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Title: Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis
Authors: Teoh, Seth En
Masuda, Yoshio
Tan, Darren Jun Hao
Liu, Nan 
Morrison, Laurie J.
Ong, Marcus Eng Hock 
Blewer, Audrey L.
Ho, Andrew Fu Wah 
Keywords: Ambulance
Cardiac arrest
Emergency medical services
Out of hospital
Sudden cardiac death
Issue Date: 1-Dec-2021
Publisher: Springer Science and Business Media Deutschland GmbH
Citation: Teoh, Seth En, Masuda, Yoshio, Tan, Darren Jun Hao, Liu, Nan, Morrison, Laurie J., Ong, Marcus Eng Hock, Blewer, Audrey L., Ho, Andrew Fu Wah (2021-12-01). Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Annals of Intensive Care 11 (1) : 169. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. Methods: PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes [annual incidence, mortality, and case fatality rate (CFR)], secondary outcomes [field termination of resuscitation (TOR), return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge], and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p < 0.001). Pooled CFR was increased by 2.65% (p < 0.001), with a pooled odds ratio (OR) of 1.95 for mortality [95% confidence interval (95%CI) 1.51–2.51]. There was increased field TOR (OR = 2.46, 95%CI 1.62–3.74). There were decreased ROSC (OR = 0.65, 95%CI 0.55–0.77), survival to hospital admission (OR = 0.65, 95%CI 0.48–0.89), and survival to discharge (OR = 0.52, 95%CI 0.40–0.69). There was decreased shockable rhythm (OR = 0.73, 95%CI 0.60–0.88) and increased asphyxial etiology of OHCA (OR = 1.17, 95%CI 1.02–1.33). Conclusion: Compared to the pre-pandemic period, the COVID-19 pandemic period was significantly associated with increased OHCA incidence and worse outcomes. © 2021, The Author(s).
Source Title: Annals of Intensive Care
ISSN: 2110-5820
DOI: 10.1186/s13613-021-00957-8
Rights: Attribution 4.0 International
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