Impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: A systematic review and meta-analysis.

Scquizzato, Tommaso; D'Amico, Filippo; Rocchi, Margherita; Saracino, Marco; Stella, Federica; Landoni, Giovanni; Zangrillo, Alberto

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.