RESEARCH PAPER
Uncovering the effects of COVID-19 on in-hospital cardiac arrest – a living systematic review and meta-analysis
 
More details
Hide details
1
Polish Society of Disaster Medicine, Raszyn, Poland
 
2
International European University, Kyiv, Ukraine
 
3
International Academy of Ecology and Medicine, Kyiv, Ukraine
 
4
Baylor College of Medicine, Houston, TX, USA
 
5
The Institute of Environmental Protection – National Research Institute (IEP-NRI), Warsaw, Poland
 
6
Institute of Rural Health, Lublin, Poland
 
7
Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
 
8
University of Parma Medical School, Italy
 
9
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
 
 
Corresponding author
Lukasz Szarpak   

Baylor College of Medicine, United States
 
 
Ann Agric Environ Med. 2023;30(3):498-504
 
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic and had a negative impact on the entire health care system. To understand the effect of COVID-19 on outcomes of in-hospital cardiac arrest (IHCA), a systematic review and meta-analysis of studies was designed to compare the pre- and intra-pandemic periods of adult patients who suffered cardiac arrest, and additionally by performing a sub-analysis related to COVID-19 positive vs. negative patients in the same group of patients.

Material and methods:
To evaluate the impact of COVID-19 on IHCA outcomes a systematic review and meta-analysis was performed. Pubmed (MEDLINE), Scopus, Embase, Web of Science, and Cochrane database were searched for articles published from 1 January 2020 – 8 April 2023.

Results:
Return of spontaneous circulation events among IHCA patients in pre-COVID-19 and COVID-19 pandemic periods varied and amounted to 64.0% vs. 60.0%, respectively (OR=1.23; 95%CI: 1.19 to 1.26; p<0.001). Re-arrest occurrence was 4.5% vs. 4.9%, respectively (OR=1.24; 95%CI: 1.00 to 1.53; p=0.05). Survival to hospital discharge (SHD) was 25.1% compared to 20.9% for COVID-19 period (OR = 1.17; 95%CI: 0.96 to 1.41; p=0.12). During the COVID-19 period, SHD in COVID-19 positive patients was 14.0% compared to 25.9% for patients without COVID-19 (OR=0.72; 95%CI: 0.28 to 1.86; p=0.50). 30-day survival rate among COVID-19 positive vs. negative patients was 62.6% vs. 58.3%, respectively (OR =0.99; 95%CI: 0.23 to 4.24; p=0.99).

Conclusions:
Patients with SARS-CoV-2 infection had reduced rates of ROSC and SDH, as well as poorer neurologic outcomes and increased in hospital re-arrests during the COVID-19 period. However, the 30-day survival rate was similar in SARS-CoV-2 positive and negative patients.

ABBREVIATIONS
CI – Confidence interval; IHCA – In-hospital cardiac arrest; MD – Mean difference; NOS – Newcastle Ottawa Scale; OR – Odds ratio; PEA – Pulseless electrical activity; PCR – polymerase chain reaction; ROSC – Return of spontaneous circulation; PRISMA – Preferred Reporting Items for Systematic Reviews and Meta-analysis; SHD – Survival to hospital discharge
 
REFERENCES (56)
1.
Tazerji SS, Shahabinejad F, Tokasi M, et al. Global data analysis and risk factors associated with morbidity and mortality of COVID-19. Gene Rep. 2022; 26:101505. https://doi.org/10.1016/j.genr....
 
2.
Choręza PS, Kruk W, Chudek J, Owczarek AJ. The COVID-19 pandemic and epidemiology of the most common cancers in the Subcarpathian and Silesian Provinces of Poland. Ann Agric Environ Med. 2023; 30(1):90–104. https://doi.org/10.26444/aaem/....
 
3.
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):5573. https://doi.org/10.3390/jcm102....
 
4.
Pal S, Gangu K, Garg I, Shuja H, et al. Gender and Race-Based Health Disparities in COVID-19 Outcomes among Hospitalized Patients in the United States: A Retrospective Analysis of a National Sample. Vaccines (Basel). 2022; 10(12):2036. https://doi.org/10.3390/vaccin....
 
5.
Matuszewski M, Ładny J, Rafique Z, et al. Prediction value of soluble urokinase plasminogen activator receptor (suPAR) in COVID-19 patients - a systematic review and meta-analysis. Ann Agric Environ Med. 2023; 30(1):142-147. https://doi.org/10.26444/aaem/....
 
6.
Navolokina A, Smereka J, Böttiger BW, et al. The Impact of COVID-19 on Pediatric Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023; 20(2):1104. https://doi.org/10.3390/ijerph....
 
7.
Bell M, Hergens MP, Fors S, Tynelius P, de Leon AP, Lager A. Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study. BMC Med. 2023; 21(1):1. https://doi.org/10.1186/s12916....
 
8.
Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2023; 64(1):90-107. https://doi.org/10.1007/s12016....
 
9.
Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018; 137(12):e67-e492. https://doi.org/10.1161/CIR.00....
 
10.
Matuszewski M, Reznikov Y, Pruc M, et al. Prognostic Performance of Cystatin C in COVID-19: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022; 19(21):14607. https://doi.org/10.3390/ijerph....
 
11.
Olczak-Pruc M, Szarpak L, Navolokina A, et al. The effect of zinc supplementation on the course of COVID-19 - A systematic review and meta-analysis. Ann Agric Environ Med. 2022; 29(4):568-574. https://doi.org/10.26444/aaem/....
 
12.
Penketh J, Nolan JP. In-hospital cardiac arrest: the state of the art. Crit Care. 2022; 26(1):376. https://doi.org/10.1186/s13054....
 
13.
Kilic M, Hokenek UD. Association between D-dimer and mortality in COVID-19 patients: a single center study from a Turkish hospital. Disaster Emerg Med J. 2022;7(4):225-230. https://doi.org/10.5603/DEMJ.a....
 
14.
Fialek B, Yanvarova O, Pruc M, et al. Systematic review and meta-analysis of serum amyloid a prognostic value in patients with COVID-19. Disaster Emerg Med J. 2022;7(2):107-113. https://doi.org/10.5603/DEMJ.a....
 
15.
Matuszewski M, Afolabi AA, Ilesanmi OS, et al. Associations between Interleukin-4 and COVID-19 severity: A systematic review and meta-analysis. J Health Soc Sci. 2022; 7(4): 381-396. https://doi.org/10.19204/2022/....
 
16.
Szarpak L, Borkowska M, Peacock FW, et al. Characteristics and outcomes of in-hospital cardiac arrest in COVID-19. A systematic review and meta-analysis. Cardiol J. 2021;28(4):503-508. https://doi.org/10.5603/CJ.a20....
 
17.
Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019; 321(12):1200-1210. https://doi.org/10.1001/jama.2....
 
18.
DiLibero J, Misto K. Outcomes of In-hospital Cardiac Arrest: A Review of the Evidence. Crit Care Nurs Clin North Am. 2021; 33(3):343-356. https://doi.org/10.1016/j.cnc.....
 
19.
Park JH, Song KJ, Do Shin S, Hong KJ. 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. https://doi.org/10.1016/j.ajem....
 
20.
Chauvin A, Slagman A, Polyzogopoulou E, et al. Clinical Characteristics and Management of Patients with a Suspected COVID-19 Infection in Emergency Departments: A European Retrospective Multicenter Study. J Pers Med. 2022; 12(12):2085. https://doi.org/10.3390/jpm121....
 
21.
Kim JH, Ahn C, Namgung M. Epidemiology and Outcome of Out-of-Hospital Cardiac Arrests during the COVID-19 Pandemic in South Korea: A Systematic Review and Meta-Analyses. Yonsei Med J. 2022; 63(12):1121-1129. https://doi.org/10.3349/ymj.20....
 
22.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. https://doi.org/10.1136/bmj.n7....
 
23.
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: 603-605.
 
24.
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. https://doi.org/10.1186/1471-2....
 
25.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557–560. https://doi.org/10.1136/bmj.32....
 
26.
Ahmed F, Abbasi L, Ghouri N, Patel MJ. Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic. Pak J Med Sci. 2022; 38(2):387-392. https://doi.org/10.12669/pjms.....
 
27.
Edwards JM, Nolan JP, Soar J, et al. Impact of the COVID-19 pandemic on in-hospital cardiac arrests in the UK. Resuscitation. 2022; 173:4-11. https://doi.org/10.1016/j.resu....
 
28.
Girotra S, Chan ML, Starks MA, Churpek M, Chan PS, American Heart Association Get With the Guidelines–Resuscitation Investigators. Association of COVID-19 Infection With Survival After In-Hospital Cardiac Arrest Among US Adults. JAMA Netw Open. 2022; 5(3):e220752. https://doi.org/10.1001/jamane....
 
29.
Gupta K, Girotra S, Nallamothu BK, et al. Impact of the three COVID-19 surges in 2020 on in-hospital cardiac arrest survival in the United States. Resuscitation. 2022; 170:134-140. https://doi.org/10.1016/j.resu....
 
30.
Holm A, Jerkeman M, Sultanian P, et al. Cohort study of the characteristics and outcomes in patients with COVID-19 and in-hospital cardiac arrest. BMJ Open. 2021; 11(11):e054943. https://doi.org/10.1136/bmjope....
 
31.
Lyu T, Khan FA, Sajeed SM, et al. In-hospital cardiac arrest incidence and outcomes in the era of COVID-19: an observational study in a Singapore hospital. Int J Emerg Med. 2021; 14(1):33. https://doi.org/10.1186/s12245....
 
32.
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. https://doi.org/10.1161/CIRCOU....
 
33.
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. https://doi.org/10.1186/s13049....
 
34.
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. https://doi.org/10.1093/eurhea....
 
35.
Tong SK, Ling L, Zhang JZ, Yap FHY, Law KL, Joynt GM. Effect of the COVID-19 pandemic on cardiac arrest resuscitation practices and outcomes in non-COVID-19 patients. J Intensive Care. 2021; 9(1):55. https://doi.org/10.1186/s40560....
 
36.
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. https://doi.org/10.1016/j.resp....
 
37.
Karim S, Eidizadeh M, Kazemi M, et al. Risk factors related to COVID-19 survival and mortality: a cross-sectional-descriptive study in regional COVID-19 registry in Fasa, Iran. Disaster Emerg Med J. 2023. https://doi.org/10.5603/DEMJ.a....
 
38.
Meyer-Szary J, Jaguszewski MJ, Smereka J, et al. Impact of COVID-19 on pediatric out-of-hospital cardiac arrest in the Masovian region. Disaster Emerg Med J. 2021;6(4):183-185. https://doi.org/10.5603/DEMJ.a....
 
39.
Dubey L, Dorosh O, Dubey N, et al. COVID-19-induced coagulopathy: Experience, achievements, prospects. Cardiol J. 2023 Jan 2. https://doi.org/10.5603/CJ.a20....
 
40.
Dubey L, Lytvyn H, Dorosh O, et al. The pathogenesis of COVID-19: Hypercoagulation and D-dimer in thrombotic complications. J Health Soc Sci. 2023, 8, 1, 45-58. https://doi.org/10.19204/2023/....
 
41.
Foley LJ, Urdaneta F, Berkow L, et al. Difficult Airway Management in Adult Coronavirus Disease 2019 Patients: Statement by the Society of Airway Management. Anesth Analg. 2021; 133(4):876-890. https://doi.org/10.1213/ANE.00....
 
42.
Guimarães HP, Timerman S, Rodrigues RDR, et al. Position Statement: Cardiopulmonary Resuscitation of Patients with Confirmed or Suspected COVID-19 - 2020. Arq Bras Cardiol. 2020; 114(6):1078-1087. https://doi.org/10.36660/abc.2....
 
43.
Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020; 8(5):506-517. https://doi.org/10.1016/S2213-....
 
44.
Chirico F, Nucera G, Sacco A, Taino G, Szarpak L, Imbriani M. Protecting hospitals from SARS-CoV-2 infection: A review-based comprehensive strategy for COVID-19 prevention and control. G Ital Med Lav Ergon. 2022; 44(1):32-40.
 
45.
Ceruti S, Glotta A, Biggiogero M, et al. Admission criteria in critically ill COVID-19 patients: A physiology-based approach. PLoS One. 2021; 16(11):e0260318. https://doi.org/10.1371/journa....
 
46.
Hajjar LA, Costa IBSDS, Rizk SI, et al. Intensive care management of patients with COVID-19: a practical approach. Ann Intensive Care. 2021; 11(1):36. https://doi.org/10.1186/s13613....
 
47.
Bartoletti M, Azap O, Barac A, et al. ESCMID COVID-19 living guidelines: drug treatment and clinical management. Clin Microbiol Infect. 2022; 28(2):222-238. https://doi.org/10.1016/j.cmi.....
 
48.
Chirico F, Yıldırım M, Dzieciatkowski T, et al. Efficiency rating of SG Diagnostics COVID-19 antigen rapid test kit. Future Virol. 2023 Mar:10.2217/fvl-2021-0210. https://doi.org/10.2217/fvl-20....
 
49.
Gadek L, Szarpak L, Konge L, et al. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J Clin Med. 2021; 10(24):5740. https://doi.org/10.3390/jcm102....
 
50.
Szarpak L, Peacock FW, Rafique Z, et al. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med. 2022; 53:122-126. https://doi.org/10.1016/j.ajem....
 
51.
Drozd A, Smereka J, Pruc M, Malysz M, Gasecka A, Sonmez LO, Cyran M, Konge L, Szarpak L. Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial. Am J Emerg Med. 2021; 49:189-194. https://doi.org/10.1016/j.ajem....
 
52.
Ruetzler K, Drozd A, Gasecka A, et al. Pediatric intravascular access in simulated COVID-19 patients among paramedics wearing personal protective equipment. Resusc Plus. 2021; 5:100073. https://doi.org/10.1016/j.resp....
 
53.
Al-Jeabory M, Borkowska GO, Olecka A, Goss A, Wieczorek W, Evrin T. Mechanical chest compression devices as an option for out-of-hospital cardiac arrest in COVID-19 pandemic. Disaster Emerg Med J. 2021; 6(1):50-51 https://doi.org/10.5603/DEMJ.a....
 
54.
Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation. 2022; 181:28-36. https://doi.org/10.1016/j.resu....
 
55.
Arrogante O, González-Romero GM, Carrión-García L, Polo A. Reversible causes of cardiac arrest: Nursing competency acquisition and clinical simulation satisfaction in undergraduate nursing students. Int Emerg Nurs. 2021; 54:100938. https://doi.org/10.1016/j.ienj....
 
56.
Choi H, Lee JH, Park HK, et al. Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction. J Korean Med Sci. 2022; 37(21):e167. https://doi.org/10.3346/jkms.2....
 
eISSN:1898-2263
ISSN:1232-1966
Journals System - logo
Scroll to top