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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | COVID-19 | Research

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

Authors: Seth En Teoh, Yoshio Masuda, Darren Jun Hao Tan, Nan Liu, Laurie J. Morrison, Marcus Eng Hock Ong, Audrey L. Blewer, Andrew Fu Wah Ho

Published in: Annals of Intensive Care | Issue 1/2021

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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.
Appendix
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Metadata
Title
Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis
Authors
Seth En Teoh
Yoshio Masuda
Darren Jun Hao Tan
Nan Liu
Laurie J. Morrison
Marcus Eng Hock Ong
Audrey L. Blewer
Andrew Fu Wah Ho
Publication date
01-12-2021
Publisher
Springer International Publishing
Keyword
COVID-19
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00957-8

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