JMIR Publications

ABSTRACT

Background:

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival (CoS). Even after the end of the pandemic, the risk of new variants and surges persists.

Objective:

We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the pre-pandemic and pandemic periods using data from a nationwide multicenter registry.

Methods:

We conducted a multicenter prospective observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA across three distinct one-year periods: pre-pandemic (January 2019 to December 2019), early pandemic (July 2020 to June 2021), and late pandemic (July 2021 to June 2022). We extracted and contrasted the OHCA characteristics, pre-hospital time factors and outcomes for the patients across these three periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome (GNO).

Results:

A total of 9031 adult patients with OHCA were eligible for analysis (pre-pandemic, 2728; early pandemic, 2954; late pandemic, 3349). Witnessed arrest and arrest at home/residence were significantly more frequent during the pandemic period than during the pre-pandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm and pre-hospital endotracheal intubation decreased significantly. Cardiac arrest cognition upon emergency department arrival time increased sequentially (33 min vs. 35 min vs. 36 min; P < .001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (14.1% vs. 12.0% vs. 11.7%, P = .011). Additionally, none of the outcomes differed significantly between the early and late pandemic phases.

Conclusions:

During the pandemic, especially amidst community COVID-19 surges, the incidence of OHCA increased while survival rates and GNO at discharge decreased. Pre-hospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain CoS in the event of a new pandemic. Clinical Trial: The project was registered at ClinicalTrials.gov with the identifier NCT03222999.