key: cord-0986889-aluhww78
authors: Singh, Sandeep; Fong, Hee Kong; Mercedes, Brisandi Ruiz; Serwat, Ayna; Malik, Faizan Ahmad; Desai, Rupak
title: COVID-19 and Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis
date: 2020-09-16
journal: Resuscitation
DOI: 10.1016/j.resuscitation.2020.08.133
sha: aa4a47274439139e152e47099adde3167269a6c7
doc_id: 986889
cord_uid: aluhww78

nan

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Abstract: Aim: Upcoming studies from different part of the world has reported an increased incidence of Out-of-Hospital cardiac arrest (OHCA). However, due to trivial data on the subject, the exact incidence and mortality remain unknown owing to which this metaanalysis was planned Method: We searched PubMed/Medline, Web of Science, SCOPUS, and Google Scholar until July 15th, 2020 using keywords "Out of hospital cardiac arrest or OHCA, COVID-19, SARS-CoV-2,2019-nCov ". Finally, three studies were included in the final analysis. Only studies reporting OHCA comparison in 2020 to the previous year were included. Results: Our search identified three articles. The number of OHCA was found to increase from 9.9, 20.8, and 15.9 per 100,000 inhabitants in 2019 to 13.9, 31.7, and 47.5 per 100,000 inhabitants in 2020 in France, Italy, and the USA respectively. During the pandemic, the rate of out-of-hospital cardiac arrest was significantly higher (OR During the COVID-19 pandemic, countries worldwide have witnessed an unprecedented decline in hospital emergency visits and even in acute coronary syndrome-related hospitalizations [1, 2] .

A high burden of cardiac injury has been seen in COVID-19 patients and also an increase in the out-of-hospital cardiac arrest (OHCA) has been reported in the during COVID-19 outbreak in various countries [3] . Therefore, we planned to do this meta-analysis to get an idea about the exact change in the OHCA incidence and mortality in the COVID-19 period compared to the pre-COVID-19 period. PubMed/Medline, Web of Science and SCOPUS search until July 15th, 2020

using keywords "Out of hospital cardiac arrest or OHCA, COVID-19, SARS-CoV-2,2019-nCov " resulted in 41 articles of which we finally included 3 articles [3] [4] [5] . The random-effects model regardless of heterogeneity using Haenszel formula was used for Odds ratios (ORs) calculation. 2019. The frequency of OHCA increased from 9.9, 20.8, and 15.9 per 100,000 inhabitants in 2019 to 13.9, 31.7, and 47.5 per 100,000 inhabitants in 2020 in France, Italy, and the USA, respectively (Fig. 1) . During the pandemic, the odds of out-of-hospital cardiac arrest was significantly higher [OR 1.92 (95%CI:1.18-3.14), p < 0.001; I 2 :45.05%, p=0.16] (Fig. 1) .

Besides, there were higher odds of mortality (OR 1.89 [95%CI: 1.25-2.84], p < 0.001; I 2 : 0.0%, p = 0.72) in patients with OHCA during the pandemic period compared to pre-pandemic.

In this meta-analysis, we found that there were nearly two times higher odds of admissions with OHCA in the COVID-19 pandemic period compared to the pre-pandemic period of 2019.

Existing studies suggest that patients with OHCA in 2020 were older with a high burden of hypertension, diabetes, and had physical limitations [3] . A proportion of patients who suffered from OHCA in 2020 also had suspected or confirmed diagnosis of COVID-19 disease. COVID-19 related hyperinflammatory state leading to the high propensity of fatal arrhythmia, atherosclerotic plaque destabilization, thromboembolic state and myocardial injury could be a leading factor for OHCA in these patients. Failure to provide bystander cardiopulmonary resuscitation (CPR) owing to the social distancing during this pandemic period, evident from an increased rate of unwitnessed OHCA, and low frequency of shockable rhythm would have influenced the outcome in these patients [3] [4] [5] . Unwitnessed CPR and initial non-shockable J o u r n a l P r e -p r o o f rhythms are considered markers of poor prognosis in patients with cardiac arrest. In conclusion, the COVID-19 pandemic period has documented an increase in the rate of OHCA and OHCArelated mortality and warrants further studies to evaluate etiopathogenesis and avoid unprecedented events.

None

None J o u r n a l P r e -p r o o f 

Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy

Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Characteristics Associated with Out-of-Hospital Cardiac Arrests and Resuscitations during the Novel Coronavirus Disease

COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests

a population-based, observational study. The Lancet Public Health