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Meta-Analysis
. 2021 Jul:164:122-129.
doi: 10.1016/j.resuscitation.2021.04.025. Epub 2021 May 5.

Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis

Mariachiara Ippolito  1 , Giulia Catalisano  1 , Claudia Marino  1 , Rosa Fucà  1 , Antonino Giarratano  2 , Enrico Baldi  3 , Sharon Einav  4 , Andrea Cortegiani  5
Affiliations
Meta-Analysis

Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis

Mariachiara Ippolito et al. Resuscitation. 2021 Jul.

Abstract

Aim: To estimate the mortality rate, the rate of return of spontaneous circulation (ROSC) and survival with favorable neurological outcome in patients with COVID-19 after in-hospital cardiac arrest (IHCA) and attempted cardiopulmonary resuscitation (CPR).

Methods: PubMed, EMBASE, Web of Science, bioRxiv and medRxiv were surveyed up to 8th February 2021 for studies reporting data on mortality of patients with COVID-19 after IHCA. The primary outcome sought was mortality (in-hospital or at 30 days) after IHCA with attempted CPR. Additional outcomes were the overall rate of IHCA, the rate of non-shockable presenting rhythms, the rate of ROSC and the rate of survival with favorable neurological status.

Results: Ten articles were included in the systematic review and meta-analysis, for a total of 1179 COVID-19 patients after IHCA with attempted CPR. The estimated overall mortality rate (in-hospital or at 30 days) was 89.9% (95% Predicted Interval [P.I.] 83.1%-94.2%; 1060/1179 patients; I2 = 82%). The estimated rate of non-shockable presenting rhythms was 89% (95% P.I. 82.8%-93.1%; 1022/1205 patients; I2 = 85%), and the estimated rate of ROSC was 32.9% (95% P.I. 26%-40.6%; 365/1205 patients; I2 = 82%). The estimated overall rate of survival with favorable neurological status at 30 days was 6.3% (95% P.I. 4%-9.7%; 50/851 patients; I2 = 48%). Sensitivity analysis showed that COVID-19 patients had higher risk of death after IHCA than non COVID-19 patients (OR 2.34; 95% C.I. 1.37-3.99; number of studies = 3; 1215 patients).

Conclusions: Although one of three COVID-19 patients undergoing IHCA may achieve ROSC, almost 90% may not survive at 30 days or to hospital discharge.

Keywords: COVID-19; Cardiac arrest; Mortality; cpr.

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Figures

Fig. 1
Fig. 1
Forest plot reporting the results of the meta-analysis for mortality of COVID-19 patients undergoing in-hospital cardiac arrest with cardiopulmonary resuscitation. The figure shows the forest plots reporting the results of meta-analysis for mortality (in-hospital or at 30-day when the former was not reported) of COVID-19 patients undergoing in-hospital cardiac arrest with cardiopulmonary resuscitation.
Fig. 2
Fig. 2
Forest plots reporting the results of the meta-analysis for additional outcomes of COVID-19 patients undergoing in-hospital cardiac arrest with cardiopulmonary resuscitation. The figure shows the forest plots reporting the results of meta-analysis for non-shockable presentation rhythm (panel a), ROSC (panel b) and 30-day favorable neurological status (defined as a CPC score of 1 or 2) (panel c) of COVID-19 patients undergoing in-hospital cardiac arrest with cardiopulmonary resuscitation. In this analysis, the total number of patients in the study by Miles et al. included 12 patients tested negative for COVID-19 and 14 patients with indeterminate result at COVID-19 testing.
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