Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China.

BACKGROUND: Systematic evaluation of the successful heartbeat recovery rate (HRR) in patients during the platinum ten minutes after cardiac arrest.

METHODS: The databases of CNKI (January 1979-March 2019), Chongqing VIP (January 1989-March 2019), Wanfang (January 1990-March 2019) and Web of Science (1900-May 2020) were searched. To collect the clinical data of patients with cardiac arrest before hospitalization and analyze the cardiopulmonary resuscitation (CPR) at different times. Literature selection and data extraction were carried out by two researchers independently, and the meta package of R software (version 3. 61) was used for analysis.

RESULTS: A total of 116 papers met the inclusion criteria, including 37,181 patients. Of these patients, 3367 had their heartbeats successfully restored. The results showed a high degree of heterogeneity (χ2  = 6999.21, P < 0.01, I2  = 97.6%). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.199 (0.157-0.250). (1) According to the five CPR groups (International Cardiopulmonary Resuscitation Guide 2000, 2005, 2010, 2015 and other versions), the HRR of other versions [0.264 (0.176-0.375)] was higher than the International Cardiopulmonary Resuscitation 2005 edition [0.121 (0.092-0.158)]. (2) The rescue time was divided into the 0 to ≤5 min group, the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. The HRR were 0.417 (0.341-0.496), 0.143 (0.104-0.193), 0.049 (0.034-0.069), and 0.022 (0.009-0.051), respectively. The HRR was higher in the 0 to ≤5 min group than in the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. There was no difference between the 10 to ≤15 min group and the > 15 min group. (3) When the groups were stratified with the cutoff of 10 min, the ≤10 min group HRR [0.250 (0.202-0.306)] was higher than the > 10 min group rate [0.041 (0.029-0.057)]. (4) The HRR of the telephone guidance group was [0.273 (0.227-0.325)] lower than that of the 0 to ≤5 min group [0.429 (0.347-0.516)] but higher than that of the 5 to ≤10 min group, the 10 to ≤15 min group, and the > 15 min group. (5) The HRR of the witness group [0.325 (0.216-0.458)] was not different from that of the 0 to ≤5 min group, but it was higher than those of the 5 to ≤10 min group, the 10 to ≤15 min group and the > 15 min group. (6) There was no significant difference HRR between the witnessed group, the telephone guidance group and the ≤10 min group.

CONCLUSIONS: (1) The HRR is time-sensitive, and early rescue can improve it. (2) CPR performed within the platinum ten minutes must be executed by the public, and other forces are auxiliary. (3) The concept of peri-cardiac arrest period (PCAP) should be established and improved to guide CPR.