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One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis
Marc Schluep1, Benjamin Yaël Gravesteijn1, Robert Jan Stolker1
1Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Insights
One-year survival after in-hospital cardiac arrest (IHCA) is poor at 13.4%. Survival rates are higher for cardiac patients and show a modest improvement from 1985-2018.
Area of Science:
- Cardiology
- Critical Care Medicine
- Public Health
Background:
- In-hospital cardiac arrest (IHCA) is a critical event with limited research on long-term survival.
- Current research primarily focuses on survival to discharge, neglecting crucial long-term outcomes.
Purpose of the Study:
- To quantitatively synthesize one-year survival rates following in-hospital cardiac arrest.
- To analyze survival trends and identify factors influencing outcomes in IHCA patients.
Main Methods:
- Systematic search and meta-analysis of published data on one-year survival after IHCA up to March 2018.
- Pooled proportion calculation with 95% prediction intervals and heterogeneity assessment (I2 statistic).
- Subgroup analyses were conducted for cardiac versus non-cardiac patient populations.
Main Results:
- The pooled one-year survival after IHCA across 40 studies was 13.4% (95%PI: 5.6-28.8%).
- One-year survival was significantly higher for cardiac patients (39.3%) compared to non-cardiac patients (10.7%).
- A modest improvement in one-year survival was observed between 1985 and 2018 (10-year OR: 1.70).
Conclusions:
- One-year survival following in-hospital cardiac arrest remains critically low.
- Cardiac patients exhibit better long-term survival outcomes post-IHCA.
- Further research into IHCA population characteristics is needed to address survival heterogeneity and stagnation.
Introduction:
In-hospital cardiac arrest is a major adverse event with an incidence of 1-6/1000 admissions. It has been poorly researched and data on survival is limited. The outcome of interest in IHCA research is predominantly survival to discharge, however recent guidelines warrant for more long-term outcomes. In this systematic review we sought to quantitatively summarize one-year survival after in-hospital cardiac arrest.
Methods:
For this systematic review and meta-analysis we performed a systematic search of all published data on one-year survival after IHCA up to March 9th, 2018. Results of the meta-analyses are presented as pooled proportions with corresponding 95% prediction intervals (95%PI). Between-study heterogeneity was assessed using I2 statistic and the DerSimonian-Laird estimator for τ2. Subgroup analyses were performed for cardiac and non-cardiac patients.
Results:
We included 40 studies in our systematic review and meta-analysis. The pooled one-year survival after in-hospital cardiac arrest was 13.4% (95%PI: 5.6-28.8%, I2 = 100%). Subgroup analysis of cardiac patients revealed a one-year survival of 39.3% (16.1%-68.6%) in patients with a non-cardiac admission characteristic one-year survival was 10.7% (4.4%-23.6%). These data cover the period 1985-2018 and show a modest change in survival over that period (10-year OR: 1.70, 95% CI: 1.04-2.76).
Discussion:
One-year survival after in-hospital cardiac arrest is poor. Survival is higher in patients admitted to cardiac wards. The time trend between 1985-2018 has shown a modest improvement in one-year survival rates. Research into IHCA population characteristics might elicit the issue of heterogeneity and stagnated survival over the past decades.
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