysis

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000588 ◽

2020 ◽

Vol 35 (4) ◽

pp. 372-381

Author(s):

Junhong Wang ◽

Hua Zhang ◽

Zongxuan Zhao ◽

Kaifeng Wen ◽

Yaoke Xu ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

The Impact ◽

Hospital Cardiac Arrest

AbstractObjective:This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA).Methods:Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1.Results:In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36).Conclusion:This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.

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Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01058-9 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Melaku Bimerew ◽

Adam Wondmieneh ◽

Getnet Gedefaw ◽

Teshome Gebremeskel ◽

Asmamaw Demis ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Pediatric Patients ◽

Meta Analysis ◽

Cochrane Review ◽

Probability Of Survival ◽

Pooled Prevalence ◽

Hospital Cardiac Arrest

Abstract Background In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. Methods PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. Results Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0–50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by “continent” and “income level”, lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01–52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0–51.0%, I2 = 97.67%, p < 0.001) respectively. Conclusion Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

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Open-chest cardiopulmonary resuscitation versus closed-chest cardiopulmonary resuscitation in patients with cardiac arrest: a systematic review and meta-analysis

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0690-7 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Mao Wang ◽

Xiaoguang Lu ◽

Ping Gong ◽

Yilong Zhong ◽

Dianbo Gong ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Subgroup Analysis ◽

Meta Analysis ◽

Spontaneous Circulation ◽

Cochrane Library ◽

Return Of Spontaneous Circulation ◽

Closed Chest ◽

Open Chest

Abstract Background Cardiopulmonary resuscitation is the most urgent and critical step in the rescue of patients with cardiac arrest. However, only about 10% of patients with out-of-hospital cardiac arrest survive to discharge. Surprisingly, there is growing evidence that open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation. Meanwhile, The Western Trauma Association and The European Resuscitation Council encouraged thoracotomy in certain circumstances for trauma patients. But whether open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation remains undetermined. Therefore, the aim of this study was to summarize current studies on open-chest cardiopulmonary resuscitation in a systematic review, comparing it to closed-chest cardiopulmonary resuscitation, in a meta-analysis. Methods In this systematic review and meta-analysis, we searched the PubMed, EmBase, Web of Science, and Cochrane Library databases from inception to May 2019 investigating the effect of open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in patients with cardiac arrest, without language restrictions. Statistical analysis was performed using Stata 12.0 software. The primary outcome was return of spontaneous circulation. The secondary outcome was survival to discharge. Results Seven observational studies were eligible for inclusion in this meta-analysis involving 8548 patients. No comparative randomized clinical trial was reported in the literature. There was no significant difference in return of spontaneous circulation and survival to discharge between open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in cardiac arrest patients. The odds ratio (OR) were 0.92 (95%CI 0.36–2.31, P > 0.05) and 0.54 (95%CI 0.17–1.78, P > 0.05) for return of spontaneous circulation and survival to discharge, respectively. Subgroup analysis of cardiac arrest patients with trauma showed that closed-chest cardiopulmonary resuscitation was associated with higher return of spontaneous circulation compared with open-chest cardiopulmonary resuscitation (OR = 0.59 95%CI 0.37–0.94, P < 0.05). And subgroup analysis of cardiac arrest patients with non-trauma showed that open-chest cardiopulmonary resuscitation was associated with higher ROSC compared with closed-chest cardiopulmonary resuscitation (OR = 3.12 95%CI 1.23–7.91, P < 0.05). Conclusions In conclusion, for patients with cardiac arrest, we should implement closed-chest cardiopulmonary resuscitation as soon as possible. However, for cardiac arrest patients with chest trauma who cannot perform closed-chest cardiopulmonary resuscitation, open-chest cardiopulmonary resuscitation should be implemented as soon as possible.

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Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.09.023 ◽

2016 ◽

Vol 67 (3) ◽

pp. 349-360.e3 ◽

Cited By ~ 46

Author(s):

Judith L. Bonnes ◽

Marc A. Brouwer ◽

Eliano P. Navarese ◽

Dominique V.M. Verhaert ◽

Freek W.A. Verheugt ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Observational Studies ◽

Meta Analysis ◽

Compression Device ◽

Mechanical Chest Compression ◽

Hospital Cardiac Arrest

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Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00344-x ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Mohammed S. Alshahrani ◽

Hassan W. Aldandan

Keyword(s):

Cardiac Arrest ◽

Sodium Bicarbonate ◽

Observational Studies ◽

Meta Analysis ◽

Spontaneous Circulation ◽

Current Evidence ◽

Cochrane Library ◽

Return Of Spontaneous Circulation ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a common cause of death worldwide (Neumar et al., Circulation 122:S729–S767, 2010), affecting about 300,000 persons in the USA on an annual basis; 92% of them die (Roger et al., Circulation 123:e18–e209, 2011). The existing evidence about the use of sodium bicarbonate (SB) for the treatment of cardiac arrest is controversial. We performed this study to summarize the evidence about the use of SB in patients with out-of-hospital cardiac arrest (OHCA). Methods We searched PubMed, Scopus, EBSCO, Web of Science, and Cochrane Library, until June 2019, for randomized controlled trials (RCTs) and observational studies that used SB in patients with OHCA. Outcomes of interest were the rate of survival to discharge, return of spontaneous circulation (ROSC), sustained ROSC, and good neurological outcomes at discharge. Odds ratio (OR) with their 95% confidence interval (CI) were pooled in a random or fixed meta-analysis model. Results A total of 14 studies (four RCTs and 10 observational studies) enrolling 28,412 patients were included; of them, eight studies were included in the meta-analysis. The overall pooled estimate did not favor SB or control in terms of survival rate at discharge (OR= 0.66, 95% CI [0.18, 2.44], p=0.53) and ROSC rate (OR= 1.54, 95% CI [0.38, 6.27], p=0.54), while the pooled estimate of two studies showed that SB was associated with less sustained ROSC (OR= 0.27, 95% CI [0.07, 0.98], p=0.045) and good neurological outcomes at discharge (OR= 0.12, 95% CI [0.09, 0.15], p<0.01). Conclusion The current evidence demonstrated that SB was not superior to the control group in terms of survival to discharge and return of spontaneous circulation. Further, SB was associated with lower rates of sustained ROSC and good neurological outcomes.

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The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073636 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3636

Author(s):

Yi-Rong Chen ◽

Chi-Jiang Liao ◽

Han-Chun Huang ◽

Cheng-Han Tsai ◽

Yao-Sing Su ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Primary Outcome ◽

Medical Service ◽

Spontaneous Circulation ◽

High Quality ◽

Urban City ◽

Service Response Time ◽

Mechanical Cpr ◽

Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

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Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis

International Journal of Critical Illness and Injury Science ◽

10.4103/ijciis.ijciis_155_20 ◽

2020 ◽

Vol 10 (3) ◽

pp. 109

Author(s):

AndrewC Miller ◽

Kiyoshi Scissum ◽

Lorena McConnell ◽

Nathaniel East ◽

Amir Vahedian-Azimi ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Real Time ◽

Visual Feedback ◽

Meta Analysis ◽

Hospital Cardiac Arrest ◽

External Defibrillator

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The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10235573 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5573

Author(s):

Karol Bielski ◽

Agnieszka Szarpak ◽

Miłosz Jaroslaw Jaguszewski ◽

Tomasz Kopiec ◽

Jacek Smereka ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Survival Outcomes ◽

Cochrane Central Register ◽

Mortality And Morbidity ◽

Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

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Out-of-hospital cardiac arrest patients with an initial non-shockable rhythm could be candidates for extracorporeal cardiopulmonary resuscitation: a retrospective study.

10.21203/rs.3.rs-31150/v1 ◽

2020 ◽

Author(s):

Atsunori Tanimoto ◽

Kazuhiro Sugiyama ◽

Maki Tanabe ◽

Kanta Kitagawa ◽

Ayumi Kawakami ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

Low Flow ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Emergency Medical Service Personnel ◽

Good Outcome ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory out-of-hospital cardiac arrest (OHCA). Most studies evaluating the effectiveness of ECPR include patients with an initial shockable rhythm. However, the effectiveness of ECPR for patients with an initial non-shockable rhythm remains unknown. This retrospective single-center study aimed to evaluate the effectiveness of ECPR for patients with an initial non-shockable rhythm, with reference to the outcomes of OHCA patients with an initial shockable rhythm. Methods Adult OHCA patients treated with ECPR at our center during 2011–2018 were included in the study. Patients were classified into the initial shockable rhythm group and the non-shockable rhythm group. The primary outcome was the cerebral performance category (CPC) scale score at hospital discharge. A CPC score of 1 or 2 was defined as a good outcome. Results In total, 186 patients were eligible. Among them, 124 had an initial shockable rhythm and 62 had an initial non-shockable rhythm. Among all patients, 158 (85%) were male, with a median age of 59 (interquartile range [IQR], 48–65) years, and the median low flow time was 41 (IQR, 33–48) min. Collapse was witnessed in 169 (91%) patients, and 36 (19%) achieved return of spontaneous circulation (ROSC) transiently. Proportion of female patients, presence of bystander cardiopulmonary resuscitation, and collapse after the arrival of emergency medical service personnel were significantly higher in the non-shockable rhythm group. The rate of good outcomes at hospital discharge was not significantly different between the shockable and non-shockable groups (19% vs. 16%, p=0.69). Initial shockable rhythm was not significantly associated with good outcome after controlling for potential confounders (adjusted odds ratio 1.58, 95% confidence interval: 0.66–3.81, p=0.31). In the non-shockable group, patients with good outcomes had a higher rate of transient ROSC, and pulmonary embolism was the leading etiology. Conclusions The outcomes of patients with an initial non-shockable rhythm are comparable with those having an initial shockable rhythm. OHCA patients with an initial non-shockable rhythm could be candidates for ECPR, if they are presumed to have reversible etiology and potential for good neurological recovery.

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