Outcomes of in‐hospital cardiac arrest in COVID‐19 patients: A proportional prevalence meta‐analysis

Abstract

Background Limited epidemiological data are available on the outcomes of in‐hospital cardiac arrest (CA) in COVID‐19 patients. Methods We performed literature search of PubMed, EMBASE, Cochrane, and Ovid to identify research articles that studied outcomes of in‐hospital cardiac arrest in COVID‐19 patients. The primary outcome was survival at discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and types of cardiac arrest. Pooled percentages with a 95% confidence interval (CI) were calculated for the prevalence of outcomes. Results A total of 7,891 COVID patients were included in the study. There were 621 (pooled prevalence 8%, 95% CI 4–13%) cardiac arrest patients. There were 52 (pooled prevalence 3.0%; 95% CI 0.0–10.0%) patients that survived at the time of discharge. ROSC was achieved in 202 (pooled prevalence 39%;95% CI 21.0–59.0%) patients. Mean time to ROSC was 7.74 (95% CI 7.51–7.98) min. The commonest rhythm at the time of cardiac arrest was pulseless electrical activity (pooled prevalence 46%; 95% 13–80%), followed by asystole (pooled prevalence 40%; 95% CI 6–80%). Unstable ventricular arrhythmia occurred in a minority of patients (pooled prevalence 8%; 95% CI 4–13%). Conclusion This pooled analysis of studies showed that the survival post in‐hospital cardiac arrest in COVID patients is dismal despite adequate ROSC obtained at the time of resuscitation. Nonshockable rhythm cardiac arrest is commoner suggesting a non‐cardiac cause while cardiac related etiology is uncommon. Future studies are needed to improve the survival in these patients.

Cardiopulmonary Resuscitation of Patients with Coronavirus Disease 2019: A One-Year Survey in The West of Iran

“…Findings showed that the total rate of in-hospital CA was 9.39%. In line with this nding, a former study reported that the rate of in-hospital CA among patients with COVID-19 was 10% (9). Most participants suffered from at least one underlying disease, particularly diabetes mellitus, hypertension, cardiovascular disease, and cancer.…”

“…A former study in this area reported that the rate of ROSC after CPR was 25.9% for out-of-hospital CA and 30.6% for in-hospital CA (25). Moreover, a meta-analysis on four studies on 621 patients with COVID-19 showed that the pooled prevalence of primary CPR success was 39% (95% CI: 21.0-59.0%) (9). The rate of primary CPR success in these two studies are much better than the rate in our study.…”

“…For example, a study reported a two times increase in the rate of out-of-hospital CA and reduced survival during the COVID-19 pandemic (8). A metaanalysis on four studies also indicated a two times increase in the rate of in-hospital CA among patients with COVID-19 (9). Before the COVID-19 pandemic, in the U.S., an average of 292,000 cardiac arrests occurred annually (10,11).There are no reliable statistics on CA rate in Iran; however, the average rate of CA in the United Arab Emirates and Saudi Arabia was respectively 11.7 and 7.76 cases per 1000 hospitalizations before the pandemic (12,13).…”

“…Moreover, survival to hospital discharge rate after successful CPR is 25% in the United States and 7.2-13.5% in Iran (21)(22)(23)(24). However, CPR outcomes among patients with COVID-19 are poor (9,25). For instance, a study in China reported that the primary CPR success rate and thirty-day survival rate were 13.2% and 2.9%, respectively (26).…”

The Use of Vancomycin Versus Teicoplanin in Treating Febrile Neutropenia: A Meta-Analysis and Systematic Review

“…Statistical analyses were performed using the random effect restricted maximum-likelihood (REML) model to calculate an unadjusted odds ratio (OR). "The random-effects model assumes that the studies included in the meta-analysis are a random sample of hypothetical study populations" [ 6 ]. The estimated effect size was reported as a point estimate and 95% confidence interval (CI) for all studies and separate sub-analyses of randomized controlled trials (RCTs) as well as retrospective cohort studies.…”