Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

RESUSCITATION

卷:148

Review

Nas, Joris¹  Kleinnibbelink, Geert^1,2  Hannink, Gerjon³  Navarese, Eliano P.^4,5,6  van Royen, Niels¹  de Boer, Menko-Jan¹  Wik, Lars⁷  Bonnes, Judith L.¹  Brouwer, Marc A.¹ 

[1] Radboud Univ Nijmegen, Med Ctr, Radboud Inst Hlth Sci, Dept Cardiol, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands

[2] Liverpool John Moores Univ, Inst Sport & Exercise Sci, 3 Byrom St, Liverpool L3 3AF, Merseyside, England

[3] Radboud Univ Nijmegen, Med Ctr, Dept Operating Rooms, Nijmegen, Netherlands

[4] Mater Dei Hosp, Cardiovasc Inst, Intervent Cardiol & Cardiovasc Med Res, Bari, Italy

[5] SIRIO MED Cardiovasc Network, Rome, Italy

[6] Univ Alberta, Fac Med, Edmonton, AB, Canada

[7] Oslo Univ Hosp, Norwegian Natl Advisory Unit Prehosp Emergency Me, Oslo, Norway

关键词: Cardiopulmonary resuscitation;    Termination of resuscitation;    Meta-analysis;    Out-of-hospital cardiac arrest;   

DOI  :  10.1016/j.resuscitation.2019.12.016

来源: Elsevier

【 摘 要 】

Aim: To minimize termination of resuscitation (TOR) in potential survivors, the desired positive predictive value (PPV) for mortality and specificity of universal TOR-rules are >= 99%. In lack of a quantitative summary of the collective evidence, we performed a diagnostic meta-analysis to provide an overall estimate of the performance of the basic and advanced life support (BLS and ALS) termination rules. Data sources: We searched PubMed/EMBASE/Web-of-Science/CINAHL and Cochrane (until September 2019) for studies on either or both TOR-rules in non-traumatic, adult cardiac arrest. PRISMA-DTA-guidelines were followed. Results: There were 19 studies: 16 reported on the BLS-rule (205.073 patients, TOR-advice in 57%), 11 on the ALS-rule (161.850 patients, TOR-advice in 24%). Pooled specificities were 0.95 (0.89-0.98) and 0.98 (0.95-1.00) respectively, with a PPV of 0.99 (0.99-1.00) and 1.00 (0.99-1.00). Specificities were significantly lower in non-Western than Western regions: 0.84 (0.73-0.92) vs. 0.99 (0.97-0.99), p<0.001 for the BLS rule. For the ALS-rule, specificities were 0.94 (0.87-0.97) vs. 1.00 (0.99-1.00), p<0.001. For non-Western regions, 16 (BLS) or 6 (ALS) out of 100 potential survivors met the TOR-criteria. Meta-regression demonstrated decreasing performance in settings with lower rates of in-field shocks. Conclusions: Despite an overall high PPV, this meta-analysis highlights a clinically important variation in diagnostic performance of the BLS and ALS TOR-rules. Lower specificity and PPV were seen in non-Western regions, and populations with lower rates of in-field defibrillation. Improved insight in the varying diagnostic performance is highly needed, and local validation of the rules is warranted to prevent in-field termination of potential survivors.

【 授权许可】

Free