Vol 9, No 1 (2024)
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Published online: 2024-02-15

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A systematic review and meta-analysis of the impact of the pandemic on dispatcher-assisted cardiopulmonary resuscitation

Artur Krawczyk1, Krzysztof Kurek2, Michal Pruc13, Francesco Chirico4, Damian Swieczkowski5, Jacek Kubica6, Zofia Zadorozna7, Murat Yıldırım89, Lukasz Szarpak21011, Karol Bielski13
Medical Research Journal 2024;9(1):75-81.


Introduction: The influence of the COVID-19 pandemic on the incidence and effectiveness of dispatcher-assisted
cardiopulmonary resuscitation (DA-CPR) in the context of out-of-hospital cardiac arrests (OHCA)
remains an area of ambiguity and requires further elucidation. The study aims to conduct a systematic
review and meta-analysis of the DA-CPR among pre- vs. during COVID-19 periods.

Material and methods: This search was conducted in accordance with the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic review of the current literature
was performed to identify articles that evaluated the impact of the pandemic on DA-CPR. English-language
literature was searched up to December 11, 2023, in three databases, including MEDLINE (via PubMed),
Embase, and the Cochrane Library.

Results: Six studies with 605,354 patients (431,308 patients with OHCA from before the pandemic period
and 174,046 OHCA patients from the COVID-19 pandemic period) were included. Pooled analysis
showed that DA-CPR before and during the COVID-19 period varied and amounted to 61.4% vs. 62.4%,
respectively (OR = 0.94; 95% CI: 0.90 to 0.99; p = 0.02). Moreover, dispatchers recognized cardiac arrest
by phone in 61.8% of cases in the pre-pandemic period as well as in the pandemic period (OR = 0.98;
95%CI: 0.95 to 1.01; p = 0.17).

Conclusions: This systematic review and meta-analysis suggest the resilience and adaptability of emergency
response systems in maintaining DA-CPR effectiveness despite the challenges posed by the pandemic.

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  1. Riva G, Jonsson M, Ringh M, et al. Survival after dispatcher-assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2020; 157: 195–201.
  2. Lee YuJ, Song KJ, Shin SDo, et al. Dispatcher-assisted cardiopulmonary resuscitation program and outcomes after pediatric out-of-hospital cardiac arrest. Pediatr Emerg Care. 2019; 35(8): 561–567.
  3. Ho AF, Sim ZJ, Shahidah N, et al. Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore. Resuscitation. 2016; 105: 149–155.
  4. Bielski K, Böttiger BW, Pruc M, et al. Outcomes of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation: a systematic review and meta-analysis. Ann Med. 2022; 54(1): 464–471.
  5. Siman-Tov M, Strugo R, Podolsky T, et al. Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study. Am J Emerg Med. 2021; 44: 333–338.
  6. Eberhard KE, Linderoth G, Gregers MC, et al. Impact of dispatcher-assisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review. Scand J Trauma Resusc Emerg Med. 2021; 29(1): 70.
  7. Ng JY, Sim ZJ, Siddiqui FJ, et al. Incidence, characteristics and complications of dispatcher-assisted cardiopulmonary resuscitation initiated in patients not in cardiac arrest. Resuscitation. 2022; 170: 266–273.
  8. Smereka J, Szarpak L. COVID-19 a challenge for emergency medicine and every health care professional. Am J Emerg Med. 2020; 38(10): 2232–2233.
  9. Smereka J, Szarpak L. The use of personal protective equipment in the COVID-19 pandemic era. Am J Emerg Med. 2020; 38(7): 1529–1530.
  10. Chavez S, Huebinger R, Chan HK, et al. The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas. Am J Emerg Med. 2022; 57: 1–5.
  11. 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.
  12. Bielski K, Szarpak A, Jaguszewski MJ, et al. The influence of COVID-19 on out-hospital cardiac arrest survival outcomes: an updated systematic review and meta-analysis. J Clin Med. 2021; 10(23).
  13. Ushimoto T, Yao S, Nunokawa C, et al. Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis. Emerg Med J. 2023; 40(8): 556–563.
  14. Page M, McKenzie J, Bossuyt P, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021: 372.
  15. Phelps R, Dumas F, Maynard C, et al. Cerebral performance category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013; 41(5): 1252–1257.
  16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9): 603–605.
  17. 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.
  18. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons, Chichester (UK) 2019.
  19. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109): 629–634.
  20. Sterne JAC, Sutton AJ, Ioannidis JPA, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011; 343: d4002.
  21. Ahn JY, Ryoo HW, Cho JW, et al. Impact of the COVID-19 outbreak on adult out-of-hospital cardiac arrest outcomes in Daegu, South Korea: an observational study. Clin Exp Emerg Med. 2021; 8(2): 137–144.
  22. Lim SL, Toh C, Fook-Chong S, et al. Impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation in adult out-of-hospital cardiac arrests in Singapore. Resuscitation. 2022; 181: 40–47.
  23. Liu CH, Tsai MJ, Hsu CF, et al. The influence of the COVID-19 pandemic on emergency medical services to out-of-hospital cardiac arrests in a low-incidence urban city: an observational epidemiological analysis. Int J Environ Res Public Health. 2023; 20(3): 2713.
  24. Park JHo, Song KJ, Do Shin S, et al. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: Which survival chain factor contributed the most? Am J Emerg Med. 2023; 63: 61–68.
  25. Ristau P, Wnent J, Gräsner JT, et al. Impact of COVID-19 on out-of-hospital cardiac arrest: A registry-based cohort-study from the German Resuscitation Registry. PLoS One. 2022; 17(9): e0274314.
  26. Tanaka Y, Okumura K, Yao S, et al. Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study. Resusc Plus. 2023; 14: 100377.
  27. Ball J, Nehme Z, Villani M, et al. Abstract 11901: CPR quality during the COVID-19 pandemic — more evidence of collateral damage during out-of-hospital cardiac arrest. Circulation. 2021; 144(Suppl_2).
  28. Perman SM. Overcoming fears to save lives: COVID-19 and the threat to bystander CPR in out-of-hospital cardiac arrest. Circulation. 2020; 142(13): 1233–1235.
  29. Al-Shiakh S, Tran QK, Caggiula A, et al. Attitudes among healthcare professionals towards cardiopulmonary resuscitation during COVID-19. Am J Emerg Med. 2022; 52: 34–42.
  30. Baldi E, Sechi GM, Mare C, et al. Lombardia CARe Researchers. Out-of-hospital cardiac arrest during the COVID-19 outbreak in Italy. N Engl J Med. 2020; 383(5): 496–498.
  31. Baldi E, Klersy C, Chan P, et al. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis. Resuscitation. 2023 [Epub ahead of print]; 194: 110043.
  32. Ageta K, Naito H, Yorifuji T, et al. Delay in emergency medical service transportation responsiveness during the COVID-19 pandemic in a minimally affected region. Acta Med Okayama. 2020; 74(6): 513–520.
  33. Schumann H, Böckelmann I, Thielmann B, et al. Recovery and stress of control center dispatchers in the first waves of the SARS-CoV-2 pandemic. Wien Klin Wochenschr. 2023; 135(9-10): 228–234.
  34. Makara-Studzińska M, Załuski M, Adamczyk K. Polish emergency dispatchers during a COVID-19 pandemic — burnout syndrome, perceived stress, and self-efficacy. Effects of multidimensional path analysis. Front Psychol. 2021; 12: 729772.
  35. Nelson T, Kagan N, Critchlow C, et al. The danger of misinformation in the COVID-19 crisis. Mo Med. 2020; 117(6): 510–512.