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Review
. 2022 Dec:181:40-47.
doi: 10.1016/j.resuscitation.2022.10.012. Epub 2022 Oct 22.

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

Shir Lynn Lim  1 , Cherylyn Toh  2 , Stephanie Fook-Chong  3 , Muhammad Yazid  4 , Nur Shahidah  5 , Qin Xiang Ng  6 , Andrew Fw Ho  7 , Shalini Arulanandam  6 , Benjamin Sh Leong  8 , Alexander E White  9 , Marcus Eh Ong  10
Affiliations
Review

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

Shir Lynn Lim et al. Resuscitation. 2022 Dec.

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.

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Conflict of interest statement

Declaration of Competing Interest SL Lim is supported by National University Health System Clinician Scientist Program; she has received research grants from National University Health System, National Kidney Foundation of Singapore and Singapore Heart Foundation. MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient.” All other authors have no conflict of interest to disclose.

Figures

Fig. 1
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
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.
See this image and copyright information in PMC

References

    1. Merchant R.M., Topjian A.A., Panchal A.R., et al. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142:S337–S357. - PubMed
    1. Deakin C.D. The chain of survival: Not all links are equal. Resuscitation. 2018;126:80–82. - PubMed
    1. Blewer A.L., Ho A.F.W., Shahidah N., et al. Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study. Lancet Public Health. 2020;5:e428–e436. - PubMed
    1. Singapore Heart Foundation. Out-of-Hospital Cardiac Arrest Data Report 2018 Singapore. 2022. (Accessed 4 March 2022, at https://www.myheart.org.sg/heart-news/singapores-out-of-hospital-cardiac...).
    1. Marijon E., Karam N., Jost D., et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020;5:e437–e443. - PMC - PubMed

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