Out-of-hospital cardiac arrest volumes and characteristics during the COVID-19 pandemic

Abstract

Aim The COVID-19 pandemic has significantly impacted Emergency Medical Services (EMS) operations throughout the country. Some studies described variation in total volume of out-of-hospital cardiac arrests (OHCA) during the pandemic. We aimed to describe the changes in volume and characteristics of OHCA patients and resuscitations in one urban EMS system. Methods We performed a retrospective cohort analysis of all recorded atraumatic OHCA in Marion County, Indiana, from January 1, 2019 to June 30, 2019 and from January 1, 2020 to June 30, 2020. We described patient, arrest, EMS response, and survival characteristics. We performed paired and unpaired t -tests to evaluate the changes in those characteristics during COVID-19 as compared to the prior year. Data were matched by month to control for seasonal variation. Results The total number of arrests increased from 884 in 2019 to 1034 in 2020 ( p = 0.016). Comparing 2019 to 2020, there was little difference in age [median 62 (IQR 59–73) and 60 (IQR 47–72), p = 0.086], gender (38.5% and 39.8% female, p = 0.7466, witness to arrest (44.3% and 39.6%, p = 0.092), bystander AED use (10.1% and 11.4% p = 0.379), bystander CPR (48.7% and 51.4%, p = 0.242). Patients with a shockable initial rhythm (19.2% and 15.4%, p = 0.044) both decreased in 2020, and response time increased by 18 s [6.0 min (IQR 4.5–7.7) and 6.3 min (IQR 4.7–8.0), p = 0.008]. 47.7% and 54.8% ( p = 0.001) of OHCA patients died in the field, 19.7% and 19.3% ( p = 0.809) died in the Emergency Department, 21.8% and 18.5% ( p = 0.044) died in the hospital, 10.8% and 7.4% ( p = 0.012) were discharged from the hospital, and 9.3% and 5.9% ( p = 0.005) were discharged with Cerebral Performance Category score ≤ 2. Conclusion Total OHCA increased during the COVID-19 pandemic when compared with the prior year. Although patient characteristics were similar, initial shockable rhythm, and proportion of patients who died in the hospital decreased during the pandemic. Further investigation will explore etiologies of those findings.

Observational, retrospective study evaluating the temporal variability of out-of-hospital cardiac arrests (OHCA) in the district of Bydgoszcz in a 24-month period

“…The last two years have unexpectedly brought another threat -related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. As reported by the latest registers from around the world, the incidence of OHCA increased significantly during the pandemic [32,[34][35][36][37][38][39]. Moreover, performed meta-analyzes demonstrated that not only the incidence but also mortality following OHCA were higher during the COVID-19 pandemic [32,33,40].…”

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

“…[47] Certain protocol revisions could have also contributed to the increase in intubation use, as these guidelines recommended the use of supraglottic airways over endotracheal intubation. [23] While the overload of healthcare systems is to be expected during a pandemic, this should not come at the cost of worsening outcomes for non-COVID illnesses including OHCA. More needs to be done to nd a balance in resource allocation when saving lives affected by COVID-19 or other non-COVID life-threatening diseases.…”

“…All studies achieved a score from seven to nine on the Newcastle-Ottawa Scale, signifying high quality and low risk of bias for selection (Supplemental [20,25] In contrast, Fothergill et al reported the highest percentage of patients with OHCA at home in both Pre-COVID-19 and COVID-19 time periods (85.5%, 92.9% respectively). [13] With the exception of four studies [12,[23][24][25], which showed a higher percentage of patients with OHCA at home before as compared to during the pandemic, a trend was observed where the percentage of patients with OHCA at home was higher in the COVID-19 period as compared to the pre-pandemic period (Table 2). Meta-analysis showed that the odds of patients undergoing OHCA at home was signi cantly higher in the COVID-19 period as compared to the Pre-COVID-19 period (OR = 1.38, 95% CI 1.11-1.71, p = 0.0069, I 2 = 90%) (Fig.…”

“…Seven studies accounted for the use of endotracheal intubation [9, 12, 18-20, 23, 28], while ve studies accounted for the use of supraglottic airway. [9,12,20,23,28] All relevant studies reported a higher percentage of endotracheal intubation use in the Pre-COVID-19 period as compared to in the COVID-19 period. In contrast, almost all studies (except Cho et al [12]) reported a higher percentage of supraglottic airway use in the COVID-19 period as compared to the Pre-COVID-19 period (Table 3).…”

Out-of-hospital cardiac arrest and COVID-19 pandemic

“…Data from the North East England Ambulance Service revealed that despite reduced incidence of emergency calls during the pandemic compared with 2019, there was a rise in the incidence of OHCA and OHCA deaths during the same period [3]. Also, Glober et al [4] observed increased OHCA incidence during the COVID-19 pandemic when compared with the prior year. Although patient characteristics were similar, initial shockable rhythm and proportion of patients who died in the hospital decreased during the pandemic.…”