Impact of the COVID-19 pandemic on cardiac arrest systems of care

Abstract

Purpose of review The emergence of severe acute respiratory syndrome coronavirus 2 virus, which causes coronavirus disease 2019 (COVID-19), led to the declaration of a global pandemic by the World Health Organization on March 11, 2020. As of February 6, 2021, over 105 million persons have been infected in 223 countries and there have been 2,290,488 deaths. As a result, emergency medical services and hospital systems have undergone unprecedented healthcare delivery reconfigurations. Here, we review the effects of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) epidemiology and systems of care. Recent findings Areas severely affected by the pandemic have reported increased incidence of OHCA, lower rates of successful resuscitation, and increased mortality. COVID-19 has significantly impacted patient outcomes through increased disease severity, decreased access to care, and the reshaping of emergency medical response and hospital-based healthcare systems and policies. The pandemic has negatively influenced attitudes toward resuscitation and challenged providers with novel ethical dilemmas provoked by the scarcity of healthcare resources. Summary The COVID-19 pandemic has had direct, indirect, psychosocial, and ethical impacts on the cardiac arrest chain of survival.

An evidence-based perspective on Lower Urinary Tract Symptoms and telemedicine during the COVID-19 pandemic

“…Social distancing forced changes in the delivery of care in outpatient services so as to balance provision against while minimising risk of viral transmission to patients and health care professionals [ 2 ]. In these circumstances there is always a risk that what are perceived to be less pressing needs, such as the treatment of lower urinary tract symptoms (LUTS) and incontinence may be subordinated to more concerning problems such as cardiac disease with a COVID-19 diagnosis [ 3 ] or cancer treatment with adverse COVID-19 symptoms [ 4 ], as well as pre-existing respiratory diseases such as COPD in addition to COVID-19 [ 5 ]. This may affect patients and staff alike who will tend to weigh risk against need so that those with chronic diseases are not disadvantaged.…”

Impact of Different Waves of COVID-19 on Emergency Medical Services and Out-of-hospital Cardiopulmonary Arrest in Madrid, Spain

“…In some regions, where the calls decreased, activations often have decreased as well. 9,20 In other places, however, despite an increased number of calls, resource dispatches decreased 10 or remained the same, as in Madrid, 30 with a similar pattern occurring during subsequent waves. One possible inference is that at times of high call volume, the various call handling systems signi cantly in uenced how both resource dispatch and response time were handled, as Penverne et al demonstrated.…”

Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis

“…This prehospital component of the “chain of survival” involves timely and seamless bystander cardiopulmonary resuscitation (BCPR), the use of automated external defibrillators (AED), as well as treatment by emergency medical services (EMS). However, the unprecedented coronavirus disease 2019 (COVID-19) pandemic had a poorly understood impact on EMS resources and was believed to have disrupted the prehospital “chain of survival” particularly layperson or bystander response 3 , 4 . There is tremendous scientific and public health interest in how community and EMS-related processes were altered since these confer larger survival impact relative to advanced hospital-based interventions, and the benefits of the latter are confined to those who had received timely prehospital interventions 5 .…”