J Korean Med Sci.  2023 Mar;38(12):e92. 10.3346/jkms.2023.38.e92.

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

• Kim YS
• Lee SH
• Lim HJ
• Hong WP

• KMID: 2541040
• DOI: http://doi.org/10.3346/jkms.2023.38.e92

Abstract

Background
Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database.
Methods
We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC.
Results
The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]).
Conclusion
This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

Keyword

Out-of-Hospital Cardiac Arrest; Cardiopulmonary Resuscitation; COVID-19; Emergency Medical Services; Return of Spontaneous Circulation

Figure

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  Fig. 1 Diagram of study participants.OHCA = out-of-hospital cardiac arrest, EMS = emergency medical service, COVID-19 = coronavirus disease 2019.

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  Fig. 2 Monthly number of confirmed COVID-19 cases and the implementation rate of MCPR & ETI from 2020 to 2021.MCPR = mechanical cardiopulmonary resuscitation, ETI = endotracheal intubation, COVID-19 = coronavirus disease 2019.

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  Fig. 3 The number of COVID-19 confirmed cases and the proportion of out-of-hospital cardiac arrest patients with prehospital ROSC by large-scale outbreak period.COVID-19 = coronavirus disease 2019, ROSC = return of spontaneous circulation, WHO = World Health Organization.

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