The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

doi:10.3390/jcm10235573

Review

. 2021 Nov 27;10(23):5573.

doi: 10.3390/jcm10235573.

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Affiliations

¹ Research Unit, Polonia University, 4/6 Pulaskiego Str., 42-200 Czestochowa, Poland.
² Provincial Emergency Medical Service Dispatcher, 22 Poznanska, 00-685 Warsaw, Poland.
³ Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., 03-411 Warsaw, Poland.
⁴ 1st Department of Cardiology, Medical University of Gdansk, 3A Sklodowskiej-Curie Str., 80-210 Gdansk, Poland.
⁵ First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland.
⁶ Department of Emergency Medical Service, Wroclaw Medical University, 6 Bartla Str., 52-443 Wroclaw, Poland.
⁷ Research Unit, Polish Society of Disaster Medicine, P.O. Box 78, Raszyn, 05-090 Warsaw, Poland.
⁸ Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland.
⁹ Institute of Health Sciences, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland.
¹⁰ College of Rehabilitation, 49 Kasprzaka Str., 01-234 Warsaw, Poland.
¹¹ Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA.
¹² Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 12 Ogrodowa Str., 15-027 Bialystok, Poland.

PMID: 34884289
PMCID: PMC8658174
DOI: 10.3390/jcm10235573

Review

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Karol Bielski et al. J Clin Med. 2021.

. 2021 Nov 27;10(23):5573.

doi: 10.3390/jcm10235573.

Authors

Affiliations

¹ Research Unit, Polonia University, 4/6 Pulaskiego Str., 42-200 Czestochowa, Poland.
² Provincial Emergency Medical Service Dispatcher, 22 Poznanska, 00-685 Warsaw, Poland.
³ Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., 03-411 Warsaw, Poland.
⁴ 1st Department of Cardiology, Medical University of Gdansk, 3A Sklodowskiej-Curie Str., 80-210 Gdansk, Poland.
⁵ First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland.
⁶ Department of Emergency Medical Service, Wroclaw Medical University, 6 Bartla Str., 52-443 Wroclaw, Poland.
⁷ Research Unit, Polish Society of Disaster Medicine, P.O. Box 78, Raszyn, 05-090 Warsaw, Poland.
⁸ Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland.
⁹ Institute of Health Sciences, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland.
¹⁰ College of Rehabilitation, 49 Kasprzaka Str., 01-234 Warsaw, Poland.
¹¹ Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA.
¹² Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 12 Ogrodowa Str., 15-027 Bialystok, Poland.

PMID: 34884289
PMCID: PMC8658174
DOI: 10.3390/jcm10235573

Abstract

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06-1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37-1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1-2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35-2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13-2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

Keywords: SARS-CoV-2; cardiopulmonary resuscitation; coronavirus disease 2019; out-of-hospital cardiac arrest; outcome; pandemic.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Database search and selection of studies according to PRISMA guidelines.

**Figure 2**
Forest plot of time to Emergency Medical Service arrival in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted mean differences for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; MD = mean difference.

**Figure 3**
Forest plot of occurrence of shockable rhythm in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OR = odds ratio.

**Figure 4**
Forest plot prehospital return of spontaneous circulation in pre- vs. intra-COVID-19 periods. The center of each square represents the odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OR = odds ratio.

**Figure 5**
Forest plot of survival to hospital admission rate in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OR = odds ratio.

**Figure 6**
Forest plot of survival to hospital discharge in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OD = odds ratio.

**Figure 7**
Forest plot of survival to hospital discharge with CPC 1 or 2 in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OD = odds ratio.

**Figure 8**
Forest plot of 30-day survival rate in pre- vs. intra-COVID-19 periods. The center of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval. The diamonds represent pooled results. Legend: CI = confidence interval; OR = odds ratio.

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References

1. Baldi E., Sechi G.M., Mare C., Canevari F., Brancaglione A., Primi R., Klersy C., Palo A., Contri E., Ronchi V., et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N. Engl. J. Med. 2020;383:496–498. doi: 10.1056/NEJMc2010418. - DOI - PMC - PubMed
1. Attila K., Ludwin K., Evrin T., Katipoglu B., Torlinski T., Pruc M., Szarpak L. The impact of COVID-19 on airway management in prehospital resuscitation. Disaster Emerg. Med. J. 2020;5:216–217. doi: 10.5603/DEMJ.a2020.0047. - DOI
1. Grasselli G., Greco M., Zanella A., Albano G., Antonelli M., Bellani G., Bonanomi E., Cabrini L., Carlesso E., Castelli G., et al. COVID-19 Lombardy ICU Network. Risk Factors Associated with Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern. Med. 2020;180:1345–1355. doi: 10.1001/jamainternmed.2020.3539. - DOI - PMC - PubMed
1. Lin C.H., Lin H.Y., Tseng W.P., Ma M.H., Tsai M.S., Chen S.Y., Huang C.H. Resuscitation teamwork during the COVID-19 pandemic in the emergency department: Challenges and solutions. Resuscitation. 2021;160:18–19. doi: 10.1016/j.resuscitation.2021.01.004. - DOI - PMC - PubMed
1. Al-Jeabory M., Borkowska G.O., Olecka A., Goss A., Wieczorek W., Evrin T. Mechanical chest compression devices as an option for out-of-hospital cardiac arrest in COVID-19 pandemic. Disaster Emerg. Med. J. 2021;6:50–51. doi: 10.5603/DEMJ.a2021.0003. - DOI

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[1] Baldi E., Sechi G.M., Mare C., Canevari F., Brancaglione A., Primi R., Klersy C., Palo A., Contri E., Ronchi V., et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N. Engl. J. Med. 2020;383:496–498. doi: 10.1056/NEJMc2010418. - DOI - PMC - PubMed

[2] Baldi E., Sechi G.M., Mare C., Canevari F., Brancaglione A., Primi R., Klersy C., Palo A., Contri E., Ronchi V., et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N. Engl. J. Med. 2020;383:496–498. doi: 10.1056/NEJMc2010418. - DOI - PMC - PubMed

[3] Attila K., Ludwin K., Evrin T., Katipoglu B., Torlinski T., Pruc M., Szarpak L. The impact of COVID-19 on airway management in prehospital resuscitation. Disaster Emerg. Med. J. 2020;5:216–217. doi: 10.5603/DEMJ.a2020.0047. - DOI

[4] Attila K., Ludwin K., Evrin T., Katipoglu B., Torlinski T., Pruc M., Szarpak L. The impact of COVID-19 on airway management in prehospital resuscitation. Disaster Emerg. Med. J. 2020;5:216–217. doi: 10.5603/DEMJ.a2020.0047. - DOI

[5] Grasselli G., Greco M., Zanella A., Albano G., Antonelli M., Bellani G., Bonanomi E., Cabrini L., Carlesso E., Castelli G., et al. COVID-19 Lombardy ICU Network. Risk Factors Associated with Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern. Med. 2020;180:1345–1355. doi: 10.1001/jamainternmed.2020.3539. - DOI - PMC - PubMed

[6] Grasselli G., Greco M., Zanella A., Albano G., Antonelli M., Bellani G., Bonanomi E., Cabrini L., Carlesso E., Castelli G., et al. COVID-19 Lombardy ICU Network. Risk Factors Associated with Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern. Med. 2020;180:1345–1355. doi: 10.1001/jamainternmed.2020.3539. - DOI - PMC - PubMed

[7] Lin C.H., Lin H.Y., Tseng W.P., Ma M.H., Tsai M.S., Chen S.Y., Huang C.H. Resuscitation teamwork during the COVID-19 pandemic in the emergency department: Challenges and solutions. Resuscitation. 2021;160:18–19. doi: 10.1016/j.resuscitation.2021.01.004. - DOI - PMC - PubMed

[8] Lin C.H., Lin H.Y., Tseng W.P., Ma M.H., Tsai M.S., Chen S.Y., Huang C.H. Resuscitation teamwork during the COVID-19 pandemic in the emergency department: Challenges and solutions. Resuscitation. 2021;160:18–19. doi: 10.1016/j.resuscitation.2021.01.004. - DOI - PMC - PubMed

[9] Al-Jeabory M., Borkowska G.O., Olecka A., Goss A., Wieczorek W., Evrin T. Mechanical chest compression devices as an option for out-of-hospital cardiac arrest in COVID-19 pandemic. Disaster Emerg. Med. J. 2021;6:50–51. doi: 10.5603/DEMJ.a2021.0003. - DOI

[10] Al-Jeabory M., Borkowska G.O., Olecka A., Goss A., Wieczorek W., Evrin T. Mechanical chest compression devices as an option for out-of-hospital cardiac arrest in COVID-19 pandemic. Disaster Emerg. Med. J. 2021;6:50–51. doi: 10.5603/DEMJ.a2021.0003. - DOI

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The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Affiliations

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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Conflict of interest statement

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