Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic
Authors: Ruiz Azpiazu José Ignacio , Fernández del Valle Patricia , Echarri Sucunza Alfredo , Iglesias Vázquez Jose Antonio , del Pozo Carmen , Knox Emily Caitlin Lily , Azeli Youcef , Sánchez García Francisco José , Fernández Barreras Cristian , Escriche María Carmen , Martín Hernández Pedro Jesús , Juanes García Marcos , Ramos García Natividad , Royo Embid Sonia , Cortés Ramas José Antonio , Mateo-Rodríguez Inmaculada , Sola Muñoz Silvia , Alcalá-Zamora Marcó Elena , Fornér Canos Ana Belén , Mainar Gómez Belén , Dacal Pérez Pedro , Camacho Leis Carmen , García Cortés Jose Javier , Hernández Royano José Manuel , Escalada Roig Xavier , Daponte Codina Antonio , Rosell Ortiz Fernando ,   OHSCAR Investigators Group, Olavarria Govantes Luis , Luque-Hernández María J , Paz-Rodríguez Miguel A , Ayuso-Batista Fernando , Gutiérrez-García Carmen , Soto-García María R , Caballero-García María A , Antón Ramas Roberto , Chueca García        Marcel , González Herráiz Ignacio , Ceniceros-Rozalen Maria I , Arias Moya Esther , Gonzalez Quintana María N , Redondo Revilla Faustino , Guerra García Cesar M , Valenciano Rodriguez Juan , Lara Sánchez Juan J , Martinez-Villalobos Aguilar Cristina , Noriega Miguez Almudena , Sánchez del Rio Leticia , Tomàs Fort Vanessa , Sanchis Nuñez Carlos , Nieto Ferrando Jose L , Ilzarbe Ucelay Itziar I , Jimenez  Fabrega Francesc X , Salaberria Udabe Ruth , Vicente Casanova Fernando , Batres Gomez Susana , Medina Aragon Francisco J , López Alvarez Xesús M , Dorribo Masid Marta , García-Ochoa Blanco María J , Jose María Navalpotro Pascual Jose M , Villar Arias Alicia , González León Manuel J , Muñoz Isabel Belén , Hortelano Alonso Jose A , Jose Peinado Francisco A , Guirao Salinas Francisco A , Lopez Perez Cruz , García Mendoza Junior J , Artigas Miguel , Rivera Sánz Félix , Fernández González Alvaro 
Published: January 2024

Importance

Out-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery.

Objective

To determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels.

Design, Setting, and Participants

This observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder.

Exposure

The pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection.

Main Outcome and Measures

The main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance.

Results

A total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P &amp;lt; .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P &amp;lt; .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P &amp;lt; .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P &amp;lt; .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P &amp;lt; .001).

Conclusions and Relevance

In this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.