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Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis
- Source :
- Journal of Clinical Medicine, Journal of Clinical Medicine, Vol 10, Iss 1209, p 1209 (2021), Volume 10, Issue 6, Journal of clinical medicine, 10(6):1209, 1-10. Multidisciplinary Digital Publishing Institute (MDPI)
- Publication Year :
- 2021
-
Abstract
- Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25<br />95% confidence interval, CI: 0.12, 0.53<br />p &lt<br />0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88<br />95% CI: 0.63, 1.22<br />p = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19<br />95% CI: 0.04, 0.96<br />p = 0.04<br />I2 = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67<br />95% CI: 0.55, 0.81<br />0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35<br />95% CI: 0.07, 26.19<br />p = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients.
- Subjects :
- survival rate
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
medicine.medical_treatment
lcsh:Medicine
Disease
030204 cardiovascular system & hematology
Return of spontaneous circulation
cardiopulmonary resuscitation
Article
03 medical and health sciences
0302 clinical medicine
systematic review
Internal medicine
medicine
Cardiopulmonary resuscitation
out-of-hospital cardiac arrest
Survival rate
business.industry
SARS-CoV-2
lcsh:R
COVID-19
030208 emergency & critical care medicine
General Medicine
Odds ratio
Confidence interval
meta-analysis
Meta-analysis
outcome
business
Subjects
Details
- ISSN :
- 20770383
- Volume :
- 10
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of clinical medicine
- Accession number :
- edsair.doi.dedup.....5295f3db4857b66a62de674ec0b054d2