Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City

Abstract

hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year. OBJECTIVE To describe the characteristics (race/ethnicity, comorbidities, and emergency medical services [EMS] response) associated with outpatient cardiac arrests and death during the COVID-19 pandemic in NYC. DESIGN, SETTING, AND PARTICIPANTS This population-based, cross-sectional study compared patients with out-of-hospital cardiac arrest receiving resuscitation by the NYC 911 EMS system from March 1 to April 25, 2020, compared with March 1 to April 25, 2019. The NYC 911 EMS system serves more than 8.4 million people. EXPOSURES The COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Characteristics associated with out-of-hospital arrests and the outcomes of out-of-hospital cardiac arrests. RESULTS A total of 5325 patients were included in the main analysis (2935 men [56.2%]; mean [SD] age, 71 [18] years), 3989 in the COVID-19 period and 1336 in the comparison period. The incidence of nontraumatic out-of-hospital cardiac arrests in those who underwent EMS resuscitation in 2020 was 3 times the incidence in 2019 (47.5/100 000 vs 15.9/100 000). Patients with out-of-hospital cardiac arrest during 2020 were older (mean [SD] age, 72 [18] vs 68 [19] years), less likely to be white (611 of 2992 [20.4%] vs 382 of 1161 [32.9%]), and more likely to have hypertension (2134 of 3989 [53.5%] vs 611 of 1336 [45.7%]), diabetes (1424 of 3989 [35.7%] vs 348 of 1336 [26.0%]), and physical limitations (2259 of 3989 [56.6%] vs 634 of 1336 [47.5%]). Compared with 2019, the odds of asystole increased in the COVID-19 period (odds ratio [OR], 3.50; 95% CI, 2.53-4.84; P < .001), as did the odds of pulseless electrical activity (OR, 1.99; 95% CI, 1.31-3.02; P = .001). Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (727 of 3989 patients [18.2%] vs 463 of 1336 patients [34.7%], P < .001) and sustained ROSC (423 of 3989 patients [10.6%] vs 337 of 1336 patients [25.2%], P < .001), with fatality rates exceeding 90%. These associations remained statistically significant after adjustment for potential confounders (OR for ROSC, 0.59 [95% CI, 0.50-0.70; P < .001]; OR for sustained ROSC, 0.53 [95% CI, 0.43-0.64; P < .001]). CONCLUSIONS AND RELEVANCEIn this population-based, cross-sectional study, out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly increased compared with the same period the previous year and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms. Identifying patients with the greatest risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should allow for early, targeted interventions in the outpatient setting that could lead to reductions in out-of-hospital deaths.

Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care

“…Casefatality rates have been between 4.5 and 15-fold higher 16 . Seattle/ King County (USA) and Padua (Italy) similarly reported no increase in OHCA incidence during the COVID-19 pandemic 5,6 but in Victoria, we demonstrated no increase in OHCA incidence, low COVID-19 incidence, and low COVID-19 case-fatality. Findings out of Padua also reported delays in key response time intervals (call-to-dispatch and dispatch-to-departure) 7 , however, the major delays we identified occurred after arrival at scene.…”

Diabetes and Covid-19 among hospitalized patients in Saudi Arabia: a single-centre retrospective study

“…In terms of predictors, preliminary evidence from 191 SARS-CoV2 infected patients in Wuhan showed that the most common factors associated with poor prognosis include advanced age, the presence of pre-existing conditions such as hypertension and diabetes mellitus (DM), as well as elevated inflammatory markers, amongst others [5]. These findings have been mostly consistent in other countries [6][7][8]. In KSA, the earliest national data (March, 2020) involving 1519 confirmed cases (mean age 36 years) also showed that the most common comorbidities were hypertension (8.8%) and DM (7.6%) [9].…”

“…5 King Saud University Medical City, Riyadh 12746, Saudi Arabia. 6 Obesity, Endocrine, and Metabolism Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia. 7 Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.…”

Cardiovascular Deaths During the COVID-19 Pandemic in the United States

“…At the same time, hospitalizations for acute cardiovascular conditions, including myocardial infarction, heart failure, and stroke, have declined precipitously ( 5 , 6 , 7 ). These patterns have raised concern that patients may be avoiding hospitals because of fear of contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and that some may have died of cardiovascular conditions without seeking medical care ( 8 , 9 ). Other factors, including the deferral of outpatient cardiovascular visits, diagnostic testing, and semi-elective procedures, as well as greater strain on health care systems, may also have unintended effects on higher-risk patients.…”