An international perspective of out-of-hospital cardiac arrest and cardiopulmonary resuscitation during the COVID-19 pandemic

Abstract

Background Out-of-hospital cardiac arrest (OHCA) accounts for a substantial proportion of sudden cardiac events globally, with hundreds of thousands of cases reported annually in the United States. The mortality rate of patients who suffer OHCA remains high despite extensive utilization of resources. Objectives We aim to describe the current landscape of OHCA during the COVID-19 pandemic and provide an overview of the logistical challenges and resuscitation protocols amongst emergency medical service (EMS) personnel. Discussion Recent studies in Italy, New York City, and France characterized a significant increase in OHCA incidence in conjunction with the arrival of the 2019 coronavirus disease (COVID-19) pandemic. The presence of the pandemic challenged existing protocols for field resuscitation of cardiac arrest patients as the pandemic necessitated prioritization of EMS personnel and other healthcare providers' safety through stringent personal protective equipment (PPE) requirements. Studies also characterized difficulties encountered by the first responder system during COVID-19, such as dispatcher overload, increased response times, and adherence to PPE requirements, superimposed on PPE shortages. The lack of guidance by governmental agencies and specialty organizations to provide unified safety protocols for resuscitation led to the development of different resuscitative protocols globally. Conclusions The ongoing COVID-19 pandemic modified the approach of first responders to OHCA. With the rise in OCHA during the pandemic in several geographic regions and the risks of disease transmission with superimposed equipment shortages, novel noninvasive, adjunct tools, such as point of care ultrasound, warrant consideration. Further prehospital studies should be considered to optimize OHCA and resource management while minimizing risk to personnel.

Impact of Coronavirus Disease 2019 Pandemic on Cardiac Arrest and Emergency Care

“…Further, workforce reduction due to illness and overwhelmed healthcare systems leading to longer patient offload times at the hospital resulted in less available resources to response to time-sensitive emergencies. Changes in resuscitation protocols during the COVID-19 pandemic by various EMS systems in response to resource limitations as well as uncertainties early in the pandemic may have affected prehospital management, response and transport times [ 22 , 25 ]. Early recommendations, when PPE was scarce, included limiting personal during the resuscitation, which could have had implications for outcome, and considering the appropriateness of initiation resuscitation [ 26 ].…”

“…The pandemic has led some to suggest modifications to cardiac arrest care including: (1) use of field point of care ultrasound to assess for cardiac standstill as means to supplement prognostication [ 25 ]; (2) reduction in the duration of CPR cycle from 2 min to 1 min, given the deterioration in the quality of chest compressions among rescuers wearing PPE [ 61 ]; and (3) placement of a towel or mask over the patient’s mouth and nose during cardiac resuscitation with compression-only CPR [ 60 ]. These modifications may be reasonable as long as they do not interfere with high-quality CPR.…”

Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review

“…Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020 [ 1 ]. The event stormed the entire world, and its spread via the mode of aerosol transmission seriously impacted multiple clinical management of patients, including those requiring cardiopulmonary resuscitation (CPR) [ 2 ]. The uncertainty of the safest technique and anxiety of contracting the COVID-19 disease may cause bystander CPR (BPCR) to take a back seat.…”

First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

“…The results of our study demonstrate a huge variation in impact of the pandemic on FR schemes and correspondingly a huge variation in precautionary measures for providers and patients; however, these variations are not only caused by the heterogeneity of the responder systems, but also by a comprehensible lack of knowledge around the new viral disease, lack of experience in dealing with highly contagious infectious diseases, and a lack of guidance on how to deal with this unprecedented challenge [ 49 ]. This led the majority of systems to suspend their operations at some point.…”