We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Acute SARS-CoV-2 Infection and Incidence and Outcomes of Out-of-Hospital Cardiac Arrest.
- Authors
Liu, Jennifer Z.; Counts, Catherine R.; Drucker, Christopher J.; Emert, Jamie M.; Murphy, David L.; Schwarcz, Leilani; Kudenchuk, Peter J.; Sayre, Michael R.; Rea, Thomas D.
- Abstract
Key Points: Question: What proportion of the change in out-of-hospital cardiac arrest (OHCA) incidence and outcomes between the prepandemic and pandemic periods was associated with patient-specific acute SARS-CoV-2 infection? Findings: In this cohort study of 13 081 patients, the incidence of OHCA increased by 19.0% during the pandemic, even though only 6.2% of emergency medical services (EMS)–treated patients and 3.7% of EMS-attended but untreated patients during the pandemic period were classified with acute SARS-CoV-2 infection. OHCA survival decreased from 19.2% to 15.4%; acute SARS-CoV-2 infection accounted for 18.5% of this decrease, whereas more generalizable characteristics related to OHCA circumstances and resuscitation care mediated 68.2% of the decrease. Meaning: The findings underscore the adverse public health consequences resulting from indirect effects of the COVID-19 pandemic. This cohort study assesses the association of acute SARS-CoV-2 infection with the incidence and outcomes of out-of-hospital cardiac arrest in Seattle and King County, Washington. Importance: Little is known about how COVID-19 affects the incidence or outcomes of out-of-hospital cardiac arrest (OHCA), and it is possible that more generalized factors beyond SARS-CoV-2 infection are primarily responsible for changes in OHCA incidence and outcome. Objective: To assess whether COVID-19 is associated with OHCA incidence and outcomes. Design, Setting, and Participants: This retrospective cohort study was conducted in Seattle and King County, Washington. Participants included persons aged 18 years or older with nontraumatic OHCA attended by emergency medical services (EMS) between January 1, 2018, and December 31, 2021. Data analysis was performed from November 2022 to March 2023. Exposures: Prepandemic (2018-2019) and pandemic (2020-2021) periods and SARS-CoV-2 infection. Main Outcomes and Measures: The primary outcomes were OHCA incidence and patient outcomes (ie, survival to hospital discharge). Mediation analysis was used to determine the percentage change in OHCA incidence and outcomes between prepandemic and pandemic periods that was attributable to acute SARS-CoV-2 infection vs conventional Utstein elements related to OHCA circumstances (ie, witness status and OHCA location) and resuscitation care (ie, bystander cardiopulmonary resuscitation, early defibrillation, and EMS response intervals). Results: There were a total of 13 081 patients with OHCA (7102 dead upon EMS arrival and 5979 EMS treated). Among EMS-treated patients, the median (IQR) age was 64.0 (51.0-75.0) years, 3864 (64.6%) were male, and 1027 (17.2%) survived to hospital discharge. The total number of patients with OHCA increased by 19.0% (from 5963 in the prepandemic period to 7118 in the pandemic period), corresponding to an incidence increase from 168.8 to 195.3 events per 100 000 person-years. Of EMS-treated patients with OHCA during the pandemic period, 194 (6.2%) were acutely infected with SARS-CoV-2 compared with 7 of 191 EMS-attended but untreated patients with OHCA (3.7%). In time-series correlation analysis, there was a positive correlation between community SARS-CoV-2 incidence and overall OHCA incidence (r = 0.27; P =.01), as well as OHCA incidence with acute SARS-CoV-2 infection (r = 0.43; P <.001). The survival rate during the pandemic period was lower than that in the prepandemic period (483 patients [15.4%] vs 544 patients [19.2%]). During the pandemic, those with OHCA and acute SARS-CoV-2 infection had lower likelihood of survival compared with those without acute infection (12 patients [6.2%] vs 471 patients [16.0%]). SARS-CoV-2 infection itself accounted for 18.5% of the pandemic survival decline, whereas Utstein elements mediated 68.2% of the survival decline. Conclusions and Relevance: In this cohort study of COVID-19 and OHCA, a substantial proportion of the higher OHCA incidence and lower survival during the pandemic was not directly due to SARS-CoV-2 infection but indirect factors that challenged OHCA prevention and treatment.
- Subjects
WASHINGTON (State); CARDIOPULMONARY resuscitation; SARS-CoV-2; COVID-19; DISEASE incidence; RETROSPECTIVE studies; ACQUISITION of data; RISK assessment; SOCIOECONOMIC factors; COMPARATIVE studies; CARDIAC arrest; MEDICAL records; EMERGENCY medical services; FACTOR analysis; DESCRIPTIVE statistics; ACUTE diseases; LONGITUDINAL method; DISEASE risk factors
- Publication
JAMA Network Open, 2023, Vol 6, Issue 10, pe2336992
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.36992