Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021


The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021.  To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology & Public Health; Prehospital Resuscitation; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique.  Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication.  Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively.  Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation.

1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479-87.
2. Wong CX, Brown A, Lau DH, Chugh SS, Albert CM, Kalman JM, et al. Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ. 2019;28(1):6-14.
3. Yu Y, Meng Q, Munot S, Nguyen TN, Redfern J, Chow CK. Assessment of Community Interventions for Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209256.
4. Murphy TW, Cohen SA, Hwang CW, Avery KL, Balakrishnan MP, Balu R, et al. Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020. J Am Coll Emerg Physicians Open. 2022;3(4):e12773.
5. Murphy TW, Cohen SA, Avery KL, Balakrishnan MP, Balu R, Chowdhury MAB, et al. Cardiac arrest: An interdisciplinary scoping review of the literature from 2019. Resusc Plus. 2020;4:100037.
6. Schroeder ED, Jacquet G, Becker TK, Foran M, Goldberg E, Aschkenasy M, et al. Global emergency medicine: a review of the literature from 2011. Acad Emerg Med. 2012;19(10):1196-203.
7. Gul SS, Cohen SA, Avery KL, Balakrishnan MP, Balu R, Chowdhury MAB, et al. Cardiac arrest: An interdisciplinary review of the literature from 2018. Resuscitation. 2020;148:66-82.
8. Čulić V, AlTurki A, Proietti R. Public health impact of daily life triggers of sudden cardiac death: A systematic review and comparative risk assessment. Resuscitation. 2021;162:154-62.
9. Jones KA, Jani KH, Jones GW, Nye ML, Duff JP, Cheng A, et al. Using natural language processing to compare task-specific verbal cues in coached versus noncoached cardiac arrest teams during simulated pediatrics resuscitation. AEM Educ Train. 2021;5(4):e10707.
10. de Graaf C, Beesems SG, Oud S, Stickney RE, Piraino DW, Chapman FW, et al. Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new AED algorithm. Resuscitation. 2021;162:320-8.
11. Dundar ZD, Ayranci MK, Kocak S, Girisgin AS. Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study. Prehosp Disaster Med. 2021;36(2):189-94.
12. Standards and guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). National Academy of Sciences - National Research Council. JAMA. 1986;255(21):2905-89.
13. Azeli Y, Bardají A, Barbería E, Lopez-Madrid V, Bladé-Creixenti J, Fernández-Sender L, et al. Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial. Crit Care. 2021;25(1):176.
14. Ng QX, Han MX, Lim YL, Arulanandam S. A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes. J Clin Med. 2021;10(10):2098.
15. Hsieh YL, Wu MC, Wolfshohl J, d'Etienne J, Huang CH, Lu TC, et al. Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies. Scand J Trauma Resusc Emerg Med. 2021;29(1):44.
16. Alshahrani MS, Aldandan HW. Use of sodium bicarbonate in out-of-hospital cardiac arrest: a systematic review and meta-analysis. Int J Emerg Med. 2021;14(1):21.
17. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-468.
18. Nas J, Thannhauser J, van Dijk EGJA, Verkroost C, Damman P, van Wely M, et al. Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest. Resuscitation. 2021;164:54-61.
19. Downing J, Al Falasi R, Cardona S, Fairchild M, Lowie B, Chan C, et al. How effective is extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest? A systematic review and meta-analysis. Am J Emerg Med. 2022;51:127-38.
20. Kern KB, Radsel P, Jentzer JC, Seder DB, Lee KS, Lotun K, et al. Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study. Circulation. 2020;142(21):2002-12.
21. Lemkes JS, Janssens GN, van der Hoeven NW, Jewbali LSD, Dubois EA, Meuwissen MM, et al. Coronary Angiography After Cardiac Arrest Without ST Segment Elevation: One-Year Outcomes of the COACT Randomized Clinical Trial. JAMA Cardiol. 2020;5(12):1358-65.
22. Barbarawi M, Zayed Y, Kheiri B, Barbarawi O, Al-Abdouh A, Dhillon H, et al. Optimal timing of coronary intervention in patients resuscitated from cardiac arrest without ST-segment elevation myocardial infarction (NSTEMI): A systematic review and meta-analysis. Resuscitation. 2019;144:137-44.
23. Desch S, Freund A, Akin I, Behnes M, Preusch MR, Zelniker TA, et al. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2021;385(27):2544-53.
24. Nehme Z, Ball J, Stephenson M, Walker T, Stub D, Smith K. Effect of a resuscitation quality improvement programme on outcomes from out-of-hospital cardiac arrest. Resuscitation. 2021;162:236-44.
25. Harhash AA, May TL, Hsu CH, Agarwal S, Seder DB, Mooney MR, et al. Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography. J Am Coll Cardiol. 2021;77(4):360-71.
26. Cales RH, Anderson PG, Heilig RW. Utilization of medical care in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med. 1985;14(9):853-8.
27. Nathens AB, Jurkovich GJ, Rivara FP, Maier RV. Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma. 2000;48(1):25-30; discussion -1.
28. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363(9411):768-74.
29. Gross BW, Dauterman KW, Moran MG, Kotler TS, Schnugg SJ, Rostykus PS, et al. An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2007;99(10):1360-3.
30. Le May MR, Davies RF, Dionne R, Maloney J, Trickett J, So D, et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol. 2006;98(10):1329-33.
31. Yeo JW, Ng ZHC, Goh AXC, Gao JF, Liu N, Lam SWS, et al. Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022;11(1):e023806.
32. Chan JL, Lehrich J, Nallamothu BK, Tang Y, Kennedy M, Trumpower B, et al. Association Between Hospital Resuscitation Champion and Survival for In-Hospital Cardiac Arrest. J Am Heart Assoc. 2021;10(5):e017509.
33. Lin CY, Hsia SH, Lee EP, Chan OW, Lin JJ, Wu HP. Effect of Audiovisual Cardiopulmonary Resuscitation Feedback Device on Improving Chest Compression Quality. Sci Rep. 2020;10(1):398.
34. Gugelmin-Almeida D, Tobase L, Polastri TF, Peres HHC, Timerman S. Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resusc Plus. 2021;6:100108.
35. Kirkbright S, Finn J, Tohira H, Bremner A, Jacobs I, Celenza A. Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomised and non-randomised trials. Resuscitation. 2014;85(4):460-71.
36. Miller AC, Scissum K, McConnell L, East N, Vahedian-Azimi A, Sewell KA, et al. Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis. Int J Crit Illn Inj Sci. 2020;10(3):109-22.
37. Goharani R, Vahedian-Azimi A, Pourhoseingholi MA, Amanpour F, Rosano GMC, Sahebkar A. Survival to intensive care unit discharge among in-hospital cardiac arrest patients by applying audiovisual feedback device. ESC Heart Fail. 2021;8(6):4652-60.
38. Grundgeiger T, Hahn F, Wurmb T, Meybohm P, Happel O. The use of a cognitive aid app supports guideline-conforming cardiopulmonary resuscitations: A randomized study in a high-fidelity simulation. Resusc Plus. 2021;7:100152.
39. Crabb DB, Hurwitz JE, Reed AC, Smith ZJ, Martin ET, Tyndall JA, et al. Innovation in resuscitation: A novel clinical decision display system for advanced cardiac life support. Am J Emerg Med. 2021;43:217-23.
40. Jang DH, Lee DK, Shin J, Jo YH, Park SM, Investigators SC. Association between length of stay in the emergency department and outcomes in out-of-hospital cardiac arrest. Am J Emerg Med. 2021;49:124-9.
41. Baldi E, Schnaubelt S, Caputo ML, Klersy C, Clodi C, Bruno J, et al. Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2021;4(1):e2032875.
42. Nikolaou NI, Netherton S, Welsford M, Drennan IR, Nation K, Belley-Cote E, et al. A systematic review and meta-analysis of the effect of routine early angiography in patients with return of spontaneous circulation after Out-of-Hospital Cardiac Arrest. Resuscitation. 2021;163:28-48.
43. Kuroki N, Nagao K, Otsuka T, Kuwabara M, Nakata J, Takayama T, et al. Combined use of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump after cardiac arrest. Resuscitation. 2021;167:345-54.
44. Niimura T, Zamami Y, Koyama T, Izawa-Ishizawa Y, Miyake M, Koga T, et al. Hydrocortisone administration was associated with improved survival in Japanese patients with cardiac arrest. Sci Rep. 2017;7(1):17919.
45. Mentzelopoulos SD, Malachias S, Chamos C, Konstantopoulos D, Ntaidou T, Papastylianou A, et al. Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial. JAMA. 2013;310(3):270-9.
46. Wongtanasarasin W, Krintratun S. Clinical benefits of corticosteroid administration during adult cardiopulmonary resuscitation: A systemic review and meta-analysis. World J Crit Care Med. 2021;10(5):290-300.
47. Levito MN, McGinnis CB, Groetzinger LM, Durkin JB, Elmer J. Impact of benzodiazepines on time to awakening in post cardiac arrest patients. Resuscitation. 2021;165:45-9.
48. De Fazio C, Skrifvars MB, Søreide E, Grejs AM, Di Bernardini E, Jeppesen AN, et al. Quality of targeted temperature management and outcome of out-of-hospital cardiac arrest patients: A post hoc analysis of the TTH48 study. Resuscitation. 2021;165:85-92.
49. Morris NA, Mazzeffi M, McArdle P, May TL, Burke JF, Bradley SM, et al. Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations - A study from the CARES Investigators. Resuscitation. 2021;169:97-104.
50. Wenger NS, Pearson ML, Desmond KA, Harrison ER, Rubenstein LV, Rogers WH, et al. Epidemiology of do-not-resuscitate orders. Disparity by age, diagnosis, gender, race, and functional impairment. Arch Intern Med. 1995;155(19):2056-62.
51. Quill CM, Ratcliffe SJ, Harhay MO, Halpern SD. Variation in decisions to forgo life-sustaining therapies in US ICUs. Chest. 2014;146(3):573-82.
52. Gates S, Quinn T, Deakin CD, Blair L, Couper K, Perkins GD. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation. 2015;94:91-7.
53. Buckler DG, Burke RV, Naim MY, MacPherson A, Bradley RN, Abella BS, et al. Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes: A Population-Based Study Using the CARES Registry (Cardiac Arrest Registry to Enhance Survival). Circulation. 2016;134(25):2131-3.
54. Fuest K, Dorfhuber F, Lorenz M, von Dincklage F, Mörgeli R, Kuhn KF, et al. Comparison of volume-controlled, pressure-controlled, and chest compression-induced ventilation during cardiopulmonary resuscitation with an automated mechanical chest compression device: A randomized clinical pilot study. Resuscitation. 2021;166:85-92.
55. Sandroni C, D'Arrigo S, Cacciola S, Hoedemaekers CWE, Kamps MJA, Oddo M, et al. Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med. 2020;46(10):1803-51.
56. Sandroni C, D'Arrigo S, Cacciola S, Hoedemaekers CWE, Westhall E, Kamps MJA, et al. Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review. Intensive Care Med. 2022;48(4):389-413.
57. Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation. 2021;161:220-69.
58. Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO. Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation. Lancet Neurol. 2020;19(7):611-22.
59. Henson T, Rawanduzy C, Salazar M, Sebastian A, Weber H, Al-Mufti F, et al. Outcome and prognostication after cardiac arrest. Ann N Y Acad Sci. 2022;1508(1):23-34.
60. Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, et al. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2019;140(9):e517-e42.
61. Cloostermans MC, van Meulen FB, Eertman CJ, Hom HW, van Putten MJ. Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: a prospective cohort study. Crit Care Med. 2012;40(10):2867-75.
62. Carrai R, Grippo A, Scarpino M, Spalletti M, Cossu C, Lanzo G, et al. Time-dependent and independent neurophysiological indicators of prognosis in post-anoxic coma subjects treated by therapeutic hypothermia. Minerva Anestesiol. 2016;82(9):940-9.
63. Carrai R, Spalletti M, Scarpino M, Lolli F, Lanzo G, Cossu C, et al. Are neurophysiologic tests reliable, ultra-early prognostic indices after cardiac arrest? Neurophysiol Clin. 2021;51(2):133-44.
64. Lee H, Shin H, Oh J, Lim TH, Kang BS, Kang H, et al. Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(16):8389.
65. Jung YH, Lee BK, Lee DH, Lee SM, Cho YS, Jeung KW. The association of body mass index with outcomes and targeted temperature management practice in cardiac arrest survivors. Am J Emerg Med. 2017;35(2):268-73.
66. Testori C, Sterz F, Losert H, Krizanac D, Haugk M, Uray T, et al. Cardiac arrest survivors with moderate elevated body mass index may have a better neurological outcome: a cohort study. Resuscitation. 2011;82(7):869-73.
67. Jain R, Nallamothu BK, Chan PS, investigators AHANRoCRN. Body mass index and survival after in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2010;3(5):490-7.
68. Chang CY, Wu PH, Hsiao CT, Chang CP, Chen YC, Wu KH. Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2021;162:188-97.
69. Le Bastard Q, Rouzioux J, Montassier E, Baert V, Recher M, Hubert H, et al. Endotracheal intubation versus supraglottic procedure in paediatric out-of-hospital cardiac arrest: a registry-based study. Resuscitation. 2021;168:191-8.
70. Siebert JN, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, et al. Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(8):e2123007.
71. Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, et al. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation. 2021;162:351-64.
72. Morgan RW, Himebauch AS, Griffis H, Quarshie WO, Yeung T, Kilbaugh TJ, et al. Pulmonary hypertension among children with in-hospital cardiac arrest: A multicenter study. Resuscitation. 2021;168:52-7.
73. Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98-114.
74. Perkins GD, Graesner JT, Semeraro F, Olasveengen T, Soar J, Lott C, et al. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021;161:1-60.
75. Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021;161:80-97.
76. Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, et al. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation. 2021;161:388-407.
77. Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Resuscitation. 2021;169:229-311.
78. Colls Garrido C, Riquelme Gallego B, Sánchez García JC, Cortés Martín J, Montiel Troya M, Rodríguez Blanque R. The Effect of Therapeutic Hypothermia after Cardiac Arrest on the Neurological Outcome and Survival-A Systematic Review of RCTs Published between 2016 and 2020. Int J Environ Res Public Health. 2021;18(22):11817.
79. Cekmen B, Bildik B, Bozan O, Atis SE, Koksal M, Uzuncu HB, et al. Chest compression quality during CPR of potential contagious patients wearing personal protection equipment. Am J Emerg Med. 2022;52:128-31.
IssueVol 7 No 1 (2023): Winter (February) QRcode
SectionReview article
DOI 10.18502/fem.v7i1.11698
Cardiopulmonary Resuscitation Emergency Medical Services Epidemiology Heart Arrest Out-of-Hospital Cardiac Arrest Sudden Cardiac Death

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Hwang C, Murphy T, Antoine J, Avery KL, Carr C, Han F, Snipes G, Zhou S, Becker T. Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021. Front Emerg Med. 2022;7(1):e8.


Download data is not yet available.