Influence of the Covid-19 pandemic on out-of-hospital cardiac arrest. A Spanish nationwide prospective cohort study

Abstract

Aims: The influence of the COVID-19 pandemic on attendance to out-of-hospital cardiac arrest (OHCA) has only been described in city or regional settings. The impact of COVID-19 across an entire country with a high infection rate is yet to be explored.

Methods: The study uses data from 8629 cases recorded in two time-series (2017/2018 and 2020) of the Spanish national registry. Data from a non-COVID-19 period and the COVID-19 period (February 1st-April 30th 2020) were compared. During the COVID-19 period, data a further analysis comparing non-pandemic and pandemic weeks (defined according to the WHO declaration on March 11th, 2020) was conducted. The chi-squared analysis examined differences in OHCA attendance and other patient and resuscitation characteristics. Multivariate logistic regression examined survival likelihood to hospital admission and discharge. The multilevel analysis examined the differential effects of regional COVID-19 incidence on these same outcomes.

Results: During the COVID-19 period, the incidence of resuscitation attempts declined and survival to hospital admission (OR = 1.72; 95%CI = 1.46-2.04; p < 0.001) and discharge (OR = 1.38; 95%CI = 1.07-1.78; p = 0.013) fell compared to the non-COVID period. This pattern was also observed when comparing non-pandemic weeks and pandemic weeks. COVID-19 incidence impinged significantly upon outcomes regardless of regional variation, with low, medium, and high incidence regions equally affected.

Conclusions: The pandemic, irrespective of its incidence, seems to have particularly impeded the pre-hospital phase of OHCA care. Present findings call for the need to adapt out-of-hospital care for periods of serious infection risk.

Study registration number: ISRCTN10437835.

Keywords: Covid 19; Emergency services; Out-of hospital cardiac arrest; Survival.

Fig. 1

Participant flow diagram. All cases included in the study were registered in the OHSCAR database in one of two time-series (April 1st 2017 to March 31st 2020 or February 1st 2020 to April 31st 2020). Non-COVID-19 period data includes cases collected between February 1st and April 31st from the 2017/2018 time-series. COVID-19 period data includes all data collected from the 2020 time-series.

Fig. 2

Average number of weekly resuscitation attempts in a non-COVID-19 period (NCovP) and the COVID-19 period (CovP), and daily COVID-19 incidence. Data collected between February the 1st and April the 30th. Solid lines and area (COVID-19 incidence) present 2 week moving average. Dashed lines present raw data.

Fig. 3

Weekly trends in resuscitation attempts (A), survival to hospital admission (B) and hospital discharge (C) in a non-COVID-19 period (NCovP) and the COVID-19 period (CovP) between February the 1st and April the 30th. In A there is a significant (p = 0.036) change in trend for the CovP at week 4. Solid lines represent trends. Dots represent raw data.

Fig. 4

Average resuscitation attempts (A), survival to hospital admission (B) and survival to hospital discharge (C) during pandemic weeks (PW) and non-pandemic weeks (NPW) of 2020, stratified according to autonomous community grouped according to COVID-19 incidence (low/medium/high).