Smida Tanner, Dayal Sahil, Bardes James, Scheidler James
West Virginia University School of Medicine, Morgantown, West Virginia.
Department of Emergency Medicine, Division of Prehospital Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.
Prehosp Emerg Care. 2024 Oct 18:1-9. doi: 10.1080/10903127.2024.2408628.
Exposure to prehospital rearrest has previously been associated with mortality following out-of-hospital cardiac arrest (OHCA). Our objective was to conduct a systematic review and meta-analysis examining the association between prehospital rearrest and survival in adults following OHCA resuscitation.
We searched the PubMed, Scopus, and Web of Science bibliographic databases for observational studies that included adult OHCA patients who achieved return of spontaneous circulation in the prehospital setting following OHCA and reported survival to hospital discharge data stratified by rearrest status. The primary exposure was prehospital rearrest. The primary outcome for this study was survival to hospital discharge. Secondary outcomes included survival with a favorable neurological outcome and rearrest prevalence. We pooled data using inverse heterogeneity modeling and presented effect sizes for the survival outcomes as odds ratios with 95% confidence intervals. We quantified heterogeneity using Cochran's Q and the I statistic and examined small study effects using Doi plots and the LFK index.
Of the 84 publications screened, we included 7 observational studies containing 27,045 patients with survival to hospital discharge data. Rearrest was common (30% [18-43%]; = 7 studies; = 1086.1, p < 0.001; I = 99%; LFK index = 1.21) and associated with both decreased odds of survival to discharge (pooled aOR: 0.27 [0.22, 0.33]; = 7 studies; = 32.2, p < 0.01, I = 81%, LFK index = -0.08) and decreased odds of survival to discharge with a favorable neurological outcome (pooled aOR: 0.25, [0.22, 0.28]; = 4 studies; = 3.5, p = 0.3; I = 13%, LFK index = 1.30).
Rearrest is common and associated with decreased survival following OHCA. The pooled result of this meta-analysis suggests that preventing rearrest in five patients would be necessary to save one life.
既往研究表明，院外心脏骤停（OHCA）复苏后再次发生心脏骤停与死亡率相关。我们的目的是进行一项系统评价和荟萃分析，以研究OHCA复苏后成人患者的院前再次心脏骤停与生存之间的关联。
我们检索了PubMed、Scopus和Web of Science文献数据库，查找观察性研究，这些研究纳入了在OHCA后院前实现自主循环恢复的成年OHCA患者，并报告了按再次心脏骤停状态分层的出院生存率数据。主要暴露因素为院前再次心脏骤停。本研究的主要结局是出院生存。次要结局包括伴有良好神经功能结局的生存和再次心脏骤停的患病率。我们使用逆异质性模型汇总数据，并将生存结局的效应量表示为具有95%置信区间的比值比。我们使用Cochran's Q和I统计量对异质性进行量化，并使用Doi图和LFK指数检查小研究效应。
在筛选的84篇出版物中，我们纳入了7项观察性研究，共27045例患者有出院生存数据。再次心脏骤停很常见（30%[18 - 43%]；n = 7项研究；Q = 1086.1，p < 0.001；I = 99%；LFK指数 = 1.21），并且与出院生存几率降低（合并调整后比值比：0.27[0.22, 0.33]；n = 7项研究；Q = 32.2，p < 0.01，I = 81%，LFK指数 = -0.08）以及伴有良好神经功能结局的出院生存几率降低（合并调整后比值比：0.25，[0.22, 0.28]；n = 4项研究；Q = 3.5，p = 0.3；I = 13%，LFK指数 = 1.30）相关。
再次心脏骤停很常见，并且与OHCA后的生存几率降低相关。这项荟萃分析的汇总结果表明，每预防5例患者再次心脏骤停才能挽救1例生命。
