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

• Published in: Resuscitation Vol. 157; pp. 230 - 240
• Main Authors: Rosell Ortiz, Fernando, Fernández del Valle, Patricia, Knox, Emily C., Jiménez Fábrega, Xavier, Navalpotro Pascual, José M., Mateo Rodríguez, Inmaculada, Ruiz Azpiazu, José I., Iglesias Vázquez, José A., Echarri Sucunza, Alfredo, Alonso Moreno, Daniel F., Forner Canos, Ana B., García-Ochoa Blanco, María J., López cabeza, Nuria, Mainar Gómez, Belén, Batres Gómez, Susana, Cortés Ramas, José A., ceniceros Rozalén, María I., Guirao Salas, Francisco A., Fernández martínez, Begoña, Daponte Codina, Antonio, Vergel, Francisco José Mellado, Royo, Sonia, Aguilo, Bernardo, Cuervo, Elvira Prieto, Lindez, Juan Jose Garcia, Campo, Marta Sansegundo, Arenal, Ignacio del Campo, Pérez, Carmen del Pozo, Pozo, Margarita Baez del, de la Cruz Martínez, Marta, Vives, Angels Mora, Jiménez, Francisco José Carmona, Muñoz, Silvia Solà, Roig, Xavier Escalada, Escriche, Carmen, Gómez, María Remedios Belmonte, Barril, Antonio José Fernández, Márquez, Juan Ramírez, López, Gabina Pérez, Pérez, Pedro Dacal, Rivera, Antonio Rodríguez, González, Elena Pastor, Gómez, María luz Sabin, Leis, Carmen Camacho, Vallejo, Francisco Alfonso Peinado, Moya, Alfredo Carrillo, Cuesta, Yago Muñecas, Isabel, Belén Muñoz, León, Manuel José González, González, Juan Ignacio Les, Jiménez, Antonia Sáez, Muñoz Pastor, José, Pérez, María Teresa López, Laspalas, Maitane Tainta, Barreras, Cristian Fernández, Mar Vaqueriza Iturriza, Mª, Mercado, Mario Jiménez, Aranzasti, Blanca Alberro, Gall, Amelie Le, Bragado-Blas, María Lourdes, Teja-Ruiz, Basilio
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-12-2020
• Subjects: Aftercare; Aged; Cardiopulmonary Resuscitation - methods; Clinical Paper; Covid 19; COVID-19 - complications; COVID-19 - epidemiology; Emergency Medical Services; Emergency services; Female; Humans; Incidence; Male; Middle Aged; Out-of hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - epidemiology; Out-of-Hospital Cardiac Arrest - etiology; Pandemics; Prospective Studies; Registries; SARS-CoV-2; Spain - epidemiology; Survival; Spain; Covid 19; Emergency services; Out-of hospital cardiac arrest; Survival
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2020.09.037

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.
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.
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.
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.
ISRCTN10437835.