Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand

Abstract

Background The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand. Methods This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January–September 2019) and during the outbreak (January–September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared. Results The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68–1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49–1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2–9.3] min vs 10 [6–14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak. Conclusion There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.

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

“…While guidelines do not suggest avoiding intubation, some regions had protocols that prioritized the use of supraglottal airway devices ( 34 , 51 , 67 ). Rapid transport without intubation has also been recommended in some studies ( 73 ). The risk of infection during intubation may not be significantly higher when wearing personal protective equipment, but endotracheal intubation may have been avoided at front-line rescue sites due to a lack of studies on the risk of infection during intubation in the early stages of the pandemic.…”

“…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 ).…”

Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest

“…Thus, another convincing explanation for decreasing the number of STEMI might be a higher incidence of fatal sudden cardiac arrest before hospital admission compared to the pre-pandemic era. Importantly, such disturbing outcomes were noted irrespective of the geographical location and in low-and high-income countries with well-developed healthcare systems [7,9,26,[29][30][31]. Furthermore, alarming data suggested a decrease in bystander CPR, utilization of AED, and a higher rate of non-shockable rhythms [1,7,9].…”

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

“…This finding aligns with those of most previous studies [11][12][13], but a different trend has been reported in some Asian populations. For instance, Riyapan et al [14] reported no significant change in the occurrence of OHCA in public places in Thailand before and during the pandemic. Watanabe et al [15] also reported no decrease in the occurrence of OHCA in public places.…”