HOUSTON — Outcomes of out-of-hospital cardiac arrest appears to have worsened, not only nationally but also at the state level, according to a new study focusing on Texas.
Researchers led by the McGovern Medical School in Houston and including participation from Brooke Army Medical Center in San Antonio hypothesized that public interventions, especially those shown to improve OHCA outcomes such as bystander CPR and public access defibrillation decreased during the pandemic, worsening survival.
“To date, no other state-wide studies have been comparable in terms of geographic size, patient population or temporal length,” they wrote in the American Journal of Emergency Medicine. “By utilizing such a comprehensive reach, this study adds to the evidence that OHCA care and outcomes has continued to worsen in the COVID-19 pandemic period. Better characterization of which aspects of pre-hospital cardiac care have deteriorated due to the pandemic can help drive quality improvement efforts and restore the chain of the survival.”1
Added to that, according to the study, is the higher incidence of cardiac arrest outside hospitals. Researchers sought to characterize the incidence of OHCA during the early pandemic period and the subsequent long-term period, while describing changes in OHCA outcomes and survival.
To do that, they analyzed adult OHCAs in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) from March 11 to Dec. 31 of both 2019 and 2020. Cases were stratified into pre-COVID-19 and COVID-19 periods. Prehospital outcomes took into account bystander cardiopulmonary resuscitation (BCPR), public AED use (PAD), sustained return of spontaneous circulation (ROSC), and prehospital termination of resuscitation (TOR).
Hospital survival outcomes, meanwhile, were survival to hospital admission, survival to hospital discharge, good neurological outcomes (CPC Score of 1 or 2) and Utstein bystander survival.
The study team determined there were 3,619 OHCAs (45.0% of the overall study population) in 2019 compared to 4,418 (55.0% of the overall study population) in 2020.
“Rates of BCPR (46.2% in 2019 to 42.2% in 2020, P < 0.01) and PAD (13.0% to 7.3%, p < 0.01) decreased,” the researchers noted. “Patient survival to hospital admission decreased from 27.2% in 2019 to 21.0% in 2020 (p < 0.01) and survival to hospital discharge decreased from 10.0% in 2019 to 7.4% in 2020 (p < 0.01). OHCA patients were less likely to receive PAD (aOR = 0.5, 95% CI [0.4, 0.8]), and the odds of field termination increased (aOR = 1.5, 95% CI [1.4, 1.7]).”
The authors said their study adds statewide evidence ‘to the national phenomenon of long-term increased OHCA incidence during COVID-19, worsening rates of BCPR, PAD use’
“This study can help fill the gap regarding long-term impacts of the pandemic beyond the initial first wave on cardiac arrest care and patient outcomes,” they added.
- Chavez S, Huebinger R, Chan HK, Gill J, White L, Mendez D, Jarvis JL, Vithalani VD, Tannenbaum L, Al-Araji R, Bobrow B. The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas. Am J Emerg Med. 2022 Jul;57:1-5. doi: 10.1016/j.ajem.2022.04.006. Epub 2022 Apr 13. PMID: 35468504; PMCID: PMC9005367.