Dwivedi Dhiraj Bhatia, Ball Jocasta, Smith Karen, Nehme Ziad
School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, Victoria, Australia; Critical Care and Perioperative Medicine, Monash Health, Clayton, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Prahran, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.
Resuscitation. 2025 Jul;212:110629. doi: 10.1016/j.resuscitation.2025.110629. Epub 2025 May 3.
To examine global variation in the incidence and outcomes of Emergency Medical Services (EMS) attended and treated out-of-hospital cardiac arrest (OHCA) from initial asystole.
We systematically reviewed electronic databases for studies between 1990 and August 2024 reporting EMS-attended or treated asystolic OHCA populations. The primary outcome was survival to hospital discharge or 30-days. Random-effects models were used to pool primary and secondary outcomes and meta-regression was used to examine sources of heterogeneity. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies.
The search returned 4464 articles, of which 82 studies were eligible for inclusion encompassing 540,054 EMS-treated patients across 35 countries. Five studies reported on EMS attended populations (n = 35,561). The studies included in the review had high clinical and statistical heterogeneity. The pooled proportion of EMS-treated initial asystolic OHCA was 53.0% (95% CI: 49.0%, 58.0%; I = 100%). The overall pooled proportion of survivors to hospital discharge or 30-days was 1.5% (95% CI: 1.2%, 1.8%, I = 97%). The pooled proportion of event survivors was 11.6% (95% CI 6.5%, 17.8%, I = 99%), the pooled proportion of prehospital ROSC was 16.0% (95% CI 14.0%, 17.0%, I = 100%) and the pooled proportion of neurologically favourable survival at longest follow-up was 0.6% (95% CI 0.5%, 0.8%, I = 100%). The overall pooled incidence of EMS-treated asystolic OHCA was 11.0 cases per 100,000 person-years (95% CI: 10.5, 11.5, I = 100%). In stratified analysis of survival to hospital discharge or 30-days, population type, study duration, study design and aetiology were the only variables that were significantly associated with survival to hospital discharge or 30-days. In adjusted analysis, population type, study duration, highest EMS skill level and region were significantly associated with the primary outcome. In the multivariable analysis of incidence, study region, arrest aetiology, sample size, year of publication, study population, study duration and study quality significantly explained variation in incidence across studies.
Initial asystolic OHCA made up 53% of all EMS-treated patients and pooled survival rates were extremely poor. Research efforts in this population should focus on developing prevention strategies as well as adherence to termination or withholding of resuscitation guidelines for asystolic OHCA.
研究因初始心搏骤停而接受紧急医疗服务（EMS）救治的院外心脏骤停（OHCA）的发病率及治疗结果的全球差异。
我们系统检索了1990年至2024年8月期间的电子数据库，以查找报告接受EMS救治或治疗的心搏骤停型OHCA人群的研究。主要结局为出院或30天存活。采用随机效应模型汇总主要和次要结局，并采用meta回归分析异质性来源。使用乔安娜·布里格斯研究所患病率研究的批判性评价工具评估研究质量。
检索到4464篇文章，其中82项研究符合纳入标准，涵盖35个国家的540,054例接受EMS治疗的患者。5项研究报告了接受EMS救治的人群（n = 35,561）。纳入综述的研究具有较高的临床和统计学异质性。接受EMS治疗的初始心搏骤停型OHCA的汇总比例为53.0%（95%CI：49.0%，58.0%；I² = 100%）。出院或30天存活的总体汇总比例为1.5%（95%CI：1.2%，1.8%，I² = 97%）。事件存活者的汇总比例为11.6%（95%CI 6.5%，17.8%，I² = 99%），院前恢复自主循环（ROSC）的汇总比例为16.0%（95%CI 14.0%，17.0%，I² = 100%），最长随访时神经功能良好存活的汇总比例为0.6%（95%CI 0.5%，0.8%，I² = 100%）。接受EMS治疗的心搏骤停型OHCA的总体汇总发病率为每10万人年11.0例（95%CI：10.5，11.5，I² = 100%）。在出院或30天存活的分层分析中，人群类型、研究持续时间、研究设计和病因是与出院或30天存活显著相关的仅有的变量。在调整分析中，人群类型、研究持续时间、最高EMS技能水平和地区与主要结局显著相关。在发病率的多变量分析中，研究地区、心搏骤停病因、样本量、发表年份、研究人群、研究持续时间和研究质量显著解释了各研究间发病率的差异。
初始心搏骤停型OHCA占所有接受EMS治疗患者的53%，汇总存活率极低。针对该人群的研究应集中于制定预防策略以及遵循心搏骤停型OHCA的复苏终止或不进行复苏指南。
