Impact of Different Waves of COVID-19 on Emergency Medical Services and Out-of-hospital Cardiopulmonary Arrest in Madrid, Spain

Abstract

Background: COVID-19 has led to decreased survival of out-of-hospital cardiorespiratory arrest (OHCA). We analysed the impact of the first COVID-19 pandemic year on emergency medical services and OHCA care compared with the previous year.Methods: Data for this observational study were collected for OHCAs attended by the SUMMA 112 emergency service during March 2019 to March 2021. We compared data covering 15 March 2020–14 March 2021 (pandemic year) to retrospective data covering 15 March 2019–14 March 2020 (non-pandemic year). Results: During the pandemic period, 1743 OHCA patients were attended, compared to 1781 during the non-pandemic year. Median patient age during the pandemic period was lower than in the non-pandemic period (71 vs 72, p=0·037). Emergency services response activation time increased during the pandemic year, to 3 minutes, 16 seconds from 2 minutes, 48 seconds in the non-pandemic period (p=0·001). Time to arrival at the scene also increased during the pandemic (12 minutes vs 11 minutes, 25 seconds before the pandemic; p=0·001). The percentage of OHCAs in which resuscitation was attempted was lower during the pandemic (59·4% vs 62·9%, p=0·034), as were survival on hospital arrival (30·3% vs 34·6%, p=0·04). Differences in response activation time (p=0·003) and scene arrival times (p=0·003) were greater during the first pandemic wave compared with the later phases. Conclusions: The different phases of the pandemic variably affected OHCA care. The first wave led to longer resource activation, increased home events and scene arrival times, as well as lower patient survival.

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

“…After full-text assessment for eligibility, 14 were excluded because they did not meet the inclusion criteria. Finally, thirty-one articles, including 88,188 patients, were included in this meta-analysis [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. A flow diagram showing stages of database search and study selection is shown in Figure 1 .…”

“…Twenty-seven studies reported OHCA outcomes in pre- vs. intra-COVID-19 periods [ 23 , 24 , 26 , 27 , 28 , 29 , 31 , 33 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], and OHCA outcomes in SARS-CoV-2-positive vs. -negative patients were reported in seven trials [ 25 , 30 , 32 , 34 , 36 , 43 , 51 ]. Characteristics of the individual studies are presented in Tables S1 and S2 .…”

“…The Cochrane risk of bias of the included studies is shown in Figures S1 and S2 . The overall risk of bias was judged as low in twenty-nine studies [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 ], and reviewers indicate some concerns on the other two [ 33 , 47 ].…”

“…A flow diagram showing stages of database search and study selection is shown in Figure 1. Twenty-seven studies reported OHCA outcomes in pre-vs. intra-COVID-19 periods [23,24,[26][27][28][29]31,33,35,[37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53], and OHCA outcomes in SARS-CoV-2-positive vs. -negative patients were reported in seven trials [25,30,32,34,36,43,51]. Characteristics of the individual studies are presented in Tables S1 and S2.…”

“…The Cochrane risk of bias of the included studies is shown in Figures S1 and S2. The overall risk of bias was judged as low in twenty-nine studies [23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][48][49][50][51][52][53], and reviewers indicate some concerns on the other two [33,47].…”