Outcomes of in‐hospital cardiac arrest in COVID‐19 patients: A proportional prevalence meta‐analysis

Mir, Tanveer; Sattar, Yasar; Ahmad, Javeed; Ullah, Waqas; Shanah, Layla; Alraies, M Chadi; Qureshi, Waqas T.

BACKGROUND: Limited epidemiological data are available on the outcomes of in‐hospital cardiac arrest (CA) in COVID‐19 patients. METHODS: We performed literature search of PubMed, EMBASE, Cochrane, and Ovid to identify research articles that studied outcomes of in‐hospital cardiac arrest in COVID‐19 patients. The primary outcome was survival at discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and types of cardiac arrest. Pooled percentages with a 95% confidence interval (CI) were calculated for the prevalence of outcomes. RESULTS: A total of 7,891 COVID patients were included in the study. There were 621 (pooled prevalence 8%, 95% CI 4–13%) cardiac arrest patients. There were 52 (pooled prevalence 3.0%; 95% CI 0.0–10.0%) patients that survived at the time of discharge. ROSC was achieved in 202 (pooled prevalence 39%;95% CI 21.0–59.0%) patients. Mean time to ROSC was 7.74 (95% CI 7.51–7.98) min. The commonest rhythm at the time of cardiac arrest was pulseless electrical activity (pooled prevalence 46%; 95% 13–80%), followed by asystole (pooled prevalence 40%; 95% CI 6–80%). Unstable ventricular arrhythmia occurred in a minority of patients (pooled prevalence 8%; 95% CI 4–13%). CONCLUSION: This pooled analysis of studies showed that the survival post in‐hospital cardiac arrest in COVID patients is dismal despite adequate ROSC obtained at the time of resuscitation. Nonshockable rhythm cardiac arrest is commoner suggesting a non‐cardiac cause while cardiac related etiology is uncommon. Future studies are needed to improve the survival in these patients.