2022 Volume 21 Issue 2 Pages 52-63
This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on bystander reaction to out-of-hospital cardiac arrest (OHCA) and present a strategy to improve the quality of bystander cardiopulmonary resuscitation (CPR) in the COVID-19 era. This systematic review and meta-analysis of observational studies were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis using the Hunter–Schmidt method in 13 previous studies identified using our criteria revealed that the pandemic is likely to decrease the rate of bystander CPR (log odds ratio with 95% confidence interval: −0.11; −0.22, −0.01) with large heterogeneity (I2 = 75.8%). Meta-regression analysis including global area and publication year revealed that heterogeneity is significantly affected by the global region (P = 0.048) and is the largest in Europe. A meta-analysis of 10 studies reporting the incidence of public-access defibrillation (PAD, automated external defibrillator use by bystanders) revealed that the PAD incidence is likely to be lowered by the pandemic (−0.30 [−0.47, −0.13]). The medical control system in each prefecture in Japan should play a central role as a community-based life-saving system to maintain and improve the quality of bystander CPR. The medical control strategy in the COVID-19 era should include continuous quality improvements of dispatcher-assisted CPR instruction and the system to recruit well-trained and qualified citizens to the scene of OHCA.
