Impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation in adult out-of-hospital cardiac arrests in Singapore

Abstract

Objective: Fewer out-of-hospital cardiac arrest (OHCA) patients received bystander cardiopulmonary resuscitation during the COVID-19 pandemic in Singapore. We investigated the impact of COVID-19 on barriers to dispatcher-assisted cardiopulmonary resuscitation (DA-CPR).

Methods: We reviewed audio recordings of all calls to our national ambulance service call centre during the pandemic (January-June 2020) and pre-pandemic (January-June 2019) periods. Our primary outcome was the presence of barriers to DA-CPR. Multivariable logistic regression was used to assess the effect of COVID-19 on the likelihood of barriers to and performance of DA-CPR, adjusting for patient and event characteristics.

Results: There were 1241 and 1118 OHCA who were eligible for DA-CPR during the pandemic (median age 74 years, 61.6 % males) and pre-pandemic (median age 73 years, 61.1 % males) periods, respectively. Compared to pre-pandemic, there were more residential and witnessed OHCA during the pandemic (87 % vs 84.9 % and 54 % vs 38.1 %, respectively); rates of DA-CPR were unchanged (57.3 % vs 61.1 %). COVID-19 increased the likelihood of barriers to DA-CPR (aOR 1.47, 95 % CI: 1.25-1.74) but not performance of DA-CPR (aOR 0.86, 95 % CI: 0.73 - 1.02). Barriers such as 'patient status changed' and 'caller not with patient' increased during COVID-19 pandemic. 'Afraid to do CPR' markedly decreased during the pandemic; fear of COVID-19 transmission made up 0.5 % of the barriers.

Conclusion: Barriers to DA-CPR were encountered more frequently during the COVID-19 pandemic but did not affect callers' willingness to perform DA-CPR. Distancing measures led to more residential arrests with increases in certain barriers, highlighting opportunities for public education and intervention.

Keywords: Barriers; COVID-19; Dispatcher-assisted cardiopulmonary resuscitation; Out-of-hospital cardiac arrest.

Fig. 1

Flowchart of patient selection Patient selection during the pre-pandemic (January to June 2019) and pandemic (January to June 2020). Red boxes indicate the final study population. Abbreviations: OHCA, out-of-hospital cardiac arrest; BCPR, bystander cardiopulmonary resuscitation; EMS, Emergency Medical Services; DA-CPR, dispatcher-assisted cardiopulmonary resuscitation.

Fig. 2

Barriers to DA-CPR Figure 3 shows the distribution of specific barriers to DA-CPR that were significantly different between periods, where the denominator is the OHCA patients who experienced barriers to DA-CPR. Abbreviations: DA-CPR, dispatcher-assisted cardiopulmonary resuscitation; COVID-19, Coronavirus Disease 2019.