Skip to main content
Top
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Cardiopulmonary Resuscitation | Research

Survival outcome among patients with out-of-hospital cardiac arrest who received cardiopulmonary resuscitation in China: a systematic review and meta-analysis

Authors: Guozhong Zhou, Yan Wang, Zihong Sun, Mingqi Yuan, Yunlin Ma, Qianxi Wu, Chunyan Wu, Jing Xu, Yongyi Li, Yunchuan Liu, Zhenzhou Wang, Chao Song

Published in: European Journal of Medical Research | Issue 1/2023

Login to get access

Abstract

Background

This study aimed to assess the survival outcomes among patients with out-of-hospital cardiac arrest (CA) who received cardiopulmonary resuscitation (CPR) in China.

Methods

Relevant studies, published between January 1, 2010 and September 5, 2022, were retrieved from databases, including EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, China National Knowledge Infrastructure, and Wanfang databases. We included clinical studies in which all patients were diagnosed with CA and underwent out-of-hospital CPR, and the outcome variables were at least one of the following: return of spontaneous circulation (ROSC), survival to admission, survival to hospital discharge, 1-month survival, achieved good neurological outcomes, and 1-year survival. Two investigators independently extracted the study data and assessed its quality using a modified Newcastle–Ottawa Scale tool. The data were pooled using random-effects models.

Results

Of the 3620 identified studies, 49 (63,378 patients) were included in the meta-analysis. The pooled ROSC rate was 9.0% (95% confidence interval [CI] 7.5–10.5%, I2 = 97%), the pooled survival to admission rate was 5.0% (95% CI 2.7–8.0%, I2 = 98%), and the pooled survival to discharge rate was 1.8% (95% CI 1.2–2.5%, I2 = 95%). Additionally, the ROSC rate of patients with bystander CPR was significantly higher than that of those without bystander CPR, and the pooled odds ratio (OR) was 7.92 (95% CI 4.32–14.53, I2 = 85%). The ROSC rate of participants who started CPR within 5 min was significantly higher than that of those who started CPR after 5 min, and the pooled OR was 5.92 (95% CI 1.92–18.26, I2 = 85%). The ROSC rate of participants with defibrillation was significantly higher than that of those without defibrillation, and the pooled OR was 8.52 (95% CI 3.72–19.52, I2 = 77%).

Conclusion

The survival outcomes of out-of-hospital CPR in China are far below the world average. Therefore, the policy of providing automated external defibrillators (AEDs) in public places and strengthening CPR training for healthcare providers and public personnel should be encouraged and disseminated nationwide.
Trial registration This study was registered in PROSPERO (CRD42022326165) on 29 April 2022.
Appendix
Available only for authorised users
Literature
1.
go back to reference Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–87.CrossRef Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–87.CrossRef
2.
go back to reference Xu F, Zhang Y, Chen Y. cardiopulmonary resuscitation training in China: current situation and future development. JAMA Cardiol. 2017;2:469–70.CrossRef Xu F, Zhang Y, Chen Y. cardiopulmonary resuscitation training in China: current situation and future development. JAMA Cardiol. 2017;2:469–70.CrossRef
3.
go back to reference Shao F, Li CS, Liang LR, Li D, Ma SK. Outcome of out-of-hospital cardiac arrests in Beijing. China Resusc. 2014;85:1411–7. Shao F, Li CS, Liang LR, Li D, Ma SK. Outcome of out-of-hospital cardiac arrests in Beijing. China Resusc. 2014;85:1411–7.
4.
go back to reference Wang Y, Zhang Q, Qu GB, Fang F, Dai XK, Yu LX, et al. Effects of prehospital management in out-of-hospital cardiac arrest: advanced airway and adrenaline administration. BMC Health Serv Res. 2022;22:546.CrossRef Wang Y, Zhang Q, Qu GB, Fang F, Dai XK, Yu LX, et al. Effects of prehospital management in out-of-hospital cardiac arrest: advanced airway and adrenaline administration. BMC Health Serv Res. 2022;22:546.CrossRef
5.
go back to reference Li X, Teng F, Xu P, Li M, Liu R, Fang P, et al. Analysis of out-of-hospital emergency treatment for ventricular fibrillation between 2013 and 2016 in Shanghai. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29:871–6. Li X, Teng F, Xu P, Li M, Liu R, Fang P, et al. Analysis of out-of-hospital emergency treatment for ventricular fibrillation between 2013 and 2016 in Shanghai. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29:871–6.
6.
go back to reference Jiang Y, Wu B, Long L, Li J, Jin X. Attitudes and willingness toward out-of-hospital cardiopulmonary resuscitation: a questionnaire study among the public trained online in China. BMJ Open. 2020;10: e038712.CrossRef Jiang Y, Wu B, Long L, Li J, Jin X. Attitudes and willingness toward out-of-hospital cardiopulmonary resuscitation: a questionnaire study among the public trained online in China. BMJ Open. 2020;10: e038712.CrossRef
7.
go back to reference Mao J, Chen F, Xing D, Zhou H, Jia L, Zhang Y. Knowledge, training and willingness to perform bystander cardiopulmonary resuscitation among university students in Chongqing, China: a cross-sectional study. BMJ Open. 2021;11: e046694.CrossRef Mao J, Chen F, Xing D, Zhou H, Jia L, Zhang Y. Knowledge, training and willingness to perform bystander cardiopulmonary resuscitation among university students in Chongqing, China: a cross-sectional study. BMJ Open. 2021;11: e046694.CrossRef
8.
go back to reference Zhang L, Luo M, Myklebust H, Pan C, Wang L, Zhou Z, et al. When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China. Emerg Med J. 2021;38:252–7.CrossRef Zhang L, Luo M, Myklebust H, Pan C, Wang L, Zhou Z, et al. When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China. Emerg Med J. 2021;38:252–7.CrossRef
9.
go back to reference Yan S, Gan Y, Wang R, Song X, Zhou N, Lv C. Willingness to attend cardiopulmonary resuscitation training and the associated factors among adults in China. Crit Care. 2020;24:457.CrossRef Yan S, Gan Y, Wang R, Song X, Zhou N, Lv C. Willingness to attend cardiopulmonary resuscitation training and the associated factors among adults in China. Crit Care. 2020;24:457.CrossRef
10.
go back to reference Zhang L, Li B, Zhao X, Zhang Y, Deng Y, Zhao A, et al. Public access of automated external defibrillators in a metropolitan city of China. Resuscitation. 2019;140:120–6.CrossRef Zhang L, Li B, Zhao X, Zhang Y, Deng Y, Zhao A, et al. Public access of automated external defibrillators in a metropolitan city of China. Resuscitation. 2019;140:120–6.CrossRef
11.
go back to reference Wang LX, Meng QY, Yu T. National consensus on cardiopulmonary resuscitation in China. Chinese J Dis Med. 2016;5:1–23. Wang LX, Meng QY, Yu T. National consensus on cardiopulmonary resuscitation in China. Chinese J Dis Med. 2016;5:1–23.
12.
go back to reference Gu XM, Li ZH, He ZJ, Zhao ZW, Liu SQ. A meta-analysis of the success rates of heartbeat restoration within the platinum 10 min among outpatients suffering from sudden cardiac arrest in China. Mil Med Res. 2016;3:6. Gu XM, Li ZH, He ZJ, Zhao ZW, Liu SQ. A meta-analysis of the success rates of heartbeat restoration within the platinum 10 min among outpatients suffering from sudden cardiac arrest in China. Mil Med Res. 2016;3:6.
13.
go back to reference Gu XM, Yao SB, He ZJ, Wang YG, Li ZH. Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China. Mil Med Res. 2020;7:34. Gu XM, Yao SB, He ZJ, Wang YG, Li ZH. Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China. Mil Med Res. 2020;7:34.
14.
go back to reference Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. a statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991;84:960–75.CrossRef Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. a statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991;84:960–75.CrossRef
15.
go back to reference Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European resuscitation council, Australian resuscitation council, New Zealand Resuscitation council, heart and stroke Foundation of Canada, InterAmerican heart Foundation, Resuscitation council of Southern Africa). Resuscitation. 2004;63:233–49.CrossRef Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European resuscitation council, Australian resuscitation council, New Zealand Resuscitation council, heart and stroke Foundation of Canada, InterAmerican heart Foundation, Resuscitation council of Southern Africa). Resuscitation. 2004;63:233–49.CrossRef
16.
go back to reference Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation; and the american heart association emergency cardiovascular care committee and the council on cardiopulmonary, critical care. Perioper Resusc Circ. 2015;132:1286–300. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation; and the american heart association emergency cardiovascular care committee and the council on cardiopulmonary, critical care. Perioper Resusc Circ. 2015;132:1286–300.
17.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339: b2700.CrossRef Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339: b2700.CrossRef
18.
go back to reference Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.CrossRef Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.CrossRef
19.
go back to reference Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24:61.CrossRef Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24:61.CrossRef
20.
go back to reference Shao F, Li H, Ma S, Li D, Li C. Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study. BMJ Open. 2021;11: e041917.CrossRef Shao F, Li H, Ma S, Li D, Li C. Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study. BMJ Open. 2021;11: e041917.CrossRef
21.
go back to reference Chen Y, Yue P, Wu Y, Li J, Lei Y, Gao D, et al. Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing. BMC Cardiovasc Disord. 2021;21:625.CrossRef Chen Y, Yue P, Wu Y, Li J, Lei Y, Gao D, et al. Trend in survival after out-of-hospital cardiac arrest and its relationship with bystander cardiopulmonary resuscitation: a six-year prospective observational study in Beijing. BMC Cardiovasc Disord. 2021;21:625.CrossRef
22.
go back to reference Nas J, Thannhauser J, Konijnenberg L, van Geuns RM, van Royen N, Bonnes JL, et al. Long-term effect of face-to-face vs virtual reality cardiopulmonary resuscitation (CPR) training on willingness to perform CPR, retention of knowledge, and dissemination of CPR awareness: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2022;5: e2212964.CrossRef Nas J, Thannhauser J, Konijnenberg L, van Geuns RM, van Royen N, Bonnes JL, et al. Long-term effect of face-to-face vs virtual reality cardiopulmonary resuscitation (CPR) training on willingness to perform CPR, retention of knowledge, and dissemination of CPR awareness: a secondary analysis of a randomized clinical trial. JAMA Netw Open. 2022;5: e2212964.CrossRef
23.
go back to reference Nas J, Thannhauser J, Herrmann JJ, van der Wulp K, van Grunsven PM, van Royen N, et al. Changes in automated external defibrillator use and survival after out-of-hospital cardiac arrest in the Nijmegen area. Neth Heart J. 2018;26:600–5.CrossRef Nas J, Thannhauser J, Herrmann JJ, van der Wulp K, van Grunsven PM, van Royen N, et al. Changes in automated external defibrillator use and survival after out-of-hospital cardiac arrest in the Nijmegen area. Neth Heart J. 2018;26:600–5.CrossRef
24.
go back to reference Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013. JAMA. 2015;314:255–64.CrossRef Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013. JAMA. 2015;314:255–64.CrossRef
25.
go back to reference Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, et al. Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest. N Engl J Med. 2017;376:1737–47.CrossRef Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K, et al. Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest. N Engl J Med. 2017;376:1737–47.CrossRef
26.
go back to reference Zheng K, Bai Y, Zhai QR, Du LF, Ge HX, Wang GX, et al. Correlation between the warning symptoms and prognosis of cardiac arrest. World J Clin Cases. 2022;10:7738–48.CrossRef Zheng K, Bai Y, Zhai QR, Du LF, Ge HX, Wang GX, et al. Correlation between the warning symptoms and prognosis of cardiac arrest. World J Clin Cases. 2022;10:7738–48.CrossRef
27.
go back to reference Yingxin C, Sisen Z, Yanzhang S, Libin L. Investigation of out-of-hospital cardiac arrest in Zhengzhou City and the risk factors of prognosis of cardiopulmonary resuscitation: case analysis for 2016–2018. Chin Crit Care Med. 2019;3:439–43. Yingxin C, Sisen Z, Yanzhang S, Libin L. Investigation of out-of-hospital cardiac arrest in Zhengzhou City and the risk factors of prognosis of cardiopulmonary resuscitation: case analysis for 2016–2018. Chin Crit Care Med. 2019;3:439–43.
29.
go back to reference Munot S, Rugel EJ, Von Huben A, Marschner S, Redfern J, Ware S, et al. Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales. Australia Resusc Plus. 2022;9: 100205.CrossRef Munot S, Rugel EJ, Von Huben A, Marschner S, Redfern J, Ware S, et al. Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales. Australia Resusc Plus. 2022;9: 100205.CrossRef
30.
go back to reference Jinglin Li LY, Zhenzhou Wang SQ, Zhou G. A survey on the perception of utstein model and the success of resuscitation among the Chinese medical staffs. J Kunming Med Univ. 2020;11:43–149. Jinglin Li LY, Zhenzhou Wang SQ, Zhou G. A survey on the perception of utstein model and the success of resuscitation among the Chinese medical staffs. J Kunming Med Univ. 2020;11:43–149.
Metadata
Title
Survival outcome among patients with out-of-hospital cardiac arrest who received cardiopulmonary resuscitation in China: a systematic review and meta-analysis
Authors
Guozhong Zhou
Yan Wang
Zihong Sun
Mingqi Yuan
Yunlin Ma
Qianxi Wu
Chunyan Wu
Jing Xu
Yongyi Li
Yunchuan Liu
Zhenzhou Wang
Chao Song
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-022-00955-x

Other articles of this Issue 1/2023

European Journal of Medical Research 1/2023 Go to the issue