Out-of-Hospital Cardiac Arrest Response and Outcomes During the COVID-19 Pandemic

Abstract

Objectives To evaluate the potential impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) response and outcomes in two US communities with relatively low infection rates. Background Studies in areas with high COVID-19 infection rates indicate that the pandemic has had direct and indirect effects on community response to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking. Methods In Multnomah County, OR and Ventura County, CA, we evaluated OHCA with attempted resuscitation by EMS from March 1 – May 31, 2020 and March 1 – May 31, 2019. Results Comparing 231 OHCA in 2019 to 278 in 2020, the proportion receiving bystander CPR was lower in 2020 (61% to 51%, p=0.02) and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, p=0.02). EMS response time increased (6.6 ± 2.0 to 7.6 ± 3.0 minutes, p<0.001), and fewer OHCA survived to hospital discharge (14.7% to 7.9%, p=0.02). Incidences rates did not change significantly (p>0.07), and coronavirus infection rates were low (Multnomah 143/100,000, Ventura 127/100,000 as of May 31), compared to rates of ∼1600-3000/100,000 in the New York City region at that time. Conclusions The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA. These results highlight the pandemic’s indirect negative impact on OHCA even in communities with relatively low incidence of COVID-19 and point to potential opportunities for countering the impact.

Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic

“…Similar patterns of increased OHCA incidence during COVID-19 have been reported from the USA, Paris, and Lombardia. 5 , 6 , 7 , 8 , 9 Taken together with the observation that a quarter of our OHCA patients either had, or were clinically suspected to have, COVID-19 our findings strongly support a link between COVID-19 and the occurrence of OHCA. Whether such a link is the direct result of the pathophysiology of the disease, or more widely related to indirect factors, such as a reluctance to access medical assistance for conditions pre-empting cardiac arrest, changes to healthcare provision and infrastructure, or even the societal restrictions that accompanied the pandemic, remains to be ascertained.…”

“…While the current literature provides a mixed picture regarding resuscitation rates and ROSC, five of the six studies published to date that have measured survival to hospital discharge, have reported decreases during COVID-19. 6 , 7 , 9 , 10 , 12…”

“…Globally, there is an emerging potential link between the COVID-19 pandemic and incidence and outcomes from out of hospital cardiac arrest (OHCA). Whilst two recent studies found no differences, 3 , 4 data from the Lombardia Region of Northwest Italy, 5 , 6 Paris, 7 New York City, 8 and two counties in the Western States of the USA 9 all reported increased incidence of OHCA along with local rises in COVID-19 infections, and poorer outcomes for patients sustaining OHCA during the pandemic. A significant increase in mortality was also observed in Victoria, Austrailia, 10 although no difference in OHCA incidence was reported.…”

“…A significant increase in mortality was also observed in Victoria, Austrailia, 10 although no difference in OHCA incidence was reported. Increased Emergency Medical Service (EMS) response times, 5 , 6 , 7 , 9 , 10 , 11 , 12 fewer resuscitations, 7 , 10 , 11 , 12 fewer shockable rhythms 6 , 7 , 8 and lower rates of bystander CPR 5 , 6 , 7 , 9 , 12 are some of the characteristics of OHCA during the pandemic that are being reported. There is growing concern that these findings represent both direct and indirect impacts of the pandemic, with indirect influences potentially relating to healthcare system reorganisation, the reluctance of individuals to access healthcare, and an unwillingness of bystanders to render aid due to the fear of virus transmission.…”

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

“…In addition, the incidence out-of-hospital cardiac arrests has increased during the pandemic and cannot be entirely explained by COVID-19 ( 8 , 15 ). Recent evidence indicate that delays in emergency medical service response times and a reduction in bystander cardiopulmonary resuscitation rates have likely contributed to reduced survival after cardiac arrest ( 16 ). In contrast, we observed no increase in deaths caused by other cardiovascular conditions, such as heart failure, possibly because they often do not require emergent hospitalization for potentially life-saving treatment.…”