Updated trends in the outcomes of out-of-hospital cardiac arrest from 2017-2021: Prior to and during the coronavirus disease (COVID-19) pandemic

Cheng-Yi Fan; Chih-Wei Sung; Ching-Yu Chen; Chi-Hsin Chen; Likwang Chen; Yun-Chang Chen; Jiun-Wei Chen; Wen-Chu Chiang; Chien-Hua Huang; Edward Pei-Chuan Huang

doi:10.1002/emp2.13070

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 Nov 27;4(6):e13070. doi: 10.1002/emp2.13070. eCollection 2023 Dec.

Authors

Cheng-Yi Fan¹, Chih-Wei Sung^{1

2}, Ching-Yu Chen³, Chi-Hsin Chen¹, Likwang Chen⁴, Yun-Chang Chen³, Jiun-Wei Chen¹, Wen-Chu Chiang^{2

3

5}, Chien-Hua Huang^{2

5}, Edward Pei-Chuan Huang^{1

2

5}

Affiliations

¹ Department of Emergency Medicine National Taiwan University Hospital Hsin-Chu Branch Hsinchu Taiwan.
² Department of Emergency Medicine College of Medicine National Taiwan University Taipei Taiwan.
³ Department of Emergency Medicine National Taiwan University Hospital Yun-Lin Branch Douliu Taiwan.
⁴ Institute of Population Health Sciences National Health Research Institutes Miaoli Taiwan.
⁵ Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan.

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.

Keywords: cardiopulmonary resuscitation; coronavirus disease 2019; outcomes; out‐of‐hospital cardiac arrest; trend.