Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Abstract

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.

Impact of the COVID-19 pandemic on prehospital and in-hospital treatment and outcomes of patients after out-of-hospital cardiac arrest: a Japanese multicenter cohort study

“…We showed that duration of EMS rescue has become longer in the post-pandemic time compared with before the COVID-19 pandemic, which may have been related to the increasing mortality. The same trend has been reported in other countries [ 3 , 4 , 15 – 17 ]. Previous studies reported that the burden of infection during the COVID-19 pandemic affected EMS systems and delayed arrival and response times for all cases, including OHCA [ 18 , 19 ].…”

“…Finally, we performed multivariable regression analysis adjusting for the variables that were independently associated with death in OHCA patients, in accordance with the previous studies, and for within-hospital clustering using the generalized estimation equation. The variables were as follows: pre- or post-pandemic period, age, sex, witnessed status, bystander CPR, initial rhythm, location of arrest, and EMS time from to call to hospital [ 4 , 5 , 14 ]. The statistical significance threshold was p < 0.05.…”

Spatiotemporal Analysis of Out-of-Hospital Cardiac Arrest Incidence and Survival Outcomes in Korea (2009–2021)

“…2 ), which is consistent with prior studies suggesting a worsening of OHCA outcomes during the coronavirus disease 2019 (COVID-19) pandemic. 42 43 However, to comprehensively assess the impact of COVID-19, ongoing and systematic long-term epidemiological descriptive studies are essential. Through such studies, we can better understand whether survival outcomes will improve or challenges would continue to occur in the extended aftermath of the pandemic.…”

Recent status of sudden cardiac arrests in emergency medical facilities: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022

“…First, the trend could be related to a comparative study of in-hospital mortality before and after 2020, a year when COVID-19 produced a higher in-hospital mortality rate among patients seeking ED care [3]. Additionally, there have been reports of a decrease in return of spontaneous circulation rate prior to hospital arrival during this period [4]. Through this, we can estimate that the in-hospital mortality rate of cardiac arrest patients due to COVID-19 peaked in 2021 and subsequently decreased.…”

“…The number of sudden cardiac arrest cases in Korea increased by approximately 1.6 times over an 11-year period, from 19,480 cases in 2006 to 30,782 cases in 2019 [1]. While several studies have been conducted on the prognosis of cardiac arrest patients during the 2019 COVID-19 pandemic [2][3][4][5][6], there have been no reports on mortality rates based on acute cardiac arrest presenting to the emergency department (ED). The purpose of this commentary is to introduce the current status of sudden cardiac arrest presenting to the ED (out-of-hospital cardiac arrest [OHCA] and in-hospital cardiac arrest [IHCA]) from 2018 to 2022, and to discuss the appropriate direction for future allocation of ED medical resources through comparison with data of emergency medical services system (EMSS) in Korea [6].…”