CANCARE RESEARCH
Explore previously published research highlights by topic, study type or publication date.
An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
The Cost-Effectiveness and Health Equity of Prehospital Treatment Strategies for Out-of-Hospital Cardiac Arrest Patients: A Systematic Review.
Clinical takeaway These findings may inform resuscitation-system economic discussions, particularly around prehospital ECPR. They do not establish a survival advantage, and heterogeneous comparisons limit confidence in applying the estimates across settings.
Summary & abstract
Study summary
This systematic review included ten economic evaluations of prehospital out-of-hospital cardiac arrest strategies, mostly cost-utility analyses, with six using Markov models. Prehospital ECPR was reported as more cost-effective than in-hospital ECPR, with incremental cost-effectiveness ratios ranging from AUD $27,323 to $44,000 per quality-adjusted life-year gained. Survival and neurological outcomes influenced cost-effectiveness estimates, while almost all studies reported fewer than 40% of assessed equity criteria. The authors concluded that many strategies enabling earlier advanced care were cost-effective, but heterogeneous comparators and sparse equity reporting limited evidence certainty.
Study limitation: The evidence primarily comprised economic evaluations, often using Markov models, with heterogeneous comparators and sparse equity reporting.
Published abstract
OBJECTIVES: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge, associated with substantial mortality and significant costs for health care system. This systematic review aimed to (i) synthesize economic evaluations of prehospital treatment strategies for OHCA from ambulance attendance through to hospital discharge; (ii) assess the methodological quality and reporting of the included studies; and (iii) evaluate the reporting of health equity-relevant data. METHODS: We searched Medline, Embase, Scopus, EconLit, and CINAHL databases for records from database inception to 12 June 2026. The QHES and CHEERS checklists were used to assess the quality and reporting standards of included studies, and the review was reported according to the PRISMA checklist. The completeness of reporting health equity outcomes was reviewed using the PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status and Social capital) - Plus framework. RESULTS: Ten economic evaluations met eligibility criteria. Most studies were cost-utility analyses (n = 8, 80%) and used Markov models (n = 6, 60%). Most evaluations were 'very good quality' (≥80%) (n = 6, 60%). Early defibrillation and advanced life support (ALS) delivered by trained emergency medical technicians were cost-effective compared with no intervention, emergency physician-led ALS, standard emergency medical services or paramedic care (ICER range from £11,407 to USD $56,700 per QALY gained). Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) was more cost-effective than in-hospital ECPR strategies (ICER range from AUD $27,323 to $44,000 per QALY gained). Termination-of-resuscitation (TOR) strategies were cost-effective compared with no TOR or other TOR strategies, including basic life support and ALS TOR, with estimates of $110,554 saved per QALY lost and USD $23,851 per QALY gained. Survival rate and neurological outcomes influenced cost-effectiveness results. Equity reporting was limited: almost all included studies addressed less than 40% of the PROGRESS-Plus equity criteria. CONCLUSIONS: Most strategies that increased prehospital treatment intensity, avoided futile transport, or enabled earlier advanced care were cost-effective; however, the certainty of evidence, particularly for sub-groups, was limited by heterogeneous comparators and sparse equity reporting.
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Mechanical versus manual bag-valve ventilation during cardiopulmonary resuscitation in adults with cardiac arrest: A systematic review and Bayesian meta-analysis.
Clinical takeaway Mechanical ventilation during CPR was associated with higher ROSC, but a survival or neurological benefit remains uncertain. These findings do not establish superiority for patient-centred outcomes.
Summary & abstract
Study summary
This Bayesian meta-analysis included eight studies involving 6,847 adults with cardiac arrest, comparing mechanical ventilation during CPR with manual bag-valve ventilation alone. Mechanical ventilation was associated with more ROSC (pooled RR 1.20; 95% credible interval 1.04–1.42), with a 99% posterior probability of benefit. Posterior probabilities favoring mechanical ventilation were 92.3% for survival to admission, 93.6% for survival to discharge, and 92.2% for favorable neurological outcome. Despite these directional signals, evidence for improved survival and neurological outcomes remained imprecise and inconclusive.
Study limitation: Classification as mechanical ventilation required any use during CPR, so this group could also have received manual ventilation.
Published abstract
BACKGROUND/OBJECTIVE: Optimal ventilation delivery during cardiopulmonary resuscitation (CPR) remains uncertain. Current resuscitation guidelines do not recommend mechanical ventilation (MV) over manual bag-valve ventilation (BV). We evaluated the association between MV use during CPR and clinical outcomes in adults with cardiac arrest compared with manual BV. METHODS: We searched 6 bibliographic databases from inception through May 31, 2026. Included studies compared MV and BV ventilation CPR in adult cardiac arrest patients. Patients receiving MV at any moment during CPR were classified as the MV group; those receiving only BV comprised the BV group. Primary outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and good neurological outcome. Secondary outcomes included physiologic variables and pneumothorax. We calculated pooled risk ratios (RRs) and mean differences with 95% credible intervals (CrIs) using Bayesian random-effects meta-analyses. RESULTS: Eight studies involving 6,847 patients were included. For the primary outcome, MV use during CPR was associated with a higher rate of ROSC than BV use (pooled RR, 1.20; 95% CrI, 1.04 to 1.42), with a 99% posterior probability of benefit. Posterior probabilities favoring MV for survival to admission, survival to discharge, and favorable neurological outcome were 92.3%, 93.6%, and 92.2%, respectively. Pneumothorax incidence was similar between groups. CONCLUSION: In adult cardiac arrest, MV use during CPR was associated with higher ROSC compared with manual BV. Evidence for improved survival and neurological outcomes remains imprecise and inconclusive.
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Automated external defibrillators for in-hospital cardiac arrest: a systematic review.
Clinical takeaway The review does not establish a patient-centred outcome benefit from routine ward-level AED deployment. Heterogeneous observational evidence leaves the balance between earlier defibrillation and possible compression interruptions uncertain.
Summary & abstract
Study summary
This systematic review compared AED use with manual defibrillation for in-hospital cardiac arrest outside specialized areas, synthesizing six reports from five observational cohorts descriptively. Neurologically favorable survival findings were inconsistent, with improvement reported after a combined AED-and-training intervention in one study. The largest multicentre cohort found no significant difference in neurological disability among survivors (adjusted relative risk 1.01, 95% CI 0.93–1.09). ROSC and survival to discharge were not consistently improved. Evidence was insufficient to determine whether routine ward-level AED deployment improves outcomes.
Study limitation: Included studies were observational and heterogeneous, with incomplete characterization of CPR quality and training.
Published abstract
BACKGROUND: Automated external defibrillators (AEDs) improve survival after out-of-hospital cardiac arrest, but their role in in-hospital cardiac arrest (IHCA) remains uncertain. This systematic review evaluates whether ward-accessible AED capability prior to code blue team arrival improves survival and neurologic outcomes compared with standard resuscitation systems. METHODS: Six databases were searched. Eligible studies compared AED use to manual defibrillation in IHCA outside specialized areas. Primary outcome was survival with favorable neurological status (CPC 1-2, mRS 0-3, or no deterioration from baseline). Secondary outcomes included ROSC, survival at 24 h, survival to discharge, 30-day survival, CPR quality, and timing metrics. Three independent reviewers performed study selection, data extraction, and risk-of-bias assessment. Due to substantial heterogeneity, results were synthesized descriptively. RESULTS: Six reports from five unique study cohorts met inclusion criteria (total screened = 5510). Neurologically favorable survival was inconsistent. One study reported improved outcomes following a combined AED-and-training intervention, whereas the largest multicentre cohort found no significant difference in neurological disability among survivors (adjusted relative risk 1.01, 95% CI 0.93-1.09). ROSC and survival to discharge were not consistently improved. Only one study directly quantified AED-associated compression pauses, and effects on time to defibrillation varied by setting. CONCLUSION: Available evidence is insufficient to determine whether routine ward-level AED deployment improves IHCA outcomes. Included studies were observational and heterogeneous and CPR quality and training were incompletely characterized. Potential benefit from earlier defibrillation in shockable rhythms must be weighed against possible compression interruptions. Contemporary comparative studies are needed.
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Intra-arrest strategies to treat cardiac arrest due to a non-opioid toxicological causes in adults and children: a systematic review.
Clinical takeaway Evidence for toxicology-specific modifications during cardiac arrest remains highly uncertain. The sodium bicarbonate finding is observational and does not establish that bicarbonate caused lower survival.
Summary & abstract
Study summary
This systematic review assessed modifications to advanced life support during presumed toxicological cardiac arrest, excluding studies focused specifically on opioid toxicity. Four observational studies examined nine interventions; none specifically focused on children, and three enrolled fewer than 100 patients. The primary outcome was 30-day survival. In the largest study (1,545 patients), sodium bicarbonate use during out-of-hospital arrest following suspected drug overdose was associated with lower survival to hospital discharge (adjusted odds ratio 0.16, 95% confidence interval 0.08–0.31). All studies had critical risk of bias, and intervention effect estimates were generally very imprecise.
Study limitation: Only four observational studies were available, all at critical risk of bias; none specifically focused on children.
Published abstract
OBJECTIVE: To summarise evidence on the effectiveness of specific alterations to standard advanced life support during ongoing cardiopulmonary resuscitation in adults and children with cardiac arrest due to a presumed toxicological cause. METHODS: We searched MEDLINE (OVID platform), Embase (OVID platform), and Cochrane CENTRAL from inception to 22nd July 2026 for relevant observational and interventional studies with a control group. We excluded studies focussed specifically on opioid toxicity. Two authors independently screened studies for inclusion. Our primary outcome was 30-day survival. We assessed risk of bias using the Cochrane recommended tools and certainty of evidence using the GRADE system. RESULTS: We identified four observational studies, of which none specifically focused on children and three included fewer than 100 patients. Studies examined general toxicological causes (n = 2), smoke inhalation and cyanide poisoning (n = 1), and beta-blocker and calcium-channel blocker overdose (n = 1). All studies were at critical risk of bias.Across the four studies, nine interventions were reported. Whilst some interventions were associated with either benefit or harm, estimates of effect were very imprecise and challenging to interpret. The largest study (1545 patients) reported that sodium bicarbonate use in out-of-hospital cardiac arrest due to suspected drug overdose was associated with lower survival to hospital discharge (adjusted odds ratio 0.16, 95% confidence interval 0.08-0.31). CONCLUSION: Current evidence does not support the modification of standard advanced life support during cardiac arrest due to a presumed toxicological cause in adults or children.Registration: PROSPERO CRD420251149412.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.