scholarly journals Readmission after index hospital discharge among patients with COVID ‐19: Protocol for a systematic review and meta‐analysis

2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Abdulwahab AlSayegh ◽  
Adnan A Gassan ◽  
Ram C. Bajpai ◽  
Sara Muller ◽  
Victoria Welsh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Index Hospital

The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 34 (05) ◽  
pp. 532-539 ◽  
Author(s):  
K.T. Ng ◽  
W.Y. Teoh
Keyword(s):  
Systematic Review ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Quality Of Evidence ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

AbstractIntroduction:Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.Methods:A systematic review and meta-analysis were conducted using the following databases: MEDLINE, EMBASE, and CENTRAL, from their inception until October 2018. All the randomized controlled trials (RCTs) were included. Observational studies, case reports, case series, and non-systematic reviews were excluded.Results:Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received epinephrine during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%CI) of 4.25 (3.79-4.75), P <.001, high-quality of evidence. The number of patients transported to hospital was increased in patients who had prehospital epinephrine, with an odds ratio (95%CI) of 2.31 (2.11-2.53), P <.001, high-quality of evidence. The prehospital use of epinephrine was associated with an increased survival to hospital discharge, the odds ratio (95%CI) being 1.43 (1.10-1.87), P = .008, moderate-quality of evidence. No significant effect was noted on the favorable neurologic state of patient at hospital discharge, with an odds ratio (95%CI) of 1.21 (0.90-1.64), P = .21, moderate-quality of evidence.Conclusions:This meta-analysis suggests that the prehospital use of epinephrine increases return of spontaneous circulation, transport of patients to hospital, and survival to hospital discharge for OHCA. However, no significant effects on favorable neurologic function at hospital discharge were demonstrated. The general quality of evidence ranged from moderate to high.

scholarly journals Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Melaku Bimerew ◽  
Adam Wondmieneh ◽  
Getnet Gedefaw ◽  
Teshome Gebremeskel ◽  
Asmamaw Demis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Probability Of Survival ◽  
Pooled Prevalence ◽  
Hospital Cardiac Arrest

Abstract Background In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. Methods PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. Results Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0–50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by “continent” and “income level”, lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01–52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0–51.0%, I2 = 97.67%, p < 0.001) respectively. Conclusion Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

scholarly journals The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5573
Author(s):  
Karol Bielski ◽  
Agnieszka Szarpak ◽  
Miłosz Jaroslaw Jaguszewski ◽  
Tomasz Kopiec ◽  
Jacek Smereka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Survival Outcomes ◽  
Cochrane Central Register ◽  
Mortality And Morbidity ◽  
Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

scholarly journals Rewarming From Hypothermic Cardiac Arrest Applying Extracorporeal Life Support: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Lars J. Bjertnæs ◽  
Kristian Hindberg ◽  
Torvind O. Næsheim ◽  
Evgeny V. Suborov ◽  
Eirik Reierth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Body Temperature ◽  
Hospital Discharge ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Meta Analysis ◽  
Low Ph ◽  
Individual Data ◽  
Male Sex

Introduction: This systematic review and meta-analysis aims at comparing outcomes of rewarming after accidental hypothermic cardiac arrest (HCA) with cardiopulmonary bypass (CPB) or/and extracorporeal membrane oxygenation (ECMO).Material and Methods: Literature searches were limited to references with an abstract in English, French or German. Additionally, we searched reference lists of included papers. Primary outcome was survival to hospital discharge. We assessed neurological outcome, differences in relative risks (RR) of surviving, as related to the applied rewarming technique, sex, asphyxia, and witnessed or unwitnessed HCA. We calculated hypothermia outcome prediction probability score after extracorporeal life support (HOPE) in patients in whom we found individual data. P &lt; 0.05 considered significant.Results: Twenty-three case observation studies comprising 464 patients were included in a meta-analysis comparing outcomes of rewarming with CPB or/and ECMO. One-hundred-and-seventy-two patients (37%) survived to hospital discharge, 76 of 245 (31%) after CPB and 96 of 219 (44 %) after ECMO; 87 and 75%, respectively, had good neurological outcomes. Overall chance of surviving was 41% higher (P = 0.005) with ECMO as compared with CPB. A man and a woman had 46% (P = 0.043) and 31% (P = 0.115) higher chance, respectively, of surviving with ECMO as compared with CPB. Avalanche victims had the lowest chance of surviving, followed by drowning and people losing consciousness in cold environments. Assessed by logistic regression, asphyxia, unwitnessed HCA, male sex, high initial body temperature, low pH and high serum potassium (s-K+) levels were associated with reduced chance of surviving. In patients displaying individual data, overall mean predictive surviving probability (HOPE score; n = 134) was 33.9 ± 33.6% with no significant difference between ECMO and CPB-treated patients. We also surveyed 80 case reports with 96 victims of HCA, who underwent resuscitation with CPB or ECMO, without including them in the meta-analysis.Conclusions: The chance of surviving was significantly higher after rewarming with ECMO, as compared to CPB, and in patients with witnessed compared to unwitnessed HCA. Avalanche victims had the lowest probability of surviving. Male sex, high initial body temperature, low pH, and high s-K+ were factors associated with low surviving chances.

scholarly journals A Systematic Review and Network Meta-Analysis for COVID-19 Treatments

2020 ◽  
Author(s):  
Chenyang Zhang ◽  
Huaqing Jin ◽  
Yifeng Wen ◽  
Guosheng Yin
Keyword(s):  
Systematic Review ◽  
Hospital Discharge ◽  
Lower Risk ◽  
Fixed Effects ◽  
Comprehensive Evaluation ◽  
Discharge Rate ◽  
Meta Analysis ◽  
Viral Clearance ◽  
Effect Sizes ◽  
Research Database

AbstractBackgroundNumerous interventions for coronavirus disease 2019 (COVID-19) have been investigated by randomized controlled trials (RCTs). This systematic review and Bayesian network meta-analysis (NMA) aim to provide a comprehensive evaluation of efficacy of available treatments for COVID-19.MethodsWe searched for candidate COVID-19 studies in WHO COVID-19 Global Research Database, PubMed, PubMed Central, LitCovid, Proquest Central and Ovid up to December 19, 2020. RCTs for suspected or confirmed COVID-19 patients were included, regardless of publication status or demographic characteristics. Bayesian NMA with fixed effects was conducted to estimate the effect sizes using posterior means and 95% equal-tailed credible intervals (CrIs), while that with random effects was carried out as well for sensitivity analysis. Bayesian hierarchical models were used to estimate effect sizes of treatments grouped by their drug classifications.ResultsWe identified 96 eligible RCTs with a total of 51187 patients. Compared with the standard of care (SOC), this NMA showed that dexamethasone led to lower risk of mortality with an odds ratio (OR) of 0.85 (95% CrI [0.76, 0.95]; moderate certainty) and lower risk of mechanical ventilation (MV) with an OR of 0.68 (95% CrI [0.56, 0.83]; low certainty). For hospital discharge, remdesivir (OR 1.37, 95% CrI [1.15, 1.64]; moderate certainty), dexamethasone (OR 1.20, 95% CrI [1.08, 1.34]; low certainty), interferon beta (OR 2.15, 95% CrI [1.26, 3.74]; moderate certainty), tocilizumab (OR 1.40, 95% CrI [1.05, 1.89]; moderate certainty) and baricitinib plus remdesivir (OR 1.75, 95% CrI [1.28, 2.39]; moderate certainty) could all increase the discharge rate respectively. Recombinant human granulocyte colony-stimulating factor indicated lower risk of MV (OR 0.20, 95% CrI [0.10, 0.40]; moderate certainty); and patients receiving convalescent plasma resulted in better viral clearance (OR 2.28, 95% CrI [1.57, 3.34]; low certainty). About two-thirds of the studies included in this NMA were rated as high risk of bias, and the certainty of evidence was either low or very low for most of the comparisons.ConclusionThe Bayesian NMA identified superiority of several COVID-19 treatments over SOC in terms of mortality, requirement of MV, hospital discharge and viral clearance. These results provide a comprehensive comparison of current COVID-19 treatments and shed new light on further research and discovery of potential COVID-19 treatments.

Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis

Heart ◽  
2013 ◽  
Vol 99 (23) ◽  
pp. 1717-1726 ◽  
Author(s):  
Abdullah Pandor ◽  
Tim Gomersall ◽  
John W Stevens ◽  
Jenny Wang ◽  
Abdallah Al-Mohammad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Hospital Discharge ◽  
Remote Monitoring ◽  
Meta Analysis ◽  
Patients With Heart Failure

scholarly journals Atrial fibrillation detected initially during acute medical illness: A systematic review

2018 ◽  
Vol 8 (2) ◽  
pp. 130-141 ◽  
Author(s):  
William F McIntyre ◽  
Kevin J Um ◽  
Christopher C Cheung ◽  
Emilie P Belley-Côté ◽  
Orvie Dingwall ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Medical Illness ◽  
Atrial Fibrillation Recurrence ◽  
Ecg Monitoring ◽  
Recurrence Rates ◽  
True Rate

Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness. Data sources: Medline, Embase and Cochrane Central to September 2017. Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge. Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge. Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis ( I2=99%). In post-hoc meta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%. Conclusions: The incidence of atrial fibrillation with medical illness may be as high as 44%, with higher estimates in reports using continuous ECG monitoring. Within 5 years following hospital discharge, atrial fibrillation recurrence is documented in approximately half of patients; however, the true rate may be higher. Protocol registration PROSPERO CRD42016043240

scholarly journals Esmolol for the treatment of refractory ventricular fibrillation: a systematic review and meta-analysis

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Richard Armour ◽  
Leon Baranowski
Keyword(s):  
Systematic Review ◽  
Ventricular Fibrillation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Life Support ◽  
Cardiopulmonary Arrest ◽  
Meta Analysis ◽  
Grey Literature ◽  
Neurological Status ◽  
Cochrane Library

<p><strong>Introduction: </strong>In light of recent research the efficacy of current advanced life support treatments has been questioned. Ventricular fibrillation refractory to standard therapy is a presentation which may benefit from an updated approach to management, with the b<sub>1</sub>-adrenoreceptor antagonist esmolol considered a therapy which may confer benefit. This systematic review and meta-analysis aimed to summarise the available evidence for esmolol in refractory ventricular fibrillation and identify if it may have any role in ACLS guidelines.</p><p><strong>Methods: </strong> The Cochrane Library, MEDLINE, CINAHL and EMBASE were systematically reviewed, along with trial registries and the grey literature. Studies were included in the review and subsequent meta-analysis if they examined adult patients in cardiopulmonary arrest with ventricular fibrillation refractory to at least three attempts at defibrillation and one dose of adrenaline or anti-arrhythmic therapy, who subsequently received intravenous esmolol.</p><p><strong>Results: </strong> 2,617 results were obtained with 12 full-text articles reviewed for inclusion. Ultimately, two unique results fulfilled the inclusion criteria. A total of 66 patients were included in the meta-analysis, of whom 22 received esmolol. Esmolol appears to improve to survival to hospital admission (RR 2.63, 95% CI 1.37-5.07, p=0.004), temporary (RR 2.34, 95% CI 1.09-5.02, p=0.03) and sustained ROSC (RR 2.63, 95% CI 1.37-5.07, p=0.004) and favourable neurological status at hospital discharge (RR 3.44, 95% CI 1.11-10.67, p=0.03). The use of esmolol also appeared to likely confer a benefit in survival to hospital discharge (RR 2.82, 95% CI 1.01-7.93, p=0.05). However, significant bias was observed across all outcomes and overall these results were considered to be of low to very low certainty.</p><p><strong>Conclusion: </strong>The use of esmolol in refractory ventricular fibrillation appears to improve survival to hospital admission, temporary and sustained ROSC and neurological status at hospital discharge, but not survival to hospital discharge. However, these results should be interpreted with caution in light of the limitations of included studies and the subsequent impact of these limitations on the outcomes included in the meta-analysis. Further high-quality, prospective research is required prior to recommending esmolol for use in refractory ventricular fibrillation.<strong></strong></p>

scholarly journals Extra-Corporeal Membrane Oxygenation (ECMO) for Postcardiotomy Cardiogenic Shock (PCCS) in Asian Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Di-huan Li ◽  
Ming-wei Sun ◽  
Ting Li ◽  
Ting Yuan ◽  
Ping Zhou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Failure ◽  
Survival Rate ◽  
Cardiogenic Shock ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Adult Patients ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Postcardiotomy Cardiogenic Shock

Abstract Background Extra-corporeal membrane oxygenation (ECMO) is an important extracorporeal life support system to treat patients with postcardiotomy cardiogenic shock (PCCS). But its effectiveness and safety are still inconclusive. Existing systematic reviews and meta-analysis have heterogeneity challenges such as the inclusion of different races in the same study.Objective The impact of ECMO treatment on the survival rate of Asian adult patients with PCCS was evaluated by searching the literature and using the method of systematic review and meta-analysis.Study Design and Methods PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, WANFANG MED ONLINE, SinoMed were searched to find relevant research on the use of ECMO on PCCS patients in Asia. Outcomes included survival rate to hospital discharge, long-term survival rate, complications.Results A total of 32 articles were selected, including observational studies and one RCT, involving China and Japan covering 4,278 PCCS patients. The pooled rate of survival to hospital discharge was 43.0% (95% CI 38% ~47%, I2 = 87%), the pooled 1-year, 2-year, and 3-year survival rate were 34% (95% CI 26% ~ 42%, I2 = 85%), 29% (95% CI 18% ~39%, I2 = 93%), 25% (95%CI 16% ~35%, I2=93%). The pooled rate of bleeding, neurologic complications, rethoracotomy, leg ischemia, renal failure, renal replacement therapy, and infection were 18% (95% CI 13% ~24%, I2=91%), 13% (95% CI 9% ~17%, I2 = 90.0%), 36% (95% CI 27% ~46%, I2 = 97.0%), 11% (95% CI 9% ~13%, I2 = 55%), 40% (95% CI 27% ~54%, I2 = 90%), 45% (95% CI 35% ~ 56%, I2 = 98%), 26% (95%CI (20%~31%, I2=95%).Conclusion ECMO can provide survival benefits for Asian adult patients with PCCS. However, attention should be paid to reducing the incidence of complications, especially renal failure. More high-quality clinical studies are needed to confirm the survival benefit of ECMO.

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