A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

Abstract

Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, p < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, p < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, p < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I2 greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject.

Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study

“…However, the fact that the benefit in survival was greater in the earlier rates might suggest that the hospital effect was minimal [ 34 ]. Lastly, the teams led by the physicians had four members, while the EMT team used as the control group consisted of only two, which could also be related to survival [ 35 , 36 , 37 ].…”

A survey on technologies used during Out of Hospital Cardiac Arrest

“…After the dispatcher confirms that the patient is experiencing cardiac arrest, the next step is to guide the caller to perform CPR. CPR performed by bystanders plays a vital role in increasing the patient's survival chances 78,79,80,81 . Bystander CPR is necessary because the ambulance dispatched to the patient's location takes approximately 8-10 minutes, depending on the site of dispatch vehicles 82,83 .…”

“…The CPR quality directly affects the patient's survival chances; high quality CPR increases a patients chances of survival 79,85,80 . Medical agencies have defined CPR performance metrics; for instance, the American Heart Association (AHA) defines that high-quality CPR should have a chest compression depth between 2 and 2.4 inches at a rate of 100-120 compressions per minute 86 .…”

The impact of a high-performance cardiopulmonary resuscitation protocol on survival from out-of-hospital cardiac arrests witnessed by paramedics

“…Recently, there has been growing interest in the advantages of high-quality prehospital resuscitative efforts to achieve optimal OHCA outcomes. 3 High-performance cardiopulmonary resuscitation (HP-CPR) practices have been implemented by a number of international EMS systems, 4 , 5 and typically include the collective strategies of team-based training, real-time feedback on CPR performance, structured choreography and scene leadership, and post-event debriefing. Although some reports have demonstrated significant improvements in patient outcomes, the majority are focussed on initial shockable arrests or non-EMS witnessed populations.…”

“… 4 , 5 To date, there are no reports that have examined the value of HP-CPR in EMS witnessed OHCA populations. 3 As the majority of EMS witnessed OHCA survivors achieve a return of spontaneous circulation (ROSC) within the first cycle of CPR/defibrillation, 1 the value of HP-CPR in these populations is less certain.…”