Long-term functional outcomes and health-related quality of life following in-hospital cardiac arrest (IHCA): A systematic review.

Abstract

To evaluate long-term functional outcomes following in-hospital cardiac arrest (IHCA). A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro were searched to 14 February 2025. Eligible studies included adults (≥18 years) who received conventional cardiopulmonary resuscitation for IHCA and reported neurological, cognitive, psychological, or health-related quality of life (HRQoL) outcomes at ≥ 3 months post-IHCA. Risk of bias was assessed using the QUIPS tool. Meta-analyses of binary outcomes were performed using random-intercept logistic regression. Narrative synthesis was used where pooling of results was not feasible. The protocol was registered with PROSPERO (CRD420251009496). Thirty-nine studies from 21 countries were included (sample size n = 16-1539 patients). Most were moderate to high risk of bias. Across the full cohort, the pooled proportion of poor neurological outcome was 78.9% (95% CI 73.5-83.4%; I² = 95.6%). Among survivors, 9.9% (95% CI 5.8-16.3%; I² 86.4%) had poor neurological outcome, with lower proportions at longer follow-up. Clinically significant anxiety and depression affected 13.1% (95% CI 6.1-26.0%; I² = 92.3%) and 8.1% (95% CI 4.6-13.7%; I² = 75.7%) of survivors, respectively. HRQoL impairments were frequently reported, particularly in pain/discomfort (60.5% [95% CI 57.9-63.0%; I² = 37.6%]), usual activities (52.6% [95% CI 50.0-55.2%; I² = 0.0%]), and anxiety/depression (49.0% [95% CI 46.4-51.6%; I² = 0.0%]). Cognitive impairments were reported in one study. Substantial statistical heterogeneity (I² > 75%) was observed across most analyses. Wide variation in outcome measures, follow-up duration, and reporting methods limited synthesis. While many IHCA survivors achieve favourable long-term outcomes, a significant proportion experience persistent impairments. Greater standardisation in outcome measurement and reporting is needed to improve comparability across studies and guide post-arrest care.