In-hospital cardiac arrest in Intensive Care Unit versus non-Intensive Care Unit patients with COVID-19. A systematic review and meta-analysis

Aim

To estimate the incidence of in-hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID-19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non-ICU patients with COVID-19.

Methods

We systematically reviewed the PubMed, Scopus and <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://clinicaltrials.gov">clinicaltrials.gov</ext-link> databases to identify relevant studies.

Results

Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID-19 patients was 7% [95% CI: 4 – 11%; P < 0.0001] and 44% [95% CI: 30 – 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42 – 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow-up was 59% [95% CI: 37 – 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards.

Conclusion

The incidence of IHCA amongst hospitalized COVID-19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

What this paper adds

Section 1: What is already known on this subject

• Mortality in COVID-19 patients ranges between 20% and 40%.

• it has been reported that patients with COVID-19 have a high incidence of IHCA and higher mortality.

• This paper aimed to calculate the proportion of COVID-19 patients who experience IHCA and their outcome, as well as compare the outcome of IHCA between ICU and non-ICU patients.

Section 2: What this study adds

• Approximately 7% of hospitalized COVID-19 patients suffer from IHCA and 44% of those achieve ROSC.

• The rate of ROSC was higher in ICU patients, but the rate of mortality did not differe between ICU and non-ICU patients.