The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Abstract

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas

“…Our study found rates of survival to hospital admission (OR = 0.56–0.65) and survival to hospital discharge (OR = 0.46–0.68) to be slightly higher than what is reported in the literature [ 13 , 19 , 24 , 25 ]. While the rates of good neurologic scores did not change significantly in our study, conflicting research exists, demonstrating worse or unchanged CPC scores compared to the pre-COVID-19 period [ 12 , 26 ].…”

Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings

“…Among patients with COVID-19, the incidence of IHCA for non-ICU patients was 2.2% and 15.4% for ICU patients [ 48 ]; cardiac arrest most often occurred on hospital day 4 [ 18 , 26 ]. For IHCA patients with COVID-19 infection, ROSC varied from 13.2–54%, survival to hospital discharge ranges from 0 to 12%, and good neurologic outcomes 0–0.7% [ 14 , 15 , 17 , 44 , [48] , [49] , [50] , [51] ]; when considering inpatient location of cardiac arrest, survival to hospital discharge was worse for non-ICU patients (0.7%) versus ICU patients (9.1%) [ 48 ]. As noted in the OHCA population, co-morbid conditions also occurred with greater frequency among inpatients [ 49 ].…”

“…For IHCA patients with COVID-19 infection, ROSC varied from 13.2–54%, survival to hospital discharge ranges from 0 to 12%, and good neurologic outcomes 0–0.7% [ 14 , 15 , 17 , 44 , [48] , [49] , [50] , [51] ]; when considering inpatient location of cardiac arrest, survival to hospital discharge was worse for non-ICU patients (0.7%) versus ICU patients (9.1%) [ 48 ]. As noted in the OHCA population, co-morbid conditions also occurred with greater frequency among inpatients [ 49 ]. The majority of IHCA patients presented with a non-shockable rhythm (89%) [ 18 ].…”

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.…”

“… 1 The updated meta-analysis included 31 articles and showed no significant differences in the outcomes, demonstrating a similar trend. 4 However, when compared to the unsystematic healthcare system and poor public health services due to partial concentration of medical resources for the treatment of COVID-19 at the beginning of the pandemic, several factors such as a systematically changed medical environment, improved response ability for patient with confirmed or suspected the COVID-19, increased vaccination rate, and change of the main COVID subtype show differences varies with the time and region of COVID-19 spread in recent environment. Therefore, combining the all-time data after the COVID-19 outbreak and comparing it to data before pandemic could lead to serious interpretation errors.…”