Unraveling the Consequences of the COVID-19 Pandemic on Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis

Aim: The aim of this systematic review and meta-analysis was to assess the influence of the Coronavirus disease-2019 (COVID-19) pandemic on the incidence, characteristics, and clinical consequences of out-of-hospital cardiac arrest (OHCA). Materials and Methods: We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases up to May 30, 2023 for studies containing comparative data of OHCA patients in COVID-19 and pre-pandemic periods. Results: A total of 35 articles concerning to 34 studies screening based on the inclusion criteria. COVID-19 was associated with higher incidence of OHCA at home compared with the pre-pandemic period (p<0.001), longer emergency medical services arrival time (p<0.001), longer on-scene time (p<0.001), as well as reduction of shockable rhythms (p=0.02). COVID-19 compared with the pre-pandemic period was associated with lower survival to hospital admission (11.2% vs. 19.3%; p<0.001). Survival to hospital discharge (SHD) was 4.8% vs. 12.9%, respectively (p<0.001), while SHD with a good neurological outcome also varied and amounted to 3.6% vs. 5.8%, respectively (p<0.001). Conclusion: COVID-19, compared with the pre-pandemic period, was characterized by a reduced rate of defibrillation rhythms during OHCA, as well as a worse prognosis in terms of both survival to hospital admission, SHD, and SHD good neurological outcome.