Characteristics and outcomes of out-of-hospital cardiac arrest patients before and during the COVID-19 pandemic in Thailand

Abstract

Background Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand. Methods This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital’s emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected. Results A total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period). Conclusions During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups. Trial registration This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.

Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis

“…A total of ten studies were included in the analysis of CPR using mechanical CPR devices, with six studies showing significant results. Among them, a significant increase in CPR with mechanical CPR devices during the COVID-19 pandemic was reported in three studies ( 34 , 57 , 71 ), and a significant decrease was reported in the other studies ( 13 , 78 , 98 ). Talikowska et al noted that the increase in the number of patients who stopped CPR in the field could be explained by the desire to follow local protocols, and a decrease in the number of people who required CPR using mechanical CPR devices ( 78 ).…”

“…The frequency of percutaneous coronary intervention reported by Ahn et al, Riyapan et al, and Phattharapornjaroen et al and the frequency of emergency coronary angiography reported by Sultanian et al did not show significant differences before and during the COVID-19 pandemic. Therefore, it can be assumed that the impact of the COVID-19 pandemic on the hospital-stage treatments of OHCA patients may be low; however, interpretation is limited because meta-analyses were not performed due to the small number of studies ( 34 , 71 , 73 , 76 ).…”

Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023

“…By the end of this study’s period, the STA rate had slightly increased to 6.7% in the first 5 months of 2023 but remained approximately 65% lower than the rate observed in the final year of the prepandemic period (2019). The STA rate was lower in HK than in other countries or regions during the pandemic [ 12 , 27 , 28 ]. Several factors may have accounted for this discrepancy.…”

Prevalence of COVID-19 Among Patients Arriving in Pre-arrest/Cardiac Arrest, at a Tertiary Hospital’s ED in the Eastern Province of Saudi Arabia During the COVID-19 Pandemic

“…A total of 136 patients participated in Phatthranit Phattharapornjaroen et al, a single-center, retrospective cohort study in Thailand to evaluate the characteristics and prognosis of patients who experienced out-of-hospital cardiac arrest during and before the COVID-19 pandemic ( 15 ). Hypertension and diabetes were present in 46.67% and 25% of people, respectively ( 15 ).…”