Abstract

The duration of cardiopulmonary resuscitation (CPR) affects neurological outcomes. Conclusive data on its decremental effect on neurological outcomes have not been explored before in a quantitative review. PubMed and Google Scholar were searched for relevant studies from 2015 up to May 2023 using relevant keywords. The odds of good neurological outcomes were studied. Binary random effects were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). A leave-one-out sensitivity analysis was performed. Heterogeneity was assessed using I² statistics. For outcomes showing moderate to high heterogeneity, subgroup analysis was performed for follow-up duration or type of study. A p value of < 0.05 was considered statistically significant. A total of 349,027 cardiac arrest patients (mean age, 70.2 years; males, 56.6%) from four studies were included in the meta-analysis. Of them, the initial rhythm was shockable in 11% (38,465/349,027) and non-shockable in 88.97% (310,562/349,027) of the population. Odds of having favorable neurological outcomes were 0.32 (95% CI 0.10–1.01, p = 0.05) for 6–10 min (n = 14,118), 0.10 (95% CI 0.02–0.64, p = 0.02) for 11–15 min (n = 43,885), 0.05 (95% CI 0.01–0.36, p 0.01) for 16–20 min (n = 66,174), 0.04 (95% CI 0.01–0.21, p < 0.01) for > 20 min (n = 181,262), and 0.03 (95% CI 0.00–1.55, p = 0.08) for > 30 min (n = 66,461) when compared to patients receiving CPR for < 5 min (n = 6420). Steady decremental odds of favorable neurological outcomes were seen with every 5 min of increased CPR duration, with a statistically significant decline seen in CPR duration from 11 to 15 min onwards.

中文翻译：

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心脏骤停脑损伤中增加心肺复苏持续时间的不良神经学结果：系统回顾和荟萃分析

摘要

心肺复苏 (CPR) 的持续时间会影响神经系统结果。之前尚未在定量综述中探讨过其对神经系统结果减少影响的结论性数据。使用相关关键词在 PubMed 和 Google Scholar 中搜索了 2015 年至 2023 年 5 月的相关研究。研究了良好神经学结果的几率。二元随机效应用于估计合并比值比 (OR) 和 95% 置信区间 (CI)。进行了留一敏感性分析。使用I ²统计数据评估异质性。对于显示中度至高度异质性的结果，针对随访持续时间或研究类型进行亚组分析。p值 < 0.05 被认为具有统计显着性。荟萃分析共纳入了来自四项研究的 349,027 名心脏骤停患者（平均年龄 70.2 岁；男性，56.6%）。其中，11% (38,465/349,027) 的初始心律是可电击的，88.97% (310,562/349,027) 的人是不可电击的。 6-10 分钟（n  = 14,118）获得良好神经学结果的几率为 0.32（95% CI 0.10-1.01，p = 0.05），11-15 分钟（n = 14,118）获得良好神经学结果的几率为 0.10（95% CI 0.02-0.64， p  = 0.02）（n  = 43,885), 0.05 (95% CI 0.01–0.36, p < 0.01) 16–20 分钟 ( n  = 66,174), 0.04 (95% CI 0.01–0.21, p  < 0.01) 20 分钟以上 ( n  = 181,262)与接受 CPR 时间 < 5 分钟 ( n  = 6420) 的患者相比， > 30 分钟 (n = 66,461) 为0.03 (95% CI 0.00–1.55, p = 0.08  )。CPR 持续时间每增加 5 分钟，良好神经系统结果的几率就会稳步下降，从 11 分钟到 15 分钟，CPR 持续时间出现统计学上显着的下降。