Intra-arrest blood-based biomarkers for out-of-hospital cardiac arrest: A scoping review

Justin L Benoit; Andrew N Hogan; Katherine M Connelly; Jason T McMullan

doi:10.1002/emp2.13131

Intra-arrest blood-based biomarkers for out-of-hospital cardiac arrest: A scoping review

J Am Coll Emerg Physicians Open. 2024 Mar 18;5(2):e13131. doi: 10.1002/emp2.13131. eCollection 2024 Apr.

Authors

Justin L Benoit¹, Andrew N Hogan², Katherine M Connelly³, Jason T McMullan¹

Affiliations

¹ Department of Emergency Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA.
² Department of Emergency Medicine UT Southwestern Medical Center Dallas Texas USA.
³ Department of Emergency Medicine University of Wisconsin-Madison Madison Wisconsin USA.

Abstract

Objective: Blood-based biomarkers play a central role in the diagnosis and treatment of critically ill patients, yet none are routinely measured during the intra-arrest phase of out-of-hospital cardiac arrest (OHCA). Our objective was to describe methodological aspects, sources of evidence, and gaps in research surrounding intra-arrest blood-based biomarkers for OHCA.

Methods: We used scoping review methodology to summarize existing literature. The protocol was designed a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. Inclusion criteria were peer-reviewed scientific studies on OHCA patients with at least one blood draw intra-arrest. We excluded in-hospital cardiac arrest and animal studies. There were no language, date, or study design exclusions. We conducted an electronic literature search using PubMed and Embase and hand-searched secondary literature. Data charting/synthesis were performed in duplicate using standardized data extraction templates.

Results: The search strategy identified 11,834 records, with 118 studies evaluating 105 blood-based biomarkers included. Only eight studies (7%) had complete reporting. The median number of studies per biomarker was 2 (interquartile range 1-4). Most studies were conducted in Asia (63 studies, 53%). Only 22 studies (19%) had blood samples collected in the prehospital setting, and only six studies (5%) had samples collected by paramedics. Pediatric patients were included in only three studies (3%). Out of eight predefined biomarker categories of use, only two were routinely assessed: prognostic (97/105, 92%) and diagnostic (61/105, 58%).

Conclusions: Despite a large body of literature on intra-arrest blood-based biomarkers for OHCA, gaps in methodology and knowledge are widespread.

Keywords: advanced cardiac life support; biomarkers; cardiac arrest; emergency medical services; hematologic tests; out‐of‐hospital; prehospital; pulseless electrical activity; scoping review.