Impact of COVID-19 on resuscitation after hospital arrival for patients with out-of-hospital cardiac arrest: An interrupted time series analysis

Abstract

Background

In this study, we aimed to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on in-hospital cardiopulmonary resuscitation (CPR) in patients with out-of-hospital cardiac arrest (OHCA).

Methods and Results

Using the Japanese Diagnosis Procedure Combination inpatient database, we included patients with OHCA who were transported to hospitals between April 2018 and March 2021. Patients were categorized into groups, before and during the COVID-19 pandemic, according to the day of admission (before or after April 1, 2020, respectively). The primary outcome was in-hospital CPR duration after hospital arrival, and secondary outcomes included in-hospital death, intubation, and other resuscitation-related treatments. We examined the impact of the pandemic using interrupted time series (ITS) analyses. Among 144,867 patients with OHCA, 82,425 died in the outpatient department (53,286 before the pandemic and 29,139 during the pandemic) during the study period. The ITS analyses for patients who died in the outpatient department showed no significant level change in CPR duration after hospital arrival (0.41 min increase; 95% confidence interval [CI]: −0.54 to 1.4; p = 0.39), but the intubation rate was significantly lower (−5.9%; 95% CI: −8.4 to 3.4; p < 0.001). In-hospital death among all patients with OHCA showed a significant increase in trend (0.41% per month; 95% CI: 0.081–0.74; p = 0.016).

Conclusions

The COVID-19 pandemic had little impact on CPR duration after hospital arrival; however, there was a marked decrease in intubation for patients with OHCA after hospital arrival.