OBJECTIVE To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database. STUDY SELECTION CRITERIA English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DATA EXTRACTION PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence. RESULTS The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival. CONCLUSION Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018104795.

中文翻译：

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与院内心脏骤停后生存相关的骤停前和骤停期间预后因素：系统评价和荟萃分析。

目的 确定重要的骤停前和骤停期间预后因素与院内心脏骤停后生存率之间的关联。设计系统回顾和荟萃分析。数据来源 Medline、PubMed、Embase、Scopus、Web of Science 和 Cochrane 系统评价数据库，从开始到 2019 年 2 月 4 日。来自英国国家心脏骤停审计数据库的主要未发表数据。研究选择标准 调查逮捕前和逮捕中预后因素以及院内心脏骤停后生存的英语语言研究。遵循数据提取进展（预后研究策略组）建议和 CHARMS（预测建模研究的系统评价的关键评估和数据提取）清单。通过使用 QUIPS 工具（预后研究的质量）评估偏倚风险。主要分析仅在针对相关混杂因素进行调整后才汇总关联。GRADE 方法（推荐评估、制定和评估的分级）用于评估证据的确定性。结果 主要分析包括 23 项队列研究。在逮捕前因素中，男性（优势比 0.84，95% 置信区间 0.73 至 0.95，中等确定性），60 岁或以上（0.50，0.40 至 0.62，低确定性），活动性恶性肿瘤（0.57，0.45 至 0.71，高确定性）和慢性肾脏病史（0.56, 0.40 至 0.78, 高确定性）与院内心脏骤停后生存几率降低有关。在逮捕内因素中，目击逮捕（2.71，2.17 至 3.38，高确定性），监测逮捕（2.23，1. 41 至 3.52，高确定性）、白天停止（1.41、1.20 至 1.66，高确定性）和初始可电击节律（5.28、3.78 至 7.39，高确定性）与生存几率增加相关。骤停期间插管（0.54, 0.42 至 0.70，中等确定性）和至少 15 分钟的复苏持续时间（0.12, 0.07 至 0.19，高确定性）与生存几率降低相关。结论 中度到高度确定性的证据表明，骤停前和骤停中的预后因素与院内心脏骤停后的生存率有关。系统审查注册 PROSPERO CRD42018104795。骤停期间插管（0.54, 0.42 至 0.70，中等确定性）和至少 15 分钟的复苏持续时间（0.12, 0.07 至 0.19，高确定性）与生存几率降低相关。结论 中度到高度确定性的证据表明，骤停前和骤停中的预后因素与院内心脏骤停后的生存率有关。系统审查注册 PROSPERO CRD42018104795。骤停期间插管（0.54, 0.42 至 0.70，中等确定性）和至少 15 分钟的复苏持续时间（0.12, 0.07 至 0.19，高确定性）与生存几率降低相关。结论 中度到高度确定性的证据表明，骤停前和骤停中的预后因素与院内心脏骤停后的生存率有关。系统审查注册 PROSPERO CRD42018104795。