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

  1. Georgios Mavrovounis
  2. Maria Mermiri
  3. Athanasios Chalkias
  4. Vishad Sheth
  5. Vasiliki Tsolaki
  6. Konstantinos Gourgoulianis
  7. Ioannis Pantazoulos

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Abstract

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 clinicaltrials.gov 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.

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  1. ScreenIT

    SciScore for 10.1101/2021.05.08.21256885: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Literature search: Two of the authors (M.G. and M.M.) individually performed a database search of the PubMed (MEDLINE), Scopus and clinicaltrials
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Statistical analysis: All statistical analyses were performed in Review Manager (RevMan) Version 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark (http://tech.cochrane.org/revman)) and OpenMeta[Analyst] [14].
    RevMan
    suggested: (RevMan, RRID:SCR_003581)
    Cochrane Collaboration
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations that should be acknowledged. Due to the COVID-19 pandemic being a recent event, there are limited data available in the literature, especially pertaining to the comparison between ICU versus non-ICU patients with IHCA. Furthermore, it is important to note that the included studies reported outcomes at different follow-up points. Some studies only included patients with IHCA treated in the ICU and didn’t analyze data concerning patients from the general wards. Finally, only observational studies were available in the literature.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.05.08.21256885v1 on medRxiv