IHCA: meta-analysis isolates prognostic factors

  • Fernando SM & al.
  • BMJ
  • 4 Dec 2019

  • International Clinical Digest
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Takeaway

  • Factors associated with worse prognosis after in-hospital cardiac arrest (IHCA) include male sex, older age, and history of serious comorbidities.

Why this matters

  • Data on IHCA incidence and survival are comparatively scarce.
  • Family members often expect unrealistically high survival rates. 
  • Better data could ease shared decision-making and decisions during and after resuscitation. 

Key results

  • Prearrest factors associated with survival (pooled ORs, 95% CIs, certainty level):
    • Male sex: 0.84 (0.73-0.95, moderate).
    • Age ≥60 years: 0.50 (0.40-0.62, low).
    • Age ≥70 years: 0.42 (0.18-0.99, low).
    • History of malignancy: 0.57 (0.45-0.71, high).
    • Chronic kidney disease: 0.56 (0.40-0.78, high).
  • Intra-arrest factors associated with survival (pooled ORs, 95% CIs, certainty level): 
    • Witnessed arrest: 2.71 (2.17-3.38, high).
    • On telemetry: 2.23 (1.41-3.52, high).
    • Daytime arrest: 1.41 (1.20-1.66, high).
    • Shockable rhythm: 5.28 (3.78-7.39, high).
    • Endotracheal intubation: 0.54 (0.42-0.70, moderate).
    • Arrest duration ≥15 minutes: 0.12 (0.07-0.19, high).

Study design

  • Systematic review and meta-analysis of 23 cohort studies assessing pre- and intra-arrest prognostic factors and post-IHCA survival (n=90,276).
  • Funding: None.

Limitations

  • Findings do not constitute prediction tool.
  • No trials.
  • No information on neurological outcomes.