Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute.
Faculty of Medicine, Vita-Salute San Raffaele University, Milan.
Eur J Emerg Med. 2021 Dec 1;28(6):423-431. doi: 10.1097/MEJ.0000000000000878.
Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest.
PubMed and EMBASE were searched up to April 05, 2021. We included studies comparing out-of-hospital cardiac arrests patients with suspected or confirmed SARS-CoV-2 infection versus noninfected patients. The primary outcome was survival at hospital discharge or at 30 days. Secondary outcomes included return of spontaneous circulation, cardiac arrest witnessed and occurring at home, bystander-initiated cardiopulmonary resuscitation, proportion of nonshockable rhythm and resuscitation attempted, and ambulance arrival time.
In the ten included studies, 18% (1341/7545) of out-of-hospital cardiac arrests occurred in patients with SARS-CoV-2 infection. Patients with out-of-hospital cardiac arrest and SARS-CoV-2 infection had reduced rates of survival (16/856 [1.9%] vs. 153/2344 [6.5%]; odds ratio (OR) = 0.33; 95% confidence interval (CI), 0.17-0.65; P = 0.001; I2 = 28%) and return of spontaneous circulation (188/861 [22%] vs. 640/2403 [27%]; OR = 0.75; 95% CI, 0.65-0.86; P < 0.001; I2 = 0%) when compared to noninfected patients. Ambulance arrived later (15 ± 10 vs. 13 ± 7.5 min; mean difference = 1.64; 95% CI, 0.41-2.88; P = 0.009; I2 = 61%) and nonshockable rhythms (744/803 [93%] vs. 1828/2217 [82%]; OR = 2.79; 95% CI, 2.08-3.73; P < 0.001; I2 = 0%) occurred more frequently. SARS-CoV-2 positive patients suffered a cardiac arrest at home more frequently (1186/1263 [94%] vs. 3598/4055 [89%]; OR = 1.86; 95% CI, 1.45-2.40; P<0.001; I2 = 0%) but witnessed rate (486/890 [55%] vs. 1385/2475 [56%]; OR = 0.97; 95% CI, 0.82-1.14; P = 0.63; I2 = 0%) and bystander-initiated cardiopulmonary resuscitation rate (439/828 [53%] vs. 1164/2304 [51%]; OR = 0.95; 95% CI, 0.73-1.24; P = 0.70; I2 = 53%) were similar.
One-fifth of out-of-hospital cardiac arrest patients had SARS-CoV-2 infection. These patients had low rates of return of spontaneous circulation and survival and were characterized by higher nonshockable rhythms but similar bystander-initiated cardiopulmonary resuscitation rate.
PROSPERO - CRD42021243540.
COVID-19 大流行期间，院外心脏骤停的发生率增加，并且假设感染患者中存在心脏骤停的直接机制。因此，我们进行了系统评价和荟萃分析，以评估 SARS-CoV-2 患者院外心脏骤停的结局。
截至 2021 年 4 月 05 日，我们在 PubMed 和 EMBASE 上进行了检索。我们纳入了比较疑似或确诊 SARS-CoV-2 感染与未感染患者院外心脏骤停的研究。主要结局为出院或 30 天的生存率。次要结局包括自主循环恢复、目击和在家中发生的心脏骤停、旁观者启动的心肺复苏、非颤动感律的比例以及复苏尝试和救护车到达时间。
在纳入的十项研究中，18%（1341/7545）的院外心脏骤停发生在 SARS-CoV-2 感染患者中。院外心脏骤停合并 SARS-CoV-2 感染患者的生存率（16/856[1.9%] vs. 153/2344[6.5%]；比值比（OR）=0.33；95%置信区间（CI），0.17-0.65；P=0.001；I2=28%）和自主循环恢复率（188/861[22%] vs. 640/2403[27%]；OR=0.75；95%CI，0.65-0.86；P<0.001；I2=0%）均低于未感染患者。救护车到达时间较晚（15±10 分钟 vs. 13±7.5 分钟；平均差值=1.64；95%CI，0.41-2.88；P=0.009；I2=61%），非颤动感律（744/803[93%] vs. 1828/2217[82%]；OR=2.79；95%CI，2.08-3.73；P<0.001；I2=0%）更常见。SARS-CoV-2 阳性患者更常在家中发生心脏骤停（1186/1263[94%] vs. 3598/4055[89%]；OR=1.86；95%CI，1.45-2.40；P<0.001；I2=0%），但目击率（486/890[55%] vs. 1385/2475[56%]；OR=0.97；95%CI，0.82-1.14；P=0.63；I2=0%）和旁观者启动的心肺复苏率（439/828[53%] vs. 1164/2304[51%]；OR=0.95；95%CI，0.73-1.24；P=0.70；I2=53%）相似。
五分之一的院外心脏骤停患者患有 SARS-CoV-2 感染。这些患者的自主循环恢复率和生存率较低，且更可能是非颤动感律，但旁观者启动的心肺复苏率相似。
PROSPERO-CRD42021243540。
