| Literature DB >> 33049385 |
Fernando Rosell Ortiz1, Patricia Fernández Del Valle2, Emily C Knox3, Xavier Jiménez Fábrega4, José M Navalpotro Pascual5, Inmaculada Mateo Rodríguez6, José I Ruiz Azpiazu7, José A Iglesias Vázquez8, Alfredo Echarri Sucunza9, Daniel F Alonso Moreno10, Ana B Forner Canos11, María J García-Ochoa Blanco12, Nuria López Cabeza13, Belén Mainar Gómez14, Susana Batres Gómez15, José A Cortés Ramas16, María I Ceniceros Rozalén17, Francisco A Guirao Salas18, Begoña Fernández Martínez19, Antonio Daponte Codina20.
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.Entities:
Keywords: Covid 19; Emergency services; Out-of hospital cardiac arrest; Survival
Year: 2020 PMID: 33049385 PMCID: PMC7547318 DOI: 10.1016/j.resuscitation.2020.09.037
Source DB: PubMed Journal: Resuscitation ISSN: 0300-9572 Impact factor: 5.262
Fig. 1Participant 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. 2Average 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. 3Weekly 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.
Resuscitation characteristics compared between a non-COVID-19 period (2017/2018) and the COVID-19 period (2020), and non-pandemic weeks (pre-COVID-19 period/COVID-19 period February the 1st to March the 10th) and pandemic weeks (COVID-19 period March 11th to April 30th). Data collected between February the 1st and April the 30th.
| Time period | Type of weeks (data collected between February 1st and April 30th) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total | non-COVID-19 (2017/2018) | Missing | COVID-19 (2020) | Missing | p-value | Non-pandemic weeks (NPW) | Missing | Pandemic weeks (PW) | Missing | p-value | |
| All resuscitations, N (%) | 3169 (100.0) | 1723 (54.4) | 1446 (45.6) | 1652 (0.50 | 623 (0.30 | ||||||
| Female, N (%) | 931 (29.4) | 513 (29.8) | 2 (0.1) | 418 (28.9) | 1 (0.1) | 0.588 | 479 (29.0) | 0 (0.0) | 190 (30.5) | 1 (0.2) | 0.469 |
| Age (years), mean (SD) | 65.04 (16.7) | 65.61 (16.9) | 5 (0.3) | 64.36 (16.5) | 4 (0.3) | 65.40 (17.3) | 4 (0.2) | 63.73 (15.5) | 2 (0.4) | ||
| Aged 14 and under | 43 (1.4) | 22 (1.3) | 5 (0.3) | 21 (1.5) | 4 (0.3) | 0.671 | 26 (1.6) | 4 (0.2) | 8 (1.3) | 2 (0.4) | 0.613 |
| Aged 75 and over | 1023 (32.4) | 588 (34.2) | 5 (0.3) | 435 (30.32) | 4 (0.3) | 569 (34.5) | 4 (0.2) | 156 (25.1) | 2 (0.4) | ||
| OHCA at home, N (%) | 2030 (64.2) | 1042 (60.8) | 9 (0.5) | 988 (68.3) | 0 (0.0) | 1003 (60.9) | 6 (0.4) | 478 (76.7) | 0 (0.0) | ||
| Witnessed OHCA, N (%) | 2468 (77.9) | 1331 (77.2) | 0 (0.0) | 1137 (78.6) | 0 (0.0) | 0.351 | 1291 (78.1) | 0 (0.0) | 493 (79.1) | 0 (0.0) | 0.610 |
| Bystander CPR performed, N (%) | 1326 (47.3) | 788 (51.1) | 0 (0.0) | 538 (42.6) | 0 (0.0) | 694 (46.9) | 0 (0.0) | 230 (42.8) | 0 (0.0) | 0.103 | |
| AED used, N (%) | 286 (10.2) | 173 (11.2) | 0 (0.0) | 113 (9.0) | 5 (0.4) | 0.051 | 150 (10.2) | 3 (0.2) | 43 (8.0) | 2 (0.4) | 0.153 |
| Shockable initial rhythm, N (%) | 668 (21.9) | 386 (23.1) | 48 (3.1) | 282 (20.5) | 54 (4.3) | 0.083 | 347 (21.8) | 56 (3.8) | 118 (19.9) | 23 (4.3) | 0.334 |
| Airway isolation | 2638 (88.4) | 1441 (92.4) | 163 (9.5) | 1197 (84.1) | 23 (1.6) | 1392 (89.4) | 95 (5.8) | 500 (81.7) | 11 (2.0) | ||
| Orotracheal intubation | 2082 (78.9) | 1224 (84.9) | 163 (9.5) | 858 (71.7) | 23 (1.6) | 1139 (81.8) | 95 (5.8) | 320 (64.0) | 11 (2.0) | ||
| Supraglottic device | 271 (10.3) | 103 (7.1) | 163 (9.5) | 168 (14.0) | 23 (1.6) | 105 (7.5) | 95 (5.8) | 110 (22.0) | 11 (2.0) | ||
| Median call to arrival time, min (IQR) | 13.0 (9.0−20.0) | 12.0 (8.0−19.0) | 102 (6.6) | 14.0 (9.0−22.0) | 358 (28.3) | 13.0 (9.0−20.0) | 235 (15.9) | 15.0 (9.0−23.0) | 170 (31.7) | ||
| Ambulance arrived within 8 min | 535 (22.8) | 389 (27.0) | 102 (6.6) | 146 (16.1) | 358 (28.3) | 275 (22.1) | 235 (15.9) | 48 (13.1) | 170 (31.7) | ||
| Ambulance arrived within 15 min | 1451 (61.9) | 936 (65.0) | 102 (6.6) | 515 (56.9) | 358 (28.3) | 760 (61.1) | 235 (15.9) | 199 (54.2) | 170 (31.7) | ||
| Utstein subgroup | |||||||||||
| Witnessed by emergency services personnel (subgroup 1) | 365 (11.5) | 182 (10.6) | 0 (0.0) | 183 (12.7) | 0 (0.0) | 0.066 | 173 (10.5) | 0 (0.0) | 86 (13.8) | 0 (0.0) | |
| Shockable initial rhythm and bystander witnessed (subgroup 2a) | 514 (16.4) | 291 (17.0) | 12 (0.7) | 223 (15.7) | 28 (1.9) | 0.336 | 271 (16.7) | 25 (1.5) | 95 (15.5) | 11 (2.0) | 0.518 |
| Shockable initial rhythm and bystander CPR (subgroup 2b) | 363 (11.5) | 208 (12.1) | 5 (0.3) | 155 (10.8) | 28 (1.9) | 0.253 | 199 (12.1) | 20 (1.2) | 60 (9.7) | 11 (2.0) | 0.103 |
| Non-shockable initial rhythm and bystander witnessed (subgroup 2c) | 1549 (49.5) | 846 (49.4) | 12 (0.7) | 703 (49.6) | 26 (1.8) | 0.941 | 822 (50.5) | 22 (1.3) | 301 (49.2) | 12 (2.2) | 0.572 |
| Patients with ROSC admitted to hospital N (%) | 815 (27.6) | 525 (32.1) | 5 (0.3) | 290 (22.0) | 13 (0.9) | 441 (28.9) | 6 (1.5) | 107 (18.4) | 9 (0.5) | ||
| Patients with ongoing CPR admitted to hospital | 143 (4.5) | 38 (2.2) | 5 (0.3) | 105 (7.3) | 13 (0.9) | 87 (5.3) | 6 (1.5) | 37 (5.9) | 9 (0.5) | ||
| Donation in asystole | 53 (1.7) | 46 (2.6) | 5 (0.3) | 7 (0.5) | 13 (0.9) | 28 (1.7) | 6 (1.5) | 0 (0.0) | 9 (0.5) | ||
| In hospital treatment | |||||||||||
| Treatment with thrombolysis, N (%) | 13 (1.6) | 8 (1.5) | 0 (0.0) | 5 (1.7) | 0 (0.0) | 0.827 | 0 (0.0) | 0 (0.0) | 9 (2.0) | 0 (0.0) | 0.136 |
| Treatment with PCI, N (%) | 198 (24.3) | 119 (22.7) | 0 (0.0) | 79 (27.2) | 0 (0.0) | 0.145 | 28 (26.2) | 0 (0.0) | 102 (23.1) | 0 (0.0) | 0.507 |
| Treatment with ICD implant | 35 (4.3) | 24 (4.6) | 0 (0.0) | 11 (3.8) | 0 (0.0) | 0.600 | 4 (3.7) | 0 (0.0) | 18 (4.1) | 0 (0.0) | 0.871 |
| Treatment with TTM, N (%) | 56 (6.9) | 33 (6.3) | 0 (0.0) | 23 (7.9) | 0 (0.0) | 0.374 | 6 (5.6) | 0 (0.0) | 32 (7.3) | 0 (0.0) | 0.547 |
| Survival at hospital discharge | 276 (8.7) | 168 (9.8) | 0 (0.0) | 108 (7.5) | 0 (0.0) | 146 (8.8) | 0 (0.0) | 42 (6.7) | 0 (0.0) | 0.105 | |
Average weekly incidence of OHCA resuscitation attempts per 100,000 inhabitants.
Cases witnessed by emergency services personnel were excluded from this analysis.
Comparison of overall survival odds between a non-COVID-19 period (2017/2018) and the COVID-19 period (2020), and non-pandemic weeks (non-COVID-19 period/COVID-19 period February the 1st to March the 10th) and pandemic weeks (COVID-19 period March 11th to April 30th). Data is presented overall and stratified according to resuscitation characteristics. Data collected between February the 1st and April the 30th.
| Survival to hospital admission | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Non-COVID-19 period (NCovP) | COVID-19 period (CovP) | NCovP v CovP, OR (95%CI) | p-value | Non-pandemic weeks (PW) | Pandemic weeks (NPW) | NPW v PW, OR (95%CI) | p-value | ||
| All patients | 525/1634 (32.1) | 290/1321 (22.0) | 1.72 (1.46−2.04) | 441/1528 (28.9) | 107/580 (18.4) | 1.82 (1.44−2.32) | |||
| OHCA at home | Yes | 250/994 (25.2) | 164/915 (17.9) | 1.57 (1.26−1.97) | 204/936 (21.8) | 80/450 (17.8) | 1.33 (1.00−1.78) | 0.053 | |
| No | 274/632 (43.4) | 126/406 (31.0) | 1.70 (1.31−2.22) | 236/587 (40.2) | 27/130 (20.8) | 2.52 (1.59−3.97) | |||
| Witnessed OHCA | Yes | 453/1252 (36.2) | 261/1034 (25.2) | 1.73 (1.44−2.08) | 387/1186 (32.6) | 98/457 (21.4) | 1.82 (1.41−2.35) | ||
| No | 72/382 (18.8) | 29/287 (10.1) | 2.10 (1.32−3.34) | 54/342 (15.8) | 9/123 (7.3) | 2.35 (1.12−4.95) | |||
| Bystander CPR | Yes | 260/745 (34.9) | 133/497 (26.8) | 1.49 (1.16−1.91) | 204/643 (31.7) | 53/219 (24.2) | 1.47 (1.04−2.10) | ||
| No | 187/721 (25.9) | 125/682 (18.4) | 1.59 (1.23−2.06) | 180/743 (24.2) | 43/291 (14.8) | 1.85 (1.28−2.66) | |||
| AED used | Yes | 59/166 (35.5) | 30/102 (29.4) | 1.33 (0.78−2.26) | 0.298 | 38/136 (27.9) | 15/42 (35.7) | 0.69 (0.33−1.45) | 0.324 |
| No | 388/1300 (29.8) | 225/1072 (21.0) | 1.63 (1.35−1.97) | 344/1247 (27.6) | 80/466 (17.2) | 1.85 (1.41−2.43) | |||
| Shockable initial rhythm | Yes | 211/363 (58.1) | 119/246 (48.4) | 1.53 (1.10−2.13) | 170/308 (55.2) | 50/108 (46.3) | 1.45 (0.93−2.26) | 0.100 | |
| No | 302/1222 (24.7) | 156/1019 (15.3) | 1.84 (1.48−2.28) | 252/1161 (21.7) | 53/449 (11.8) | 2.11 (1.53−2.91) | |||
| Utstein subgroup | |||||||||
| Witnessed by emergency services personnel | 78/168 (46.4) | 32/142 (22.5) | 3.29 (1.98−5.48) | 57/142 (40.1) | 11/70 (15.7) | 3.81 (1.81−8.02) | |||
| Shockable initial rhythm and bystander witnessed | 153/271 (56.5) | 96/199 (48.2) | 1.42 (0.98−2.06) | 0.063 | 128/244 (52.5) | 43/87 (49.4) | 1.14 (0.70−1.87) | 0.600 | |
| Shockable initial rhythm and bystander CPR | 112/197 (56.9) | 70/133 (52.6) | 1.18 (0.75−1.85) | 0.470 | 98/177 (55.4) | 29/54 (53.7) | 1.04 (0.56−1.93) | 0.902 | |
| Non-shockable initial rhythm and bystander witnessed | 216/801 (27.0) | 123/668 (18.4) | 1.67 (1.30−2.14) | 190/776 (24.5) | 42/291 (14.4) | 2.03 (1.40−2.94) | |||
| Survival to hospital discharge | |||||||||
| All patients | 168/1723 (9.8) | 108/1446 (7.5) | 1.38 (1.07−1.78) | 146/1652 (8.8) | 42/623 (6.6) | 1.37 (0.96−1.97) | 0.083 | ||
| OHCA at home | Yes | 65/1042 (6.2) | 49/988 (5.0) | 1.31 (0.89−1.92) | 0.172 | 50/1003 (5.0) | 24/478 (5.0) | 1.04 (0.63−1.72) | 0.873 |
| No | 103/672 (15.3) | 59/458 (12.9) | 1.28 (0.90−1.81) | 0.173 | 96/643 (14.9) | 18/145 (12.4) | 1.21 (0.70−2.08) | 0.493 | |
| Witnessed OHCA | Yes | 149/1331 (11.2) | 100/1137 (8.8) | 1.39 (1.06−1.82) | 135/1291 (10.5) | 37/493 (7.5) | 1.50 (1.02−2.20) | ||
| No | 19/392 (4.8) | 8/309 (2.6) | 1.99 (0.85−4.64) | 0.111 | 11/361 (3.0) | 5/130 (3.8) | 0.78 (0.26−2.31) | 0.648 | |
| Bystander CPR | Yes | 87/788 (11.0) | 52/538 (9.7) | 1.21 (0.84−1.74) | 0.315 | 66/694 (9.5) | 22/230 (9.6) | 0.98 (0.59−1.64) | 0.948 |
| No | 50/753 (6.6) | 38/725 (5.2) | 1.38 (0.89−2.14) | 0.151 | 51/785 (6.5) | 15/307 (4.9) | 1.42 (0.78−2.57) | 0.252 | |
| AED used | Yes | 21/173 (12.1) | 16/113 (14.2) | 0.85 (0.42−1.72) | 0.852 | 15/150 (10.0) | 9/43 (20.9) | 0.42 (0.17−1.04) | 0.062 |
| No | 116/1368 (8.5) | 74/1145 (6.5) | 1.41 (1.04−1.92) | 102/1326 (7.7) | 28/492 (5.7) | 1.42 (0.92−2.19) | 0.117 | ||
| Shockable initial rhythm | Yes | 211/363 (58.1) | 119/246 (48.4) | 1.53 (1.10−2.13) | 170/308 (55.2) | 33/118 (28.0) | 1.45 (0.93−2.26) | 0.100 | |
| No | 302/1222 (24.7) | 156/1019 (15.3) | 1.84 (1.48−2.28) | 252/1161 (21.7) | 252/1161 (21.7) | 2.11 (1.53−2.91) | |||
| Utstein subgroup | |||||||||
| Witnessed by emergency services personnel | 31/182 (17.0) | 18/183 (9.8) | 2.06 (1.10−3.87) | 29/173 (16.8) | 5/86 (5.8) | 3.67 (1.35−10.02) | |||
| Shockable initial rhythm and bystander witnessed | 84/291 (28.9) | 56/223 (25.1) | 1.25 (0.84−1.86) | 0.281 | 70/271 (25.8) | 28/95 (29.5) | 0.83 (0.49−1.41) | 0.498 | |
| Shockable initial rhythm and bystander CPR | 62/208 (29.8) | 40/155 (25.8) | 1.23 (0.77−1.97) | 0.394 | 50/199 (25.1) | 19/60 (31.7) | 0.70 (0.37−1.33) | 0.276 | |
| Non-shockable initial rhythm and bystander witnessed | 33/846 (3.9) | 19/703 (2.7) | 1.53 (0.86−2.72) | 0.149 | 30/822 (3.6) | 3/301 (1.0) | 4.01 (1.21−13.29) | ||
Cases witnessed by emergency services personnel were excluded from this analysis.
Resuscitation characteristics compared between non-pandemic weeks (February 1st to March 10th 2020) and pandemic weeks (March 11th to April 30th 2020), stratified according to COVID-19 incidence.
| Non-pandemic weeks | Pandemic weeks | |||||||
|---|---|---|---|---|---|---|---|---|
| COVID-19 incidence | COVID-19 incidence | |||||||
| Low | Medium | High | p-value | Low | Medium | High | p-value | |
| All resuscitations | 152 (0.49) | 416 (0.49) | 255 (0.49) | 0.343 | 107 (0.29) | 321 (0.30) | 195 (0.30) | 0.330 |
| Female, N (%) | 38 (25.0) | 125 (30.0) | 65 (25.5) | 0.313 | 31 (29.0) | 102 (31.9) | 57 (29.2) | 0.759 |
| Age (years), mean (SD) | 62.36 (15.4) | 65.32 (17.5) | 65.49 (17.9) | 0.152 | 61.81 (15.8) | 64.92 (15.6) | 62.83 (15.0) | 0.124 |
| Aged 14 and under | 0 (0.0) | 7 (1.7) | 6 (2.4) | 0.182 | 1 (0.9) | 4 (1.3) | 3 (1.5) | 0.905 |
| Aged 75 and over | 34 (22.7)a | 145 (34.9)b | 100 (39.2)b | 24 (22.6) | 92 (28.7) | 40 (20.5) | 0.091 | |
| OHCA at home, N (%) | 88 (57.9) | 252 (60.6) | 170 (66.7) | 0.150 | 75 (70.1) | 248 (77.3) | 155 (79.5) | 0.172 |
| Witnessed OHCA, N (%) | 120 (78.9) | 317 (76.2) | 207 (81.2) | 0.309 | 91 (85.0) | 246 (76.6) | 156 (80.0) | 0.168 |
| Bystander CPR performed, N (%)+ | 58 (40.8)a | 123 (35.0)a | 127 (54.5)b | 28 (31.8)a | 92 (33.3)a | 110 (63.6)b | ||
| AED used, N (%)+ | 17 (12.1)a, b | 24 (6.8)b | 29 (12.6)a | 4 (4.5)a | 13 (4.7)a | 26 (15.0)b | ||
| Shockable initial rhythm, N (%) | 39 (26.9) | 69 (17.8) | 56 (22.1) | 0.059 | 25 (26.0) | 53 (17.5) | 40 (20.7) | 0.178 |
| Airway isolation | 134 (88.2) | 353 (86.9) | 210 (83.0) | 0.251 | 92 (86.0) | 249 (78.8) | 159 (84.1) | 0.147 |
| Orotracheal intubation | 81 (60.4)a | 275 (77.9)b | 182 (86.7)c | 44 (47.8)a | 159 (63.9)b | 117 (73.6)c | ||
| Supraglottic device | 12 (9.0) | 28 (7.9) | 18 (8.6) | 0.878 | 20 (21.7) | 51 (20.5) | 39 (24.5) | 0.958 |
| Median call to arrival time, min (IQR)+ | 17.5 (12.0−33.0)a | 15.0 (9.0−21.0)b | 11.0 (8.0−18.5)c | 16.5 (10.0−27.5) | 14.0 (9.0−23.0) | 15.0 (10.0−22.0) | 0.757 | |
| Ambulance arrived within 8 min+ | 4 (8.0)a | 46 (17.0)a, b | 48 (22.1)b | 3 (13.6) | 22 (12.0) | 23 (14.3) | 0.182 | |
| Ambulance arrived within 15 min+ | 21 (42.0)a | 146 (53.9)a | 149 (68.9)b | 11 (50.0) | 103 (56.0) | 85 (52.8) | 0.772 | |
| Utstein subgroup | ||||||||
| Witnessed by emergency services personnel (subgroup 1) | 10 (6.6)a | 65 (15.6)b | 22 (8.6)a | 19 (17.8) | 45 (14.0) | 22 (11.3) | 0.292 | |
| Shockable initial rhythm and bystander witnessed (subgroup 2a) | 29 (19.6) | 57 (14.1) | 42 (16.6) | 0.270 | 18 (17.5) | 44 (14.0) | 33 (17.0) | 0.547 |
| Shockable initial rhythm and bystander CPR (subgroup 2b) | 28 (18.7)a | 31 (7.5)b | 36 (14.2)a | 8 (7.5) | 26 (8.2) | 26 (13.3) | 0.112 | |
| Non-shockable initial rhythm and bystander witnessed (subgroup 2c) | 77 (52.0)a,b | 184 (45.4)a | 141 (55.7)b | 50 (48.5) | 151 (47.9) | 100 (51.5) | 0.724 | |
| Patients with ROSC admitted to hospital N (%) | 30 (24.8) | 87 (22.8) | 66 (27.6) | 0.405 | 16 (17.8)a,b | 41 (13.7)a | 50 (26.3)b | |
| Patients with ongoing CPR admitted to hospital | 26 (17.1)a | 30 (7.2)b | 12 (4.7)b | 13 (12.1)a | 20 (6.2)b | 4 (2.1)c | ||
| Donation in asystole | 0 (0.0) | 4 (1.0) | 3 (1.2) | 0.441 | 0 (0.0) | 0 (0.0) | 0 (0.0) | – |
| In hospital treatment | ||||||||
| Treatment with thrombolysis, N (%) | 1 (1.8) | 1 (0.9) | 3 (3.8) | 0.339 | 0 (0.0) | 0 (0.0) | 0 (0.0) | – |
| Treatment with PCI, N (%) | 10 (17.9) | 29 (24.8) | 23 (29.5) | 0.306 | 5 (17.2) | 20 (32.8) | 12 (22.2) | 0.219 |
| Treatment with ICD implant | 0 (0.0) | 3 (2.6) | 4 (5.1) | 0.202 | 0 (0.0) | 2 (3.3) | 3 (5.6) | 0.417 |
| Treatment with TTM, N (%) | 1 (1.8) | 14 (12.0) | 6 (7.7) | 0.075 | 0 (0.0) | 5 (8.2) | 3 (5.6) | 0.284 |
| Survival at hospital discharge | 15 (9.9) | 30 (7.2) | 21 (8.2) | 0.580 | 7 (6.5) | 17 (5.3) | 18 (9.2) | 0.224 |
The reference population for all included regions was 30,298,000 (low incidence regions: 8,819,000; medium incidence regions: 11,327,000; high incidence regions: 10,152,000).
Superscript denotes statistically significant differences between adjacent cells.
Average weekly incidence of OHCA resuscitation attempts per 100,000 inhabitants.
Fig. 4Average 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).