Warwick Medical School, University of Warwick, United Kingdom.
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Resuscitation. 2019 Apr;137:102-115. doi: 10.1016/j.resuscitation.2019.02.006. Epub 2019 Feb 16.
To 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?'
The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st 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) RESULTS: We 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 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) 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 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34).
Very 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.
进行系统评价，以回答“在非创伤性心脏骤停后进行复苏尝试的成年人中，与在未指定为专门心脏骤停中心的医疗机构接受治疗相比，在专门心脏骤停中心（CAC）接受治疗是否能改善患者结局？”
遵循 PRISMA 指南。我们从成立到 2018 年 8 月 1 日搜索了书目数据库（Embase、MEDLINE 和 Cochrane 图书馆（CENTRAL））。纳入的研究包括随机对照试验（RCT）和非随机研究。两位评审员独立审查了研究的相关性，提取了数据并评估了研究的质量。使用 ROBINS-I 工具评估研究的偏倚风险，使用 GRADEpro 评估证据质量。主要结局为 30 天生存且神经功能良好，以及住院期间神经功能良好的生存。次要结局为 30 天生存、住院期间生存以及在到达医院后持续复苏的患者恢复自主循环（ROSC）。这项系统评价已在 PROSPERO（CRD42018093369）中注册。
我们纳入了 17 项关于院外心脏骤停（OHCA）患者的观察性研究的数据进行荟萃分析。总体而言，证据的确定性非常低。仅对调整后的分析进行数据合并，与在其他医院接受治疗相比，在 CAC 接受治疗并不能增加 30 天神经功能良好的生存几率（OR 2.92，95%CI 0.68-12.48）和 30 天生存几率（OR 2.14，95%CI 0.73-6.29）。然而，在 CAC 接受治疗的患者在出院时具有更好的神经功能良好的生存几率（OR 2.22，95%CI 1.74-2.84）和出院生存几率（OR 1.85，95%CI 1.46-2.34）。
极低的证据确定性表明，CAC 后的心脏骤停后治疗与出院时的结局改善有关。仍然需要高质量的数据来充分阐明 CAC 的影响。
