Characteristics and outcomes of in-hospital cardiac arrest in COVID-19. A systematic review and meta-analysis
, 2, 3, 3, 45, 67, 1, 8, 67, 9, 9
Abstract
Background: The purpose herein, was to perform a systematic review of interventional outcome studies in patients with in-hospital cardiac arrest before and during the coronavirus disease 2019 (COVID-19) pandemic period.
Methods: A meta-analysis was performed of publications meeting the following PICOS criteria: (1) participants, patients > 18 years of age with cardiac arrest due to any causes; (2) intervention, cardiac arrest in COVID-19 period; (3) comparison, cardiac arrest in pre-COVID-19 period; (4) outcomes, detailed information for survival; (5) study design, randomized controlled trials, quasi-randomized or observational studies comparing cardiac arrest in COVID-19 and pre-COVID-19 period for their effects in patients with cardiac arrest.
Results: Survival to hospital discharge for the pre-pandemic and pandemic period was reported in 3 studies (n =1432 patients) and was similar in the pre-pandemic vs. the pandemic period, 35.6% vs. 32.1%, respectively (odds ratio [OR] 1.72; 95% confidence interval [CI] 0.81–3.65; p = 0.16; I2 = 72%). Return of spontaneous circulation was reported by all 4 studies and were also similar in the pre and during COVID-19 periods, 51.9% vs. 48.7% (OR 1.27; 95% CI 0.78–2.07; p = 0.33; I2 = 71%), respectively. Pooled analysis of cardiac arrest recurrence was also similar, 24.9% and 17.9% (OR 1.60; 95% CI 0.99–2.57; p = 0.06; I2 = 32%) in the pre and during COVID-19 cohorts. Survival with Cerebral Performance Category 1 or 2 was higher in pre vs. during pandemic groups (27.3 vs. 9.1%; OR 3.75; 95% CI 1.26–11.20; p = 0.02). Finally, overall mortality was similar in the pre vs. pandemic groups, 65.9% and 67.2%, respectively (OR 0.67; 95% CI 0.33–1.34; p = 0.25; I2 = 76%).
Conclusions: Compared to the pre-pandemic period, in hospital cardiac arrest in COVID-19 patients was numerically higher but had statistically similar outcomes.
Keywords: coronavirus disease 2019SARS-CoV-2pandemicin-hospital cardiac arrestcardiopulmonary resuscitationoutcome
References
- Rodriguez-Morales AJ, Bonilla-Aldana DK, Balbin-Ramon GJ, et al. History is repeating itself: probable zoonotic spillover as the cause of the 2019 novel coronavirus epidemic. Infez Med. 2020; 28(1): 3–5.
- Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020; 20(5): 533–534.
- Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(24): 759–765.
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5): 475–481.
- Ayaz A, Arshad A, Malik H, et al. Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients. Acute Crit Care. 2020; 35(4): 249–254.
- Armstrong RA, Kane AD, Kursumovic E, et al. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anaesthesia. 2021; 76(4): 537–548.
- Shao F, Xu S, Ma X, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020; 151: 18–23.
- Moher D, Liberati A, Tetzlaff J, et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009; 6(7): e1000097.
- Sterne JAc, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919.
- McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021; 12(1): 55–61.
- Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
- Miles JA, Mejia M, Rios S, et al. Characteristics and outcomes of in-hospital cardiac arrest events during the COVID-19 pandemic: a single-center experience from a new york city public hospital. Circ Cardiovasc Qual Outcomes. 2020; 13(11): e007303.
- Roedl K, Söffker G, Fischer D, et al. Effects of COVID-19 on in-hospital cardiac arrest: incidence, causes, and outcome - a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2021; 29(1): 30.
- Sultanian P, Lundgren P, Strömsöe A, et al. Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the swedish registry for cardiopulmonary resuscitation. Eur Heart J. 2021; 42(11): 1094–1106.
- Yuriditsky E, Mitchell OJL, Brosnahan SB, et al. Clinical characteristics and outcomes of in-hospital cardiac arrest among patients with and without COVID-19. Resusc Plus. 2020; 4: 100054.
- Perman SM, Stanton E, Soar J, et al. American Heart Association's Get With the Guidelines®—Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes. J Am Heart Assoc. 2016; 5(10): e003638.
- Wampler DA, Collett L, Manifold CA, et al. Cardiac arrest survival is rare without prehospital return of spontaneous circulation. Prehosp Emerg Care. 2012; 16(4): 451–455.
- Sheth V, Chishti I, Rothman A, et al. Outcomes of in-hospital cardiac arrest in patients with COVID-19 in New York City. Resuscitation. 2020; 155: 3–5.
- Moskowitz A, Holmberg MJ, Donnino MW, et al. In-hospital cardiac arrest: are we overlooking a key distinction? Curr Opin Crit Care. 2018; 24(3): 151–157.
- Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991; 84(2): 960–975.
- Dzieciatkowski T, Szarpak L, Filipiak KJ, et al. COVID-19 challenge for modern medicine. Cardiol J. 2020; 27(2): 175–183.
- Smereka J, Szarpak L, Gadalla F, et al. Ethical and organizational dilemmas related to the treatment of COVID-19 patients. Disaster Emerg Med J. 2020.
