Variation in Community and Ambulance Care Processes for Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Abstract Bystander cardiopulmonary resuscitation (BCPR) and early defibrillation can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of COVID-19 on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR=1.38, 95%CI 1.11-1.71, p=0.0069). BCPR did not differ between COVID-19 and Pre-COVID-19 populations (OR=0.94, 95%CI 0.80-1.11, p=0.4631), although bystander defibrillation was significantly lower during the COVID-19 period (OR=0.65, 95%CI 0.48-0.88, p=0.0107). EMS call-to-arrival time was significantly higher in COVID-19 populations (SMD=0.27, 95%CI 0.13-0.40, p=0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.