The effect of system performance improvement on patients with cardiac arrest: A systematic review
Journal
Resuscitation
Journal Volume
157
Pages
156-165
Date Issued
2020
Author(s)
Abstract
Aim: The aim of our review was to understand the effect of interventions to improve system-level performance on the clinical outcomes of patients with cardiac arrest. Methods: We searched PubMed, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify randomised controlled trials and non-randomised studies published before July 21, 2020 reporting systems interventions to improve outcomes. Characteristics, study design, evaluation methods and outcomes of included studies were extracted. (PROSPERO registration CRD42020161882). Results: One cluster randomised trial and 26 non-randomised studies were included. There were 18 studies focusing on interventions for patients with out-of-hospital cardiac arrest and 9 studies for patients with in-hospital cardiac arrest. Interventions included implementation of a bundle of care strategy, evaluation of cardiopulmonary resuscitation (CPR) quality with feedback/debriefing, data surveillance, and CPR training programs. Although improved survival with favorable neurologic outcome at discharge after the implementation of specific interventions was found in 13 studies, improved survival to hospital discharge in 14 studies and improved survival to admission in 3 studies, there were still 7 studies showing no significant improvement of clinical outcomes after interventions. Conclusion: Although only moderate to very low certainty of evidence exists to support the effect of system-level performance improvement on the clinical outcomes of patients, we recommend that organisations or communities evaluate their performance and target key areas with the goal to improve performance because of no known risks and the potential for a large beneficial effect. ? 2020 Elsevier B.V.
SDGs
Other Subjects
epinephrine; advanced life support; basic life support; care bundle; clinical outcome; defibrillation; emergency health service; endotracheal intubation; heart arrest; hospital admission; hospital discharge; hospital mortality; hospital patient; human; hyperventilation; induced hypothermia; medical education; out of hospital cardiac arrest; overall survival; priority journal; randomized controlled trial (topic); rescue personnel; resuscitation; return of spontaneous circulation; Review; survival rate; systematic review; total quality management