Modifiable Survival Factors of Out-of-Hospital Cardiac Arrest among Global Population: Systematic Review and Meta-Analysis

  • Jeremy Rafael Tandaju Universitas Indonesia
  • Kareen Tayuwijaya
Keywords: Cardiac arrest, Healthcare, Management, Out-of-hospital, Resuscitation


Out-of-hospital cardiac arrest (OHCA) is the most common type of cardiac arrest and causing much mortality and burden even preventive measure has been made. Therefore, we conducted study to reduce OHCA morbidity and mortality by finding modifiable survival factors in-order to interfere them. We did systematic review of large cohort studies (n>100,000) on general population from four databases, then filtered 3,560 studies into 9 studies and appraised them using Newcastle-Ottawa scale for quality and Cochrane risk-of-bias before being synthesized. Among 486,012 subjects, we found out that age and shockable rhythm is unmodifiable but could be helped with lifestyle. Modifiable factors are grouped into two: bystander response including public location (OR=1.24; CI 95%=1.16–1.32), bystander witness (OR=1.45; CI 95%=1.36–1.56), bystander CPR (OR=1.45; CI 95%=1.36–1.56); and emergency service delivery including paramedic response <10 minutes (OR=1.55; CI 95%=1.41–1.70), ambulance physician (OR=1.52; CI 95%=1.37–1.68). Having OHCA in public means bigger chance of being resuscitated. However, resuscitation by uneducated bystander shown harmful thus public education was needed. Emergency services were considered important to arrive with competent workers, especially physicians who was trained on defibrillator usage and management regiment. Therefore, increasing public awareness, provide more ambulance and district health center facility, and training of health care workers are essential. In conclusion, management of OHCA involved multidisciplinary action throughout the nation to increase outcome of OHCA and lessen the burden. More area-specified and factor-specified studies should be conducted to improve applicability.


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1. Longo D, Kasper D, Jameson L, Fauci A, Hauser S, Loscalzo J. Harrison’s cardiovascular. 2nd ed. New York: McGraw-Hill; 2013: p. 328–39.
2. Yang K, Kyle J, Makielski J, Dudley S. Mechanism of sudden cardiac death. Circulation Res. 2015; 96(1): p. 290–5.
3. World Health Organization. Cardiovascular diseases. 2016 [Cited 2019 September 23]. Available on:
4. Newman M. Statistics on sudden cardiac arrest. 2018 [Cited 2019 September 23]. Available on:
5. Health Ministry of Indonesia. Indonesia national health research. Jakarta: Kemenkes; 2018: p. 8–12.
6. Myat A. Out-of-hospital cardiac arrest: current concepts. The Lancet. 2018; 391(1): p. 970–9.
7. Riva G, Righ M, Jonsson M, Svensson L, Herlitz J, Claesson A. Survival in out-of-hospital cardiac arrest after standard cardiopulmonary resuscitation or chest compressions only before arrival of emergency medical services. Circulation. 2019; 139(23): p. 2600–9.
8. World Health Organization. Sustainable development goals platform. 2016 [Cited 2019 September 23]. Available from:
9. Higgins J, Savovic J, Page M, Sterne J. Revised Cochrane risk-of-bias tool for randomized trials. London: The Cochrane Collaboration; p. 2–67.
10. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa scale. World J of Meta-Analysis. 2017; 5(4): p. 80–4.
11. Ahn E, Kang H. Introduction to systematic review and meta-analysis. Korean J of Anes. 2018; 71(2): p. 103–12.
12. Buick J, Ray J, Kiss A, Morrison L. The association between neighborhood effects and out-of-hospital cardiac arrest outcomes. Elsevier. 2016; 103(2): p. 14–9.
13. Fukuda T, Osashi-Fukuda N, Kondo Y, Sera T, Doi K, Yahagi N. Epidemiology, risk factors, and outcomes of out-of-hospital cardiac arrest caused by stroke. Medicine. 2016; 95(14): p. 3107–18.
14. Kida M, Kawamura T, Fukuoka T, Tamakoshi A, Wakai K, Ohno Y, et al. Out-of-hospital cardiac arrest and survival. Circulation J. 2004; 68(7): p. 603–9.
15. Kitamura T, Iwami T, Kawamura T, Nitta M, Nagao K, Nonogi H. Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan. Circulation. 2012; 126(24): p. 2834–43.
16. Liu J, Yang Q, Pirralo R, Klein J, Auferheide T. Hospital variability of out-of-hospital cardiac arrest survival. Prehospital Emerg Care. 2008; 12(3): p. 339–46.
17. Mathiesen W, Bjorshol C, Kvaloy J, Soreide E. Effects of modifiable pre-hospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas. Critical Care. 2018; 22(1): p. 7.
18. O’Keefe C, Nicholl J, Turner J, Goodacre S. Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest. Emergency Medicine J. 2010; 28(8): p. 703–6.
19. Tanaka H, Ong M, Siddiqui F, Ma M, Lin C, Gam H, et. Modifiable factors associated with survival after out-of-hospital cardiac arrest in the Pan-Asian resuscitation outcomes study. Elsevier. 2018; 71(5): p. 608–17.
20. Vonvopelius J. The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Elsevier. 2015; 96(1): p. 290–5.
21. Hiemstra B, Bergman R, Absalom A, van der Naalt J, van der Harst P, de Vos R, et al. Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Therapeutic Advances in Cardiovascula Disease. 2018; 12(12): p. 341–9.
22. Hirlekar G, Jonsson M, Karlsson T, hollenberg J, Albertsson P, Herlitz J. Comorbidity and survival in out-of-hospital cardiac arrest. Resuscitation. 2018; 133: p. 118–23.
23. van Gijn M, Frijns D, van de Glind E, van Munster B, Hamaker M. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age and aging. 2014; 43(4): p. 456–63.
24. Qvick A, Radif M, Brever C, Myrvik J, Schenk K, Djary T. Survival of out-hospital cardiac arrest in men and women in large Swedish cohort. Scandinavian J of Trauma Res and Emerg Med. 2018; 26(1): p. 108.
25. Hawkes C, Brown T, Booth S, Fothergill R, Siriwardena N, Zakaria S, et al. Attitudes to cardiopulmonary resuscitation and dfibrillator use: a survey of UK adults in 2017. J of The Am Heart Assoc. 2019; 8(7): p. 3.
26. Deliliga A, Chatznikolaou F, Koutsoukis D, Chrysovergis I, Voultsos P. Cardiopulmonary resuscitation (CPR) complication encountered in forensic autopsy cases. BMC Emergency Med. 2019; 19(1): p. 23.
27. Suharsono T, Fikriana R. Effect of tutorial teaching for knowledge and skill of CPR. E-journal Univ Muhammadiyah Malang. 2016; 7(2): p. 155–62.
28. Golpaygani A, Movahedi M, Reza M. A study on performance and safety tests of defibrillator equipment. J Biomet Phys Eng. 2017; 7(4): p. 397–402.
29. Cabral E, Castro W, Florentino D, Viana D, Junior J, de Souza R, et al. Response time in the emergency services: systematic review. Acta Chirurgical Brasilea. 2018; 33(12): p. 1111–21.
30. Suryanto, Boyle M, Plummer V. The hospital and healthcare system in Malang, Indonesia. Australian J of Paramed. 2017; 14(2): p. 1–8.
31. Pitt E. Prehospital care in Indonesia. Emerg Med J. 2005; 22(2): p. 144–7.
32. The Jakarta Post. ‘Believe it or not’: Jakarta traffic improves, says global index. Cited 2019 September 23. Available on:
33. Koning S, Gaakeer M, Vougelers R. Three-year emergency medicine training in The Netherlands: first evaluation from the resident’s perspective. Inter J of Emerg Med. 2013; 6(1): p. 30.
34. Organization of Indonesia Social Assurance. Indonesia national health insurance. 2015 [Cited 2019 September 23]. Available from:
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Tandaju, J., & Tayuwijaya, K. (2020). Modifiable Survival Factors of Out-of-Hospital Cardiac Arrest among Global Population: Systematic Review and Meta-Analysis. Indonesian Journal of Cardiology, 1(1).
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