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. 2021 Jan;7(1):6-11.
doi: 10.1016/j.jacep.2020.08.010. Epub 2020 Aug 14.

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

Audrey Uy-Evanado  1 , Harpriya S Chugh  1 , Arayik Sargsyan  1 , Kotoka Nakamura  1 , Ronald Mariani  1 , Katy Hadduck  2 , Angelo Salvucci  2 , Jonathan Jui  3 , Sumeet S Chugh  1 , Kyndaron Reinier  4
Affiliations

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

Audrey Uy-Evanado et al. JACC Clin Electrophysiol. 2021 Jan.

Abstract

Objectives: The purpose of this study was to evaluate the potential impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) responses and outcomes in 2 U.S. 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 responses to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking.

Methods: Cases of OHCA in Multnomah County, Oregon, and Ventura County, California, with attempted resuscitation by emergency medical services (EMS) from March 1 to May 31, 2020, and from March 1 to May 31, 2019, were evaluated.

Results: In a comparison of 231 OHCA in 2019 to 278 in 2020, the proportion of cases receiving bystander cardiopulmonary resuscitation (CPR) was lower in 2020 (61% to 51%, respectively; p = 0.02), and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, respectively; p = 0.02). EMS response time increased (6.6 ± 2.0 min to 7.6 ± 3.0 min, respectively; p < 0.001), and fewer OHCA cases survived to hospital discharge (14.7% to 7.9%, respectively; p = 0.02). Incidence rates did not change significantly (p > 0.07), and coronavirus infection rates were low (Multnomah County, 143/100,000; Ventura County, 127/100,000 as of May 31) compared to rates of ∼1,600 to 3,000/100,000 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 infection, and point to potential opportunities for countering the impact.

Keywords: COVID-19; out-of-hospital cardiac arrest; resuscitation.

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Conflict of interest statement

Author Disclosures Dr. Chugh was funded by National Institutes of Health, National Heart Lung and Blood Institute (NHLBI) grants R01 HL147358 and R01 HL145675. Dr. Chugh holds the Pauline and Harold Price Chair in Cardiac Electrophysiology at Cedars-Sinai, Los Angeles. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
Impact of the COVID-19 Pandemic on EMS Response Time, Bystander CPR, and Survival to Hospital Discharge Among OHCA Cases In a comparison of the pre-pandemic (March 1 to May 31, 2019) and pandemic (March 1 to May 31, 2020) periods, the proportion of OHCA cases with EMS response ≥6 min (red line) increased from 57% in the pre-pandemic period to 71% in the pandemic period (p = 0.002). The proportion of OHCA with bystander CPR (gray line) decreased from 61% to 51% (p = 0.02). Survival to hospital discharge (blue area) decreased from 14.7% to 7.9% (p = 0.02). Error bars are 95% confidence intervals of proportions. CPR = cardiopulmonary resuscitation; EMS = emergency medical services; OHCA = out-of-hospital cardiac arrest.
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