Epidemiology and Outcome of Out-of-Hospital Cardiac Arrests during the COVID-19 Pandemic in South Korea: A Systematic Review and Meta-Analyses

Abstract

Purpose: To evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and meta-analysis.

Materials and methods: MEDLINE, Embase, KoreaMed, and Korean Information Service System databases were searched up to June 2022. We included observational studies and letters on OHCA during the COVID-19 pandemic and compared them to those before the pandemic. Epidemiologic characteristics, including at-home OHCA, bystander cardiopulmonary resuscitation, unwitnessed arrest, use of an automated external defibrillator (AED), shockable cardiac rhythm, and airway management, were evaluated. Survival and favorable neurological outcomes were extracted. We conducted a meta-analysis of each characteristic and outcome.

Results: Six studies including 4628 OHCA patients were included in this study. The incidence of at-home OHCA significantly increased and the AED use decreased during the COVID-19 pandemic compared to before the pandemic [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.08-1.55; I²=0% and OR, 0.74; 95% CI, 0.57-0.97; I²=0%, respectively]. Return of spontaneous circulation after OHCA, survival, and favorable neurological outcomes during and before the pandemic did not differ significantly (OR, 0.90; 95% CI, 0.71-1.13; I²=37%; OR, 0.74; 95% CI, 0.43-1.26; I²=72%; OR, 0.77; 95% CI, 0.43-1.37; I²=70%, respectively).

Conclusion: During the COVID-19 pandemic in South Korea, the incidence of at-home OHCA increased and AED use decreased among OHCA patients. However, survival and favorable neurological outcomes did not significantly differ from before the pandemic. This insignificant effect of the pandemic on OHCA in South Korea could be attributed to the slow increase in patient count in the early days of the pandemic. OSF Registry (DOI: 10.17605/OSF.IO/UGE9D).

Keywords: COVID-19; Out-of-hospital cardiac arrest; South Korea; survival.

Fig. 1. Flow diagram for the identification of relevant studies.

Fig. 2. Incidence and mortality of patients with COVID-19, major events during the pandemic in South Korea, and the study period of the included studies.

Fig. 3. A forest plot comparing the during-COVID-19-pandemic and before-pandemic periods in South Korea. (A) OHCA at home, (B) bystander CPR, (C) unwitnessed arrest, (D) AED use, (E) shockable cardiac rhythm, (F) intubation, (G) supraglottic airway device use, (H) ROSC, (I) survival to discharge, and (J) favorable neurological outcome.