Impact of COVID-19 Pandemic on Out-of-Hospital Cardiac Arrest System-of-Care: A Systematic Review and Meta-Analysis

摘要

Introduction: COVID-19 pandemic overwhelmed healthcare systems and diverted resources allocated for other conditions. This systematic review and meta-analysis aimed to analyse how the pandemic impacted the system-of-care of out-of-hospital cardiac arrest. Methods: We searched PubMed and Embase up to May 31, 2021, for studies comparing out-of-hospital cardiac arrests that occurred during the COVID-19 pandemic versus a non-pandemic period. Survival at hospital discharge or at 30 days was the primary outcome. Results: We included 24 studies for a total of 75,952 patients. Out-of-hospital cardiac arrests during COVID-19 pandemic had lower survival (19 studies; 603/11,666 5.2 vs. 1320/17,174 7.7; OR = 0.54; 95 CI, 0.44-0.65; P = 0.001) and return of spontaneous circulation (4370/24353 18 vs. 7401/34510 21; OR = 0.64; 95 CI, 0.55-0.75; P < 0.001) compared with non-pandemic periods. Ambulance response times (10.1 vs 9.0 minutes, MD = 1.01; 95 CI, 0.59-1.42; P < 0.001) and non-shockable rhythms (18,242/21,665 84 vs. 19,971/24,817 81; OR = 1.27; 95 CI, 1.10-1.46; P < 0.001) increased. Use of supraglottic airways devices increased (2853/7645 37 vs. 2043/17521 12; OR = 1.97; 95 CI, 1.42-2.74; P < 0.001). Conclusions: The COVID-19 pandemic affected the system-of-care of out-of-hospital cardiac arrest, and patients had worse short-term outcomes compared to pre-pandemic periods. Advanced airway management strategy shifted from endotracheal intubation to supraglottic airway devices. Review registration PROSPERO CRD42021250339.