Author + information
- Audrey Uy-Evanado, MD1,
- Harpriya S. Chugh, BS1,
- Arayik Sargsyan, MD MPH1,
- Kotoka Nakamura, PhD1,
- Ronald Mariani, BS1,
- Katy Hadduck, RN2,
- Angelo Salvucci, MD2,
- Jonathan Jui, MD, MPH3,
- Sumeet S. Chugh, MD1 and
- Kyndaron Reinier, PhD, MPH1,∗ ()
- 1Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
- 2Ventura County Emergency Medical Services, Ventura, CA, US
- 3Oregon Health and Science University, Portland, OR, US
- ↵∗Address for correspondence: Kyndaron Reinier, PhD, MPH Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System Advanced Health Sciences Pavilion, Suite A3100 127 S. San Vicente Blvd., Los Angeles, CA 90048 Fax 1-310-423-3522; Phone 1-310-423-1206
Objectives To evaluate the potential impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) response and outcomes in two US communities with relatively low infection rates.
Background Studies in areas with high COVID-19 infection rates indicate that the pandemic has had direct and indirect effects on community response to OHCA and negative impacts on survival. Data from areas with lower infection rates are lacking.
Methods In Multnomah County, OR and Ventura County, CA, we evaluated OHCA with attempted resuscitation by EMS from March 1 – May 31, 2020 and March 1 – May 31, 2019.
Results Comparing 231 OHCA in 2019 to 278 in 2020, the proportion receiving bystander CPR was lower in 2020 (61% to 51%, p=0.02) and bystander use of automated external defibrillators (AEDs) declined (5% to 1%, p=0.02). EMS response time increased (6.6 ± 2.0 to 7.6 ± 3.0 minutes, p<0.001), and fewer OHCA survived to hospital discharge (14.7% to 7.9%, p=0.02). Incidences rates did not change significantly (p>0.07), and coronavirus infection rates were low (Multnomah 143/100,000, Ventura 127/100,000 as of May 31), compared to rates of ∼1600-3000/100,000 in the New York City region at that time.
Conclusions The community response to OHCA was altered from March to May 2020, with less bystander CPR, delays in EMS response time, and reduced survival from OHCA. These results highlight the pandemic’s indirect negative impact on OHCA even in communities with relatively low incidence of COVID-19 and point to potential opportunities for countering the impact.
Grant Support: Funded by National Institutes of Health, National Heart Lung and Blood Institute (NHLBI) grants R01 HL147358 and R01 HL145675 to Dr Chugh.
Relationship with Industry: None.
Twitter Summary: Survival from out of hospital sudden cardiac arrest lower during COVID-19 pandemic even in moderately affected US communities. Could counter by reducing EMS response delays and encouraging safe bystander CPR. #JACCCEP #CCAP @SumeetSChugh @CedarsSinai (Use Central Illustration to accompany Tweet)
CONFLICTS OF INTEREST
The authors report no conflicts of interest.
The authors would like to acknowledge the significant contribution of American Medical Response in Multnomah and Ventura counties, Portland/Gresham Fire Departments, Gold Coast Ambulance, LifeLine Medical Transport, Ventura County Fire Protection District, Ventura City Fire Department, and Fillmore Fire Department.
Sources of funding and support:
Funded by National Institutes of Health, National Heart Lung and Blood Institute (NHLBI) grants R01 HL147358 and R01 HL145675 to Dr Chugh. Dr Chugh holds the Pauline and Harold Price Chair in Cardiac Electrophysiology at Cedars-Sinai, Los Angeles. Study sponsors had no role in the study design, data collection, analysis and interpretation of the data, writing of the manuscript, or decision to submit the manuscript.
- Received July 27, 2020.
- Revision received August 6, 2020.
- Accepted August 10, 2020.