Pre-Arrest and Intra-Arrest Prognostic Factors for Survival to Discharge in In-Hospital Cardiac Arrest – A Systematic Review and Meta-analysis
CCCF ePoster library. Fernando S. Nov 8, 2018; 233425
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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Introduction: Prognosis from adult in-hospital cardiac arrest (IHCA) is typically poor, with roughly 10-20% of patients surviving to hospital discharge. Likelihood of survival with good neurologic function is even lower. Therefore, it is important for clinicians to understand the factors influencing survival from IHCA, to provide accurate information to patients for informed goals-of-care discussions, and to consider cessation of in-hospital resuscitation when the likelihood of survival is exceedingly low.    

 

Objectives: We sought to summarize all studies evaluating pre-arrest and intra-arrest prognostic factors associated with survival in adult patients with IHCA.  

 

Methods: We searched six databases (including Medline, EMBASE, and Web of Science) from inception through May 30, 2018. We included English-language studies (including observational studies, randomized controlled trials, and non-randomized controlled trials) evaluating prognostic factors associated with survival to hospital discharge in adult patients with IHCA. We excluded studies of patients with intra-operative arrest, and studies which only included patients who achieved return of spontaneous circulation (ROSC). We followed PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Prognosis. Two reviewers independently extracted data and assessed study quality using the Ottawa-Newcastle Scale. The main outcome was survival to hospital discharge. Pooled adjusted odds ratios (OR) were calculated. All adjusted ORs included in meta-analysis had to at minimum adjust for age and sex.

 

Results: The initial search yielded 8,856 articles. Following screening and full-text evaluation, 51 studies were deemed eligible and were included. We found that patients with existing comorbidities such as active malignancy (pooled adjusted OR 0.57 [95% CI: 0.45-0.71]) and chronic kidney disease (pooled adjusted OR 0.62 [95% CI: 0.44-0.89]) had significantly decreased odds of survival. Likewise, patients with an admission diagnosis of sepsis had significantly decreased odds of survival (pooled adjusted OR 0.80 [95% CI: 0.70-0.91]). Factors associated with significantly increased odds of survival included witnessed arrest (pooled adjusted OR 2.46 [95% CI: 1.75-3.45]), monitored arrest (pooled adjusted OR 1.85 [95% CI: 1.42-2.41]), arrest during daytime hours (pooled adjusted OR 1.35 [1.12-1.62]), and shockable rhythm (pooled adjusted OR 4.11 [95% CI: 3.01-5.59]). Intubation during IHCA was associated with decreased odds of survival (pooled adjusted OR 0.54 [95% CI: 0.42-0.70]).

 

Conclusions: Pre-arrest factors associated with reduced odds of survival to discharge include existing comorbidities (e.g. active malignancy, chronic kidney disease), and admission diagnosis of sepsis, while intra-arrest factors include unwitnessed arrest, unmonitored arrest, non-shockable rhythm, arrest outside of daytime hours, and intubation during arrest. Intubation during arrest was associated with reduced odds of survival. These results may inform discussions with patients when determining goals-of-care during admission, and consideration when determining cessation of IHCA management.  


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