The impact of system performance improvement on patients with cardiac arrest: An updated systematic review

To investigate the effect of system-level interventions designed to enhance outcomes for cardiac arrest patients.

We searched PubMed, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify publication from July 2020 to December 2024. Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. This update was conducted following the previous systematic review on this topic, which was registered in PROSPERO (CRD42020161882). This review included studies addressing system-level performance improvement in organizations or systems caring for patients with cardiac arrest in any setting.

Among the 4162 articles screened; 15 non-randomized controlled studies were selected for inclusion. Twelve studies focused on interventions for patients with out-of-hospital cardiac arrest and three studies for patients with in-hospital cardiac arrest. The identified interventions included the implementation of a bundled care strategy such as resuscitation training, quality monitoring, enhancing emergency response, medical direction, along with efforts to optimize the quality of cardiopulmonary resuscitation. Among these studies, four reported improved survival with favorable neurological outcomes at discharge, while six reported improved survival to hospital discharge. Risk of bias varied from moderate to critical and the certainty of evidence across outcomes was very low.

This systematic review shows that interventions on a system-level were associated with improved clinical outcomes in cardiac arrest patients. The available evidence suggests organizations or communities that are responsible for the treatment of cardiac arrest patients should adopt system improvement strategies to improve outcomes.