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Impact of cardiac arrest centers on the survival of patients with nontraumatic out‐of‐hospital cardiac arrest : a systematic review and meta‐analysis
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National Targeted Temperature Management Workgroup (Including:
). (2022) Impact of cardiac arrest centers on the survival of patients with nontraumatic out‐of‐hospital cardiac arrest : a systematic review and meta‐analysis. Journal of the American Heart Association, 11 (1). e023806. doi:10.1161/jaha.121.023806 ISSN 2047-9980.
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WRAP-Impact-cardiac-arrest-centers-survival-patients-nontraumatic-review-meta‐analysis-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (3570Kb) | Preview |
Official URL: https://doi.org/10.1161/jaha.121.023806
Abstract
Background
The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups.
Methods and Results
Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected.
Conclusions
Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||||||||
| SWORD Depositor: | Library Publications Router | |||||||||||||||
| Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment, Cardiac resuscitation, Emergency medical services | |||||||||||||||
| Journal or Publication Title: | Journal of the American Heart Association | |||||||||||||||
| Publisher: | Ovid Technologies (Wolters Kluwer Health) | |||||||||||||||
| ISSN: | 2047-9980 | |||||||||||||||
| Official Date: | 4 January 2022 | |||||||||||||||
| Dates: |
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| Volume: | 11 | |||||||||||||||
| Number: | 1 | |||||||||||||||
| Article Number: | e023806 | |||||||||||||||
| DOI: | 10.1161/jaha.121.023806 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||||||||
| Copyright Holders: | Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell | |||||||||||||||
| Date of first compliant deposit: | 8 March 2022 | |||||||||||||||
| Date of first compliant Open Access: | 8 March 2022 | |||||||||||||||
| RIOXX Funder/Project Grant: |
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