Management of Out-of-Hospital Cardiac Arrest during COVID-19: A Tale of Two Cities

• Type of Material: Article
• Authors: Shir Lynn Lim, National University Heart Centre, Singapore; Lekshmi Kumar, Emory University; Seyed Ehsan Saffari, National University of Singapore; Nur Shahidah, Singapore General Hospital; Rabab Al-Araji, Emory University; Qin Xiang Ng, Singapore Civil Defence Force; Andrew Fu Wah Ho, National University of Singapore; Shalini Arulanandam, Singapore Civil Defence Force; Benjamin Sieu-Hon Leong, National University Hospital, Singapore; Nan Liu, Natl Univ Singapore; Fahad Javaid Siddiqui, Natl Univ Singapore; Bryan McNally, Emory University; Marcus Eng Hock Ong, National University of Singapore
• Language: English
• Date: 2022-09-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm11175177
• Title of Journal or Parent Work: JOURNAL OF CLINICAL MEDICINE
• Volume: 11
• Issue: 17
• Grant/Funding Information: This study was supported by grant from National Medical Research Council, Clinician Scientist Award, Singapore (NMRC/CSA-SI/0014/2017). The funders of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author and senior authors had full access to all the data and the final responsibility to submit for publication.
• Keywords: Life Sciences & Biomedicine; IMPACT; cardiac arrest; survival to hospital discharge; General & Internal Medicine; CARDIOPULMONARY-RESUSCITATION; Science & Technology; pandemic; SURVIVAL; Medicine, General & Internal; pre-hospital interventions
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Variations in the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to, using population-based registries, compare community response, Emergency Medical Services (EMS) interventions and outcomes of adult, EMS-treated, non-traumatic OHCA in Singapore and metropolitan Atlanta, before and during the pandemic. Associations of OHCA characteristics, pre-hospital interventions and pandemic with survival to hospital discharge were analyzed using logistic regression. There were 2084 cases during the pandemic (17 weeks from the first confirmed COVID-19 case) and 1900 in the pre-pandemic period (corresponding weeks in 2019). Compared to Atlanta, OHCAs in Singapore were older, received more bystander interventions (cardiopulmonary resuscitation (CPR): 65.0% vs. 41.4%; automated external defibrillator application: 28.6% vs. 10.1%), yet had lower survival (5.6% vs. 8.1%). Compared to the pre-pandemic period, OHCAs in Singapore and Atlanta occurred more at home (adjusted odds ratio (aOR) 2.05 and 2.03, respectively) and were transported less to hospitals (aOR 0.59 and 0.36, respectively) during the pandemic. Singapore reported more witnessed OHCAs (aOR 1.96) yet less bystander CPR (aOR 0.81) during pandemic, but not Atlanta (p < 0.05). The impact of COVID-19 on OHCA outcomes did not differ between cities. Changes in OHCA characteristics and management during the pandemic, and differences between Singapore and Atlanta were likely the result of systemic and sociocultural factors.