中 国 心 肺 复 苏

CHINARESUSCITATION.COM

Methods and results:

A systematic literature search was performed using the EMBASE, MEDLINE and Web of Science databases without restrictions on publication date. The last search was performed on 15 July 2022. Randomized controlled trials (RCTs) and non-randomized studies (NRS) comparing the effect of early CAG to selective CAG after NSTE-OHCA on survival and/or neurological outcomes were included. Meta-analyses were performed based on a DerSimonian-Laird random effects model. A total of 18 studies were identified by the literature search. After the exclusion of two studies due to high risk of bias, 16 studies (six RCTs, ten NRS) were included in the final analyses. Meta-analyses showed a statistically significant increase in survival after early CAG compared with selective CAG in the overall analysis [OR: 1.40, 95% confidence interval (CI): (1.12-1.76), P < 0.01, I2 = 68%]. This effect was lost in the subgroup analysis of RCTs [OR: 0.89, 95% CI: (0.73-1.10), P = 0.29, I2 = 0%]. Random effects model network meta-analysis of NRS based on a Bayesian method showed statistically significant increased survival after late compared with early CAG [OR: 4.20, 95% CI: (1.22, 20.91)].

研究方法和结果：

使用EMBASE、MEDLINE和Web of Science数据库进行系统文献检索，不严格限制发表时间，末次搜索在2022年7月15日，纳入NSTE-OHCA后早期CAG和选择性CAG对生存和/或神经系统结局的影响的随机对照试验（RCTs）和非随机研究（NRS）。基于DerSimonian-Laird随机效应模型进行荟萃分析。通过文献检索确定18项研究，因高偏倚风险排除2项，最终纳入16项研究（6项RCTs, 10项NRS）。荟萃分析显示，在总体分析中，早期CAG与选择性CAG相比生存率改善（OR：1.40，95% CI：1.12-1.76，P < 0.01，I2 = 68%）。在RCTs亚组分析中这种效应消失（OR：0.89, 95% CI： 0.73-1.10，P = 0.29，I2 = 0%）。基于贝叶斯方法的NRS随机效应模型网络Meta分析显示，晚期CAG与早期CAG相比生存率提高（OR：4.20：95% CI：1.22-20.91）。