Abstract 13514: Unfavorable Neurological Outcomes With Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis

Abstract

Introduction: Duration of Cardiopulmonary resuscitation (CPR) affects neurological outcomes. Data on its decremental effect on neurological outcomes haven’t been explored before Methods: PubMed, Scopus and Google Scholar were searched for relevant studies until May 2023 using relevant keywords. Odds of good neurological outcomes were studied. Binary random-effects models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study. A p<0.05 was considered statistically significant. Results: A total of 349,027 cardiac arrest patients (mean age: 70.2 years; males: 56.5%) from four studies were included in the meta-analysis. Of them the initial rhythm was shockable in 11% (38,465/349,027) and non-shockable in 88.97% (310,562/349,027) of the population. Odds of having favorable neurologic outcomes were OR 0.32 (95% CI 0.10-1.01, p=0.05) for 6-10-minute(n=14,118), OR 0.10 (95 %CI 0.02-0.64,p=0.02) for 11-15 min(n=43885), OR 0.05 (95% CI 0.01-0.36, p<0.01) for 16-20 minutes(n=66,174), OR 0.04 (95% CI 0.01-0.21, p< 0.01) for > 20 min(n=181,262) and OR 0.03 (95% CI 0.00-1.55, p=0.08) for > 30 minutes (n=66,461) when compared to patients receiving CPR for < 5 mins (n=6420).(Fig.1) Conclusions: Steady decremental odds of favorable neurological outcomes were seen with every five minutes of increase in CPR duration with a statistically significant decline seen in CPR duration of 11-15 mins onwards