| Background and objectivesOut-of-hospital cardiac arrest(OHCA)is a fatal emergency in which cardiac ejection is terminated due to a variety of causes outside the hospital.In 2019,the novel Coronavirus pneumonia(COVID-19)epidemic has seriously affected global public health security,drawing worldwide attention.In the face of this public health emergency,China has adopted an active prevention and control policy.Many foreign studies have shown that in the context of COVID-19,the epidemiological characteristics,treatment and prognosis of OHCA have changed.(b)Epidemiological characteristics,such as a marked increase in the proportion of people at home where arrests occur;The proportion of non-defibrillation rhythm initially increased significantly.An increased proportion of suspicious cardiogenic causes of sudden arrest.In terms of treatment,such as emergency medical services(EMS)response time is longer than before;The proportion of bystanders involved in treatment decreased.The prognosis of OHCA patients is worse than before.For example,the proportion of return of spontaneous circulation(ROSC)of OHCA patients at any time decreased from 6.5%to 48.6%in the early period of COVID-19 to 2.6%to 37.8%during COVID-19.The proportion of survivors admitted to hospital decreased from 22.8%-32.1%to 12.8%-22.0%,the proportion of survivors discharged from hospital decreased from 9.8%-38.9%to 7.5%-33.0%,and the 30-day survival rate decreased from 10.6%to 4.4%.Few studies have analyzed the epidemiology,treatment and prognosis of OHCA in the context of COVID-19 in China.In this study,the out-of-hospital Cardiac Arrest Section(BASIC-OHCA)of Baseline Investigation of Cardiac Arrest Incidence,Mortality,and Risk Factors in the Chinese population was analyzed.To explore the epidemiological characteristics,treatment quality and prognosis of OHCA in China under COVID-19,so as to provide a scientific basis for the treatment of external cardiac arrest in public health emergencies.Research methodsIn this multicenter prospective study,OHCA patient information was collected from the BASIC-OHCA database from September 1,2019 to November 30,2020.Demographic characteristics were extracted from the database:gender,age;Characteristics of sudden arrest:cause of arrest,location of sudden arrest,initial rhythm,and presence of bystanders;Treatment of OHCA:The bystander cardiopulcitation(BCPR),EMS rescue interval,advanced life support,and resuscitation after treatment,such as target temperature management,coronary angiography),Coronary angiography(CAG);Prognosis information:return of spontaneous circulation(ROSC)at any time,survival and discharge,good neurological outcome,that is,cerebral function score(CPC)at discharge ≤ 2 points.According to the official announcement of the time node of national epidemic prevention and control and regular prevention and control,the analysis is divided into three groups,which are as follows:The early stage of COVID-19(2019.11.1-2019.11.30),the period of COVID-19(2020.2.1-2020.4.30),and the period of regular COVID-19 prevention and control(2020.9.1-2020.11.30).The incidence of COVID-19 in each region was calculated according to the daily confirmed cases published by the National Health Commission and the seventh national census population in the region,and the impact of COVID-19 on the primary outcome of OHCA patients was analyzed according to the stratified incidence of COVID-19.Continuity variables were expressed as mean±standard deviation or median(interquartile range(IQR)),and categorical variables were expressed as frequency(percentage).Independent sample T test was used for continuous variables,and Chi-square or Fisher exact test was used for categorical variables.The Odds Ratio(OR)and 95%Confidence Interval(CI)were calculated by Logistic regression.P<0.05 was statistically significant.Research resultsFinally,16,595 OHCA patients were included in this study,including 3890 in the early stage of COVID-19,5929 in the period of COVID-19,and 6766 in the period of regular COVID-19 control.The median age of OHCA patients was 68 years in the early stage of COVID-19,69 years in the period of COVID-19,and 69 years in the period of normal COVID-19 prevention and control,and there was no statistical difference between the three periods(P=0.16).Male patients were the majority of OHCA patients in the three periods,and there was no significant difference in gender ratio(P=0.36).The proportion of OHCA occurring at home was 79.59%(3096 cases)in the early stage of COVID-19,87.30%(5185 cases)in the period of COVID-19,and 83.15%(5626 cases)in the period of regular COVID-19 prevention and control.There was statistical difference in the component ratio of arrest site among OHCA patients in the three periods(P<0.01).The proportion of suspicious cardiogenic disease in OHCA patients was 81.21%(3159 cases)in the early stage of COVID-19,82.02%(4872 cases)in the period of COVID-19,and 84.07%(5688 cases)in the period of normal COVID-19 prevention and control.There were statistical differences in the etiological component ratio of OHCA patients in the three periods(P<0.05).The proportion of OHCA patients with initial non-defibrillation rhythm was 94.32%(3669 cases)in the early phase of COVID-19,94.48%(5611 cases)in the early phase of COVID-19,and 94.40%(6387 cases)in the normal phase of COVID-19 prevention and control.There was no significant difference in the initial rhythm composition ratio of OHCA patients in the three periods(P=0.05).The proportion of OHCA patients witnessed by bystanders was 54.22%(2109 cases)in the early stage of COVID-19,52.05%(3901 cases)in the period of COVID-19,and 46.51%(3147 cases)in the period of normal COVID-19 prevention and control.The proportion of OHCA patients witnessed by bystanders was statistically different among the three periods(P<0.05).The median EMS response time was 11min in the early stage of COVID-19,12min in the period of COVID-19,and 12min in the period of normal COVID-19 prevention and control,with statistical differences(P<0.05).The median time from cardiac arrest to CPR initiation was 22min in the early stage of COVID-19,23min in the period of COVID-19,and 24min in the period of normalized COVID-19 prevention and control,with statistical differences(P<0.001).The median time from cardiac arrest to the establishment of advanced airway was 22min in the early stage of COVID-19,22min in the period of COVID-19,and 22min in the period of normalized COVID-19 prevention and control,showing no statistical difference.The proportion of OHCA patients receiving BCPR was 23.62%(919 cases)in the early stage of COVID-19,22.38%(1329 cases)in the period of COVID-19 epidemic,and 16.45%(1113 cases)in the period of normal COVID-19 prevention and control,with statistical differences(P<0.05).The proportion of OHCA patients receiving bystander CPR guided by dispatcher phone was 14.83%(577 cases)in the early stage of COVID-19 epidemic,13.84%(821 cases)in the period of COVID-19 epidemic,and 9.3%(629 cases)in the period of normal COVID-19 prevention and control,showing statistical differences(P<0.05).The proportion of OHCA patients receiving epinephrine was 75.04%(2919 cases)in the early stage of COVID-19,76.26%(4529 cases)in the period of COVID-19,and 77.58%(5249 cases)in the period of normal COVID19 prevention and control,showing statistical differences(P=0.01).The proportion of OHCA patients receiving advanced airway was 32.24%(1253 cases)in the early stage of COVID-19,33.64%(1,998 cases)in the period of COVID-19,and 36.50%(2472 cases)in the period of normal COVID-19 prevention and control,showing statistical difference(P<0.001).The proportion of OHCA patients receiving TTM was 0.03%(1 case)in the early stage of COVID19,0.05%(3 cases)in the period of COVID-19,and 0.10%(7 cases)in the period of normal COVID-19 prevention and control,showing no statistical difference(P=0.33).The proportion of OHCA patients receiving CAG was 0.03%(1 case)in the early stage of COVID-19,0.05%(3 cases)in the period of COVID-19,and 0.06(4 cases)in the period of normal COVID-19 prevention and control,showing statistical difference(P<0.001).The proportion of ROSC in OHCA patients at any time was 5.27%(206 cases)in the early stage of COVID-19,3.59%(213 cases)in the period of COVID-19,and 3.51%(239 cases)in the period of normal COVID-19 prevention and control,showing statistical differences(P<0.05).The proportion of OHCA patients who survived and were discharged was 0.90%(35 cases)in the early stage of COVID-19,0.54%(32 cases)in the period of COVID-19,and 0.65%(44 cases)in the period of normal COVID-19 prevention and control,showing no statistical difference(P=0.09).The proportion of good neurological function prognosis in OHCA patients was 0.54%(21 cases)in the early stage of COVID-19,0.30%(18 cases)in the period of COVID-19,and 0.45%(30 cases)in the period of normal COVID-19 prevention and control,showing no statistical difference(P=0.18).Binary Logistic regression analysis showed that the factors independently affecting the ROSC of OHCA patients at any time were as follows:male(OR 1.352;95%CI 1.137-1.607),received BCPR(OR 1.303;95%CI 1.072-1.585);Negative factors independently affecting ROSC at any time in OHCA patients were:age 65-84 years(OR 0.635;95%CI 0.503-0.802),age≥ 85 years(OR 0.427;95%CI 0.306-0.597),non-defibrillation rhythm(OR 0.291;95%CI 0.229-0.369),EMS response time was 15-20min(OR 0.616;95%CI 0.424-0.894),EMS response time was 20-25min(OR 0.557;95%CI 0.349-0.888),EMS response time was 2530min(OR 0.449;95%CI 0.216-0.936),during the COVID-19 pandemic(OR 0.721;95%CI 0.5888-0.883),the normalized COVID-19 control period(OR 0.729;95%CI 0.5999-0.889).Research conclusions1.Epidemiological characteristics:there was no difference in age and gender of OHCA patients in these three periods.All OHCA patients stopped at home during the three periods.In addition,the proportion of bystander sightings was lower in the normal COVID-19 prevention and control period than in the early COVID-19 epidemic period.More education and training may improve the early and rapid recognition of cardiac arrest by the public and medical staff,thus improving the prognosis of OHCA patients.2.Quality of care:EMS response time,the time from cardiac arrest to CPR,defibrillation,and arrival at the emergency department were significantly longer during the COVID-19 epidemic,and the period of normal COVID-19 prevention and control was significantly longer than that before the COVID-19 epidemic.The proportion of OHCA patients receiving BCPR and dispatchers directing bystander CPR by telephone decreased significantly during the COVID-19 epidemic period and the normal COVID-19 control period compared with the preCOVID-19 epidemic period.The proportion of bystander treatment is low,so it is necessary to raise the public awareness of first aid,strengthen the publicity of self-rescue and mutual rescue such as CPR,and do CPR popularization to further improve the prognosis.3.Prognosis:The proportion of ROSC in OHCA patients at any time was lower during the COVID-19 epidemic and during the normal prevention and control period of COVID-19 compared with the pre-COVID-19 epidemic period.There was no difference in secondary outcomes--survival,discharge,and good neurological outcomes in the three periods.In the face of public health emergencies,reasonable allocation of pre-hospital public resources is more conducive to good prognosis.Logistic regression analysis showed that the incidence of COVID-19 in different periods affected the prognosis of OHCA patients. |
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