(P035) PREDICTORS OF SURVIVAL IN PATIENTS WHO SUFFER AN IN HOSPITAL CARDIAC ARREST: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: In hospital cardiac arrest (IHCA) is common occurrence within the healthcare setting and associated with a high mortality rate. Whilst there is ample prognostic data on patients who suffer an out of hospital cardiac arrest, there is a paucity of information on IHCA, despite IHCA accounting for approximately 40% of all cardiac arrests. The aim of our systematic review and meta-analysis was to evaluate predictive factors that are associated with survival to discharge in populations who suffer an IHCA.

METHODS AND RESULTS: A systematic literature search of medical databases and grey literature using PRISMA principles identified all relevant studies comparing survival vs mortality in IHCAs (2000-2024; English Only; PROSPERO CRD42024520780). Figure 1. Data for all variables were extracted and those with low heterogeneity were then meta-analyzed using a random-effect model for odds ratios (OR) or standardized mean differences (SMD). Out of a total of 428 studies that were screened, 12 peer-reviewed articles fulfilled criteria for inclusion. A total of 5088 patients were included in the meta-analysis, with 26 factors assessed. Table 1. There were several predictors of survival, including a witnessed arrest (OR 2.99, p=0.009), arrest in operating room (OR 2.19, p=0.005), initial rhythm ventricular tachycardia / ventricular fibrillation (OR 4.67, p< 0.001), coronary angiogram performed during index admission (OR 2.80, p< 0.001) and an identifiable cardiac cause for arrest (OR 3.44, p< 0.001). Predictors of death included an initial non-shockable rhythm (OR 0.47, p< 0.001), requiring intubation (OR 0.50, p=0.027) and older age (SMD -0.30, p=0.03). Factors that were non-predictive for survival vs death included all baseline demographics, time of arrest, weekend vs weekday, location of arrest, duration of CPR, requirement of extra corporeal membrane oxygenation (p>0.05 for all).

Conclusion: The meta-analysis highlights that patients with an identifiable reversible cardiac cause for IHCA demonstrate more favorable survival rates. Further, non-cardiac causes of arrest, particularly in patients requiring intubation, results in higher rates of mortality.