Objectives
To evaluate the potential impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) response and outcomes in two US communities with relatively low infection rates.
Background
Studies in areas with high COVID-19 infection rates indicate that the pandemic has had direct and indirect effects on community response to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking.
Methods
In Multnomah County, OR and Ventura County, CA, we evaluated OHCA with attempted resuscitation by EMS from March 1 – May 31, 2020 and March 1 – May 31, 2019.
Results
Comparing 231 OHCA in 2019 to 278 in 2020, the proportion receiving bystander CPR was lower in 2020 (61% to 51%, p=0.02) and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, p=0.02). EMS response time increased (6.6 ± 2.0 to 7.6 ± 3.0 minutes, p<0.001), and fewer OHCA survived to hospital discharge (14.7% to 7.9%, p=0.02). Incidences rates did not change significantly (p>0.07), and coronavirus infection rates were low (Multnomah 143/100,000, Ventura 127/100,000 as of May 31), compared to rates of ∼1600-3000/100,000 in the New York City region at that time.
Conclusions
The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA. These results highlight the pandemic’s indirect negative impact on OHCA even in communities with relatively low incidence of COVID-19 and point to potential opportunities for countering the impact.
Key Points
Question
Are race and ethnicity associated with incidence rates, clinical profiles, and outcomes in individuals experiencing sudden cardiac arrest?
Findings
In this 5-year cohort study of sudden cardiac arrest in a Southern California community comprising 848 112 individuals, rates of sudden cardiac arrest were similar in the non-Hispanic White, non-Hispanic Black, and Hispanic populations, but lower in the Asian population. Survival outcomes were similar by race and ethnicity, despite a higher prevalence before sudden cardiac arrest of hypertension, diabetes, and chronic kidney disease in Asian and Hispanic individuals compared with White individuals.
Meaning
The findings of this study suggest that sudden cardiac arrest prevention in the overall population may require an improved understanding of race/ethnicity-specific differences in risk.
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