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      The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis

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          Abstract

          Background

          To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR).

          Methods

          We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis.

          Results

          A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI 6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR.

          Conclusions

          The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.

          Electronic supplementary material

          The online version of this article (10.1186/s13054-020-2773-2) contains supplementary material, which is available to authorized users.

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          Most cited references33

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          Bias in meta-analysis detected by a simple, graphical test

          Jos I. M. Egger, G D Smith, M. Schneider … (1997)
          Article 0 comments Cited 6441 times – based on 0 reviews     Review now
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            Quantifying heterogeneity in a meta-analysis.

            Julian P T Higgins, Simon G Thompson (2002)
            The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
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              The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

              Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2009)
              Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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                Author and article information

                Contributors
                Chuanzhu Lv: lvchuanzhu677@126.com
                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central (London )
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Electronic): 22 February 2020
                Publication date PMC-release: 22 February 2020
                Publication date Collection: 2020
                Volume: 24
                Electronic Location Identifier: 61
                Affiliations
                [1 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, School of Public Health, , Hainan Medical University, ; Haikou, Hainan China
                [2 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, Key Laboratory of Emergency and Trauma of Ministry of Education, , Hainan Medical University, ; Haikou, Hainan China
                [3 ]ISNI 0000 0004 0368 7223, GRID grid.33199.31, Department of Social Medicine and Health Management, , School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, ; Wuhan, Hubei China
                [4 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, Department of Emergency, , Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, ; Haikou, Hainan China
                [5 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, Emergency and Trauma College, , Hainan Medical University, ; Haikou, Hainan China
                [6 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, School of International Education, , Hainan Medical University, ; Haikou, Hainan China
                [7 ]ISNI 0000 0004 0368 7493, GRID grid.443397.e, Department of Emergency, , the First Affiliated Hospital of Hainan Medical University, ; No.3 Xueyuan Road, Longhua Zone, Haikou, 571199 China
                Article
                Publisher ID: 2773
                DOI: 10.1186/s13054-020-2773-2
                PMC ID: 7036236
                PubMed ID: 32087741
                SO-VID: 3c402d5c-7de3-4a9d-95e0-3de8729a5689
                Copyright © © The Author(s). 2020
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 25 October 2019
                Date accepted : 11 February 2020
                Funding
                Funded by: Major Science and Technology Plan Project of Hainan Province
                Award ID: ZDKJ201804
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: out-of-hospital cardiac arrest,resuscitation,emergency medical services
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: out-of-hospital cardiac arrest, resuscitation, emergency medical services

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