Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

Tommaso Scquizzato, Giovanni Landoni, Andrea Paoli, Rosalba Lembo, Evgeny Fominskiy, Artem Kuzovlev, Valery Likhvantsev, Alberto Zangrillo

Research output: Contribution to journalReview articlepeer-review


Introduction: In addition to the directly attributed mortality, COVID-19 is also likely to increase mortality indirectly. In this systematic review, we investigate the direct and indirect effects of COVID-19 on out-of-hospital cardiac arrests. Methods: We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled Trials for studies comparing out-of-hospital cardiac arrests occurring during the pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool. The primary endpoint was return of spontaneous circulation. Secondary endpoints were bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge, and survival with favourable neurological outcome. Results: We identified six studies. In two studies, rates of return of spontaneous circulation and survival to hospital discharge decreased significantly during the pandemic. Especially in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation and resuscitation attempted by emergency medical services were reduced during the pandemic. Also, ambulance response times were significantly delayed across all studies and patients presenting with non-shockable rhythms increased in two studies. In 2020, 3.9–5.9% of tested patients were SARS-CoV-2 positive and 4.8–26% had suggestive symptoms (fever and cough or dyspnoea). Conclusions: Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect effects from lockdown and disruption of healthcare systems. Patients at high risk of deterioration should be identified outside the hospital to promptly initiate treatment and reduce fatalities. Study registration PROSPERO CRD42020195794.

Original languageEnglish
Pages (from-to)241-247
Number of pages7
Publication statusPublished - Dec 2020


  • Cardiopulmonary resuscitation
  • COVID-19
  • Out-of-hospital cardiac arrest

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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