Introduction and objective:
The COVID-19 pandemic caused by the SARS-CoV-2 virus has recently presented the world with an unprecedented challenge. The purpose of this systematic review and meta-analysis is to investigate the relationship between SARS-CoV-2 infection and out-of-hospital cardiac arrest (OHCA) by comparing data from infected and non-infected individuals. The study adds to our understanding of the broader effects of the pandemic on public health and emergency care by examining the influence of COVID-19 on OHCA.

Material and methods:
A comprehensive systematic literature search was performed using PubMed, EMBASE, Scopus, Web of Science, the Cochrane Library and Google Scholar from 1 January 2020 – 24 May 2023. Incidence rates and odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) for risk factors were recorded from individual studies, and random-effects inverse variance modelling used to generate pooled estimates.

Six studies, involving 5,523 patients, met the criteria for inclusion in the meta-analysis. Survival to hospital admission, defined as admission to the emergency department with sustained return of spontaneous circulation (ROSC), among patients with and without on-going infection was 12.2% and 20.1%, respectively (p=0.09). Survival to hospital discharge/30-day survival rate was 0.8% vs. 6.2% (p<0.001). Two studies reported survival to hospital discharge in good neurological condition; however, the difference was not statistically significant (2.1% vs. 1.8%; p=0.37).

Compared to the non-infected patients, the ongoing SARS-CoV-2 infection was associated with worse OHCA outcomes.

ACLS: advanced cardiovascular life support; ARDS: acute respiratory distress syndrome; CI: confidence interval; CPC: Cerebral Performance Categories; CPR: cardiopulmonary resuscitation; CVD: cardiovascular disease; EMS: emergency medical service; IHCA: in-hospital cardiac arrest; MD: mean difference; NOS: Newcastle Ottawa Scale; OHCA: out-of-hospital cardiac arrest; OR: odds ratio; ROSC: return of spontaneous circulation; PPE: personal protective equipment; PRISMA: preferred reporting items for systematic reviews and meta-analysis; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SHA: survival to hospital admission; SHD: survival to hospital discharge; VTE: venous thromboembolism
The study was supported by the European Research Council (ERC) Research Net and by the Polish Society of Disaster Medicine in Warsaw, Poland.
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