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Background Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. Methods We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. Results The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). Conclusion This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

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Early risk stratification of out-of-hospital cardiac arrest (OHCA) patients with insufficient information in emergency departments (ED) is difficult but critical in improving intensive care resource allocation. This study aimed to develop a simple risk stratification score using initial information in the ED. Adult patients who had OHCA with medical etiology from 2016 to 2020 were enrolled from the Korean Cardiac Arrest Research Consortium (KoCARC) database. To develop a scoring system, a backward logistic regression analysis was conducted. The developed scoring system was validated in both external dataset and internal bootstrap resampling. A total of 8240 patients were analyzed, including 4712 in the development cohort and 3528 in the external validation cohort. An ED-PLANN score (range 0–5) was developed incorporating 1 point for each: P for serum pH ≤ 7.1, L for serum lactate ≥ 10 mmol/L, A for age ≥ 70 years old, N for non-shockable rhythm, and N for no-prehospital return of spontaneous circulation. The area under the receiver operating characteristics curve (AUROC) for favorable neurological outcome was 0.93 (95% CI, 0.92–0.94) in the development cohort, 0.94 (95% CI, 0.92–0.95) in the validation cohort. Hosmer–Lemeshow goodness-of-fit tests also indicated good agreement. The ED-PLANN score is a practical and easily applicable clinical scoring system for predicting favorable neurological outcomes of OHCA patients.

Objective: We hypothesize that there is difference in outcomes of out-of-hospital cardiac arrest according to bystander gender. Methods: We used a nationwide, out-of-hospital cardiac arrest cohort database during 2006-2020. We extracted cases involving patient older than 18 years with presumed cardiac etiology and witnessed arrest, but not by EMS or nursing home worker or medical personnel. The primary outcome was the good neurologic outcome. Secondary outcomes were successful bystander cardiopulmonary resuscitation rate which defined that starting bystander CPR and keep going until by EMS arrival and survival outcome. Results: The total number of populations was 24919 patients. Of these, 10413 patients (41.8%) were resuscitated by female bystander. When cardiopulmonary resuscitation by female bystander, patient more likely to achieve good neurological outcome (206(2.0%) vs 235(1.6%), p=0.344), and survival (352(3.4%) vs 400(2.8%), p=0.0046). However, female bystander less likely to do successful cardiopulmonary resuscitation (5730(55.0%) vs 9405(64.8%), p<0.0001). Adjusted odds ratios for good neurologic outcomes, survival and successful bystander cardiopulmonary resuscitation rate resuscitated by female bystander, when compared with male bystander, were 1.46 (1.18-1.80), 1.44 (1.23-1.69) and 0.68 (0.64-0.71), respectively. In the interaction model, adjusted odd ratio (95% Confidence interval) for good neurological outcome of patient resuscitated by female bystander was 1.53 (1.21-1.94) in patients who arrested at private place and 1.18 (0.71-1.98) in patients who arrested in public place. Conclusion: Patient who resuscitated by female bystander were more likely to have good neurologic outcome and achieve survival discharge. Effect of bystander gender was increased when patient arrested in private place.

Background: Previous studies have shown that chest compression release velocity (CCRV) of over 400mm/s is associated with improved survival and favorable neurologic outcome after cardiac arrest. However, it is uncertain whether CCRV during CPR is related to cerebral perfusion pressure (CePP). The purpose of this study was to evaluate the association between CCRV and CePP in a porcine cardiac arrest model. Methods: After 6 minutes of untreated ventricular fibrillation, 2 cycles of basic life support (BLS) and 12 cycles of advanced cardiovascular life support (ACLS) were conducted. During ACLS phase, CCRV was accelerated from 250mm/s to 450mm/s by 50mm/s (accelerating group) or decelerated from 450mm/s to 250mm/s by 50mm/s (decelerating group). Both groups performed BLS with the self-set value of the mechanical CPR device (LUCAS 2 chest compression system, CCRV of 170mm/s). Twenty-four pigs were randomly assigned to each group. Macrovascular circulation (CePP) and microvascular circulation using laser doppler flowmetry presented as a fraction of the baseline flow (f-LDF) were measured. We excluded the last 2 cycles of ACLS phase from the analysis due to time-dependent deterioration effects of hemodynamic outcomes. Linear mixed model was used to measure the median difference in CePP and f-LDF according to CCRV. Results: A total of 24 pigs were analyzed. Decelerating group of CCRV of 400mm/s showed significantly higher CePP values compared to the group of 170mm/s. Effect of changes in CCRV on CePP, stratified by groups, are as follows (median, [95% confidence intervals]): 1. Accelerating group: CCRV of 170mm/s; reference, 250mm/s; -1.98 [-10.78 - 11.79] mmHg, 300mm/s; -1.88 [-11.15 - 12.55] mmHg, 350mm/s; -2.55 [-11.46 - 12.24], 400mm/s; -6.05 [-5.59 - 16.86], and 2. Decelerating group: CCRV of 170mm/s; reference, 250mm/s; 5.71 [-16.27 - 27.11] mmHg, 300mm/s; 6.01 [-16.28 - 27.90] mmHg, 350mm/s; 6.96 [6.36 - 47.70], 400mm/s; 26.96 [6.36 - 47.70]. However, there was no significant CCRV effects on f-LDF (Accelerating CCRV of 400mm/s; 1.54 [ -0.03 - 3.10] and decelerating CCRV of 400mm/s; -2 [-4.42 - 0.34]). Conclusion: In a VF cardiac arrest porcine study, CCRV of 400mm/s at early phase of CPR has positive effects on CePP.