Factors associated with good neurological outcomes in survivors of in-hospital cardiac arrest: A systematic review and meta-analysis.

BACKGROUND

Accurate predictors of neurological outcome after in-hospital cardiac arrest (IHCA) remain limited.

METHODS

We conducted a systematic review and meta-analysis of 15 studies (n = 4948 adults) to identify peri-arrest factors associated with favourable neurological outcomes in IHCA survivors. Study quality was assessed using the QUIPS tool and evidence certainty was rated with GRADE.

RESULTS

A favourable neurological outcome was associated with pre-arrest factors such as male sex (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.13-1.78, Level of Evidence (LOE): low), established ischaemic heart disease (OR: 1.84, 95% CI: 1.12-3.02 LOE: low), acute myocardial infarction diagnosis upon hospital admission (OR: 2.14 95% CI: 1.53-2.99 LOE: low), acute heart failure (OR: 1.99, 95% CI: 1.42-2.78 LOE: low) and arrests in telemetry units (OR: 1.34, 95% CI: 1-1.78 LOE: low). Initial shockable rhythm (OR: 3.0, 95% CI: 2.3-3.9, LOE: moderate), cardiac-related causes (OR: 2.12, 95% CI: 1.54-2.92, LOE: low to moderate) and shorter cardiopulmonary resuscitationduration (standardised mean difference: -0.62, 95% CI: -0.89, -0.35) were also associated with improved neurological recovery. Post-arrest interventions such as emergent coronary catheterisation (OR: 4.55, 95% CI: 2.11-9.82, LOE: low), pulmonary artery catheterisation monitoring (OR: 3.84, 95% CI: 1.51-9.75, LOE: low), and extracorporeal membrane oxygenation after return of spontaneous circulation (OR: 1.71, 95% CI: 1.20-2.43, LOE: low) were associated with better neurological outcomes. The overall quality of included studies was generally of low certainty, limited by moderate bias and substantial heterogeneity.

CONCLUSIONS

Early detection and management of reversible cardiac causes in IHCA are associated with improved patient outcomes. This study identifies peri-arrest factors associated with favourable neurological outcomes in adult survivors of IHCA who were discharged alive. All findings and interpretations are limited to this conditional population and should not be extrapolated to the broader IHCA cohort. While these findings offer valuable insights for risk stratification and protocol development, high-quality prospective studies are needed to validate these associations and confirm their clinical significance.