Cited by 116Cardiac Arrest and ResuscitationPalliative Care and End-of-Life IssuesMechanical Circulatory Support Devices

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? – A systematic review

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Yeung, J., Matsuyama, T., Bray, J., Reynolds, J., Skrifvars, M.B.·2019·Resuscitation

Abstract

Aim To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' Methods The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTS: We included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95% CI 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95% CI 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34). Conclusions Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.

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Crossref · 10.1016/j.resuscitation.2019.02.006

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  • A key concern is that respondents may be systematically different to non-respondents.

    “A key concern is that respondents may be systematically different to non-respondents. 310”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [310]

    The Risk of bias for individual studies section discusses patient selection, including studies that included only survivors, but not differences between respondents and non-respondents. Searches for respondent differences and nonresponse bias found no passage addressing that concern. Page numbers were unavailable in our copy. (LLM, conf=0.74)

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  • The SPIIRT PRO extension guidelines provide information on including patient reported outcomes in clinical trials.

    “The SPIIRT (Standard Protocol Items: Recommendations for Interventional Trials) PRO (Patient-reported outcome) extension guidelines provide information on including patient reported outcomes in clinical trials. 310”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [310]

    The Methods section says this cardiac-arrest-centre review followed PRISMA reporting guidelines, not SPIRIT-PRO. Searches for SPIRIT-PRO and patient-reported-outcome guidance found no passage in our copy addressing the cited claim; page numbers were unavailable. (LLM, conf=0.75)

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1 of the 71 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane [24_TD $DIFF]Collaboration; 2014.
  2. Kellerman A, Hackman B, Somes G. Cardiology: survival poor after unsuccessful prehospital advanced cardiac life support. Physician Assist 1993;17:13-9.

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Authors
Yeung, J., Matsuyama, T., Bray, J., Reynolds, J., & Skrifvars, M. B.
Affiliations
  • University of Warwick (GB)
  • Kyoto Prefectural University of Medicine (JP)
  • Monash University (AU)
  • Michigan State University (US)
  • University of Helsinki (FI)
Corresponding author
Yeung, J.
Venue
Resuscitation
Publisher
Elsevier BV
Published
2019-04
Volume
137
Pages
102-115
ISSN
0300-9572 (ISSN-L)
OpenAlex
W2913395504
Cited by
116
References
71
Citations by year
2026: 8 · 2025: 13 · 2024: 18 · 2023: 9 · 2022: 18 · 2021: 29 · 2020: 13 · 2019: 7 · 2015: 1
FWCI
4.28
Type
journal article
Language
en
Open access
Locations
  • Resuscitation (publishedVersion)
  • Monash University Research Portal (Monash University) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Warwick Research Archive Portal (University of Warwick) (submittedVersion)
Funders
American Heart Association
Topics
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
Keywords
out-of-hospital cardiac arrest, post-resuscitation care, neurological outcome, survival to hospital discharge, return of spontaneous circulation
MeSH terms
Adult, Cardiac Care Facilities, Humans, Survival Analysis, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest

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