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Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City

Lai PH, Lancet EA, Weiden MD, et. al. JAMA Cardiol. doi:10.1001/jamacardio.2020.2488

Background:

  • Out of Hospital cardiac arrests (OHCA) have increased during the COVID – 19 Pandemic.
  • In New York City the incidence of OHCA was increased to 10X that of 2019 at the peak.

Study Goal:

  • To assess factors associated with OHCA during the COVID – 19 period.

Key Points:

  • Study period – March 1 – April 25, 2019 (baseline) compared with the same dates in 2020 (COVID – 19 Period).
  • Study populations: Baseline period – 1336; COVID – 19 Period -3989.
  • Incidence of OHCA Baseline was 15.9/100,000 population; COVID – 19 47.5/100,000 population; 3 times greater in the COVID – 19 Period.
  • Demographics: Patients during the COVID – 19 period tended to be older 72 vs. 68 years and more likely African American 34.2 vs. 20.4% and Hispanic 25.5 vs. 20.6% while the number of whites declined from 34.3% to 20.4%.
  • Comorbidities: Patients during the COVID – 19 Period were more likely hypertensive (53.5 vs. 45.7%); Diabetic (35.7 vs. 26.0%) and more likely to have physical limitations (56.6 vs. 47.5%). In contrast, the incidence of cardiac disease, asthma/COPD, cancer and CVAs were not differenct between the two periods.
  • OHCA presentations: During COVID – 19 Period, patients were significantly more likely to have pulseless electrical activity or asystole.
  • Outcomes: During the COVID – 19 Period return of spontaneous circulation (ROSC) was reduced 18.2 vs. 34.7% (p<0.001) while sustained ROSC was achieved in only 10.2 vs. 25.2% (p<0.001) of patients in the COVID – 19 Period, with significantly more frequent discontinuance of resuscitation in the field because of failure to attain ROSC despite no difference in bystander CPR, time to resuscitation, or total resuscitation time between the two periods.
  • The authors conclude that vulnerable populations need to be identified early and intensely managed in the outpatient setting to minimize risk of OHCA during the COVID – 19 Pandemic.