停搏前和停搏间预后因素与院内心脏停搏后生存率之间的相关性，这一成果由加拿大渥太华大学Shannon M Fernando研究小组取得。该项研究成果在线发表在2019年12月4日的《英国医学杂志》上。

研究组在Medline、Pubmed、Embase等大型数据库中检索从成立至2019年2月4日间的相关文献，筛选出关于停博前和停博间预后因素和院内心脏停博后存活率的研究。初步分析23项队列研究，使用QUIPS工具评估偏倚风险。对相关混杂因素进行校正后，将这些关联集合起来。

在停博前因素中，男性、年龄超过60岁、活动性恶性肿瘤和慢性肾病史，是院内心脏停博后存活率降低的危险因素。在停博间因素中，发现停博、监测停博、白天停博和初期电击心律等是存活率增加的保护因素。而停博期间插管和复苏持续时间超过15分钟，可导致存活率降低。

综上，停博前和停博间预后因素与院内心脏停博后生存率之间存在着中高度的相关性。

附：英文原文

Title: Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

Author: Shannon M Fernando, Alexandre Tran, Wei Cheng, Bram Rochwerg, Monica Taljaard, Christian Vaillancourt, Kathryn M Rowan, David A Harrison, Jerry P Nolan, Kwadwo Kyeremanteng, Daniel I McIsaac, Gordon H Guyatt, Jeffrey J Perry

Issue&Volume: 2019/12/04

Abstract:

Objective To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest.

Design Systematic review and meta-analysis.

Data sources Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database.

Study selection criteria English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest.

Data extraction PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence.

Results The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival.

Conclusion Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest.

DOI: 10.1136/bmj.l6373

Source: https://www.bmj.com/content/367/bmj.l6373