Aims

Long term outcomes after out-of-hospital cardiac arrest (OHCA) are not well understood. This study aimed to evaluate the long-term (1-year and beyond) survival outcomes, including overall survival and survival with favorable neurological status and the quality-of-life (QOL) outcomes, among patients who survived the initial OHCA event (30 days or till hospital discharge).

Methods

Embase, Medline and PubMed were searched for primary studies (randomized controlled trials, cohort and cross-sectional studies) which reported the long-term survival outcomes of OHCA patients. Data abstraction and quality assessment was conducted, and survival at predetermined timepoints were assessed via single-arm meta-analyses of proportions, using generalized linear mixed models. Comparative meta-analyses were conducted using the Mantel-Haenszel Risk Ratio (RR) estimates, using the DerSimonian and Laird model.

Results

67 studies were included, and among patients that survived to hospital discharge or 30-days, 77.3% (CI = 71.2–82.4), 69.6% (CI = 54.5–70.3), 62.7% (CI = 54.5–70.3), 46.5% (CI = 32.0–61.6), and 20.8% (CI = 7.8–44.9) survived to 1-, 3-, 5-, 10- and 15-years respectively. Compared to Asia, the probability of 1-year survival was greater in Europe (RR = 2.1, CI = 1.8–2.3), North America (RR = 2.0, CI = 1.7–2.2) and Oceania (RR = 1.9, CI = 1.6–2.1). Males had a higher 1-year survival (RR:1.41, CI = 1.25–1.59), and patients with initial shockable rhythm had improved 1-year (RR = 3.07, CI = 1.78–5.30) and 3-year survival (RR = 1.45, CI = 1.19–1.77). OHCA occurring in residential locations had worse 1-year survival (RR = 0.42, CI = 0.25–0.73).

Conclusion

Our study found that up to 20.8% of OHCA patients survived to 15-years, and survival was lower in Asia compared to the other regions. Further analysis on the differences in survival between the regions are needed to direct future long-term treatment of OHCA patients.

中文翻译：

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院外心脏骤停后的长期结果：系统评价和荟萃分析

目标

院外心脏骤停 (OHCA) 后的长期结果尚不清楚。本研究旨在评估在初始 OHCA 事件中幸存的患者的长期（1 年及以上）生存结果，包括总体生存和具有良好神经状态的生存和生活质量（QOL）结果（30天或直到出院）。

方法

检索了 Embase、Medline 和 PubMed 的主要研究（随机对照试验、队列和横断面研究），这些研究报告了 OHCA 患者的长期生存结果。进行数据提取和质量评估，并使用广义线性混合模型通过单臂比例荟萃分析评估预定时间点的生存率。使用 DerSimonian 和 Laird 模型，使用 Mantel-Haenszel 风险比 (RR) 估计值进行比较荟萃分析。

结果

纳入了 67 项研究，在存活至出院或 30 天的患者中，77.3% (CI = 71.2–82.4)、69.6% (CI = 54.5–70.3)、62.7% (CI = 54.5–70.3)、46.5% (CI = 32.0–61.6) 和 20.8% (CI = 7.8–44.9) 分别存活到 1、3、5、10 和 15 年。与亚洲相比，欧洲 (RR = 2.1, CI = 1.8–2.3)、北美 (RR = 2.0, CI = 1.7–2.2) 和大洋洲 (RR = 1.9, CI = 1.6) 的 1 年生存率更高–2.1)。男性的 1 年生存率更高（RR：1.41，CI = 1.25-1.59），初始可电击心律的患者 1 年（RR = 3.07，CI = 1.78-5.30）和 3 年生存率（RR = 1.45，CI = 1.19–1.77）。发生在住宅区的 OHCA 的 1 年生存率较差（RR = 0.42，CI = 0.25-0.73）。

结论

我们的研究发现，高达 20.8% 的 OHCA 患者存活至 15 年，与其他地区相比，亚洲的存活率较低。需要进一步分析各地区之间的生存差异，以指导未来对 OHCA 患者的长期治疗。