Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: A systematic review and meta-analysis

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. Methods PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes (annual incidence, mortality, and case fatality rate [CFR]), secondary outcomes (field termination of resuscitation [TOR], return of spontaneous circulation [ROSC]), survival to hospital admission, and survival to hospital discharge), and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p < 0.001). Pooled CFR was increased by 2.65% (p < 0.001), with a pooled odds ratio (OR) of 1.95 for mortality (95% confidence interval [95%CI] 1.51–2.51). There was increased field TOR (OR = 2.46, 95%CI 1.62–3.74). There were decreased ROSC (OR = 0.65, 95%CI 0.55–0.77), survival to hospital admission (OR = 0.65, 95%CI 0.48–0.89), and survival to discharge (OR = 0.52, 95%CI 0.40–0.69). There was decreased shockable rhythm (OR = 0.73, 95%CI 0.60–0.88) and increased asphyxial etiology of OHCA (OR = 1.17, 95%CI 1.02–1.33). Conclusion Compared to the pre-pandemic period, the COVID-19 pandemic period was significantly associated with increased OHCA incidence and worse outcomes.

Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea

“…In this study conducted on patients with OHCA in Seoul, the number of TOR cases confirmed by EMS paramedics increased during the COVID-19 pandemic, and those due to decisions by medical directors and refusal of CPR by family members significantly increased. These results are consistent with those of previous studies reporting a rise in OHCAs occurring at home and an increase in TOR at the scene due to strengthened social distancing and a decrease in patients' use of medical institutions during the COVID-19 pandemic [15][16][17]. In an observational study using an OHCA registry in the United States, Chan et al [18] found that, in regions with high COVID-19 mortality rates, the number of on-site resuscitation termination cases was more likely to be increased; however, even in areas with relatively low COVID-19 mortality rates, the number of on-site resuscitation termination cases significantly increased.…”

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.…”

Cardiac arrest and coronavirus disease 2019

“…Moreover, in many areas, an increase in unwitnessed OHCA was highlighted [7 ▪ ,8 ▪ ,20], probably due to the fact that many people spent the quarantine in different rooms or houses than their relatives. The spectrum of etiologies of OHCA has also been influenced by the pandemic, with an increase of medical etiology [7 ▪ ,9 ▪ ,36], especially in those regions who experienced an increase in OHCA. Similarly, in these areas, the rate of OHCA with a shockable presenting rhythm decreased in favor of not-shockable ones [7 ▪ ,8 ▪ ,11 ▪ ,13,36].…”

“…The spectrum of etiologies of OHCA has also been influenced by the pandemic, with an increase of medical etiology [7 ▪ ,9 ▪ ,36], especially in those regions who experienced an increase in OHCA. Similarly, in these areas, the rate of OHCA with a shockable presenting rhythm decreased in favor of not-shockable ones [7 ▪ ,8 ▪ ,11 ▪ ,13,36]. Both these changes may be explained considering that many of the exceeding OHCA in 2020 were due to COVID-19 [6 ▪ ].…”

“…One of the most alarming and terrible factors concerning this topic is the dramatic reduction in the outcome of OHCA during the pandemic [8 ▪ ,9 ▪ ,10,11 ▪ ,13,17 ▪▪ ,23 ▪ ,27,29,30,31 ▪▪ ,36,42 ▪▪ ,43,55,56,57 ▪▪ ,58]. This affected all the outcomes commonly used for OHCA following Utstein recommendations [59], as the return of spontaneous circulation (ROSC), the survival at hospital admission and the survival at hospital discharge or at 30days, with and without good neurological outcome.…”