The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis

• Published in: Resuscitation Vol. 194; p. 110043
• Main Authors: Baldi, Enrico, Klersy, Catherine, Chan, Paul, Elmer, Jonathan, Ball, Jocasta, Counts, Catherine R., Rosell Ortiz, Fernando, Fothergill, Rachael, Auricchio, Angelo, Paoli, Andrea, Karam, Nicole, McNally, Bryan, Martin-Gill, Christian, Nehme, Ziad, Drucker, Christopher J., Ruiz Azpiazu, José Ignacio, Mellett-Smith, Adam, Cresta, Ruggero, Scquizzato, Tommaso, Jouven, Xavier, Primi, Roberto, Al-Araji, Rabab, Guyette, Francis X., Sayre, Michael R., Daponte Codina, Antonio, Benvenuti, Claudio, Marijon, Eloi, Savastano, Simone
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2024
• Subjects: COVID-19; Individual patient data meta-analysis; Out-of-hospital cardiac arrest; SARS-CoV-2; COVID-19; Out-of-hospital cardiac arrest; Individual patient data meta-analysis; SARS-CoV-2
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2023.110043

Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients’ outcomes, accounting for regional COVID-19 incidence and OHCA characteristics. Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period). We computed COVID-19 incidence per 100,000 inhabitants in each of 97 regions per each week and divided it into its quartiles. We considered a total of 49,882 patients in 10 studies. OHCA incidence increased significantly compared to previous years in regions where weekly COVID-19 incidence was in the fourth quartile (>136/100,000/week), and patients in these regions had a lower odds of bystander CPR (OR 0.49, 95%CI 0.29–0.81, p = 0.005). Overall, the COVID-period was associated with an increase in medical etiology (89.2% vs 87.5%, p < 0.001) and OHCAs at home (74.7% vs 67.4%, p < 0.001), and a decrease in shockable initial rhythm (16.5% vs 20.3%, p < 0.001). The COVID-period was independently associated with pre-hospital death (OR 1.73, 95%CI 1.55–1.93, p < 0.001) and negatively associated with survival to hospital admission (OR 0.68, 95%CI 0.64–0.72, p < 0.001) and survival to discharge (OR 0.50, 95%CI 0.46–0.54, p < 0.001). During the first COVID-19 pandemic wave, there was higher OHCA incidence and lower bystander CPR rate in regions with a high-burden of COVID-19. COVID-19 was also associated with a change in patient characteristics and lower survival independently of COVID-19 incidence in the region where OHCA occurred.