Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis

Abstract

Background: The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA.

Methods: A systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale.

Results: Ten studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p = 0.036). While mortality (OR = 0.67, 95%-CI 0.49-0.91) and supraglottic airway use (OR = 0.36, 95%-CI 0.27-0.46) was higher during the pandemic, automated external defibrillator use (OR = 1.78 95%-CI 1.06-2.98), return of spontaneous circulation (OR = 1.63, 95%CI 1.18-2.26) and intubation (OR = 1.87, 95%-CI 1.12--3.13) was more common before the pandemic. More patients survived to hospital admission (OR = 1.75, 95%-CI 1.42-2.17) and discharge (OR = 1.65, 95%-CI 1.28-2.12) before the pandemic. Bystander CPR (OR = 1.18, 95%-CI 0.95-1.46), unwitnessed OHCA (OR = 0.84, 95%-CI 0.66-1.07), paramedic-resuscitation attempts (OR = 1.19 95%-CI 1.00-1.42) and mechanical CPR device use (OR = 1.57 95%-CI 0.55-4.55) did not defer significantly.

Conclusions: The incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required.

Review registration: PROSPERO (CRD42020203371).

Keywords: COVID-19; Cardiac arrest; OHCA; Out of hospital; SARS-CoV-2.

Fig. 1

PRISMA 2009 flow diagram.

Fig. 2

Forest plot comparison before COVID-19 pandemic vs. during COVID-19 pandemic for mortality. M-H: Mantel-Haenszel; CI: Confidence Interval.

Fig. 3

Forest plot comparison before COVID-19 pandemic vs. during COVID-19 pandemic for (a) Cause of OHCA, (b) Bystander CPR, (c) Unwitnessed OHCA, (d) Resuscitation attempted by paramedics, (e) ROSC achieved, (f) Shockable rhythm/shocked events, (g) Frequency of OHCA at home, (h) Endotracheal Intubation, (i) Supraglottic airway, (j) Mechanical CPR device used, (k) Automatic external defibrillator used, (l) Survival to hospital admission, and (m) Survival to hospital discharge.

Fig. 3

Forest plot comparison before COVID-19 pandemic vs. during COVID-19 pandemic for (a) Cause of OHCA, (b) Bystander CPR, (c) Unwitnessed OHCA, (d) Resuscitation attempted by paramedics, (e) ROSC achieved, (f) Shockable rhythm/shocked events, (g) Frequency of OHCA at home, (h) Endotracheal Intubation, (i) Supraglottic airway, (j) Mechanical CPR device used, (k) Automatic external defibrillator used, (l) Survival to hospital admission, and (m) Survival to hospital discharge.

Fig. 3

Forest plot comparison before COVID-19 pandemic vs. during COVID-19 pandemic for (a) Cause of OHCA, (b) Bystander CPR, (c) Unwitnessed OHCA, (d) Resuscitation attempted by paramedics, (e) ROSC achieved, (f) Shockable rhythm/shocked events, (g) Frequency of OHCA at home, (h) Endotracheal Intubation, (i) Supraglottic airway, (j) Mechanical CPR device used, (k) Automatic external defibrillator used, (l) Survival to hospital admission, and (m) Survival to hospital discharge.