Abstract
Introduction
In addition to the directly attributed mortality, COVID-19 is also likely to increase
mortality indirectly. In this systematic review, we investigate the direct and indirect
effects of COVID-19 on out-of-hospital cardiac arrests.
Methods
We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled
Trials for studies comparing out-of-hospital cardiac arrests occurring during the
pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool.
The primary endpoint was return of spontaneous circulation. Secondary endpoints were
bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge,
and survival with favourable neurological outcome.
Results
We identified six studies. In two studies, rates of return of spontaneous circulation
and survival to hospital discharge decreased significantly during the pandemic. Especially
in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation
and resuscitation attempted by emergency medical services were reduced during the
pandemic. Also, ambulance response times were significantly delayed across all studies
and patients presenting with non-shockable rhythms increased in two studies. In 2020,
3.9–5.9% of tested patients were SARS-CoV-2 positive and 4.8–26% had suggestive symptoms
(fever and cough or dyspnoea).
Conclusions
Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic
than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect
effects from lockdown and disruption of healthcare systems. Patients at high risk
of deterioration should be identified outside the hospital to promptly initiate treatment
and reduce fatalities.
Study registration PROSPERO CRD42020195794.
Keywords
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Article info
Publication history
Published online: October 28, 2020
Accepted:
October 7,
2020
Received in revised form:
October 3,
2020
Received:
July 22,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
