Background
Methods
Search methods
Database | Keywords | Limits | ||
---|---|---|---|---|
Cinahl (EbscoHost) | Resuscitation, Cardiopulmonary (MeSH) | duration | neurolog* | Jan 10 – Mar 16 |
time | cogniti* | English | ||
“cerebral performance” | ||||
“function* outcome” | ||||
Medline (OVID) | Cardiopulmonary resuscitation (MeSH) | duration | neurolog* | Jan 10 – Mar 16 |
time | cogniti* | English | ||
“cerebral performance” | ||||
“function* outcome” | ||||
PubMed (NCBI) | “Cardiopulmonary resuscitation” | duration | neurolog* | Jan 10 – Mar 16 |
“Advanced cardiac life support” | time | cogniti* | English | |
“Advanced life support” | “cerebral performance” | |||
“function* outcome” | ||||
Web of science | “Cardiopulmonary resuscitation” | duration | neurolog* | Jan 10 – Mar 16 |
“Advanced cardiac life support” | time | cogniti* | English | |
“Advanced life support” | “cerebral performance” | |||
“function* outcome” | ||||
Scopus | “Cardiopulmonary resuscitation” | duration | neurolog* | Jan 10 – Mar 16 |
“Advanced cardiac life support” | time | cogniti* | English | |
“Advanced life support” | “cerebral performance” | Health sciences | ||
“function* outcome” | Life sciences |
Inclusion | Exclusion | |
---|---|---|
Population | Adults survivors of cardiac arrest receiving resuscitation in hospital | Animal studies; paediatrics |
Intervention | CPR duration described as collapse to ROSC | Prehospital ROSC; additional interventions including but not limited to extracorporeal resuscitation, therapeutic hypothermia |
Outcomes measured | Neurological outcome of survivors of CPR | Studies in which CPR duration is not compared with neurological outcome |
Type of article | Research studies | Case studies |
Language | English | Papers not published in English |
Date | Published from 01/01/2010 | Published prior to 2010 |
Data extraction
Author, year of publication | Title | Country of origin | Aims/objectives | Study design | Data collection | n= | Age (yrs) median (IQR) or mean ± SD | Gender (% male) | Inclusion (Incl) Exclusion (Excl) | Type of CA | Location | Outcome measures | Findings |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chan et al., 2012 [20] | A validated prediction tool for initial survivors of in-hospital cardiac arrest | USA (Not stated in study) | to develop a valid and clinically useful risk prediction tool among succesfully resuscitated patients with an IHCA, to estimate favourable neurological survival | Cohort study | National CA database (GWTG-R registry) | 42,957 | 68 (56–78) Mean 66 | 56 | Incl: 2000–2009; adults (≥18 yrs), achieved ROSC Excl: Arrest location ED, OT, post-op, procedural areas; incomplete data | IHCA | USA, multicentre, 551 hospitals | Neurologically favourable survival to discharge measured by CPC score | Duration of CPR is a good predictor of neurological status at discharge |
Constant et al., 2014 [21] | Predictors of functional outcome after intraoperative cardiac arrest | France | to identify factors associated with 90-day favourable functional outcomes in adults admitted to the ICU after succesful resuscitation of intra-operative CA | Cohort study | Medical records (Utstein format) interviewing patients, NOK, GP, neurologist | 140 | 60 (46–70) | 56.4 | Incl: 2000–2013; adults; received anaesthesia, admitted to ICU after succesful resuscitation | IOCA | France, multicentre, 11 hospital ICUs | Functional status at 90 days measured by CPC score | Shorter duration of CPR is associated with a more favourable outcome (CPC 1–2) |
Goldberg et al., 2012 [22] | Duration of resuscitation effors and survival after in-hospital cardiac arrest: an observational study | USA | to investigate whether duration of resuscitation attempt varies between hospitals and whether patients at hospitals that attempt resuscitation for longer have higher survival rates than those with shorter durations of resuscitation efforts | Cohort study | National CA database (GWTG-R registry) | 64,339 (8724 with CPC score) | 69 (57–78) | 55.8 | Incl: 2000–2008; adults (≥18 yrs); first CA during inpatient stay Excl: ICD; arrest location ED, OT, post-op, procedural areas, rehab areas; <2 mins arrest; incomplete data | IHCA | USA, multicentre, 435 hospitals | Neurological status at discharge measured by CPC score | No significant link between duration of CPR and neurological outcome |
Iqbal et al., 2015 [23] | Predictors of survival and favourable outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack cener (from the Harefield cardiac arrest study) | UK | to determine the predictors of favourable functional status at discharge and long-term survival in patients experiencing out of hospital CA who are brought to a dedicated heart attack centre | Cohort study | National research database (Utstein-style template) Case notes reviewed for data on functional status | 174 | 65 (56–65) | 79.9 | Incl: 2011–2013 | OHCA | UK, single site, dedicated heart attack centre | Functional status at discharge measured by mRS | Shorter duration of CPR is a powerful predictor of favourable functional outcome at discharge. |
Reynolds et al., 2013 [24] | Duration of resuscitation effors and functional outcome after out-of-hospital cardiac arrest when should we change to novel therapies? | USA | to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration to identify when to use novel therapies | Cohort study | Hospital CA database (Utstein-style template) | 1014 | Mean 65.2 | 57.7 | Incl: 2005–2011; adults (≥18 yrs) | Non-traumatic OHCA | USA, single site, ED | Functional status at discharge measured by mRS | Shorter duration of CPR is independantly associated with survival to d/c with a favourable outcome (mRs of 0–3) |
Vancini-Campanharo et al., 2015 [25] | One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital | Brazil | to describe neurological status and associated factors of survivors after CA, upon discharge and at six and twelve month follow ups | Cohort study | Utstein-style recording of consecutive IHCAs Neurological status evaluated with patient, family or guardian | 16 | not stated | not stated | Incl: 2011–2012; adults (≥17 yrs); resuscitated in ED; survivors to discharge | OHCA | Brazil, single site, city hospital ED | Neurological status at discharge, 1, 6 and 12 months measured by CPC score | No significant link between duration of CPR and neurological outcome |
Xue et al., 2013 [26] | Factors influencing outcomes after cardiopulmonary resuscitation in the emergency department | China | to assess the factors influencing outcome of CPR in ED | Cohort study | Hospital registry Utstein-style template | 725 | 46.94 ± 19.05 | 71.6 | Incl: 2005–2011; adults (≥16 yrs) Excl: DNAR; incomplete data | IHCA and OHCA | China, single site, city hospital ED | Neurologically favourable survival to discharge measured by CPC score | CPR ≤15mins had significantly higher percentage of survivors with a neurologically favourable outcome |
Quality appraisal
Research question | Are the research question and objectives clearly stated? |
---|---|
Recruitment | Are the recruitment methods and study population clearly described? |
Baseline measured | Was the outcome of interest measured prior to exposure to gain a baseline for the participants? Was this accounted for when measuring the outcome? |
Similar cohorts | Were eligibility criteria applied uniformly across cohorts and all participants recruited from the same or similar population? |
Sample size | Is there a sample size justification, power description, or variance and effect estimates provided? |
Causation | Was the exposure assessed prior to outcome measurement? |
Time-frame | Was there sufficient time-frame to see an effect? |
Exposure levels | Did the study examine different levels of the exposure of interest? (i.e. multiple categories of exposure or exposure measured as a continuous variable)? |
Exposure measurement | Were the exposures (independent variables) measured in a way that minimised bias? Were they clearly defined, valid, reliable, and implemented consistently across all study participants? |
Outcome measurement | Were the outcomes (dependent variables) measured in a way that minimised bias? Were they clearly defined, valid, reliable, and implemented consistently across all study participants? |
Blinding | Were assessors blinded to exposure? (Where researchers are using data already collected, this would be yes) |
Confounders | Were key potential confounding variables identified and controlled for in statistical analysis? (i.e. were regression models used?) |
Analysis
Results
Search outcomes
Quality appraisal findings
Author, year | Research question | Recruitment | Baseline measured | Similar cohorts | Sample size | Causation | Time-frame | Exposure levels | Exposure measurement | Outcome measurement | Blinding | Confounders | Score |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Chan et al., 2012 [20] | y | y | y | y | n | y | y | y | y | y | y | y | 11 |
Constant et al., 2014 [21] | y | y | unclear | y | n | y | y | y | y | y | unclear | y | 9 |
Goldberger et al., 2012 [22] | y | y | unclear | y | n | y | y | y | y | y | y | y | 10 |
Iqbal et al., 2015 [23] | y | y | unclear | y | n | y | y | y | y | y | y | y | 10 |
Reynolds et al., 2013 [24] | y | y | unclear | y | n | y | y | y | y | y | y | y | 10 |
Vancini-Campanharo et al., 2015 [25] | y | n | y | y | n | y | y | y | y | y | unclear | n | 8 |
Xue et al., 2013 [26] | y | n | unclear | y | n | y | y | n | y | y | y | y | 8 |
Data synthesis findings
Discussion
Strengths and limitations
Conclusions
Key findings
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There is generally a better neurological outcome with a shorter duration of CPR in survivors of cardiac arrest, however a cut-off beyond which resuscitation is likely to lead to unfavourable outcome was not possible to determine and is unlikely to exist, as many people survive prolonged cardiac arrest with minimal consequences.
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There is not enough evidence to create a definitive rule for termination of CPR in the hospital setting. Clinicians should continue to take into account that in many cases the chance of neurologically favourable survival decreases the longer CPR is continued, however this alone is not enough to make the decision to terminate efforts.
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There is a need for a validated and reliable measure of neurological outcome following cardiac arrest.
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Future research is required in several areas in order for more specific guidelines around the duration of resuscitation attempts to be created.