Study Objective
Since the start of the COVID 19 pandemic much research has focused on the characteristics associated with increased mortality of COVID-19 patients both in the hospital and in out-of-hospital cardiac arrest (OHCA). Our analysis aimed to expand the understanding of characteristics associated with OHCA and mortality in our emergency response district and establish correspondence between out-of-hospital provider impression and treatment on the rate and survival of OHCA during the COVID 19 pandemic by comparing data abstracted from EMS charting on patients with OHCA from the March 15-May 30, 2020 as compared with the same period from 2019.
Study Design/Methods
This is a retrospective case series comparing all responses of Robert Wood Johnson Mobile Health Services to OHCA from March 15-May 30, 2019 with those March 15-May 30, 2020. After abstraction frequencies of patients are presented for demographic and medical information. Medical categories assessed include impression, medications given by EMS, past medial history, and home medications. Demographic categories include age, sex, race, and insurance status. Bivariate analyses compare each demographic or medical variable with year and then with death or not. Logistic regression is used to evaluate predictors of death among those presenting to EMS with cardiac arrest.
Results/Findings
The effect of year as a main effect was statistically significant (p=0.018, OR=1.84 for odds of death in 2020 vs. 2019; 95% (CI: 1.11, 3.06) and there was a significantly increased risk for death in males. An impression of known COVID-19 exposure or diagnosis at the time of OHCA was no associated with higher rate of death but a confirmed negative COVID-19 was associated with a statistically decreased risk of death. Impressions of cardiac arrest, unconsciousness, and pulmonary issues were all associated with lower rates of death. Those with cardiac arrest prior to EMS evaluation were more likely to die than those with cardiac arrest after. Many medications given by EMS were associated with death/no death as well. Of the medications taken at home, steroids and diabetes medication were significantly associated with higher rates of death. Comparing 2019 to 2020 significant increases in absolute and relative mortality were most commonly associated across categories with classification including “unspecified/unknown/other”.
Conclusions
There was demonstrable excess mortality from OHCA during the COVID-19 pandemic. While much of our data characterizing OHCA during COVID-19 reflects similar findings from other global studies, our focus on first responder impressions and interventions shows increased utilization of the “unspecified/unknown/other” classifications, hypothesized to reflect the increase in at-home OHCA, as reflected in other studies globally during the early days of the pandemic and show a decrease in responder- gathered data on those deaths. Understanding and addressing the contributions to gaps in data is important to properly evaluate excess deaths. This clarifies the need for a framework for investigation of OHCA and death in the setting of pandemic or other endemic outbreak to allow adequate development of training and field protocols.
No, authors do not have interests to disclose