Variation in Community and Ambulance Care Processes for Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Abstract

Bystander cardiopulmonary resuscitation (BCPR) and early defibrillation can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of COVID-19 on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR=1.38, 95%CI 1.11-1.71, p=0.0069). BCPR did not differ between COVID-19 and Pre-COVID-19 populations (OR=0.94, 95%CI 0.80-1.11, p=0.4631), although bystander defibrillation was significantly lower during the COVID-19 period (OR=0.65, 95%CI 0.48-0.88, p=0.0107). EMS call-to-arrival time was significantly higher in COVID-19 populations (SMD=0.27, 95%CI 0.13-0.40, p=0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.

Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study

“…Second, we have not further stratified the patient’s clinical status before PCI. Third, an increase in out-of-hospital cardiac arrest and death was reported in some countries during the early COVID-19 epidemic, [27,28] and this may affect our study results. However, due to the limitation of the data, we could not analyze this in the study.…”

Segítség a távolból – A videoasszisztált újraélesztés jelene és jövője

“…E probléma tárgyalása viszont kiemelten fontos, ha nem forgalmas közterületen következik be a keringésmegállás, mert akkor a legtöbb esetben nincs jelen több ellátó. Ezenkívül pedig speciális helyzetként megemlíthető a COVID-19-világjárvány, amelynek során a bevezetett intézkedések miatt kimutathatóan csökkent az OHCA-k észlelése, valamint a megkezdett segítségnyújtások száma [32,33]. E speciális esetekben viszont kompromiszszumot kell kötni: a V-CPR alkalmazásához az okostelefont el kell helyezni, ami késlelteti a mellkaskompressziók megkezdését, vagy rögtön el kell kezdeni az újraélesztést, ezáltal nem élve a V-CPR lehetőségével.…”

Suggestions for the focus of OHCA meta-analysis in the COVID-19 era

“…A meta-analysis was conducted to overcome the limitations of individual investigations, and results with implications for OHCA epidemiological features and mortality, which were notably different from those before to the pandemic, were reported. [1] , [2] , [3] , [4] Several observational studies and meta-analyses found that the composition of OHCA patients changed as the number of cardiac arrests increased in COVID-19 patients, where respiratory failure is a somewhat more prevalent cause. In addition, an increase in home arrest due to the effect of social distancing measures and self-quarantine isolation, as well as an influence on the weakening of the chain of survival due to the concentration of medical resources on COVID-19, were shown as an indirect effect.…”