One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis

Schluep, Marc; Gravesteijn, Benjamin; Stolker, Robert Jan; Endeman, Henrik; Hoeks, Sanne E.

doi:10.1016/j.resuscitation.2018.09.001

Cited by 162 publications

(139 citation statements)

References 66 publications

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“…Especially the age criteria are quite stringent, and therefore likely affect the apparent survival [42], given the average age of the CPR population [43]. Moreover, the nding that we found substantially less heterogeneity in survival rates between studies than a systematic review of the CCPR literature [1,2] also supports the hypothesis that this is a selected population. Nevertheless, part of the difference might be explained by the effect of ECPR versus CCPR on outcome [45][46][47].…”

Section: Discussionsupporting

confidence: 71%

“…Although neurological outcome is good, it remains inconclusive whether neurological outcome of patients receiving ECPR is better than patients receiving CCPR. We did nd a lower percentage of "good" neurological outcome (CPC1-2) than in a systematic review in a conventional CPR population [2]. However, in this review CPC score was a secondary outcome.…”

Section: Discussioncontrasting

confidence: 61%

“…In hospital cardiac arrest (IHCA) is a serious adverse event in hospitalized patients that inevitably leads to death if not treated appropriately. It is associated with low survival rates at discharge and at one-year follow-up (13%, 95% prediction interval: 6-29%) [1,2]. The use of extracorporeal membrane oxygenation the time to ECMO cannulation on the effect of ECPR we extracted the average time to ECMO per study.…”

Section: Introductionmentioning

confidence: 99%

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Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Gravesteijn

Schluep

Disli

et al. 2020

Preprint

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Background: In hospital cardiac arrest (IHCA) is a major adverse event with a high mortality rate if not treated appropriately. Extracorporeal cardiopulmonary resuscitation (ECPR), as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment. Evidence pertaining to neurological outcomes after ECPR is still scarce. Methods: We performed a comprehensive systematic search of all studies up to December 20th 2019. Our primary outcome was neurological outcome after ECPR at any moment after hospital discharge, defined by the Cerebral Performance Category (CPC) score. A score of 1 or 2 was defined as favourable outcome. Our secondary outcome was post-discharge mortality. A fixed-effects meta-analysis was performed. Results: Our search yielded 1215 results, of which 19 studies were included in this systematic review. The average survival rate was 30% (95% CI: 28-33%, I2=0%, p=0.24). In the surviving patients, the pooled percentage of favourable neurological outcome was 84% (95% CI: 80-88%, I2=24%, p=0.90). Conclusion: CPR as treatment for in-hospital cardiac arrest is associated with a large proportion of patients with good neurological outcome. The large proportion of favourable outcome could potentially be explained by the selection of patients for treatment using ECPR. Moreover, survival is higher than described in the conventional CPR literature. As indications for ECPR might extend to older or more fragile patient populations in the future, research should focus on increasing survival, while maintaining optimal neurological outcome.

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Section: Discussionsupporting

confidence: 71%

Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Gravesteijn

Schluep

Disli

et al. 2020

Preprint

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“…7 A recent meta-analysis of global IHCA studies found a pooled 1-year survival rate of 13.4%. 21 This meta-analysis included studies as early as 1985, which may explain some of the difference seen. We recognise that the long-term survival of our cohort was quite high, however, this was the first study of a regional cohort so there is no specific benchmark for comparison.…”

Section: Long-term Survivalmentioning

confidence: 99%

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

et al. 2019

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Introduction: Evidence about the immediate survival from in-hospital cardiac arrest (IHCA) is well established, however, beyond discharge there is very little describing the long-term outcomes of these patients. Of the few existing studies, all have been conducted in metropolitan centres. Therefore, this study describes survival from IHCA in both the short and long-term in a large regional hospital cohort. Method: A retrospective cohort study was conducted including all adult patients who suffered an IHCA between 1 February 2000 and 31 December 2017 in a large regional (non-metropolitan) hospital in Victoria, Australia. Characteristics of the arrest and patient were sourced from a prospectively collected database that captures all of the arrests occurring in the hospital. Mortality data after discharge were sourced from the state death registry, censored on 31 January 2018. Results: A total of 629 patients were included in the study. Of these, 357 (57%) survived the event, and 213 (34%) survived to discharge. At one-year post-arrest 27% of the original cohort were still alive. The age of the patient, arrest rhythm, location and duration of resuscitation were all significantly associated with long-term survival. Conclusion: Both short and long-term survival following an IHCA in a regional hospital are similar to previously described rates in metropolitan hospitals. Further research is required on the post-discharge correlates of long-term survival.

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“…1 The incidence of IHCA is 1-6 events per 1000 hospital admissions [2][3][4] and recent meta-analyses showed a pooled survival to discharge of 15% (ranging from 3% to 40%) and a one-year survival of 13% (ranging from 4% to 69%). 5,6 Patient-specific factors associated with survival are age, 7,8 comorbidities [9][10][11][12] and presence of shockable rhythm. 13 A possible advantage for patients suffering IHCA versus OHCA is that hospitals are equipped with advanced life support teams, who could employ extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model

et al. 2019

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Background: This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment.Methods: A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2-4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY). Measurements and main results: Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922-14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192-15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478-16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357-19,400) euro per extra QALY per IHCA patient.For WTP thresholds of 0-9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most costeffective strategy. Conclusions:Given that conventional WTP thresholds in Europe and North-America lie between 50,000-100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR.

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One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis

Cited by 162 publications

References 66 publications

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model

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