Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic
José Ignacio Ruiz Azpiazu, Patricia Fernández del Valle, Alfredo Echarri Sucunza, José Antonio Iglesias Vázquez, Carmen Del Pozo, Emily Knox, Youcef Azeli, Francisco José Sánchez García, Cristian Fernández Barreras, María Carmen Escriche, Pedro Jesús Martín Hernández, Marcos Juanes García, Natividad Ramos García, Sonia Royo Embid, José Antonio Cortés Ramas, Inmaculada Mateo‐Rodríguez, Silvia Solà-Muñoz, Elena Alcalá-Zamora Marcó, Ana Belén Forner Canos, Belén Mainar Gómez, Pedro Dacal Pérez, Carmen Camacho Leis, José Javier García Cortés, José Manuel Hernández Royano, Xavier Roig, Antonio Daponte, Fernando Rosell Ortiz, OHSCAR Investigators Group, Luis Olavarría Govantes, María José Luque‐Hernández, Miguel A. Paz-Rodriguez, Fernando Ayuso-Batista, Carmen Gutiérrez-García, María R Soto-García, María Auxiliadora Caballero-García, Roberto Antón Ramas, Marcel Chueca García, Ignacio González Herráiz, María Isabel Ceniceros-Rozalén, Esther Arias Moya, María N Gonzalez Quintana, Faustino Redondo Revilla, Cesar Manuel Guerra García, Juan Valenciano Rodríguez, Juan J Lara Sánchez, Cristina Martinez-Villalobos Aguilar, Ana Lucía Mesías Miguez, Leticia Sánchez del Rio, Vanessa Tomàs Fort, Carlos Sanchis Nuñez, Jose L Nieto Ferrando, Itziar I Ilzarbe Ucelay, Francesc Xavier Jiménez Fábrega, Ruth Salaberría Udabe, F Casanova, Susana Batres Gómez, Francisco Aragón, Xesús María López Álvarez, Marta Dorribo Masid, Maria Jose Garcia-Ochoa Blanco, Jose M Jose María Navalpotro Pascual, Alicia Arias, Manuel José González León, Belén Muñoz Isabel, Jose A Hortelano Alonso, Francisco A Jose Peinado, Francisco Ángel Guirao Salinas, Cruz Lopez Perez, Jesús Manuel Verona Mendoza, Miguel Artigas, Félix Rivera Sanz, Álvaro Fernández González
Abstract
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 < .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 < .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 < .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 < .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 < .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.