Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic

Quick Takes

  • During the first 3 months of the COVID-19 pandemic, EMS response times for OHCA were longer, bystander CPR and AED use decreased, and survival to hospital discharge for OHCA declined, compared to the same period the year prior in two communities (Multnomah County, OR and Ventura County, CA).
  • Incidence of OHCA also increased, but this change did not reach statistical significance.
  • There is a need to optimize community and EMS response during the ongoing pandemic and future outbreaks to improve survival after cardiac arrest.

Study Questions:

What is the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) response and outcomes in two US communities with relatively low infection rates?

Methods:

The investigators evaluated OHCA in Multnomah County, OR and Ventura County, CA, with attempted resuscitation by EMS from March 1–May 31, 2020 and March 1–May 31, 2019. OHCA was adjudicated based on detailed review of the emergency medical services (EMS) prehospital care report and defined as a sudden, circulatory collapse of likely cardiac etiology requiring cardiopulmonary resuscitation (CPR) and/or defibrillation, not due to trauma or overdose. Three-month incidence rates and 95% confidence intervals were calculated for each county for each year using cases from March 1–May 31 in the numerator and the US Census county population estimate for July 1, 2019 in the denominator.

Results:

Comparing 231 OHCAs in 2019 to 278 in 2020, the proportion receiving bystander CPR was lower in 2020 (61% to 51%, p = 0.02) and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, p = 0.02). EMS response time increased (6.6 ± 2.0 to 7.6 ± 3.0 minutes, p < 0.001), and fewer OHCAs survived to hospital discharge (14.7% to 7.9%, p = 0.02). Incidence rates did not change significantly (p > 0.07), and coronavirus infection rates were low (Multnomah 143/100,000, Ventura 127/100,000 as of May 31), compared to rates of ~1,600–3,000/100,000 in the New York City region at that time.

Conclusions:

The authors concluded that 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.

Perspective:

This study reports that during the first 3 months of the COVID-19 pandemic, EMS response times for OHCA were longer, bystander CPR and AED use decreased, and survival to hospital discharge for OHCA declined, compared to the same period the year prior in two communities (Multnomah County, OR and Ventura County, CA). Incidence of OHCA also increased, but this change did not reach statistical significance. These data suggest that pandemics may have significant effects on survival from OHCA, even in areas with relatively low COVID-19 incidence, and there is a need to optimize community and EMS response during the ongoing pandemic and future outbreaks to improve survival.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Coronavirus, Coronavirus Infections, COVID-19, Defibrillators, Emergency Medical Services, Heart Arrest, Out-of-Hospital Cardiac Arrest, Patient Discharge, Reaction Time, Secondary Prevention, severe acute respiratory syndrome coronavirus 2


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