Exposure-response relationship between COVID-19 incidence rate and incidence and survival of out-of-hospital cardiac arrest (OHCA)

• Published in: Resuscitation plus Vol. 14; p. 100372
• Main Authors: Leung, Ka Yee, Chu, Cheuk Man Manson, Lui, Chun Tat
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023; Elsevier
• Subjects: Bystander CPR; COVID-19; Out-of-hospital cardiac arrest; Survival outcome; COVID-19; Out-of-hospital cardiac arrest; Bystander CPR; Survival outcome
• ISSN: 2666-5204; 2666-5204
• DOI: 10.1016/j.resplu.2023.100372

We aimed to report the epidemiology of OHCA, bystander CPR pattern and other Utstein factors in a region in Hong Kong during the COVID-19 pandemic. In particular, we studied the relationship between COVID-19 incidence, OHCA incidence and survival outcome. This was a retrospective cohort study that used data from our registry to compare features of OHCA during pre-pandemic (Jan 2018 to Dec 2019), low-incidence pandemic (Jan 2020 to Dec 2021) and high-incidence pandemic (Jan to Mar 2022). We used multivariable logistic regression to identify survival predictors. Incidence of OHCA increased dramatically with surging COVID-19 incidence (65.9 vs 74.2 vs 159.2 per 100,000 population per year, p < 0.001). During the pandemic, there were more indoor OHCA (89.3% vs 92.6% vs 97.4%, p < 0.001), fewer witnessed arrest (38.5% vs 38.3% vs 29.6%, p = 0.001), and longer median time to basic life support upon receiving call (9 min vs 10 min vs 14 min, p < 0.001). There was a higher proportion of OHCA cases with bystander-CPR (26.1% vs 31.3% vs 35.3%, p < 0.001). The proportion of cases with survival to admission (STA) (30.8% vs 22.2% vs 15.4%, p < 0.001) and survival to discharge (STD) (2.2% vs 1.0% vs 0.2%, p = 0.001) were lowered. After controlling for confounders, the odds of STA was reduced by 33% and 55% during the low-incidence and high-incidence pandemic respectively. The increase in COVID-19 incidence had an exposure–response relationship with an increased incidence of OHCA and worsened survival outcomes.