Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25; 95% confidence interval, CI: 0.12, 0.53; p < 0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88; 95% CI: 0.63, 1.22; p = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19; 95% CI: 0.04, 0.96; p = 0.04; I2 = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67; 95% CI: 0.55, 0.81; p < 0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35; 95% CI: 0.07, 26.19; p = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients.

the determinants of resuscitation undertaken by bystanders (CPR initiation, type of CPR, use of a defibrillator), secondly, the description of BLS made by the first aid providers (timing, use of ventilation and defibrillator), and lastly, ALS details performed by the MMT (timing, initiation of ALS, administration of epinephrine and tracheal intubation). The other endpoints were return of spontaneous circulation (ROSC) and the survival 30 days after OHCA or at hospital discharge (D30 survival).
During the COVID-19 period, we observed a decrease in CPR initiation regardless of whether patients were suspected of SARS-CoV-2 infection or not. In the current atmosphere, it is important to communicate good resuscitation practices to avoid drastic and lasting reductions in survival rates after an OHCA. All OHCA patients who, during the study periods, received an EMS response from LAS (irrespective of whether a resuscitation attempt was made).
Patients who were successfully resuscitated prior to EMS arrival and so did not receive resuscitation from clinicians.
Survival at 30 days post-arrest.
During the first wave of the COVID-19 pandemic in London, we saw a dramatic rise in the incidence of OHCA, accompanied by a significant reduction in survival. The pattern of increased incidence and mortality closely reflected the rise in confirmed COVID-19 infections in the city. Sultanian et al. 2021 All cases of OHCA and IHCA registered in the SRCR from 1 January to 20 July 2020.

NS
30-day mortality. During the pandemic phase, COVID-19 was involved in at least 10% of all OHCAs and 16% of IHCAs, and, among COVID-19 cases, 30-day mortality was increased 3.4-fold in OHCA and 2.3-fold in IHCA. Legend: ALS = Advanced Life Support; BLS = Basic Life Support; DNAR = Do Not Attempt Resuscitation; NS = Not specified; OHCA = Out-of-hospital cardiac arrest Figure S1. Forest plot of patients age in COVID-19 vs. not COVID-19 group. 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. Figure S2. Forest plot of patients' sex (male) in COVID-19 vs. not COVID-19 group. 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. Figure S3. Forest plot of bystander witnessed in COVID-19 vs. not COVID-19 group. 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. Figure S4. Forest plot of bystander cardiopulmonary resuscitation in COVID-19 vs. not COVID-19 group. 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. Figure S5. Forest plot of advanced life support implementation in COVID-19 vs. not COVID-19 group. 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. Figure S6. Forest plot of first recorded cardiac rhythm in COVID-19 vs. not COVID-19 group. 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. Figure S7. Forest plot of mechanical chest compression devices application in COVID-19 vs. not COVID-19 group. 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.