Schnaubelt S, Monsieurs K G, Semeraro F, Schlieber J, Cheng A, Bigham B L, Garg R, Finn J C, Greif R
Department of Emergency Medicine, Medical University of Vienna, Austria.
Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium.
Resuscitation. 2020 Nov;156:137-145. doi: 10.1016/j.resuscitation.2020.08.126. Epub 2020 Sep 10.
Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities.
This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates.
We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034).
Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities.
关于复苏的科学建议通常是从理想资源环境的角度制定的，很少考虑在低收入国家的适用性。我们旨在确定资源匮乏国家院外心脏骤停（OHCA）的临床结局，识别这些地区与复苏相关的不足和可能的解决方案，并提出未来的研究重点。
本范围综述是国际复苏联合委员会（ILCOR）持续证据评估过程的一部分，按照系统评价和Meta分析扩展版的范围综述的首选报告项目进行。我们将资源匮乏国家定义为人均国民总收入较低或中等的国家（世界银行数据）。我们对这些国家OHCA后的结局进行了文献检索，并提取了结局数据。我们应用描述性统计，并对队列规模和自主循环恢复率进行了事后相关性分析。
我们确定了24项来自中等收入国家的合格研究，但没有来自低收入地区的研究，这表明存在报告偏倚。这些研究中报告的患者数量从54例到3214例不等。很少使用Utstein式报告。自主循环恢复率从０％到62％不等。15项研究报告了出院存活率（1.0％至16.7％）或良好神经功能结局（1.0％至9.3％）。研究队列规模与自主循环恢复率之间存在负相关（ρ = -0.48，p = 0.034）。
资源匮乏国家OHCA结局的研究存在异质性，可能受到报告偏倚的影响。应与当地专家合作制定资源匮乏地区的最低心肺复苏标准，尊重文化和背景，同时平衡相互竞争的卫生重点。
