Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic
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Published:2024-01-23
Issue:1
Volume:7
Page:e2352377
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Ruiz Azpiazu José Ignacio1, Fernández del Valle Patricia2, Echarri Sucunza Alfredo3, Iglesias Vázquez Jose Antonio4, del Pozo Carmen5, Knox Emily Caitlin Lily6, Azeli Youcef7, Sánchez García Francisco José8, Fernández Barreras Cristian9, Escriche María Carmen10, Martín Hernández Pedro Jesús11, Juanes García Marcos12, Ramos García Natividad13, Royo Embid Sonia14, Cortés Ramas José Antonio15, Mateo-Rodríguez Inmaculada16, Sola Muñoz Silvia7, Alcalá-Zamora Marcó Elena8, Fornér Canos Ana Belén10, Mainar Gómez Belén14, Dacal Pérez Pedro4, Camacho Leis Carmen13, García Cortés Jose Javier5, Hernández Royano José Manuel11, Escalada Roig Xavier17, Daponte Codina Antonio16, Rosell Ortiz Fernando1, Olavarria Govantes Luis18, Luque-Hernández María J18, Paz-Rodríguez Miguel A18, Ayuso-Batista Fernando18, Gutiérrez-García Carmen18, Soto-García María R18, Caballero-García María A18, Antón Ramas Roberto18, Chueca García Marcel18, González Herráiz Ignacio18, Ceniceros-Rozalen Maria I18, Arias Moya Esther18, Gonzalez Quintana María N18, Redondo Revilla Faustino18, Guerra García Cesar M18, Valenciano Rodriguez Juan18, Lara Sánchez Juan J18, Martinez-Villalobos Aguilar Cristina18, Noriega Miguez Almudena18, Sánchez del Rio Leticia18, Tomàs Fort Vanessa18, Sanchis Nuñez Carlos18, Nieto Ferrando Jose L18, Ilzarbe Ucelay Itziar I18, Jimenez Fabrega Francesc X18, Salaberria Udabe Ruth18, Vicente Casanova Fernando18, Batres Gomez Susana18, Medina Aragon Francisco J18, López Alvarez Xesús M18, Dorribo Masid Marta18, García-Ochoa Blanco María J18, Jose María Navalpotro Pascual Jose M18, Villar Arias Alicia18, González León Manuel J18, Muñoz Isabel Belén18, Hortelano Alonso Jose A18, Jose Peinado Francisco A18, Guirao Salinas Francisco A18, Lopez Perez Cruz18, García Mendoza Junior J18, Artigas Miguel18, Rivera Sánz Félix18, Fernández González Alvaro18,
Affiliation:
1. Servicio de Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja, Logroño, Spain 2. Agencia de Servicios Sociales y Dependencia de Andalucía, Sevilla, Spain 3. Servicio de Urgencias Extrahospitalarias de Navarra, Pamplona, Spain 4. Fundación Pública Urxencias Sanitarias 061, Galicia, Spain 5. Emergencias Sanitarias, Castilla y León, Valladolid, Spain 6. CIBER Epidemiology and Public Health, Granada, Spain 7. Sistema de Emergencies Mediques, Catalunya, Institut d’ Investigació Sanitaria Pere i Virgili, Tarragona (IISPV), Tarragona, Spain 8. SUMMA-112 Madrid, Madrid, Spain 9. Emergentziak-Emergencias, Osakidetza, Spain 10. SAMU Emergencias Sanitarias, Comunidad Valenciana, Valencia, Spain 11. Emergencias Sanitarias Extrahospitalarias de Extremadura, ESEX 112, Mérida, Spain 12. Servicio de Emergencias 061 de La Rioja, Logroño, Spain 13. SAMUR Protección Civil, Madrid, Spain 14. 061 e Instituto de Ciencias de la Salud, Aragón, Spain 15. Servicio de Bomberos de Zaragoza, Aragón, Spain 16. Andalusian School of Public Health, Universidad Nacional a Distancia, CIBER Epidemiology and Public Health, Granada, Spain 17. Sistema de Emergencies Mediques, Catalunya, Institut d’ Investigació Sanitaria Pere i Virgili, Tarragona, Barcelona, Spain 18. for the OHSCAR Investigators Group
Abstract
ImportanceOut-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery.ObjectiveTo determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels.Design, Setting, and ParticipantsThis observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder.ExposureThe pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection.Main Outcome and MeasuresThe main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance.ResultsA total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001).Conclusions and RelevanceIn this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.
Publisher
American Medical Association (AMA)
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