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Impact of COVID-19 pandemic on out-of-hospital cardiac arrest survival rate

      We read with great interest an article by Ball et al.
      • Ball J.
      • Nehme Z.
      • Bernard S.
      • Stub D.
      • Stephenson M.
      • Smith K.
      Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.
      Authors showed that in early during the pandemic, rates of sustained ROSC for OHCA and overall survival were lower in COVID-19 period. To verify the results obtained by Ball, a systematic review and meta-analysis were performed.
      The detailed study procedure is presented in the Supplementary file. The analysis of the obtained results revealed many potential causes of increased OHCA patients’ mortality in the COVID-19 era. First, as Chan and other authors bystanders point out, during the COVID-19 pandemic, they are much more afraid of undertaking cardiac resuscitation, which translates into a delay in the commencement of emergency procedures, thus reducing its effectiveness and increasing both pre-hospital and inpatient audacity [OR = 0.95; 95% CI: 0.79, 1.16; P = 0.64; I2 = 94%].
      Another potential reason for reducing the survival rate of patients during the COVID-19 pandemic is the longer travel time to the patient [MD = 1.11; 95% CI: 0.67, 1.55; P < 0.001; I2 = 100%], which is related to each time need to disinfect an ambulance after transporting a patient with suspected COVID-19. Subsequently, this limits the number of ambulances available at a time, and to conduct resuscitation in protective suits, which, as many studies show, reduce the effectiveness of medical procedures, including chest compression.
      • Borkowska M.J.
      • Smereka J.
      • Safiejko K.
      • et al.
      Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: a retrospective cohort study.
      • Chan P.S.
      • Girotra S.
      • Tang Y.
      • Al-Araji R.
      • Nallamothu B.K.
      • McNally B.
      Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic.
      • Malysz M.
      • Dabrowski M.
      • Böttiger B.W.
      • et al.
      Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: a randomized multicenter crossover simulation trial.
      Many studies show that in patients with COVID-19, microclots are often observed in both the central nervous system and the heart muscle. They can cause many areas of ischemia in the heart, thus increasing mortality. The above-described potential causes of increased insolence because of OHCA in the era of COVID-19 pandemic translate into survival to hospital admission [OR = 0.56; 95% CI = 0.44, 0.71; P < 0.001; I2 = 90%] and survival to hospital discharge [OR = 0.68; 95% CI: 0.62, 0.73; P < 0.001; I2 = 0%]. A detailed list of the publications included in the above-pooled analyzes has been presented in the Supplementary File.

      Funding sources

      None.

      Conflict of interest

      None.

      Acknowledgments

      This study was supported by the ERC Research NET and Polish Society of Disaster Medicine.

      Appendix A. Supplementary data

      The following is Supplementary data to this article:

      References

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        • Nehme Z.
        • Bernard S.
        • Stub D.
        • Stephenson M.
        • Smith K.
        Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.
        Resuscitation. 2020; 156: 157-163https://doi.org/10.1016/j.resuscitation.2020.09.017
        • Borkowska M.J.
        • Smereka J.
        • Safiejko K.
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        Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: a retrospective cohort study.
        Cardiol J. 2020; (online ahead of print)https://doi.org/10.5603/CJ.a2020.0135
        • Chan P.S.
        • Girotra S.
        • Tang Y.
        • Al-Araji R.
        • Nallamothu B.K.
        • McNally B.
        Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic.
        JAMA Cardiol. 2020; (online ahead of print)https://doi.org/10.1001/jamacardio.2020.6210
        • Malysz M.
        • Dabrowski M.
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        • et al.
        Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: a randomized multicenter crossover simulation trial.
        Cardiol J. 2020; 27: 497-506https://doi.org/10.5603/CJ.a2020.0068