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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.

SUBMITTER: Bielski K

PROVIDER: S-EPMC8658174 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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

Bielski Karol K Szarpak Agnieszka A Jaguszewski Miłosz Jaroslaw MJ Kopiec Tomasz T Smereka Jacek J Gasecka Aleksandra A Wolak Przemysław P Nowak-Starz Grazyna G Chmielewski Jaroslaw J Rafique Zubaid Z Peacock Frank William FW Szarpak Lukasz L

Journal of clinical medicine 20211127 23

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 guidel ...[more]

PMID: 34884289

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Project description:Introduction Although the global survival rate of patients after out-of-hospital cardiac arrest (OHCA) has increased in the previous years, there still remain significant multifactorial public health challenges with many important aspects influencing the overall survival rate of these patients. The objective of this article is to analyze basic epidemiological parameters of OHCA in Serbia and to evaluate the influence of pre-hospitalization factors on the survival of OHCA patients. Methods Data on OHCA within the EuReCa Serbia Registry was collected according to the EuReCa Study protocol during the period October 1, 2014 - December 31, 2019, and included basic demographic data of the patients, data related to OHCA prior to hospital arrival, as well as data regarding subsequent hospitalization. Results The study included 6,266 EuReCa events (54% males), with a median age of 73 years [interquartile range (IQR) 63-82]. Cardiac arrest was witnessed in 3,111 out of 6,266 cases (49.6%), of which 2,725 cases (87.6%) were witnessed by bystanders and 286 cases (12.4%) by the emergency medical service (EMS) team. Resuscitation measures were attempted in 2,097 of 3,111 (67.4%) witnessed OHCA cases. Bystander cardiopulmonary resuscitation (CPR) was initiated in 288 cases within the bystander-witnessed group of 2,725 cases (10.6%). An initial shockable rhythm was detected in 323 out of 3,111 witnessed cases (10.4%). Any return of spontaneous circulation (ROSC) prior to hospital arrival was observed in 441 out of 2,097 cases where CPR was initiated (21.0%). Within the group of 2,097 events where CPR was initiated, in 287 cases the patient was transported to the hospital with ROSC (13.7%). An automated external defibrillator (AED) was used by bystanders in three cases. The collapse in locations other than the place of residence [p < 0.01; odds ratio (OR) 3.928], attempt to initiate CPR by a bystander (p < 0.01; OR 2.169), and presence of initial shockable rhythm (p = 0.01; OR 2.070) were observed as significant predictors of any ROSC in OHCA patients. Out of 287 patients hospitalized with ROSC, 54 (18.8%) were discharged alive. Conclusion Collapse outside of residence place, bystander CPR initiation, and initially detected shockable rhythm are important predictors of ROSC prior to hospital arrival and overall survival. Key factors of CPR-providing performance observed in this study were witnessing OHCA, CPR initiated by a bystander, presence of initial shockable rhythm, and any ROSC prior to hospital arrival.

Project description:Study objectiveEffectiveness of a resuscitation strategy may vary across communities. We hypothesize that a strategy that prioritizes initial emergency medical services (EMS) rhythm analysis (analyze early) will be associated with survival advantage among EMS systems with lower baseline (pretrial) ventricular fibrillation survival, whereas a strategy that prioritizes initial EMS cardiopulmonary resuscitation (analyze late) will be associated with survival advantage among systems with higher ventricular fibrillation baseline survival.MethodsWe conducted a secondary, post hoc study of a randomized trial of out-of-hospital cardiac arrest. Subjects were stratified according to randomization status (analyze early versus analyze late) and EMS agency baseline ventricular fibrillation survival. We used a mixed-effects model to determine whether the association between favorable functional survival to hospital discharge and trial intervention (analyze late versus analyze early) differed according to EMS agency baseline ventricular fibrillation survival (<20% or >20%).ResultsCharacteristics were similar among patients randomized to analyze early (n=4,964) versus analyze late (n=4,426). For EMS agencies with baseline ventricular fibrillation survival less than 20%, analyze late compared with analyze early was associated with a lower likelihood of favorable functional survival (3.8% versus 5.5%; odds ratio [OR]=0.67 [95% CI 0.50, 0.90]). Conversely, among agencies with a ventricular fibrillation survival greater than 20%, analyze late compared with analyze early was associated with higher likelihood of favorable functional survival (7.5% versus 6.1%; OR=1.22 [95% CI 0.98, 1.52]). In the multivariable-adjusted model, for every 10% increase in baseline ventricular fibrillation survival, analyze late versus analyze early was associated with a 34% increase in odds of favorable functional survival (OR=1.34 [95% CI 1.07 to 1.66]).ConclusionThe findings suggest that system-level characteristics may influence resuscitation outcomes.

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

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

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