A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes
Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resus...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/10/2098 |
| _version_ | 1797534254194753536 |
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| author | Qin Xiang Ng Ming Xuan Han Yu Liang Lim Shalini Arulanandam |
| author_facet | Qin Xiang Ng Ming Xuan Han Yu Liang Lim Shalini Arulanandam |
| author_sort | Qin Xiang Ng |
| collection | DOAJ |
| description | Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, <i>p</i> < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, <i>p</i> < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, <i>p</i> < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I<sup>2</sup> greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject. |
| first_indexed | 2024-03-10T11:26:59Z |
| format | Article |
| id | doaj.art-948e68c1a6d240f39cdea787d1222a90 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T11:26:59Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-948e68c1a6d240f39cdea787d1222a902023-11-21T19:33:04ZengMDPI AGJournal of Clinical Medicine2077-03832021-05-011010209810.3390/jcm10102098A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest OutcomesQin Xiang Ng0Ming Xuan Han1Yu Liang Lim2Shalini Arulanandam3Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, SingaporeEmergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, SingaporeEmergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, SingaporeEmergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, SingaporeDespite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, <i>p</i> < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, <i>p</i> < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, <i>p</i> < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I<sup>2</sup> greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject.https://www.mdpi.com/2077-0383/10/10/2098cardiopulmonary resuscitationCPRprehospital careresuscitationemergency medical servicesEMS |
| spellingShingle | Qin Xiang Ng Ming Xuan Han Yu Liang Lim Shalini Arulanandam A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes Journal of Clinical Medicine cardiopulmonary resuscitation CPR prehospital care resuscitation emergency medical services EMS |
| title | A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes |
| title_full | A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes |
| title_fullStr | A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes |
| title_full_unstemmed | A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes |
| title_short | A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes |
| title_sort | systematic review and meta analysis of the implementation of high performance cardiopulmonary resuscitation on out of hospital cardiac arrest outcomes |
| topic | cardiopulmonary resuscitation CPR prehospital care resuscitation emergency medical services EMS |
| url | https://www.mdpi.com/2077-0383/10/10/2098 |
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