(P034) PREDICTORS OF GOOD NEUROLOGICAL RECOVERY IN SURVIVORS OF IN HOSPITAL CARDIAC ARREST: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Prognosticating neurological recovery after an in-hospital cardiac arrest (IHCA) can be difficult given the myriad of contextual factors that are involved within in each case. Whilst there is ample data on patients who suffer an out of hospital cardiac arrest, there is a paucity of data on IHCA, despite IHCA accounting for 40% of all cardiac arrests. The aim of our systematic review and meta-analysis was to evaluate factors that are associated with a favourable cerebral performance category (CPC 1-2) versus an unfavourable cerebral performance category (CPC 3-5), for IHCA patients who survive to discharge. Our hypothesis is that patients who have an identifiable reversible cardiac cause for the IHCA demonstrate a more favourable neurological recovery.

METHODS AND RESULTS: A systematic literature search of medical databases and grey literature using PRISMA principles identified all relevant studies comparing “good” (CPC 1-2) vs “poor” neurological outcomes (CPC 3-5) in IHCA (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, 15 peer-reviewed articles fulfilled criteria for inclusion. A total of 4948 patients were included in the meta-analysis, with 39 factors assessed. Table 1. Our meta-analysis identified that predictors of favourable neurological outcomes post IHCA included male gender (OR 1.43, p=0.002), a history of ischemic heart disease (OR 1.84, p=0.016), acute heart failure during admission (OR 1.99, p≤0.001), acute myocardial infarction during admission (OR 2.14, p=0.002), early ECMO (OR 1.71, p=0.003), right heart catheterisation (OR 3.84, p=0.005), coronary catheterization (OR 4.55, p≤0.001), identifiable cardiac cause for arrest (OR 2.12, p ≤0.001), shockable rhythm (OR 3.0, p≤0.001) and being on telemetry monitoring (OR 1.34, p=0.048). Conversely, predictors of poor neurological recovery included older age, presence of malignancy, hepatic insufficiency, a high Charlson Comorbidity Index, respiratory insufficiency, sepsis, initial rhythm PEA /asystole and a lower haemoglobin post arrest (p < 0.05 for all). Other factors that were meta-analyzed were all non-differentiators of good versus poor neurology in this cohort (p>0.05 for all).

Conclusion: The meta-analysis highlights that in patients with IHCA that survive to discharge, appropriate treatment of an underlying reversible cardiac cause is associated with a more favourable neurological recovery. Further, a higher comorbid status and non-cardiac causes of IHCA were liked to poor neurological recovery, despite survival to discharge.