Table 1 Meta-analyses of randomized controlled trials with survival and neurologically intact survival as outcomes
From: Interventions to improve cardiopulmonary resuscitation: a review of meta-analyses and future agenda
| Â | Comparison (setting) | N randomized | Outcome measures (timing) [N] | Relative risk (95% CI) | Heterogeneity |
|---|---|---|---|---|---|
Chest compressions | |||||
 Meier et al. [1] | Chest compression-first vs. defibrillation-first (OHCA) | 1503 | Survival (HD) [N = 1503] | OR 1.10 (0.70–1.70) | I2 = 34%, p = 0.206 |
CPC 1–2 (HD) [N = 402] | OR 1.02 (0.31–3.38) | I2 = 75%, p = 0.05 | |||
Long-term survival (1 year) [N = 1301] | OR 1.38 (0.95–2.02) | I2 = 0.0%, p = 0.647# | |||
Mechanical vs. standard manual chest compressions (OHCA and IHCA) | 868 and 1166¥ | Survival (HA) [N = 164] | Not pooled | Studies not pooled | |
CPC 1–2 (HD) [N = 767] | RR 0.41 (0.21–0.79) | Single study | |||
Survival (HD) [N = 1063] | Not pooled | Studies not pooled | |||
 Gates et al. [4] | Mechanical vs. standard manual chest compressions (OHCA) | 12,206 | Survival (HA) [N = 7208] | OR 0.95 (0.85–1.07) | I2 = 0.0%, p = 0.78 |
Survival (HD or 30 days) [N = 12,206] | OR 0.89 (0.77–1.02) | I2 = 0.0%, p = 0.49 | |||
CPC 1–2 or RS 0–3 (HD) [N = 12,206] | OR 0.76 (0.53–1.11) | I2 = 68%, p = 0.02 | |||
 Tang et al. [5] | Mechanical vs. manual chest compressions (OHCA) | 12,510 | Survival (HA) [N = 12,510] | RR 0.94 (0.89–1.00) | I2 = 0.0%, p = 0.48 |
Survival (HD) [N = 12,510] | RR 0.88 (0.78–0.99) | I2 = 27%, p = 0.24 | |||
CPC 1–2 or RS 0–3 (HD) [N = 12,058] | RR 0.80 (0.61–1.04) | I2 = 65%, p = 0.04 | |||
Long-term survival (≥ 6 months) [N = 7060] | RR 0.96 (0.79–1.16) | I2 = 16%, p = 0.28 | |||
 Li et al. [6] | Mechanical vs. manual chest compression (OHCA and IHCA) | 11,162 | Survival (HA), OOH group [N = 9975] | RR 0.97 (0.91–1.04) | I2 = 60%, p = 0.015 |
Survival (HD), OOH group [N = 4688] | RR 0.99 (0.82–1.18) | I2 = 71%, p = 0.004 | |||
Survival (HD), IH group [N = 200] | RR 0.54 (0.29–0.98) | I2 = 0.0%, p = 0.825 | |||
CPC 1–2 (HD), OOH group [N = 8885] | RR 1.11 (0.95–1.30) | I2 = 59%, p = 0.032 | |||
 Zhan et al. [7] | Continuous (+/− rescue breathing) vs. interrupted chest compression with pauses for breaths (OHCA) | 26,742¶ | Survival (HA) [N = 520] | RR 1.18 (0.94–1.48) | Single study |
Survival (HD) [N = 3031] | RR 1.21 (1.01–1.46) | I2 = 0.0%, p = 0.68 | |||
CPC 1–2 (HD) [N = 1286] | RR 1.25 (0.94–1.66) | Single study | |||
Adrenaline | |||||
 Lin et al. [8] | SDA vs. placebo (OHCA) | 12,246 | Survival (HA) [N = 534] | RR 1.95 (1.34–2.84) | Single study |
Survival (HD) [N = 534] | RR 2.12 (0.75–6.02) | Single study | |||
CPC 1–2 (HD) [N = 534] | RR 1.73 (0.59–5.11) | Single study | |||
SDA vs. HDA (OHCA) |  | Survival (HA) [N = 5699] | RR 0.87 (0.76–1.00) | I2 = 34%, p = 0.21 | |
Survival (HD) [N = 5638] | RR 1.04 (0.76–1.42) | I2 = 0.0%, p = 0.66 | |||
CPC 1–2 (HD) [N = 3883] | RR 1.20 (0.74–1.96) | I2 = 0.0%, p = 0.33 | |||
SDA vs. vasopressin (OHCA) |  | Survival (HA) [N = 336] | Not pooled | Single study | |
Survival (HD) [N = 336] | RR 0.68 (0.25–1.82) | Single study | |||
CPC 1–2 (HD) [N = 336] | RR 0.68 (0.25–1.82) | Single study | |||
SDA vs. vasopressin/adrenaline (OHCA) |  | Survival (HA) [N = 4877] | RR 0.88 (0.73–1.06) | I2 = 56%, p = 0.06 | |
Survival (HD) [N = 4877] | RR 1.00 (0.69–1.44) | I2 = 25%, p = 0.26 | |||
CPC 1–2 (HD) [N = 4807] | RR 1.32 (0.88–1.98) | I2 = 0.0%, p = 0.85 | |||
 Kempton et al. [9] | Epinephrine vs. placebo (OHCA) | 17,635 | Survival (HA) [N = 9511] | OR 2.52 (1.63–3.88) | I2 = 84%, p < 0.0001 |
Survival (HD) [N = 9805] | OR 1.09 (0.48–2.47) | I2 = 77%, p = 0.0002 | |||
CPC 1–2 or RS 0–3 (HD) [N = 9383] | OR 0.81 (0.34–1.96) | I2 = 83%, p = 0.0005 | |||
 Finn et al. [10] | SDA vs. placebo (OHCA and IHCA) | 21,704 | Survival (HA) [N = 8489] | RR 2.51 (1.67–3.76) | I2 = 77%, p = 0.04 |
Survival (HD) [N = 8538] | RR 1.44 (1.11–1.86) | I2 = 0.0%, p = 0.45 | |||
Neurological outcome (HD) [N = 8535] | RR 1.21 (0.90–1.62) | I2 = 0.0%, p = 0.49 | |||
SDA vs. HAD (OHCA and IHCA) |  | Survival (HA) [N = 5764] | RR 1.13 (1.03–1.24) | I2 = 0.0%, p = 0.42 | |
Survival (24 h) [N = 4179] | RR 1.04 (0.76–1.43) | I2 = 39%, p = 0.16 | |||
Survival (HD) [N = 6274] | RR 1.10 (0.75–1.62) | I2 = 24%, p = 0.23 | |||
Neurological outcome (HD) [N = 5803] | RR 0.91 (0.65–1.26) | I2 = 0.0%, p = 0.42 | |||
SDA vs. vasopressin (OHCA and IHCA) |  | Survival (HA) [N = 1953] | RR 1.27 (1.04–1.54) | I2 = 27%, p = 0.25 | |
Survival (HD) [N = 2511] | RR 1.25 (0.84–1.85) | I2 = 29%, p = 0.22 | |||
Neurological outcome (HD) [N = 2406] | RR 0.82 (0.54–1.25) | I2 = 0.0%, p = 0.46 | |||
SDA vs. SDA + vasopressin (OHCA) |  | Survival (HA) [N = 3249] | RR 0.95 (0.83–1.08) | I2 = 0.0%, p = 0.55 | |
Survival (HD) [N = 3242] | RR 0.76 (0.47–1.22) | I2 = 0.0%, p = 0.57 | |||
Neurological outcome (HD) [N = 2887] | RR 0.65 (0.33–1.31) | Single study | |||
 Vargas et al. [11] | Epinephrine vs. control (OHCA) | 20,716 | Survival (HA) [N = 20,306] | RR 1.02 (0.75–1.39) | I2 = 96.21%, p < 0.01 |
Survival (HD) [N = 19,909] | RR 1.16 (1.00–1.35) | I2 = 0.0%, p = 0.49 | |||
CPC 1–2 or similar (HD) [N = 18,458]£ | RR 1.24 (1.05–1.48) | I2 = 0.0%, p = 0.94 | |||
Airway management | |||||
 White et al. [12] | Endotracheal tube intubation vs. supraglottic airway devices (OHCA) | 539,146 | Survival (HA) [N = 51,756] | OR 1.36 (1.12–1.66) | I2 = 91%, p = 0.002 |
Survival (HD) [N = 440,564] | OR 1.28 (1.02–1.60) | I2 = 96%, p = 0.03 | |||
CPC 1–2 or RS < 3 [HD] [N = 438,261] | OR 1.16 (0.94–1.41) | I2 = 91%, p = 0.16 | |||