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 = 1.08, 95%-CI 0.86-1.35), 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).

Influence of COVID-19 pandemic on bystander interventions, emergency medical service activities, and patient outcomes in out-of-hospital cardiac arrest in Osaka City, Japan

“…In contrast to Lombardy, Italy, and Paris, France, where a drastic decrease in OHCA survival rate has been reported, 2 , 3 patient outcomes were maintained during the pandemic study period, similar to findings in the Province of Padua, Northeast Italy, and Bologna, Italy. 9 , 10 Consistent with previous studies, 11 , 12 fewer patients received endotracheal intubation in Osaka City because of changing EMS protocols. Scene times did not differ between periods; however, the response time and hospital arrival time were shorter during the COVID-19 period.…”

“…These results were in contrast to previously reported data that the response time was longer during the COVID-19 pandemic period. 11 , 12 One possible explanation is traffic reduction owing to the stay home policy. Elmer et al showed there were no differences in the provision of laypersons, AED use, and prehospital return of spontaneous circulation in areas with a low COVID-19 prevalence.…”

“…Lim et al reported that resuscitation practices varied greatly with respect to countries or areas during the COVID-19 pandemic. 12 A better understanding of the COVID-19 prevalence in areas might be useful for public health interventions to save more lives from OHCA.…”

COVID-19 and the global OHCA crisis: An urgent need for system level solutions

“…In this edition of Resuscitation, two systematic reviews 1 , 2 and a national Spanish cohort study 3 highlight the alarming impact of the COVID-19 pandemic on the management and outcomes of out-of-hospital cardiac arrest (OHCA). The rapidly increasing literature in this area is highlighted by the difference in the number of identified studies between the two systematic reviews, despite only a small difference in search dates.…”

“…In some patients, the OHCA may be precipitated by hypoxic respiratory failure. 9 This might also explain, in part, the lower rate of shockable rhythms documented in the pandemic OHCA cohorts 1 , 2 and may also have implications regarding the utility of providing ‘hands only’ bystander CPR in these patients. Additionally, SARS-CoV infection has also been documented to cause myocarditis, 10 arrythmias, 11 and a hyper-coagulable state leading to thrombotic events including cerebral vascular accidents.…”