Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest

Sayre, Michael R.; Barnard, Leslie M.; Counts, Catherine R.; Drucker, Christopher; Kudenchuk, Peter J.; Rea, Thomas D.; Eisenberg, Mickey S.

doi:10.1161/circulationaha.120.048951

Cited by 74 publications

(63 citation statements)

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“… 6 Similar patterns were reported in New York City 8 and in Paris 7 where OHCAs doubled and decreased towards non-pandemic levels in parallel with COVID-19 hospital admissions. On the contrary, other studies in Northern Italy 9 and in Seattle, USA, 10 did not observe an increased incidence and this might be related to the prevalence of COVID-19 in the communities.…”

Section: Discussionmentioning

confidence: 57%

“…1-2). OHCAs during the COVID-19 pandemic were more likely to occur at home in Italy (90% during the pandemic vs. 83% in the non-pandemic period; P = 0.005) 6 and France (90% vs. 77%; P < 0.001) 7 while in the other studies were similar 9 , 10 , 23 (Supplemental Fig. 3).…”

Section: Resultsmentioning

confidence: 74%

“…4 A). Proportion of cases where pre-hospital resuscitation manoeuvres were initiated by EMS providers was significantly reduced during the pandemic in one study conducted in Italy (39% vs. 53%; P = 0.048) and in France (53% vs. 66%, P < 0.001) while two further studies reported a non-statistically significant reduction in EMS-initiated resuscitations 6 , 10 ( Fig. 4 B).…”

Section: Resultsmentioning

confidence: 95%

“…SARS-CoV-2 positive patients among OHCAs were 3.9%, 4.3%, 4.8%, and 5.9% in Italy, South Korea, France, and USA, respectively. 6 , 7 , 10 , 23 COVID-like symptoms such as fever associated with cough or dyspnoea were documented in 26%, 18%, 8.1%, and 4.8% of patients with OHCA during the pandemic, respectively. 6 , 7 , 10 , 23 …”

Section: Resultsmentioning

confidence: 99%

“…We found a non-negligible prevalence of COVID-19 among OHCAs: 3.9-5.9% of tested patients were SARS-CoV-2 positive and 4.8-26% had suggestive symptoms (fever and cough or dyspnoea). 6 , 7 , 10 , 23 As highlighted by the International Liaison Committee on Resuscitation, bystanders are likely to already be exposed to COVID-19 when a cardiac arrest occurs at home if the victim was infected. 28 Public campaigns promoting the safety of chest-compression only CPR compared to certain death if resuscitation is not performed might reduce some reluctance among laypeople.…”

Section: Discussionmentioning

confidence: 99%

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Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

et al. 2020

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Introduction In addition to the directly attributed mortality, COVID-19 is also likely to increase mortality indirectly. In this systematic review, we investigate the direct and indirect effects of COVID-19 on out-of-hospital cardiac arrests. Methods We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled Trials for studies comparing out-of-hospital cardiac arrests occurring during the pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool. The primary endpoint was return of spontaneous circulation. Secondary endpoints were bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge, and survival with favourable neurological outcome. Results We identified six studies. In two studies, rates of return of spontaneous circulation and survival to hospital discharge decreased significantly during the pandemic. Especially in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation and resuscitation attempted by emergency medical services were reduced during the pandemic. Also, ambulance response times were significantly delayed across all studies and patients presenting with non-shockable rhythms increased in two studies. In 2020, 3.9-5.9% of tested patients were SARS-CoV-2 positive and 4.8-26% had suggestive symptoms (fever and cough or dyspnoea). Conclusions Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect effects from lockdown and disruption of healthcare systems. Patients at high risk of deterioration should be identified outside the hospital to promptly initiate treatment and reduce fatalities. Study registration PROSPERO CRD42020195794.

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Section: Discussionmentioning

confidence: 57%

Section: Resultsmentioning

confidence: 74%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

et al. 2020

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Acute SARS-CoV-2 Infection and Incidence and Outcomes of Out-of-Hospital Cardiac Arrest

Liu,

Counts,

Drucker

et al. 2023

JAMA Netw Open

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ImportanceLittle is known about how COVID-19 affects the incidence or outcomes of out-of-hospital cardiac arrest (OHCA), and it is possible that more generalized factors beyond SARS-CoV-2 infection are primarily responsible for changes in OHCA incidence and outcome.ObjectiveTo assess whether COVID-19 is associated with OHCA incidence and outcomes.Design, Setting, and ParticipantsThis retrospective cohort study was conducted in Seattle and King County, Washington. Participants included persons aged 18 years or older with nontraumatic OHCA attended by emergency medical services (EMS) between January 1, 2018, and December 31, 2021. Data analysis was performed from November 2022 to March 2023.ExposuresPrepandemic (2018-2019) and pandemic (2020-2021) periods and SARS-CoV-2 infection.Main Outcomes and MeasuresThe primary outcomes were OHCA incidence and patient outcomes (ie, survival to hospital discharge). Mediation analysis was used to determine the percentage change in OHCA incidence and outcomes between prepandemic and pandemic periods that was attributable to acute SARS-CoV-2 infection vs conventional Utstein elements related to OHCA circumstances (ie, witness status and OHCA location) and resuscitation care (ie, bystander cardiopulmonary resuscitation, early defibrillation, and EMS response intervals).ResultsThere were a total of 13 081 patients with OHCA (7102 dead upon EMS arrival and 5979 EMS treated). Among EMS-treated patients, the median (IQR) age was 64.0 (51.0-75.0) years, 3864 (64.6%) were male, and 1027 (17.2%) survived to hospital discharge. The total number of patients with OHCA increased by 19.0% (from 5963 in the prepandemic period to 7118 in the pandemic period), corresponding to an incidence increase from 168.8 to 195.3 events per 100 000 person-years. Of EMS-treated patients with OHCA during the pandemic period, 194 (6.2%) were acutely infected with SARS-CoV-2 compared with 7 of 191 EMS-attended but untreated patients with OHCA (3.7%). In time-series correlation analysis, there was a positive correlation between community SARS-CoV-2 incidence and overall OHCA incidence (r = 0.27; P = .01), as well as OHCA incidence with acute SARS-CoV-2 infection (r = 0.43; P &lt; .001). The survival rate during the pandemic period was lower than that in the prepandemic period (483 patients [15.4%] vs 544 patients [19.2%]). During the pandemic, those with OHCA and acute SARS-CoV-2 infection had lower likelihood of survival compared with those without acute infection (12 patients [6.2%] vs 471 patients [16.0%]). SARS-CoV-2 infection itself accounted for 18.5% of the pandemic survival decline, whereas Utstein elements mediated 68.2% of the survival decline.Conclusions and RelevanceIn this cohort study of COVID-19 and OHCA, a substantial proportion of the higher OHCA incidence and lower survival during the pandemic was not directly due to SARS-CoV-2 infection but indirect factors that challenged OHCA prevention and treatment.

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