{"title":"心搏骤停脑损伤患者心肺复苏持续时间延长带来的不利神经系统结果:系统回顾和元分析","authors":"","doi":"10.1007/s42399-024-01652-y","DOIUrl":null,"url":null,"abstract":"<h3>Abstract</h3> <p>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 <em>I</em><sup>2</sup> statistics. For outcomes showing moderate to high heterogeneity, subgroup analysis was performed for follow-up duration or type of study. A <em>p</em> 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, <em>p</em> = 0.05) for 6–10 min (<em>n</em> = 14,118), 0.10 (95% CI 0.02–0.64, <em>p</em> = 0.02) for 11–15 min (<em>n</em> = 43,885), 0.05 (95% CI 0.01–0.36, <em>p</em> 0.01) for 16–20 min (<em>n</em> = 66,174), 0.04 (95% CI 0.01–0.21, <em>p</em> < 0.01) for > 20 min (<em>n</em> = 181,262), and 0.03 (95% CI 0.00–1.55, <em>p</em> = 0.08) for > 30 min (<em>n</em> = 66,461) when compared to patients receiving CPR for < 5 min (<em>n</em> = 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.</p>","PeriodicalId":21944,"journal":{"name":"SN Comprehensive Clinical Medicine","volume":"155 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unfavorable Neurological Outcomes with Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis\",\"authors\":\"\",\"doi\":\"10.1007/s42399-024-01652-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3>Abstract</h3> <p>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 <em>I</em><sup>2</sup> statistics. For outcomes showing moderate to high heterogeneity, subgroup analysis was performed for follow-up duration or type of study. A <em>p</em> 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, <em>p</em> = 0.05) for 6–10 min (<em>n</em> = 14,118), 0.10 (95% CI 0.02–0.64, <em>p</em> = 0.02) for 11–15 min (<em>n</em> = 43,885), 0.05 (95% CI 0.01–0.36, <em>p</em> 0.01) for 16–20 min (<em>n</em> = 66,174), 0.04 (95% CI 0.01–0.21, <em>p</em> < 0.01) for > 20 min (<em>n</em> = 181,262), and 0.03 (95% CI 0.00–1.55, <em>p</em> = 0.08) for > 30 min (<em>n</em> = 66,461) when compared to patients receiving CPR for < 5 min (<em>n</em> = 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.</p>\",\"PeriodicalId\":21944,\"journal\":{\"name\":\"SN Comprehensive Clinical Medicine\",\"volume\":\"155 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-02-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SN Comprehensive Clinical Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s42399-024-01652-y\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SN Comprehensive Clinical Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s42399-024-01652-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
摘要 心肺复苏(CPR)的持续时间会影响神经系统的预后。关于心肺复苏持续时间对神经系统预后的递减效应,此前尚未有定量综述的确切数据。我们使用相关关键词检索了 PubMed 和 Google Scholar 从 2015 年到 2023 年 5 月的相关研究。研究了神经系统良好预后的几率。采用二元随机效应来估算汇总的几率比(OR)和95%置信区间(CI)。进行了 "留一 "敏感性分析。异质性使用 I2 统计量进行评估。对于显示中度至高度异质性的结果,根据随访时间或研究类型进行了亚组分析。P值为< 0.05被认为具有统计学意义。共有四项研究的 349,027 名心脏骤停患者(平均年龄 70.2 岁,男性占 56.6%)被纳入荟萃分析。其中,11%(38465/349,027 人)的初始心律为可电击,88.97%(310,562/349,027 人)的初始心律为不可电击。6-10分钟(n = 14,118)、11-15分钟(n = 43,885)、16-20分钟(n = 66,174)、16-20分钟(n = 66,174)出现有利神经系统结果的几率分别为0.32(95% CI 0.10-1.01,p = 0.05)、0.10(95% CI 0.02-0.64,p = 0.02)、0.05(95% CI 0.01-0.36,p 0.01)、0.04(95% CI 0.01-0.36,p 0.01)。04(95% CI 0.01-0.21,p = 0.01);与接受心肺复苏 5 分钟的患者(6420 人)相比,16-20 分钟为 0.05(95% CI 0.01-0.36,p = 0.01);16-20 分钟为 0.03(95% CI 0.00-1.55,p = 0.08);30 分钟为 0.03(95% CI 0.00-1.55,p = 0.08)。心肺复苏持续时间每增加 5 分钟,神经系统转归良好的几率就会稳步下降,从 11 分钟到 15 分钟,心肺复苏持续时间出现了统计学意义上的显著下降。
Unfavorable Neurological Outcomes with Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis
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.