Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland.
Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland.
Resuscitation. 2022 Mar;172:181-193. doi: 10.1016/j.resuscitation.2021.11.041. Epub 2021 Dec 9.
For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate the predictive value of clinical risk scores through meta-analysis.
We searched Embase, PubMed, CINAHL, and PsycINFO from the inception of each database up to January 22, 2021. Data were pooled using a fixed-effects model. Data collection and reporting followed the PRISMA guidelines.
Thirty-one studies were included in the systematic review and 11 in the meta-analysis. Medical futility defined by risk scores was associated with a significantly higher risk of in-hospital mortality (5 studies, 3102 participants with Pre-Arrest Morbidity (PAM) and Prognosis After Resuscitation (PAR) score; overall RR 3.38 [95% CI 1.92-5.97]) and poor neurologic outcome/in-hospital mortality (6 studies, 115,213 participants with Good Outcome Following Attempted Resuscitation (GO-FAR) and Prediction of Outcome for In-Hospital Cardiac Arrest (PIHCA) score; RR 6.93 [95% CI 6.43-7.47]). All showed high specificity (>90%) for identifying patients with poor outcome.
There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR.
对于一些患者来说，心肺复苏（CPR）后存活并保持良好神经功能的可能性极低，因此 CPR 可被认为是医学无效的。然而，在临床实践中，尚无确定 CPR 无效的既定标准、指南或措施。我们旨在研究如何定义、衡量成人患者 CPR 的医学无效性，以及其与不复苏（DNR）代码状态的关系，并通过荟萃分析评估临床风险评分的预测价值。
我们从每个数据库的创建到 2021 年 1 月 22 日在 Embase、PubMed、CINAHL 和 PsycINFO 中进行了搜索。使用固定效应模型汇总数据。数据收集和报告遵循 PRISMA 指南。
系统评价纳入 31 项研究，荟萃分析纳入 11 项研究。通过风险评分定义的医学无效性与院内死亡率显著升高相关（5 项研究，3102 名具有 Pre-Arrest Morbidity（PAM）和 Prognosis After Resuscitation（PAR）评分的患者；总体 RR 3.38 [95% CI 1.92-5.97]）和不良神经结局/院内死亡率（6 项研究，115213 名具有 Good Outcome Following Attempted Resuscitation（GO-FAR）和 Prediction of Outcome for In-Hospital Cardiac Arrest（PIHCA）评分的患者；RR 6.93 [95% CI 6.43-7.47]）。所有评分对识别预后不良的患者均具有较高的特异性（>90%）。
目前尚无国际共识，也缺乏成人患者 CPR 无效的具体定义。临床风险评分可能有助于在 CPR 被认为无效时做出决策。未来需要研究来评估其作为 CPR 无效性衡量标准的临床价值和可靠性。
