CPR success, survival to discharge in out-of-hospital cardiac arrest dropped amid COVID-19
Rates of return of spontaneous circulation and survival to discharge for out-of-hospital cardiac arrest declined in the U.S. early during the COVID-19 pandemic compared with the previous year, researchers reported.
These findings were consistent throughout the U.S, even in counties with low rates of COVID-19 deaths, according to the study presented at the virtual American Heart Association Scientific Sessions.
“It [was] unclear what the effects of the COVID-19 pandemic on out-of-hospital cardiac arrest outcomes have been in communities that were not as severely affected, with low and moderate COVID-19 disease burden,” Paul Chan, MD, MSc, clinical scholar at Saint Luke’s Mid America Heart Institute and professor of medicine at the University of Missouri-Kansas City, said during his presentation. “Moreover, initial reports only reported on rates of sustained return of spontaneous circulation, and rates of overall rates of survival to discharge remained unknown.”
This study was simultaneously published in JAMA Cardiology.
Researchers utilized the Cardiac Arrest Registry to Enhance Survival (CARES) to identify 52,186 out-of-hospital cardiac arrests that occurred from January to April in 2019 and 2020. The 2020 events were categorized as pre-pandemic (January-February), peri-pandemic (March 1-15) and pandemic (March 16-April). County-level COVID-19 deaths were categorized per 1 million residents, as very low (0-25), low (26-100), moderate (101-250), high (251-500) or very high (> 500).
The primary outcome was sustained return of spontaneous circulation for 20 minutes or more. Secondary outcomes included in-field termination of CPR, survival to discharge and incidence of out-of-hospital cardiac arrest.
Outcomes worse in 2020 vs. 2019
The rate of sustained return of spontaneous circulation after adjustment for demographics and CV risk factors was lower during the pandemic period in 2020 compared with 2019 (23% vs. 29.8%; adjusted RR = 0.82; 95% CI, 0.78-0.87; P < .001).
The rate of sustained return of spontaneous circulation was lower in communities with high (RR = 0.79; 95% CI, 0.63-0.97; P = .03) and very high (RR = 0.67; 95% CI, 0.56-0.8; P < .001) COVID-19 mortality compared with 2019. Rates also declined in counties with low (RR = 0.85; 95% CI, 0.78-0.93; P < .001) and very low (RR = 0.89; 95% CI, 0.81-0.98; P = .01) COVID-19 mortality, according to the results.
Survival to discharge was 6.6% during the pandemic compared with 9.8% in 2019 (aRR = 0.83; 95% CI, 0.69-1; P = .048). Lower survival to discharge was primarily observed in communities with moderate to very high COVID-19 mortality, the researchers reported.
“We examined sustained return of spontaneous circulation and survival to discharge for those two periods and found essentially that there was no difference in these two outcomes, confirming that the findings that we saw in the pandemic period was likely limited to the COVID-19 experience,” Chan said.
Other findings
In other results, the rate of termination of resuscitation was higher in 2020 compared with 2019 (53.9% vs. 40%; aRR = 1.27; 95% CI, 1.23-1.33; P < .001). This finding was similar in all counties, regardless of COVID-19 mortality (P for all < .001).
The incidence of out-of-hospital cardiac arrest in 2020 was higher than in 2019, largely in counties with high COVID-19 mortality (RR for high mortality = 1.52; 95% CI, 1.5-1.54; P < .001; RR for very high mortality = 1.52; 95% CI, 1.48-1.55; P < .001).
“During the early weeks of the COVID 19 pandemic, rates of sustained return of spontaneous circulation and survival discharge decreased,” Chan said. “Lower rates were seen not only in communities heavily affected by COVID-19, but also in communities with low and moderate COVID-19 mortality. Our outcomes were not explained by differences in EMS arrival and treatment times, rates of bystander CPR, or the initial rhythm, as these were adjusted for in our models.”
Reference:
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Chan PS, et al. Late-breaking resuscitation science. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).