1
|
Lee H, Oh J, Choi HJ, Shin H, Cho Y, Lee J. The Incidence and Outcomes of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic in South Korea: Multicenter Registry Study. JMIR Public Health Surveill 2024; 10:e52402. [PMID: 38913998 PMCID: PMC11231615 DOI: 10.2196/52402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/28/2023] [Accepted: 05/16/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures. OBJECTIVE We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry. METHODS We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome. RESULTS From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic 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 (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05). CONCLUSIONS During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic. TRIAL REGISTRATION ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
Collapse
Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| |
Collapse
|
2
|
Chida-Nagai A, Sato H, Yamazawa H, Takeda A, Yonemoto N, Tahara Y, lkeda T. Impact of the COVID-19 pandemic on pediatric out-of-hospital cardiac arrest outcomes in Japan. Sci Rep 2024; 14:11246. [PMID: 38755175 PMCID: PMC11099039 DOI: 10.1038/s41598-024-61650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
This study investigates the impact of the COVID-19 pandemic on pediatric out-of-hospital cardiac arrest (OHCA) outcomes in Japan, aiming to address a critical research gap. Analyzing data from the All-Japan Utstein registry covering pediatric OHCA cases from 2018 to 2021, the study observed no significant changes in one-month survival, neurological outcomes, or overall performance when comparing the pre-pandemic (2018-2019) and pandemic (2020-2021) periods among 6765 cases. However, a notable reduction in pre-hospital return of spontaneous circulation (ROSC) during the pandemic (15.1-13.1%, p = .020) was identified. Bystander-initiated chest compressions and rescue breaths declined (71.1-65.8%, 22.3-13.0%, respectively; both p < .001), while bystander-initiated automated external defibrillator (AED) use increased (3.7-4.9%, p = .029). Multivariate logistic regression analyses identified factors associated with reduced pre-hospital ROSC during the pandemic. Post-pandemic, there was no noticeable change in the one-month survival rate. The lack of significant change in survival may be attributed to the negative effects of reduced chest compressions and ventilation being offset by the positive impact of widespread AED availability in Japan. These findings underscore the importance of innovative tools and systems for safe bystander cardiopulmonary resuscitation during a pandemic, providing insights to optimize pediatric OHCA care.
Collapse
Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Yufu, Japan
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Naohiro Yonemoto
- Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| | - Yoshio Tahara
- Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| | - Takanori lkeda
- Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group, Tokyo, Japan
| |
Collapse
|
3
|
Eaton-Williams P, Williams J. 'Family members screaming for help makes it very difficult to don PPE'. A qualitative study on UK ambulance staff experiences of infection prevention and control practices during the COVID-19 pandemic. J Infect Prev 2024; 25:17-23. [PMID: 38362117 PMCID: PMC10866121 DOI: 10.1177/17571774231209494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/21/2023] [Indexed: 02/17/2024] Open
Abstract
Background During the first wave of the COVID-19 pandemic in the UK, ambulance staff continued to deliver direct patient care whilst simultaneously adapting to a considerable escalation in evolving infection prevention and control (IPC) practices. Aim To enable learning to benefit future planning, this qualitative article aims to describe ambulance staff's experiences of this rapid escalation of IPC practices. Method Three online surveys were presented during the acceleration, peak, and deceleration phases of the pandemic's first wave in the UK (2020). Overall, 18 questions contributed 14,237 free text responses that were examined using inductive thematic analysis at both descriptive and interpretive levels. Findings Many participants lacked confidence in policies related to the use of personal protective equipment (PPE) because of perceived inadequate supporting evidence, confusing communication, and low familiarity with items. Compliance with policy and confidence in PPE use were further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices within the work environment, including reducing unnecessary exposure through public education and remote triage improvements. Discussion Some participants' poor experiences of escalating IPC practices were shared with health care workers studied in other environments and in previous epidemics, emphasising the need for lessons to be learnt. PPE should be developed with consideration of ambulance staff's unique working environment and regular familiarisation training could be beneficial. Pragmatic, evidence-based, clearly communicated policies implemented with sufficient resources may protect staff and facilitate them to maintain standards of care delivery during a pandemic.
Collapse
Affiliation(s)
- Peter Eaton-Williams
- Senior Research Paramedic, South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - Julia Williams
- Professor of Paramedic Science, School of Health & Social Work, University of Hertfordshire, Hatfield, UK
- Head of Research, College of Paramedics, Bridgwater, UK
| |
Collapse
|
4
|
Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e914-e933. [PMID: 38250800 DOI: 10.1161/cir.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.
Collapse
|
5
|
Lee YT, Lai YW, Chen JH, Chen WL, Wu MY, Chung JY. Assessing the Impact of the COVID-19 Pandemic on Pediatric Emergency Department Visits in Taiwan. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:288. [PMID: 38399575 PMCID: PMC10890672 DOI: 10.3390/medicina60020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted healthcare systems worldwide. To assess the effects of the pandemic on pediatric emergency department (ED) visits in Taiwan, we conducted a study to evaluate changes in pediatric ED visits during the COVID-19 pandemic. Materials and Methods: This retrospective study included pediatric patients (age ≤ 18) who visited the ED between 21 January 2019 and 30 April 2019, at three hospitals of the Cathay Health System, and compared them with a corresponding period in 2020. Basic information, including mode of arrival, triage level, disposition, chief complaints, and incidence rates, were analyzed before and during the pandemic. Results: A total of 10,116 patients, with 6009 in the pre-pandemic group and 4107 in the pandemic group, were included in this study. The mean number of daily pediatric ED visits decreased from 60.09 before the pandemic to 40.66 during the pandemic, while ambulance use increased significantly by 2.56%. The percentage of patients with high acuity triage levels (levels 1 and 2) was significantly lower during the pandemic period (0.63% and 10.18%, respectively) than the pre-pandemic period (0.7% and 10.9%, respectively). Additionally, a significantly higher proportion of patients were discharged during the pandemic period (89.36%) than during the pre-pandemic period (88.33%). The proportion of COVID-19-related complaints, such as fever and respiratory tract infections, as well as other complaints including gastrointestinal issues, trauma, and psychological problems, significantly increased during the pandemic. Conclusions: In preparation for future pandemics, we recommend increasing emergency medical service capacity, establishing a non-contagious route for obtaining chronic medication prescriptions, optimizing staff allocation in pediatric emergency departments, and increasing the number of hospital social workers for enhanced support.
Collapse
Affiliation(s)
- Yu-Ting Lee
- Department of Emergency Medicine, Cathay General Hospital, Taipei 106438, Taiwan; (Y.-T.L.); (J.-H.C.); (W.-L.C.)
- Department of Emergency Medicine, Sijhih Cathay General Hospital, New Taipei City 221037, Taiwan;
| | - Yen-Wen Lai
- Department of Emergency Medicine, Sijhih Cathay General Hospital, New Taipei City 221037, Taiwan;
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei 106438, Taiwan; (Y.-T.L.); (J.-H.C.); (W.-L.C.)
- School of Medicine, Fu Jen Catholic University, Taipei 242062, Taiwan
| | - Wei-Lung Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei 106438, Taiwan; (Y.-T.L.); (J.-H.C.); (W.-L.C.)
- School of Medicine, Fu Jen Catholic University, Taipei 242062, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, Taipei 106438, Taiwan; (Y.-T.L.); (J.-H.C.); (W.-L.C.)
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
- Department of Education, Cathay General Hospital, Taipei 106438, Taiwan
| |
Collapse
|
6
|
Fagoni N, Bellini L, Bonora R, Botteri M, Migliari M, Pagliosa A, Sechi GM, Signorelli C, Zoli A, Stirparo G. Changing the stroke network during pandemic scenarios does not affect the management of patients with a positive Cincinnati prehospital stroke scale. Neurol Sci 2024; 45:655-662. [PMID: 37672177 PMCID: PMC10791942 DOI: 10.1007/s10072-023-07046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Time plays a crucial role in the management of stroke, and changing the prehospital emergency network, altering the HUB and spoke relationship in pandemic scenarios, might have an impact on time to fibrinolysis or thrombectomy. The aim of this study was to evaluate the time-dependent stroke emergency network in Lombardy region (Italy) by comparing 2019 with 2020 and early 2021. Three parameters were investigated: (i) time of arrival of the first vehicle at the scene, (ii) overall duration of missions, and (iii) number of patients transported by emergency vehicles. METHODS Data analysis process conducted using the SAS-AREU portal (SAS Institute, USA). RESULTS The number of patients with a positive CPSS was similar among the different pandemic waves. Mission duration increased from a mean time (SD) of 52.9 (16.1) min in 2019 to 64.1 (19.7) in 2020 and 55.0 (16.8) in 2021. Time to first vehicle on scene increased to 15.7 (8.4) min in 2020 and 16.0 (7.0) in 2021 compared to 2019, 13.6 (7.2) (P < 0.05). The number of hospital with available stroke units decreased from 46 in 2019 to 10 during the first pandemic wave. CONCLUSIONS The pandemic forced changes in the clinical mission of many hospitals by reducing the number of stroke units. Despite this, the organization of the emergency system allowed to identify strategic hospitals and thus avoid excessive transport time. The result was an adequate time for fibrinolysis/thrombectomy, in agreement with the guidelines. Coordinated management in emergency situations makes it possible to maintain service quality standards, despite the unfavorable scenario.
Collapse
Affiliation(s)
- Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy.
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Rodolfo Bonora
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Maurizio Migliari
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Andrea Pagliosa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Maria Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| |
Collapse
|
7
|
Kim HJ, Lee D, Moon HJ, Jeong D, Shin TY, In Hong S, Lee HJ. Real-world comparison between mechanical and manual cardiopulmonary resuscitation during the COVID-19 pandemic. Am J Emerg Med 2024; 76:217-224. [PMID: 38128162 DOI: 10.1016/j.ajem.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including an increase in out-of-hospital cardiac arrests (OHCA). Healthcare providers are now required to use personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR). Additionally, mechanical CPR devices have been introduced to reduce the number of personnel required for resuscitation. This study aimed to compare the outcomes of CPR performed with a mechanical device and the outcomes of manual CPR performed by personnel wearing PPE. METHODS This multicenter observational study utilized data from the Korean Cardiac Arrest Research Consortium registry. The study population consisted of OHCA patients who underwent CPR in emergency departments (EDs) between March 2020 and June 2021. Patients were divided into two equal propensity score matched groups: mechanical CPR group (n = 421) and PPE-equipped manual CPR group (n = 421). Primary outcomes included survival rates and favorable neurological outcomes at discharge. Total CPR duration in the ED was also assessed. RESULTS There were no significant between-group differences with respect to survival rate at discharge (mechanical CPR: 7.4% vs PPE-equipped manual CPR: 8.3%) or favorable neurological outcomes (3.3% vs. 3.8%, respectively). However, the mechanical CPR group had a longer duration of CPR in the ED compared to the manual CPR group. CONCLUSION This study found no significant differences in survival rates and neurological outcomes between mechanical CPR and PPE-equipped manual CPR in the ED setting. However, a longer total CPR duration was observed in the mechanical CPR group. Further research is required to explore the impact of PPE on healthcare providers' performance and fatigue during CPR in the context of the pandemic and beyond.
Collapse
Affiliation(s)
- Hyun Joon Kim
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Dongwook Lee
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea.
| | - Hyung Jun Moon
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Dongkil Jeong
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Tae Yong Shin
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Sun In Hong
- Department of internal medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Cheonan 31151, Republic of Korea
| |
Collapse
|
8
|
Armour R, Ghamarian E, Helmer J, Buick JE, Thorpe K, Austin M, Bacon J, Boutet M, Cournoyer A, Dionne R, Goudie M, Lin S, Welsford M, Grunau B. Impact of the COVID-19 pandemic on Canadian emergency medical system management of out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2024; 194:110054. [PMID: 37992799 DOI: 10.1016/j.resuscitation.2023.110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
AIM We sought to describe the impact of the COVID-19 pandemic on the care provided by Canadian emergency medical system (EMS) clinicians to patients suffering out of hospital cardiac arrest (OHCA), and whether any observed changes persisted beyond the initial phase of the pandemic. METHODS We analysed cases of adult, non-traumatic, OHCA from the Canadian Resuscitation Outcome Consortium (CanROC) registry who were treated between January 27th, 2018, and December 31st, 2021. We used adjusted regression models and interrupted time series analysis to examine the impact of the COVID-19 pandemic (January 27th, 2020 - December 31st, 2021)on the care provided to patients with OHCA by EMS clinicians. RESULTS There were 12,947 cases of OHCA recorded in the CanROC registry in the pre-COVID-19 period and 17,488 during the COVID-19 period. We observed a reduction in the cumulative number of defibrillations provided by EMS (aRR 0.91, 95% CI 0.89 - 0.93, p < 0.01), a reduction in the odds of attempts at intubation (aOR 0.33, 95% CI 0.31 - 0.34, p < 0.01), higher rates of supraglottic airway use (aOR 1.23, 95% CI 1.16-1.30, p < 0.01), a reduction in vascular access (aOR for intravenous access 0.84, 95% CI 0.79 - 0.89, p < 0.01; aOR for intraosseous access 0.89, 95% CI 0.82 - 0.96, p < 0.01), a reduction in the odds of epinephrine administration (aOR 0.89, 95% CI 0.85 - 0.94, p < 0.01), and higher odds of resuscitation termination on scene (aOR 1.38, 95% CI 1.31 - 1.46, p < 0.01). Delays to initiation of chest compressions (2 min. vs. 3 min., p < 0.01), intubation (16 min. vs. 19 min., p = 0.01), and epinephrine administration (11 min. vs. 13 min., p < 0.01) were observed, whilst supraglottic airways were inserted earlier (11 min. vs. 10 min., p < 0.01). CONCLUSION The COVID-19 pandemic was associated with substantial changes in EMS management of OHCA. EMS leaders should consider these findings to optimise current OHCA management and prepare for future pandemics.
Collapse
Affiliation(s)
- Richard Armour
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Ambulance Victoria, Victoria, Australia; Applied Health Research Centre, Unity Health Toronto, Ontario, Canada.
| | - Ehsan Ghamarian
- Applied Health Research Centre, Unity Health Toronto, Ontario, Canada
| | - Jennie Helmer
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Jason E Buick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Kevin Thorpe
- Applied Health Research Centre, Unity Health Toronto, Ontario, Canada
| | - Michael Austin
- The Ottawa Hospital, Ontario, Canada; University of Ottawa, Ontario, Canada
| | | | | | - Alexis Cournoyer
- Faculty of Medicine, Université de Montréal, Quebec, Canada; Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Quebec, Canada
| | - Richard Dionne
- The Ottawa Hospital, Ontario, Canada; University of Ottawa, Ontario, Canada; Regional Paramedic Program for Eastern Ontario, Ontario, Canada
| | - Marc Goudie
- Frontenac Paramedic Services, Ontario, Canada
| | - Steve Lin
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, Department of Medicine, McMaster University, Ontario, Canada; Hamilton Health Sciences, Ontario, Canada
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, British Columbia, Canada
| |
Collapse
|
9
|
Watanabe K, Mori K, Sato K, Abe T, Imaki S, Takeuchi I. Out-of-hospital cardiac arrest patients during the coronavirus disease 2019 pandemic. Sci Rep 2023; 13:23005. [PMID: 38155197 PMCID: PMC10754886 DOI: 10.1038/s41598-023-50150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/15/2023] [Indexed: 12/30/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had severe impact on the outcome of out-of-hospital cardiac arrest (OHCA) patients and the possibility of bystander cardiopulmonary resuscitation (CPR). Previous studies focused only on the short periods of the pandemic and reported a significant increase in the number of infections. In a retrospective cohort study we aimed to compare the outcomes of OHCA patients 1 year before and 1 year after the onset of COVID-19. Data of 519 OHCA patients during the pre-pandemic (January-December 2019; 262 patients) and intra-pandemic (April 2020-March 2021; 257 patients) periods in Yokohama Municipal Hospital, Japan were collected and analysed retrospectively. The study outcomes were the return of spontaneous circulation (ROSC), admission to hospital, survival to discharge, and cerebral performance category at discharge. The intra-pandemic period was associated with decreased bystander CPR (P = 0.004), prolonged transport time (P < 0.001), delayed first adrenaline administration (P < 0.001), and decrease in ROSC (P = 0.023). Logistic regression analysis revealed that the following factors were significantly associated with ROSC: "pandemic", "shockable initial waveform", and "witness presence".
Collapse
Affiliation(s)
- Kenta Watanabe
- Department of Emergency Medicine, Yokohama Municipal Citizen's Hospital, Yokohama City, Kanagawa, Japan.
- Department of Emergency Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan.
| | - Kosuke Mori
- Department of Emergency Medicine, Yokohama Municipal Citizen's Hospital, Yokohama City, Kanagawa, Japan
- Department of Emergency Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Kosuke Sato
- Department of Emergency Medicine, Yokohama Municipal Citizen's Hospital, Yokohama City, Kanagawa, Japan
- Department of Emergency Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Takeru Abe
- Medical Center Advanced Critical Care and Emergency Center, Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Shouhei Imaki
- Department of Emergency Medicine, Yokohama Municipal Citizen's Hospital, Yokohama City, Kanagawa, Japan
- Department of Emergency Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University, Yokohama City, Kanagawa, Japan
- Medical Center Advanced Critical Care and Emergency Center, Yokohama City University, Yokohama City, Kanagawa, Japan
| |
Collapse
|
10
|
Jafari-Oori M, Dehi M, Ebadi A, Moradian ST, Sadeghi H, Jafari M. Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study. Front Psychol 2023; 14:1230892. [PMID: 38235282 PMCID: PMC10793261 DOI: 10.3389/fpsyg.2023.1230892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Background Pre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic. Methods This phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi's approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research. Results A total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage. Conclusion The findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.
Collapse
Affiliation(s)
- Mehdi Jafari-Oori
- Atherosclerosis Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Manigeh Dehi
- Maragheh University of Medical Sciences, Maragheh, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hajar Sadeghi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | |
Collapse
|
11
|
Fan C, Sung C, Chen C, Chen C, Chen L, Chen Y, Chen J, Chiang W, Huang C, Huang EP. Updated trends in the outcomes of out-of-hospital cardiac arrest from 2017-2021: Prior to and during the coronavirus disease (COVID-19) pandemic. J Am Coll Emerg Physicians Open 2023; 4:e13070. [PMID: 38029023 PMCID: PMC10680430 DOI: 10.1002/emp2.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to describe out-of-hospital cardiac arrest (OHCA) characteristics and trends before and during the coronavirus disease-2019 (COVID-19) pandemic in Taiwan. Methods We conducted a retrospective cohort study using a 5-year interrupted time series analysis. Eligible adults with non-traumatic OHCAs from January 2017 to December 2021 in 3 hospitals (university medical center, urban second-tier hospital, and rural second-tier hospital) were retrospectively enrolled. Variables were extracted from the emergency medical service reports and medical records. The years 2020 and 2021 were defined as the COVID-19 pandemic period. Outcomes included survival to admission after a sustained return of spontaneous circulation, survival to hospital discharge, and good neurological outcomes (cerebral performance category score 1 or 2). Results We analyzed 2819 OHCA, including 1227 from a university medical center, 617 from an urban second-tier hospital, and 975 from a rural second-tier hospital. The mean age was 71 years old, and 60% of patients were males. During the COVID-19 pandemic period, video-assisted endotracheal tube intubation replaced the traditional direct laryngoscopy intubation. The trends of outcomes in the pre-pandemic and pandemic periods varied among different hospitals. Compared with the pre-pandemic period, the outcomes at the university medical center during the COVID-19 pandemic were significantly poorer in several respects. The survival rate on admission dropped from 44.6% to 39.4% (P = 0.037), and the survival rate to hospital discharge fell from 17.5% to 14.9% (P = 0.042). Additionally, there was a notable decrease in patients' good neurological outcomes, declining from 13.2% to 9.7% (P = 0.048). In contrast, the outcomes in urban and rural second-tier hospitals during the COVID-19 pandemic did not significantly differ from those in the pre-pandemic period. Conclusions COVID-19 may alter some resuscitation management in OHCAs. There were no overall significant differences in outcomes before and during COVID-19 pandemic, but there were significant differences in outcomes when stratified by hospital types.
Collapse
Affiliation(s)
- Cheng‐Yi Fan
- Department of Emergency MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Chih‐Wei Sung
- Department of Emergency MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
- Department of Emergency MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Ching‐Yu Chen
- Department of Emergency MedicineNational Taiwan University Hospital Yun‐Lin BranchDouliuTaiwan
| | - Chi‐Hsin Chen
- Department of Emergency MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Likwang Chen
- Institute of Population Health SciencesNational Health Research InstitutesMiaoliTaiwan
| | - Yun‐Chang Chen
- Department of Emergency MedicineNational Taiwan University Hospital Yun‐Lin BranchDouliuTaiwan
| | - Jiun‐Wei Chen
- Department of Emergency MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Wen‑Chu Chiang
- Department of Emergency MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University Hospital Yun‐Lin BranchDouliuTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chien‐Hua Huang
- Department of Emergency MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Edward Pei‐Chuan Huang
- Department of Emergency MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
- Department of Emergency MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| |
Collapse
|
12
|
Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet 2023; 402:1329-1337. [PMID: 37647928 PMCID: PMC10877072 DOI: 10.1016/s0140-6736(23)01351-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The International Liaison Committee on Resuscitation has called for a randomised trial of delivery to a cardiac arrest centre. We aimed to assess whether expedited delivery to a cardiac arrest centre compared with current standard of care following resuscitated cardiac arrest reduces deaths. METHODS ARREST is a prospective, parallel, multicentre, open-label, randomised superiority trial. Patients (aged ≥18 years) with return of spontaneous circulation following out-of-hospital cardiac arrest without ST elevation were randomly assigned (1:1) at the scene of their cardiac arrest by London Ambulance Service staff using a secure online randomisation system to expedited delivery to the cardiac catheter laboratory at one of seven cardiac arrest centres or standard of care with delivery to the geographically closest emergency department at one of 32 hospitals in London, UK. Masking of the ambulance staff who delivered the interventions and those reporting treatment outcomes in hospital was not possible. The primary outcome was all-cause mortality at 30 days, analysed in the intention-to-treat (ITT) population excluding those with unknown mortality status. Safety outcomes were analysed in the ITT population. The trial was prospectively registered with the International Standard Randomised Controlled Trials Registry, 96585404. FINDINGS Between Jan 15, 2018, and Dec 1, 2022, 862 patients were enrolled, of whom 431 (50%) were randomly assigned to a cardiac arrest centre and 431 (50%) to standard care. 20 participants withdrew from the cardiac arrest centre group and 19 from the standard care group, due to lack of consent or unknown mortality status, leaving 411 participants in the cardiac arrest centre group and 412 in the standard care group for the primary analysis. Of 822 participants for whom data were available, 560 (68%) were male and 262 (32%) were female. The primary endpoint of 30-day mortality occurred in 258 (63%) of 411 participants in the cardiac arrest centre group and in 258 (63%) of 412 in the standard care group (unadjusted risk ratio for survival 1·00, 95% CI 0·90-1·11; p=0·96). Eight (2%) of 414 patients in the cardiac arrest centre group and three (1%) of 413 in the standard care group had serious adverse events, none of which were deemed related to the trial intervention. INTERPRETATION In adult patients without ST elevation, transfer to a cardiac arrest centre following resuscitated cardiac arrest in the community did not reduce deaths. FUNDING British Heart Foundation.
Collapse
Affiliation(s)
- Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Gavin D Perkins
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Perkins
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Tim Clayton
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Richard Evans
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Steven Robertson
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Karen Wilson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rachael T Fothergill
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Clinical Audit and Research Unit, London Ambulance Service, London, UK; Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Miles Dalby
- Department of Cardiology, Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sam Firoozi
- Department of Cardiology, St Georges Hospital, London, UK
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free Hospital Foundation Trust, London, UK
| | - Ajay Jain
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Jerry P Nolan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Anaesthesia, Royal United Hospital, Bath, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
13
|
Kurosaki H, Okumura K, Nunokawa C, Yao S, Murasaka K, Inaba H. Effects of the 2020 COVID-19 pandemic on outcomes of out-of-hospital cardiac arrest and bystander resuscitation efforts: a nationwide cohort study in Japan. Eur J Emerg Med 2023; 30:171-178. [PMID: 36847298 DOI: 10.1097/mej.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background and importance There is limited knowledge about the nationwide impact of the 2020 COVID-19 pandemic in Japan on out-of -hospital cardiac arrest (OHCA) outcomes.Objectives The aim of this study was to investigate the impact of the 2020 COVID-19 pandemic on OHCA outcomes and bystander resuscitation efforts in Japan. Design Retrospective analysis of a nationwide population-based registry of OHCA cases. Settings and participants To conduct this study, we created a comprehensive database comprising 821 665 OHCA cases by combining and reconciling the OHCA database for 835 197 OHCA cases between 2017 and 2020 with another database, including location and time records. After applying exclusion and inclusion criteria, we analysed 751 617 cases.Outcome measures and analysis The primary outcome measure for this study was survival with neurologically favourable outcome (cerebral performance category 1 or 2). We compare OHCA characteristics and outcomes between prepandemic and pandemic years, and also investigated differences in factors associated with outcomes. Results We found that survival with neurologically favourable outcome and the rates of bystander cardiopulmonary resuscitation (CPR) slightly increased in the pandemic year [2.8% vs. 2.9%; crude odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.10; 54.1% vs. 55.3%, 1.05 (1.04-1.06), respectively], although the incidence of public access defibrillation (PAD) slightly decreased [1.8% vs. 1.6%, 0.89 (0.86-0.93)]. Calls for hospital selection by emergency medical service (EMS) increased during the pandemic. Subgroup analysis showed that the incidence of neurologically favourable outcome increased in 2020 for OHCA cases that occurred on nonstate of emergency days, in unaffected prefectures, with noncardiac cause, nonshockable initial rhythm, and during daytime hours. Conclusions During the 2020 COVID-19 pandemic in Japan, survival with neurologically favourable outcome of OHCA patients and bystander CPR rate did not negatively change, despite the decrement in PAD incidence. However, these effects varied with the state of emergency, region, and characteristics of OHCA, suggesting an imbalance between medical demand and supply, and raising concerns about the pandemic.
Collapse
Affiliation(s)
- Hisanori Kurosaki
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa
- Faculty of Health Sciences, Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Higashihiroshima
| | - Kazuki Okumura
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata
| | - Chika Nunokawa
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata
| | - Shintaro Yao
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata
| | - Kenshi Murasaka
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada
| | - Hideo Inaba
- Department of Emergency Medical Science, Niigata University of Health and Welfare, Niigata
- Department of Emergency Medicine, Kanazawa Medical University, Uchinada
- Kanazawa University, Kanazawa, Japan
| |
Collapse
|
14
|
Kim JH, Ahn C, Park Y, Won M. Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis. Front Public Health 2023; 11:1180511. [PMID: 37234770 PMCID: PMC10208072 DOI: 10.3389/fpubh.2023.1180511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).
Collapse
Affiliation(s)
- Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| |
Collapse
|
15
|
Nishimura T, Suga M, Ishihara S, Nakayama S, Nakao A, Naito H. Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan. Acute Med Surg 2023; 10:e829. [PMID: 36968647 PMCID: PMC10034623 DOI: 10.1002/ams2.829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
Aim In the current era of the coronavirus disease 2019 (COVID‐19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID‐19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID‐19 case surges on EMS transport for patients with trauma during the COVID‐19 states of emergency in Kobe, Japan. Methods EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. Results The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77–2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life‐threatening group did not change. The number of request calls increased during the states of emergency. Conclusion Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life‐threatening group.
Collapse
Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Masafumi Suga
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Atsunori Nakao
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
| |
Collapse
|
16
|
Ball J, Mahony E, Ray M, Nehme Z, Stub D, Smith K. No fear: Willingness of smartphone activated first responders to assist with cardiac arrest during the COVID-19 pandemic. Resusc Plus 2023; 13:100341. [PMID: 36530349 PMCID: PMC9747697 DOI: 10.1016/j.resplu.2022.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Aim To understand the fear and willingness to respond of smartphone activated first responders during the COVID-19 pandemic. Methods We invited smartphone activated first responders registered with the GoodSAM application in Victoria, Australia to take part in an online survey in November 2020. We assessed willingness to respond to an alert and provide CPR during the pandemic and administered the Fear of COVID-19 Scale questionnaire. Regression analysis was conducted to investigate associations between occupation, clinical training, and years of clinical experience with willingness to respond and fear of COVID-19. Results The survey response rate was 5.1%. Responders (n = 348) had a median age (interquartile range) of 46 years (33-55). Most (67%) were aged 30-59 years and 43% were female. Responders spanned several occupations including paramedics (12.6%), registered nurses (14.7%), and non-clinical individuals (21.8%). Most (92%) reported they would feel comfortable responding to a GoodSAM alert during the pandemic. Almost all (>95%) reported they would provide CPR. About 20% reported being afraid of COVID-19 but only 3.2% reported they had a high-level of fear of COVID-19. The odds of paramedics being willing to respond to an alert was reduced by 73% during the pandemic (OR 0.27, 95% CI 0.11 to 0.69). No other associations were found with willingness or fear of COVID-19. Conclusion Although willingness was high and fear of COVID-19 was low, some smartphone activated first responders were less willing to respond to an alert during the pandemic. These findings may inform future pandemic planning and decision-making around pausing first-responder programs.
Collapse
Affiliation(s)
- Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia 3004,Corresponding author at: Centre of Cardiovascular Research and Education in Therapeutics (CCRET) School of Public Health and Preventive Medicine Monash University 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Michael Ray
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
| |
Collapse
|
17
|
Huabbangyang T, Klaiangthong R, Silakoon A, Sretimongkol S, Sangpakdee S, Khiaolueang M, Seancha P, Nuansamlee T, Kamsom A, Chaisorn R. The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study. Int J Emerg Med 2023; 16:9. [PMID: 36803454 PMCID: PMC9940082 DOI: 10.1186/s12245-023-00489-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand. METHODS This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018-December 31, 2019, and January 1, 2020-December 31, 2021, respectively. RESULTS A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =- 6.0, 95% confidence interval [CI] - 4.1, - 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36-8.27; p value < 0.001), and 6.88 min (95% CI 4.55-9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50-3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58-1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic. CONCLUSIONS In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.
Collapse
Affiliation(s)
- Thongpitak Huabbangyang
- grid.413064.40000 0004 0534 8620Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Rossakorn Klaiangthong
- Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.
| | - Agasak Silakoon
- grid.413064.40000 0004 0534 8620Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand
| | - Suttida Sretimongkol
- grid.413064.40000 0004 0534 8620Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sutasinee Sangpakdee
- grid.413064.40000 0004 0534 8620Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Manit Khiaolueang
- grid.413064.40000 0004 0534 8620Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pattama Seancha
- grid.413064.40000 0004 0534 8620Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tontrakan Nuansamlee
- grid.413064.40000 0004 0534 8620Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- grid.413064.40000 0004 0534 8620Division of Biostatistic, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Ratree Chaisorn
- grid.413064.40000 0004 0534 8620Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
18
|
Li G, Zhang W, Jia D, Rong J, Yu Z, Wu D. Epidemic of the SARS-CoV-2 Omicron variant in Shanghai, China in 2022: Transient and persistent effects on Out-of-hospital cardiac arrests. Resuscitation 2023; 186:109722. [PMID: 36758849 PMCID: PMC9904852 DOI: 10.1016/j.resuscitation.2023.109722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To investigate transient and persistent effects of the Shanghai Omicron epidemic in 2022 on the incidence, characteristics, and outcomes of out-of-hospital cardiac arrest (OHCA). METHODS This retrospective study examined electronic records of patients admitted to the Shanghai Emergency Medical Center during five periods: pre-epidemic, 1 January 2018 to 31 December 2019; low COVID-19 incidence, 1 January 2020 to 27 March 2022; Omicron epidemic, 28 March to 31 May 2022; early post-epidemic, 1 June to 31 July 2022; and late post-epidemic, 1 August to 30 September 2022. Clinicodemographic characteristics and outcomes of OHCA cases were compared between the pre-epidemic and other periods. RESULTS A total of 55,104 OHCAs were included. The monthly number of OHCAs in the Omicron epidemic was 2.1 times the number in the pre-epidemic (1702 vs 793), while the number in the early post-epidemic was 1.9 times the number in the pre-epidemic (1515 vs 793). Compared to the pre-epidemic, OHCA during or after the epidemic was more likely to involve individuals with hypertension, coronary artery disease, heart failure or stroke. The probability that circulation would spontaneously resume after OHCA was significantly lower during the epidemic than before it (aOR 0.61, 95% CI 0.41-0.90; P = 0.012). However, this difference disappeared by the early post-epidemic. CONCLUSION The monthly number of OHCAs doubled during the Omicron epidemic in Shanghai, and it remained elevated for another two months. OHCA affected individuals with cardiovascular and cerebrovascular diseases more during and after the epidemic than before it.
Collapse
Affiliation(s)
- Guohui Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
| | - Wenchao Zhang
- Shanghai Emergency Medical Center, Shanghai 200233, China
| | - Dan Jia
- Shanghai Emergency Medical Center, Shanghai 200233, China
| | - Jin Rong
- Shanghai Emergency Medical Center, Shanghai 200233, China
| | - Zhiqiang Yu
- Shanghai Emergency Medical Center, Shanghai 200233, China
| | - Degen Wu
- Shanghai Emergency Medical Center, Shanghai 200233, China.
| |
Collapse
|
19
|
Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020189. [PMID: 36673557 PMCID: PMC9858873 DOI: 10.3390/healthcare11020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Objective: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. Methods: We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. Results: A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. Conclusions: This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more.
Collapse
|
20
|
Kim YS, Lee SH, Lim HJ, Hong WP. Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea. J Korean Med Sci 2023; 38:e92. [PMID: 36974401 PMCID: PMC10042732 DOI: 10.3346/jkms.2023.38.e92] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. METHODS We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. RESULTS The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96-1.09]). CONCLUSION This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
Collapse
Affiliation(s)
- Young Su Kim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Seung Hyo Lee
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Hyouk Jae Lim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Pyo Hong
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| |
Collapse
|
21
|
Maghraby N, Alshahrani A, Alghamdi M, Alzahid A, Almulhim M, Alshahrani K. Prevalence of COVID-19 Among Patients Arriving in Pre-arrest/Cardiac Arrest, at a Tertiary Hospital's ED in the Eastern Province of Saudi Arabia During the COVID-19 Pandemic. Med Arch 2023; 77:440-445. [PMID: 38313101 PMCID: PMC10834047 DOI: 10.5455/medarh.2023.77.440-445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024] Open
Abstract
Background COVID-19 pandemic has thrown the healthcare systems into confusion worldwide, resulting in major modifications on the practice due to fear of exposure to this virus and its fatal consequences. Objective the study aimed to establish the prevalence of COVID-19 in cardiac arrest patients. Methods single-centered, Retrospective, observational cohort study that included all patients who presented to ED during the period of the pandemic from January 2021 to May 2022 and documented to have either IN-hospital cardiac arrest (IHCA), specifically within the ED, or OUT-hospital cardiac arrest (OHCA). Results This study analyzed 177 patients. Out of which, 30.5% of the patients were aged more than 70 years old. Those with associated comorbidities, the most frequently mentioned comorbidity was hypertension (40.7%). It was found that the prevalence of positive COVID-19 infection was significantly more common among non-Arab (p=0.019), patients with associated chronic kidney disease (p=0.019) and those who had an in-hospital cardiac arrest (p=0.010). No significant associations were observed between COVID-19 infection in terms of age, gender, nationality, associated comorbidities, symptoms, and trauma (all p>0.05). Conclusion This study showed the prevalence of COVID-19 among cardiac arrest patients within ED and outside the hospital in our study population. Based on the study's results, the major adjustments in practice were not absolutely needed. Also, this study could help in establishing a good mitigation strategy for at-risk patients.
Collapse
Affiliation(s)
- Nisreen Maghraby
- Department of Emergency, Imam Abdulrahman bin Faisal University Hospital, Khobar, KSA
| | - Abdullah Alshahrani
- Department of Emergency, Imam Abdulrahman bin Faisal University Hospital, Khobar, KSA
| | - Mohannad Alghamdi
- Department of Emergency, Imam Abdulrahman bin Faisal University Hospital, Khobar, KSA
| | - Abdullah Alzahid
- Department of Emergency, Imam Abdulrahman bin Faisal University Hospital, Khobar, KSA
| | - Mohammad Almulhim
- Department of Emergency, Imam Abdulrahman bin Faisal University Hospital, Khobar, KSA
| | - Khalid Alshahrani
- Department of Anesthesiology, King Fahad military medical complex, Dhahran, KSA
| |
Collapse
|
22
|
Katsouras CS, Papafaklis MI, Giannopoulos S, Karapanayiotides T, Tsivgoulis G, Michalis LK. Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction? J Clin Neurol 2023; 19:1-11. [PMID: 36606641 PMCID: PMC9833878 DOI: 10.3988/jcn.2023.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
Collapse
Affiliation(s)
- Christos S Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| |
Collapse
|
23
|
The Impact of Prehospital and Hospital Care on Clinical Outcomes in Out-of-Hospital Cardiac Arrest. J Clin Med 2022; 11:jcm11226851. [PMID: 36431328 PMCID: PMC9698546 DOI: 10.3390/jcm11226851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: In recent years, several actions have been made to shorten the chain of survival in out-of-hospital cardiac arrest (OHCA). These include placing defibrillators in public places, training first responders, and providing dispatcher-assisted CPR (DA-CPR). In this work, we aimed to evaluate the impact of these changes on patients' outcomes, including achieving return of spontaneous circulation (ROSC), survival to discharge, and survival with favorable neurological function. Methods: We retrospectively retrieved data of all calls to the national emergency medical service in Ashdod city, Israel, of individuals who underwent OHCA at the age of 18 and older between the years 2018 and 2021. Data was collected on prehospital and hospital interventions. The association between pre-hospital and hospital interventions to ROSC, survival to discharge, and neurological outcomes was evaluated. Logistic regression was used for multivariable analysis. Results: During the years 2018-2021, there were 1253 OHCA cases in the city of Ashdod. ROSC was achieved in 207 cases (32%), survival to discharge was attained in 48 cases (7.4%), and survival with favorable neurological function was obtained in 26 cases (4%). Factors significantly associated with good prognosis were shockable rhythm, witnessed arrest, DA-CPR, use of AED, and treatment for STEMI. All patients that failed to achieve ROSC outside of the hospital setting had a poor prognosis. Conclusions: This study demonstrates the prognostic role of the initial rhythm and the use of AED in OHCA. Hospital management, including STEMI documentation and catheterization, was also an important prognostication factors. Additionally, when ROSC is not achieved in the field, hospital transfer should be considered.
Collapse
|
24
|
Ristau P, Wnent J, Gräsner JT, Fischer M, Bohn A, Bein B, Brenner S, Seewald S. Impact of COVID-19 on out-of-hospital cardiac arrest: A registry-based cohort-study from the German Resuscitation Registry. PLoS One 2022; 17:e0274314. [PMID: 36103547 PMCID: PMC9473624 DOI: 10.1371/journal.pone.0274314] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The global COVID-19 pandemic effects people and the health system. Some international studies reported an increasing number of out-of-hospital cardiac arrest (OHCA). Comparable studies regarding the impact of COVID-19 on incidence and outcome of OHCA are not yet available for Germany. Materials and methods This epidemiological study from the German Resuscitation Registry (GRR) compared a non-pandemic period (01.03.2018–28.02.2019) and a pandemic period (01.03.2020–28.02.2021) regarding the pandemic-related impact on OHCA care. Results A total of 18,799 cases were included. The incidence of OHCA (non-pandemic 117.9 vs. pandemic period 128.0/100,000 inhabitants) and of OHCA with resuscitation attempted increased (66.0 vs. 69.1/100,000). OHCA occurred predominantly and more often at home (62.8% vs. 66.5%, p<0.001). The first ECG rhythm was less often shockable (22.2% vs. 20.3%, p = 0.03). Fewer cases of OHCA were observed (58.6% vs. 55.6% p = 0.02). Both the bystander resuscitation rate and the proportion of telephone guided CPR remained stable (38.6% vs. 39.8%, p = 0.23; and 22.3% vs. 22.5%, p = 0.77). EMS arrival times increased (08:39 min vs. 09:08 min, p<0.001). Fewer patients reached a return of spontaneous circulation (ROSC) (45.4% vs. 40.9%, p<0.001), were admitted to hospital (50.2% vs. 45.0%, p<0.001), and discharged alive (13.9% vs. 10.2%, p<0.001). Discussion Survival after OHCA significantly decreased while the bystander resuscitation rate remained stable. However, longer EMS arrival times and fewer cases of witnessed OHCA may have contributed to poorer survival. Any change to EMS systems in the care of OHCA should be critically evaluated as it may mean a real loss of life—regardless of the pandemic situation.
Collapse
Affiliation(s)
- Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Fischer
- Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, ALB-FILS Kliniken, Göppingen, Germany
| | - Andreas Bohn
- Fire Department, City of Münster, Münster, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Berthold Bein
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - Sigrid Brenner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Dresden, Dresden, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
| |
Collapse
|
25
|
Plummer NR, Alcock H, Madden S, Brander J, Manara A, Harvey DJ, Gardiner DC. The impact of COVID-19 on organ donation and transplantation in the UK: lessons learned from the first year of the pandemic. Anaesthesia 2022; 77:1237-1250. [PMID: 36099651 DOI: 10.1111/anae.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic had a major impact on UK deceased organ donation and transplantation activity. We used national audit data from NHS Blood and Transplant to explore in detail the effects of the pandemic in comparison with 12 months pre-pandemic, and to consider the impact of the mitigating strategies and challenges placed on ICU by 'waves' of patients with COVID-19. Between 11 March 2020 and 10 March 2021, referrals to NHS Blood and Transplant of potential organ donors were initially inversely related to the number of people with COVID-19 undergoing mechanical ventilation in intensive care (incident rate ratio (95%CI) per 1000 patients 0.93 (0.88-0.99), p = 0.018), although this pattern reversed during the second wave (additional incident rate ratio (95%CI) 1.12 (1.05-1.19), p < 0.001). Adjusted numbers of donors (incident rate ratio (95%CI) 0.71 (0.61-0.81), p < 0.001) and organs retrieved (incident rate ratio (95%CI) 0.89 (0.82-0.97), p = 0.007) were inversely dependent on COVID-19 workload, though weekly numbers of transplants were unrelated (incident rate ratio (95%CI) 0.95 (0.86-1.04), p = 0.235). Non-COVID-19 mortality fell from 15,007 to 14,087 during the first wave (rate ratio (95%CI) 0.94 (0.92-0.96), p < 0.001) but climbed from 18,907 to 19,372 during the second wave (rate ratio (95%CI) 1.02 (1.00-1.05), p = 0.018). There were fewer in-hospital deaths from cardiac arrest and intracranial catastrophes throughout (rate ratio (95%CI) 0.83 (0.81-0.86), p < 0.001 and rate ratio (95%CI) 0.88 (0.85-0.91), p < 0.001, respectively). There were overall fewer eligible donors (n = 4282) when compared with pre-pandemic levels (n = 6038); OR (95%CI) 0.58 (0.51-0.66), p < 0.001. The total number of donations during the year fell from 1620 to 1140 (rate ratio (95%CI) 0.70 (0.65-0.76), p < 0.001), but the proportion of eligible donors who proceeded to donation (27%) was unchanged (OR (95%CI) 0.99 (0.91-1.08), p = 0.821). The reduction in donations and transplantation during the pandemic was multifactorial, but these data highlight the impact in the UK of a fall in eligible donors and an inverse relationship of referrals to COVID-19 workload. Despite the challenges faced, the foundations underpinning the UK deceased organ donation programme remained strong.
Collapse
Affiliation(s)
- N R Plummer
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - H Alcock
- East Midlands School of Anaesthesia, Health Education England East Midlands, Leicester, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
| | - J Brander
- NHS Blood and Transplant, Bristol, UK
| | - A Manara
- NHS Blood and Transplant, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - D J Harvey
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
| | - D C Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,NHS Blood and Transplant, Bristol, UK
| |
Collapse
|
26
|
Fazel MF, Mohamad MHN, Sahar MA, Juliana N, Abu IF, Das S. Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10968. [PMID: 36078684 PMCID: PMC9518324 DOI: 10.3390/ijerph191710968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Early cardiopulmonary resuscitation (CPR) is a strong link in the of survival for sudden cardiac arrest. Hence, bystander CPR (BPCR) plays an important role in curbing mortality and morbidity from out-of-hospital sudden cardiac arrest. However, the recent global Coronavirus disease 2019 (COVID-19) pandemic has impacted both public training and confidence in performing out-of-hospital CPR. This paper reviews detailed information from databases including Google Scholar, Scopus, PubMed and Web of Science on the readiness of BCPR during the pandemic. We also discussed the challenges bystanders encountered during the COVID-19 pandemic and the precautions to follow. Finally, we also highlighted the limitations which would benefit future endeavours in establishing well-planned and sustainable CPR training programs for the public. Therefore, regardless of the existing COVID-19 pandemic, BCPR must be emphasised to curb out-of-hospital cardiac arrest (OHCA) mortality.
Collapse
Affiliation(s)
- Muhammad Fattah Fazel
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | | | - Mohd Azmani Sahar
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Izuddin Fahmy Abu
- Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur 50250, Malaysia
| | - Srijit Das
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Alkoudh, Muscat 123, Oman
| |
Collapse
|
27
|
Morgan RW, Atkins DL, Hsu A, Kamath-Rayne BD, Aziz K, Berg RA, Bhanji F, Chan M, Cheng A, Chiotos K, de Caen A, Duff JP, Fuchs S, Joyner BL, Kleinman M, Lasa JJ, Lee HC, Lehotzky RE, Levy A, McBride ME, Meckler G, Nadkarni V, Raymond T, Roberts K, Schexnayder SM, Sutton RM, Terry M, Walsh B, Zelop CM, Sasson C, Topjian A. Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19. Pediatrics 2022; 150:188494. [PMID: 35818123 DOI: 10.1542/peds.2021-056043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.
Collapse
Affiliation(s)
- Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Antony Hsu
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Superior Township, Michigan
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, Illinois
| | - Khalid Aziz
- Department of Pediatrics, Division of Newborn Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Farhan Bhanji
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Melissa Chan
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Cheng
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Allan de Caen
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan P Duff
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Benny L Joyner
- Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Javier J Lasa
- Cardiovascular ICU, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Henry C Lee
- Division of Neonatology, Stanford University, Stanford, California
| | | | - Arielle Levy
- Departments of Pediatrics and Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Quebec, Canada
| | - Mary E McBride
- Cardiology, and Critical Care Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Garth Meckler
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Tia Raymond
- Department of Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas
| | - Kathryn Roberts
- Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Stephen M Schexnayder
- Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Springdale, Arkansas
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Brian Walsh
- Respiratory Care, Children's Hospital Colorado, Aurora, Colorado
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, NYU School of Medicine and The Valley Hospital, New York City, New York
| | - Comilla Sasson
- ECC Science & Innovation, American Heart Association, Dallas, Texas
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
28
|
Tseng WM, Lin PH, Wu PC, Kao CH. Examining patient flow in a tertiary hospital's emergency department at a low coronavirus prevalence region. BMC Emerg Med 2022; 22:137. [PMID: 35896981 PMCID: PMC9328777 DOI: 10.1186/s12873-022-00694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taiwan's successful containment of the COVID-19 outbreak prior to 2021 provided a unique environment for the surveillance of unnecessary emergency medical use. The aim of the study is to examine the impact of the coronavirus disease (COVID-19) pandemic on the patient flow in the emergency department (ED) of a tertiary hospital over 1 year in southern Taiwan, a region with low COVID-19 prevalence. METHODS Cross-sectional observational study was conducted from January to December 2020. Essential parameters of patient flow in the ED between January and February 2020 and the subsequent 11-month period were compared to data from 2019. Data were analyzed with descriptive statistics, using an independent sample t-test or Mann-Whitney U test, as applicable. RESULTS The ED census showed an acute decline (- 30.8%) from January to February 2020, reaching its nadir (- 40.5%) in April 2020. From February to December 2020, there was an average decrease of 20.3% in ED attendance (p < 0.001). The impact was most significant in ambulatory visits, lower-urgency acuity (level III) visits, and pediatric visits, without change in the acuity proportion. The length of stay shortened mainly in the adult division, which typically had an overcrowding problem (median, 5.7-4.4 hours in discharge; 24.8-16.9 hours in hospitalization; p < 0.001). The incidence of 72-hour unscheduled return visits was also reduced (4.1-3.5%, p = 0.002). CONCLUSIONS In contrast to devastated regions, the impact on the ED patient flow in regions having low COVID-19 prevalence highlights a remodeling process of emergency medical care that would improve overcrowding.
Collapse
Affiliation(s)
- Wen-Min Tseng
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan
| | - Po-Hsiang Lin
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan
| | - Pin-Chieh Wu
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Nursing, Meiho University, Pingtung County, Taiwan
| | - Chih-Hsiang Kao
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan.
| |
Collapse
|
29
|
Ratajczak J, Szczerbiński S, Kubica A. Occurrence and Temporal Variability of Out-of-Hospital Cardiac Arrest during COVID-19 Pandemic in Comparison to the Pre-Pandemic Period in Poland-Observational Analysis of OSCAR-POL Registry. J Clin Med 2022; 11:jcm11144143. [PMID: 35887907 PMCID: PMC9316491 DOI: 10.3390/jcm11144143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
An investigation of the chronobiology of out-of-hospital cardiac arrest (OHCA) during the coronavirus disease 2019 (COVID-19) pandemic and the differences in comparison to the 6-year pre-pandemic period. A retrospective analysis of the dispatch cards from the Emergency Medical Service between January 2014 and December 2020 was performed within the OSCAR-POL registry. The circadian, weekly, monthly, and seasonal variabilities of OHCA were investigated. A comparison of OHCA occurrence between the year 2020 and the 6-year pre-pandemic period was made. A total of 416 OHCAs were reported in 2020 and the median of OHCAs during the pre-pandemic period was 379 (interquartile range 337−407) cases per year. Nighttime was associated with a decreased number of OHCAs (16.6%) in comparison to afternoon (31.5%, p < 0.001) and morning (30.0%, p < 0.001). A higher occurrence at night was observed in 2020 compared to 2014−2019 (16.6% vs. 11.7%, p = 0.001). Monthly and seasonal variabilities were observed in 2020. The months with the highest OHCA occurrence in 2020 were November (13.2%) and October (11.1%) and were significantly higher compared to the same months during the pre-pandemic period (9.1%, p = 0.002 and 7.9%, p = 0.009, respectively). Autumn was the season with the highest rate of OHCA, which was also higher compared to the pre-pandemic period (30.5% vs. 25.1%, p = 0.003). The COVID-19 pandemic was related to a higher occurrence of OHCA. The circadian, monthly, and seasonal variabilities of OHCA occurrence were confirmed. In 2020, the highest occurrence of OHCA was observed in October and November, which coincided with the highest occurrence of COVID-19 infections in Poland.
Collapse
Affiliation(s)
- Jakub Ratajczak
- Department of Health Promotion, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-585-40-23; Fax: +48-52-585-40-24
| | | | - Aldona Kubica
- Department of Health Promotion, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
| |
Collapse
|
30
|
Shibahashi K, Kawabata H, Sugiyama K, Hamabe Y. Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan. Emerg Med J 2022; 39:emermed-2021-212212. [PMID: 35705365 PMCID: PMC9240453 DOI: 10.1136/emermed-2021-212212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic. METHODS This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes. RESULTS The witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes. CONCLUSION The COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.
Collapse
Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | | | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| |
Collapse
|
31
|
Riyapan S, Chantanakomes J, Roongsaenthong P, Tianwibool P, Wittayachamnankul B, Supasaovapak J, Pansiritanachot W. Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand. Int J Emerg Med 2022; 15:26. [PMID: 35681113 PMCID: PMC9178319 DOI: 10.1186/s12245-022-00429-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand. Methods This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January–September 2019) and during the outbreak (January–September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared. Results The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68–1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49–1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2–9.3] min vs 10 [6–14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak. Conclusion There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.
Collapse
Affiliation(s)
- Sattha Riyapan
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, Thailand, 10700.,Siriraj Emergency Medical Services Center, Siriraj Hospital, Bangkok, Thailand
| | - Jirayu Chantanakomes
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, Thailand, 10700.,Siriraj Emergency Medical Services Center, Siriraj Hospital, Bangkok, Thailand
| | - Pakorn Roongsaenthong
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, Thailand, 10700
| | - Parinya Tianwibool
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Borwon Wittayachamnankul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jirapong Supasaovapak
- Department of Emergency Medicine, Rajavithi Hospital, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
| | - Wasin Pansiritanachot
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, Thailand, 10700. .,Siriraj Emergency Medical Services Center, Siriraj Hospital, Bangkok, Thailand.
| |
Collapse
|
32
|
Baldi E, Cortegiani A, Savastano S. Cardiac arrest and coronavirus disease 2019. Curr Opin Crit Care 2022; 28:237-243. [PMID: 35275877 PMCID: PMC9208745 DOI: 10.1097/mcc.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). RECENT FINDINGS An increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SUMMARY Cardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.
Collapse
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| |
Collapse
|
33
|
Hawkes CA, Kander I, Contreras A, Ji C, Brown TP, Booth S, Niroshan Siriwardena A, Fothergill RT, Williams J, Rees N, Stephenson E, Perkins GD. Impact of the COVID-19 pandemic on public attitudes to cardiopulmonary resuscitation and publicly accessible defibrillator use in the UK. Resusc Plus 2022; 10:100256. [PMID: 35665312 PMCID: PMC9149208 DOI: 10.1016/j.resplu.2022.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
|
34
|
Fontanelli L, Sandroni C, Skrifvars MB. Out-of-hospital and in-hospital cardiac arrest during the COVID-19 pandemic: changes in demographics, outcomes and management. Minerva Anestesiol 2022; 88:594-603. [PMID: 35381836 DOI: 10.23736/s0375-9393.22.15994-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
During the COVID-19 pandemic, prehospital and hospital services were put under great stress because of limited resources and increased workloads. One expected effect was the increased number of out-of-hospital (OHCA) and in-hospital (IHCA) cardiac arrests that occurred during 2020 compared to previous years. Both direct and indirect mechanisms were involved. In the former case, although the exact mechanisms by which Sars-Cov-2 causes cardiac arrest (CA) are still unknown, severe hypoxia, a dysregulated immune host response and sepsis are probably implicated and are often seen in COVID-19 patients with poor outcomes. In the latter case, the strain on hospitals, changes in treatment protocols, governments' actions to limit the spread of the disease and fear of the contagion naturally affected treatment efficacy and disrupted the CA chain of survival; as expected in OHCA, only a small proportion of patients were positive to COVID-19, and yet reported outcomes were worse during the pandemic. CA patient characteristics were reported, along with modifications in patient management. In this review, we summarise the evidence to date regarding OHCA and IHCA epidemiology and management during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Luca Fontanelli
- Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy -
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Rome, Italy.,Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Markus B Skrifvars
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
35
|
Brady WJ, Chavez S, Gottlieb M, Liang SY, Carius B, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings. Am J Emerg Med 2022; 57:114-123. [PMID: 35561501 PMCID: PMC9045864 DOI: 10.1016/j.ajem.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. Objective This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. Discussion COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. Conclusion This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
Collapse
|
36
|
Perkins GD, Bray J, Couper K, Morley P, Scquizzato T, Nolan JP. Resuscitation plus – Initial successes and future direction. Resusc Plus 2022; 9:100213. [PMID: 35243450 PMCID: PMC8857650 DOI: 10.1016/j.resplu.2022.100213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
37
|
Metelmann C, Metelmann B, Müller MP, Böttiger BW, Trummer G, Thies KC. First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic. Scand J Trauma Resusc Emerg Med 2022; 30:10. [PMID: 35183230 PMCID: PMC8857892 DOI: 10.1186/s13049-022-00998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19. Methods To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe. Results We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission. Conclusions European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-00998-3.
Collapse
|
38
|
Sadiq W, Waleed MS, Suen P, Chalhoub MN. Cardiopulmonary Arrest After COVID-19 Vaccination: A Case Report. Cureus 2022; 14:e21141. [PMID: 35165592 PMCID: PMC8831382 DOI: 10.7759/cureus.21141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) emerged in Wuhan in 2019 and by far has affected the whole world, and many people have succumbed to the disease. Vaccination programs introduced around the globe are aiming to reduce morbidity, mortality, and disease spread. We report the case of a 59-year-old male who suffered from cardiopulmonary arrest post-COVID-19 mRNA booster vaccination with no history of any other cardiopulmonary disease. Association between myocarditis and mRNA COVID-19 vaccines have been previously reported. However, this is the first case of cardiopulmonary arrest post-COVID-19 booster vaccination. Further research and cases should be described to confirm if this relationship exists. We need further cases to find this temporal association as such cases can also increase vaccine hesitancy. However, vaccination-associated adverse events should be vigilantly monitored and evaluated from time to time as further reports emerge.
Collapse
Affiliation(s)
- Waleed Sadiq
- Medicine, Staten Island University Hospital, New York, USA
| | | | - Phyllis Suen
- Internal Medicine, Northwell Health, Staten Island, USA
| | - Michel N Chalhoub
- Pulmonology and Critical Care Medicine, Staten Island University Hospital, New York, USA
| |
Collapse
|
39
|
Queiroga AC, Dunne C, Manino LA, van der Linden T, Mecrow T, Bierens J. Resuscitation of Drowned Persons During the COVID-19 Pandemic: A Consensus Statement. JAMA Netw Open 2022; 5:e2147078. [PMID: 35133441 DOI: 10.1001/jamanetworkopen.2021.47078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. OBJECTIVE To develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. EVIDENCE REVIEW Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. FINDINGS Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training. Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. CONCLUSIONS AND RELEVANCE This consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.
Collapse
Affiliation(s)
- Ana Catarina Queiroga
- EPIUnit (Unidade de Investigação em Epidemiologia), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- ITR (Laboratory for Integrative and Translational Research in Population Health), Porto, Portugal
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
| | - Cody Dunne
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leonardo Andres Manino
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Costanera Rosario, Civil Defense Rosario Municipality, Rosario, Argentina
- Equipo Professional de Salvamento Acuático, Buenos Aires, Argentina
| | | | - Tom Mecrow
- International Drowning Researchers' Alliance, Kuna, Idaho
- International Maritime Rescue Federation, Enfield, United Kingdom
- Royal National Lifeboat Institution, Poole, United Kingdom
| | - Joost Bierens
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, Idaho
- Royal Dutch Lifeboat Institution, IJmuiden, the Netherlands
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Brussels, Belgium
| |
Collapse
|
40
|
Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep 2022; 12:800. [PMID: 35039578 PMCID: PMC8764072 DOI: 10.1038/s41598-021-04749-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Bystander cardiopulmonary resuscitation (BCPR), early defibrillation and timely treatment by emergency medical services (EMS) can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of the COVID-19 pandemic on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR 1.38, 95% CI 1.11–1.71, p = 0.0069). BCPR did not differ during and before the COVID-19 pandemic (OR 0.94, 95% CI 0.80–1.11, p = 0.4631), although bystander defibrillation was significantly lower during the COVID-19 pandemic (OR 0.65, 95% CI 0.48–0.88, p = 0.0107). EMS call-to-arrival time was significantly higher during the COVID-19 pandemic (SMD 0.27, 95% CI 0.13–0.40, p = 0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.
Collapse
|
41
|
Teoh SE, Masuda Y, Tan DJH, Liu N, Morrison LJ, Ong MEH, Blewer AL, Ho AFW. Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Ann Intensive Care 2021; 11:169. [PMID: 34874498 PMCID: PMC8649312 DOI: 10.1186/s13613-021-00957-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. METHODS PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes [annual incidence, mortality, and case fatality rate (CFR)], secondary outcomes [field termination of resuscitation (TOR), return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge], and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). RESULTS The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p < 0.001). Pooled CFR was increased by 2.65% (p < 0.001), with a pooled odds ratio (OR) of 1.95 for mortality [95% confidence interval (95%CI) 1.51-2.51]. There was increased field TOR (OR = 2.46, 95%CI 1.62-3.74). There were decreased ROSC (OR = 0.65, 95%CI 0.55-0.77), survival to hospital admission (OR = 0.65, 95%CI 0.48-0.89), and survival to discharge (OR = 0.52, 95%CI 0.40-0.69). There was decreased shockable rhythm (OR = 0.73, 95%CI 0.60-0.88) and increased asphyxial etiology of OHCA (OR = 1.17, 95%CI 1.02-1.33). CONCLUSION Compared to the pre-pandemic period, the COVID-19 pandemic period was significantly associated with increased OHCA incidence and worse outcomes.
Collapse
Affiliation(s)
- Seth En Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Laurie J Morrison
- Division of Emergency Medicine, Department of Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Marcus Eng Hock Ong
- Office C, Department of Emergency Medicine, Singapore General Hospital, 1 Outram Rd, Singapore, 169608, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Fu Wah Ho
- Office C, Department of Emergency Medicine, Singapore General Hospital, 1 Outram Rd, Singapore, 169608, Singapore. .,Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore.
| |
Collapse
|
42
|
Scquizzato T, Landoni G, Scandroglio AM, Franco A, Calabrò MG, Paoli A, D’Amico F, Yavorovskiy A, Zangrillo A. Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis. Eur J Emerg Med 2021; 28:423-431. [PMID: 34690258 PMCID: PMC8549129 DOI: 10.1097/mej.0000000000000878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest. METHODS PubMed and EMBASE were searched up to April 05, 2021. We included studies comparing out-of-hospital cardiac arrests patients with suspected or confirmed SARS-CoV-2 infection versus noninfected patients. The primary outcome was survival at hospital discharge or at 30 days. Secondary outcomes included return of spontaneous circulation, cardiac arrest witnessed and occurring at home, bystander-initiated cardiopulmonary resuscitation, proportion of nonshockable rhythm and resuscitation attempted, and ambulance arrival time. RESULTS In the ten included studies, 18% (1341/7545) of out-of-hospital cardiac arrests occurred in patients with SARS-CoV-2 infection. Patients with out-of-hospital cardiac arrest and SARS-CoV-2 infection had reduced rates of survival (16/856 [1.9%] vs. 153/2344 [6.5%]; odds ratio (OR) = 0.33; 95% confidence interval (CI), 0.17-0.65; P = 0.001; I2 = 28%) and return of spontaneous circulation (188/861 [22%] vs. 640/2403 [27%]; OR = 0.75; 95% CI, 0.65-0.86; P < 0.001; I2 = 0%) when compared to noninfected patients. Ambulance arrived later (15 ± 10 vs. 13 ± 7.5 min; mean difference = 1.64; 95% CI, 0.41-2.88; P = 0.009; I2 = 61%) and nonshockable rhythms (744/803 [93%] vs. 1828/2217 [82%]; OR = 2.79; 95% CI, 2.08-3.73; P < 0.001; I2 = 0%) occurred more frequently. SARS-CoV-2 positive patients suffered a cardiac arrest at home more frequently (1186/1263 [94%] vs. 3598/4055 [89%]; OR = 1.86; 95% CI, 1.45-2.40; P<0.001; I2 = 0%) but witnessed rate (486/890 [55%] vs. 1385/2475 [56%]; OR = 0.97; 95% CI, 0.82-1.14; P = 0.63; I2 = 0%) and bystander-initiated cardiopulmonary resuscitation rate (439/828 [53%] vs. 1164/2304 [51%]; OR = 0.95; 95% CI, 0.73-1.24; P = 0.70; I2 = 53%) were similar. CONCLUSIONS One-fifth of out-of-hospital cardiac arrest patients had SARS-CoV-2 infection. These patients had low rates of return of spontaneous circulation and survival and were characterized by higher nonshockable rhythms but similar bystander-initiated cardiopulmonary resuscitation rate. REVIEW REGISTRATION PROSPERO - CRD42021243540.
Collapse
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Annalisa Franco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Andrea Paoli
- Emergency Medical Services (SUEM 118), Azienda Ospedale-Università Padova, Padova, Italy
| | - Filippo D’Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
| | - Andrey Yavorovskiy
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan
| |
Collapse
|
43
|
Bielski K, Szarpak A, Jaguszewski MJ, Kopiec T, Smereka J, Gasecka A, Wolak P, Nowak-Starz G, Chmielewski J, Rafique Z, Peacock FW, Szarpak L. The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis. J Clin Med 2021; 10:5573. [PMID: 34884289 PMCID: PMC8658174 DOI: 10.3390/jcm10235573] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06-1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37-1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1-2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35-2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13-2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.
Collapse
Affiliation(s)
- Karol Bielski
- Research Unit, Polonia University, 4/6 Pulaskiego Str., 42-200 Czestochowa, Poland;
- Provincial Emergency Medical Service Dispatcher, 22 Poznanska, 00-685 Warsaw, Poland
| | - Agnieszka Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., 03-411 Warsaw, Poland;
| | - Miłosz Jaroslaw Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 3A Sklodowskiej-Curie Str., 80-210 Gdansk, Poland;
| | - Tomasz Kopiec
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 6 Bartla Str., 52-443 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, P.O. Box 78, Raszyn, 05-090 Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Przemysław Wolak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | | | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Lukasz Szarpak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 12 Ogrodowa Str., 15-027 Bialystok, Poland
| |
Collapse
|
44
|
Baldi E, Primi R, Bendotti S, Currao A, Compagnoni S, Gentile FR, Sechi GM, Mare C, Palo A, Contri E, Ronchi V, Bergamini G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Campi S, Centineo P, De Ponti R, Oltrona Visconti L, Savastano S. Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence. PLoS One 2021; 16:e0260275. [PMID: 34797840 PMCID: PMC8604324 DOI: 10.1371/journal.pone.0260275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. Aim To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. Methods We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. Results A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Conclusions Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs’ increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.
Collapse
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | - Alessandra Palo
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Contri
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vincenza Ronchi
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- ASST di Pavia, Pavia, Italy
| | - Giuseppe Bergamini
- AAT Lodi - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Francesca Reali
- AAT Lodi - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Pierpaolo Parogni
- AAT Mantova - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantua, Mantua, Italy
| | - Fabio Facchin
- AAT Mantova - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantua, Mantua, Italy
| | - Ugo Rizzi
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Daniele Bussi
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Sabina Campi
- AAT Varese - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, Varese, Italy
| | - Paola Centineo
- AAT Varese - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, Varese, Italy
| | - Roberto De Ponti
- ASST-Settelaghi, Ospedale di Circolo - Università dell’Insubria, Varese, Italy
| | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- * E-mail:
| | | |
Collapse
|
45
|
Brown TP, Perkins GD, Smith CM, Deakin CD, Fothergill R. Are there disparities in the location of automated external defibrillators in England? Resuscitation 2021; 170:28-35. [PMID: 34757059 PMCID: PMC8786665 DOI: 10.1016/j.resuscitation.2021.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022]
Abstract
Background Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence. Objectives This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England. Methods Details of the location of AEDs registered with English Ambulance Services were obtained from individual services or internet sources. Neighbourhood characteristics of lower layer super output areas (LSOA) were obtained from the Office for National Statistics. Comparisons were made between LSOAs with and without a registered AED. Results AEDs were statistically more likely to be in LSOAs with a lower residential but higher workplace population density, with people predominantly from a white ethnic background and working in higher socio-economically classified occupations (p < 0.05). There was a significant correlation between AED coverage and the LSOA Index of Multiple Deprivation (IMD) (r = 0.79, p = 0.007), with only 27.4% in the lowest IMD decile compared to about 45% in highest. AED density varied significantly across the country from 0.82/km2 in the north east to 2.97/km2 in London. Conclusions In England, AEDs were disproportionately placed in more affluent areas, with a lower residential population density. This contrasts with locations where OHCAs have previously occurred. Future PAD programmes should give preference to areas of higher deprivation and be tailored to the local community.
Collapse
Affiliation(s)
- Terry P Brown
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.
| | - Gavin D Perkins
- NIHR Applied Research Collaboration West Midlands, Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | | | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Winchester SO21 2RU, UK; University Hospital Southampton NHS Foundation Trust, Southampton S16 6YD, UK
| | - Rachael Fothergill
- Clinical Audit & Research Unit, Clinical & Quality Directorate, London Ambulance Service NHS Trust, HQ Annexe, 8-20 Pocock Street, London SE1 0BW, UK
| |
Collapse
|
46
|
Characteristics of Emergency Medical Service Missions in Out-of-Hospital Cardiac Arrest and Death Cases in the Periods of Before and After the COVID-19 Pandemic. Prehosp Disaster Med 2021; 36:676-683. [PMID: 34622749 PMCID: PMC8529353 DOI: 10.1017/s1049023x21001138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19. Objective: The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA. Methods: This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician’s on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared. Results: In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years. Conclusion: This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years
Collapse
|
47
|
Abstract
To describe and compare survival among patients with out-of-hospital cardiac arrest as a function of their status for coronavirus disease 2019.
Collapse
|
48
|
Morton S, Dawson J, McLachlan S, McGuinness W. Helicopter Emergency Medical Services Out-of-Hospital Cardiac Arrests During the Initial COVID-19 Lockdown Versus Nonpandemic: A Comparison. Air Med J 2021; 41:68-72. [PMID: 35248347 PMCID: PMC8570121 DOI: 10.1016/j.amj.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/02/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
Objective COVID-19 may have contributed to an excess of out-of-hospital cardiac arrests (OOHCAs). This observational study identified changes in OOHCA epidemiology pre– and post–COVID-19 lockdown in a single UK helicopter emergency medical service (HEMS). Methods A retrospective, single-center (Essex & Herts Air Ambulance), observational study was undertaken with anonymized OOHCA data (demographics, etiology, and outcomes) from March 23, 2020, to June 23, 2020, and comparative data from March 23, 2019, to June 23, 2019. Supplementary data (total OOHCAs and patient outcomes) were provided by the East of England Ambulance Service National Health Service Trust. Data were analyzed using the Mann-Whitney U test and chi-square test; P < .05 was statistically significant. Results: Of the HEMS activations during national lockdown, 33.6% were for OOHCAs compared with 25.8% during the reference time frame. The frequency of young and female OOHCAs demonstrated a statistically significant increase. Statistically significant variations in medical etiology and initial cardiac rhythm were identified. Conclusion During the initial UK-wide lockdown, the OOHCA characteristics attended by 1 HEMS team were altered. The changes seen may be due to the pathophysiology of COVID-19 or an alteration in dispatch due to the demand placed on the wider ambulance service; this may require further consideration for any future lockdowns or pandemics.
Collapse
Affiliation(s)
- Sarah Morton
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom.
| | - Jonathan Dawson
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom; Anglia Ruskin University, Chelmsford and Cambridge, United Kingdom
| | - William McGuinness
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, United Kingdom; Emergency Department, St George's Hospital, London, United Kingdom
| |
Collapse
|
49
|
Scquizzato T, D'Amico F, Rocchi M, Saracino M, Stella F, Landoni G, Zangrillo A. Impact of COVID-19 Pandemic on Out-of-Hospital Cardiac Arrest System-of-Care: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2021:1-12. [PMID: 34382909 DOI: 10.1080/10903127.2021.1967535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023]
Abstract
Introduction: COVID-19 pandemic overwhelmed healthcare systems and diverted resources allocated for other conditions. This systematic review and meta-analysis aimed to analyse how the pandemic impacted the system-of-care of out-of-hospital cardiac arrest.Methods: We searched PubMed and Embase up to May 31, 2021, for studies comparing out-of-hospital cardiac arrests that occurred during the COVID-19 pandemic versus a non-pandemic period. Survival at hospital discharge or at 30 days was the primary outcome.Results: We included 24 studies for a total of 75,952 patients. Out-of-hospital cardiac arrests during COVID-19 pandemic had lower survival (19 studies; 603/11,666 [5.2%] vs. 1320/17,174 [7.7%]; OR = 0.54; 95% CI, 0.44-0.65; P = 0.001) and return of spontaneous circulation (4370/24353 [18%] vs. 7401/34510 [21%]; OR = 0.64; 95% CI, 0.55-0.75; P < 0.001) compared with non-pandemic periods. Ambulance response times (10.1 vs 9.0 minutes, MD = 1.01; 95% CI, 0.59-1.42; P < 0.001) and non-shockable rhythms (18,242/21,665 [84%] vs. 19,971/24,817 [81%]; OR = 1.27; 95% CI, 1.10-1.46; P < 0.001) increased. Use of supraglottic airways devices increased (2853/7645 [37%] vs. 2043/17521 [12%]; OR = 1.97; 95% CI, 1.42-2.74; P < 0.001).Conclusions: The COVID-19 pandemic affected the system-of-care of out-of-hospital cardiac arrest, and patients had worse short-term outcomes compared to pre-pandemic periods. Advanced airway management strategy shifted from endotracheal intubation to supraglottic airway devices. REVIEW REGISTRATION PROSPERO CRD42021250339.
Collapse
Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Federica Stella
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy (TS, FDA, MR, MS, GL, AZ); School of Medicine, Vita-Salute San Raffaele University, Milan, Italy (GL, AZ); Emergency Medical Services (SUEM 118), Venice, Italy (FS)
| |
Collapse
|
50
|
Khanji MY, Ali B, Ahmed S. Virtual delivery of cardiopulmonary resuscitation training for the public: how to make it work. Eur Heart J 2021; 42:4710-4712. [PMID: 34516613 DOI: 10.1093/eurheartj/ehab652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohammed Y Khanji
- Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Bismah Ali
- Department of Occupations Therapy Studies, School of Health and Social Care, London Southbank University, 103 Borough Road, London SE1 0AA, UK
| | - Shakeel Ahmed
- Easington CAMHS, Winchester House, 3 Winchester Drive, Southwest Industrial Estate, Peterlee SR8 2RJ, UK.,Sunderland Medical School, Edinburgh Building, Chester Road, Sunderland SR1 3SD, UK
| |
Collapse
|