Uncovering the effects of COVID-19 on in-hospital cardiac arrest – a living systematic review and meta-analysis
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Polish Society of Disaster Medicine, Raszyn, Poland
International European University, Kyiv, Ukraine
International Academy of Ecology and Medicine, Kyiv, Ukraine
Baylor College of Medicine, Houston, TX, USA
The Institute of Environmental Protection – National Research Institute (IEP-NRI), Warsaw, Poland
Institute of Rural Health, Lublin, Poland
Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
University of Parma Medical School, Italy
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
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.

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).

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.

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
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