Emergency Medical Services Responses to Out‐of‐Hospital Cardiac Arrest and Suspected ST‐Segment–Elevation Myocardial Infarction During the COVID‐19 Pandemic in Los Angeles County

Abstract

Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out‐of‐hospital cardiac arrest (OHCA) and ST‐segment‒elevation myocardial infarction (STEMI) during the 2020 COVID‐19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay‐at‐home order. Methods and Results We conducted a population‐based cross‐sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI‐OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; P <0.001) while PI‐STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; P =0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI‐OHCA and decreased PI‐STEMI, the increase in PI‐OHCA observed after March 19, 2020 remained significant ( P =0.02). The proportion of PI‐OHCA who received defibrillation (16% versus 23%; risk difference [RD], −6.91%; 95% CI, −9.55% to −4.26%; P <0.001) and had return of spontaneous circulation (17% versus 29%; RD, −11.98%; 95% CI, −14.76% to −9.18%; P <0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay‐at‐home order ( P <0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI‐OHCA and decreased PI‐STEMI following the stay‐at‐home order. The increased PI‐OHCA was not fully explained by the reduction in PI‐STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.

Impact of Coronavirus Disease 2019 Pandemic on Cardiac Arrest and Emergency Care

“…During the COVID-19 pandemic, the incidence of OHCA significantly increased with multiple geographic regions throughout the world reporting similar trends [ 7 , 8 , 9 , 10 , 11 , 12 ]. In the United States, various regions noted an increase in OHCA.…”

“…In the United States, various regions noted an increase in OHCA. Rollman et al reported a 21% increase in the incidence of OHCA in Los Angeles County, California, a diverse population of approximately 10.1 million persons [ 7 ]. Matthew et al found a 62% increase in Detroit, Michigan using data from the Cardiac Arrest Registry to Enhance Survival (CARES) [ 9 ].…”

“…Early recommendations, when PPE was scarce, included limiting personal during the resuscitation, which could have had implications for outcome, and considering the appropriateness of initiation resuscitation [ 26 ]. Congruent with the observation of less frequent shockable rhythms, rates of defibrillation were significantly lower during the COVID-19 pandemic [ 7 ]. Studies also documented a reduction in attempted resuscitation measures [ 8 ].…”

Out-of-hospital cardiac arrest and COVID-19 pandemic

“…Although patient characteristics were similar, initial shockable rhythm and proportion of patients who died in the hospital decreased during the pandemic. Rollman et al [5] compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment-elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020, stay-at-home order. Increase of weekly OHCA counts (173 vs. 135; incidence rate ratios, 1.28; 95% CI, 1.19-1.37; p < 0.001) and decrease of STEMI (57 vs. 65; incidence rate ratios, 0.87; 95% CI, 0.78-0.97; p = 0.02) was found [5].…”

“…Rollman et al [5] compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment-elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020, stay-at-home order. Increase of weekly OHCA counts (173 vs. 135; incidence rate ratios, 1.28; 95% CI, 1.19-1.37; p < 0.001) and decrease of STEMI (57 vs. 65; incidence rate ratios, 0.87; 95% CI, 0.78-0.97; p = 0.02) was found [5]. Wienbergen et al [6] reported a significantly higher rate of patients admitted with cardiogenic shock (21.9% vs. 14.2%, p < 0.01) and out-of-hospital cardiac arrest (OHCA) (14.3% vs. 11.1%, p < 0.01) comparing the presentation of STEMI patients in the year 2020 with the years 2006 to 2019 in a German registry.…”