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.
Keywords
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Article info
Publication history
Published online: October 28, 2020
Accepted:
October 19,
2020
Received in revised form:
September 20,
2020
Received:
July 21,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
