Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

Abstract

Please cite this article as: Yeung J, Matsuyama T, Bray J, Reynolds J, Skrifvars MB, Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? -A systematic review, Resuscitation (2019), https://doi.on behalf of the Education, Implementation and Team Task Force and Advanced Life Support Task Force of the International Liaison Committee on Resuscitation AIMTo perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' METHODSThe PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1 st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTSWe included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95%CI 0.68 to 12.48) and survival to 30 days (OR 2.14, 95%CI 0.73 to 6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95%CI 1.74 to 2.84) and survival to hospital discharge (OR 1.85, 95%CI 1.46 to 2.34). CONCLUSIONSVery low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.

Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest

“…Multi-center observational studies and a systematic review suggest that the outcomes of patients resuscitated from OHCA are associated with the components of care administered after transportation to a receiving hospital. (53)(54)(55)(56) These include emergency coronary angiography and selective percutaneous coronary intervention, as well as deferred prognostic assessment and withdrawal of life-sustaining treatment in addition to IH. Included articles lacked information regarding these components of resuscitation after OHCA so we cannot draw conclusions about their relative contributions to patient outcomes based on the results of this systematic review and meta-analysis.…”

Cardiac Arrest Center Certification for out-of-hospital cardiac arrest patients successfully established in Germany

“…2 Since 2015 - based on all available data – the international resuscitation guidelines recommend the introduction of specialized hospitals for patients following OHCA, so called Cardiac Arrest Centers (CAC).2 Subsequently, the benefit of establishing CACs has been supported by further data. 3 , 4 …”

Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest

“…Most of those trials were typically perplexed by the pivotal interactive nature of various interdependent variables. In addition, underrecognized confounding factors such as suboptimal quality of CPR, overzealous positive pressure ventilation, time delays to interventions, and many other systematic factors played large roles ( 9 , 10 , 14 , 17 , 19 , 21 , 23 , 31 , 35 – 38 ). Low survival rates create further statistical quandaries, especially in essential subgroup analyses.…”