by Seth En Teoh, Yoshio Masuda, Darren Jun Hao Tan, Nan Liu,
Laurie J. Morrison, Marcus Eng Hock Ong, Audrey L. Blewer and Andrew Fu Wah Ho
Annals of
Intensive Care volume 11,
Article number: 169 (2021) Published: 07
December 2021
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.
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