Impact of the COVID-19 pandemic on emergency medical service response to out-of-hospital cardiac arrests in Taiwan: a retrospective observational study

Abstract

BackgroundEmergency medical service (EMS) personnel have high COVID-19 risk during resuscitation. The resuscitation protocol for patients with out-of-hospital cardiac arrest (OHCA) was modified in response to the COVID-19 pandemic. However, how the adjustments in the EMS system affected patients with OHCA remains unclear.MethodsWe analysed data from the Taichung OHCA registry system. We compared OHCA outcomes and rescue records for 622 cases during the COVID-19 outbreak period (1 February to 30 April 2020) with those recorded for 570 cases during the same period in 2019.ResultsThe two periods did not differ significantly with respect to patient age, patient sex, the presence of witnesses or OHCA location. Bystander cardiopulmonary resuscitation and defibrillation with automated external defibrillators were more common in 2020 (52.81% vs 65.76%, p<0.001%, and 23.51% vs 31.67%, p=0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (445.8±210.2 s in 2020 vs 389.7±201.8 s in 2019, p<0.001). The rate of prehospital return of spontaneous circulation was lower in 2020 (6.49% vs 2.57%, p=0.001); 2019 and 2020 had similar rates of survival discharge (5.96% vs 4.98%). However, significantly fewer cases had favourable neurological function in 2020 (4.21% vs 2.09%, p=0.035).ConclusionEMS response time for patients with OHCA was prolonged during the COVID-19 pandemic. Early advanced life support by EMS personnel remains crucial for patients with OHCA.

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

“…A flow diagram showing stages of database search and study selection is shown in Figure 1. Twenty-seven studies reported OHCA outcomes in pre-vs. intra-COVID-19 periods [23,24,[26][27][28][29]31,33,35,[37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53], and OHCA outcomes in SARS-CoV-2-positive vs. -negative patients were reported in seven trials [25,30,32,34,36,43,51]. Characteristics of the individual studies are presented in Tables S1 and S2.…”

“…The Cochrane risk of bias of the included studies is shown in Figures S1 and S2. The overall risk of bias was judged as low in twenty-nine studies [23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][48][49][50][51][52][53], and reviewers indicate some concerns on the other two [33,47].…”

“…Six studies [31,38,44,48,53] reported prehospital ROSC in pre-COVID-19 and COVID-19 periods with a variance of 12.3% vs. 8.9% (OR = 1.40; 95%CI: 1.06 to 1.87; p < 0.001; Figure 4), respectively. Pooled analysis of resuscitation outcomes are presented in Table 1.…”

“…Six studies [31,38,44,48,53] reported prehospital ROSC in pre-COVID-19 and COVID-19 periods with a variance of 12.3% vs. 8.9% (OR = 1.40; 95%CI: 1.06 to 1.87; p < 0.001; Figure 4), respectively. Survival to hospital admission with spontaneous circulation was reported in 12 studies and was significantly higher in the pre-COVID-19 period compared to the COVID-19 period (28.4% vs. 19.3%, respectively; OR = 1.76; 95%CI: 1.44 to 2.14; p < 0.001; Figure 5).…”

Variation in Community and Ambulance Care Processes for Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…Additionally, a centralized public EMS system may improve coordination between different stakeholders during the COVID-19 pandemic and reduce OHCA mortality rates. [50,51] However, more investigation is needed in this eld. Further research is also needed to investigate measures for minimizing COVID-19 transmission during resuscitation, such as supraglottic airway use and mechanical CPR, as well as the barriers to implementing them during the pandemic.…”