Abstract：
BACKGROUND: The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures.
OBJECTIVE: We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry.
METHODS: We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome.
RESULTS: From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05).
CONCLUSIONS: During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic.
BACKGROUND: ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
OBJECTIVE: We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry.
METHODS: We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome.
RESULTS: From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05).
CONCLUSIONS: During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic.
BACKGROUND: ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
摘要：
背景：COVID-19大流行严重影响了院外心脏骤停（OHCA）并破坏了生存链。即使在大流行结束后，新变体和激增的风险仍然存在。在大流行期间分析OHCA的特征对于为下一次大流行做准备并避免重复的负面结果很重要。然而,以前的研究产生了一些不同的结果，取决于医疗保健系统或社会结构的具体特征。
目的：我们旨在调查和比较发病率，结果，使用来自全国多中心OHCA注册的数据，以及流行前和大流行期间OHCA的特征。
方法：我们进行了多中心，回顾性,使用韩国心脏骤停复苏联盟（KoCARC）注册的数据进行观察性研究。这项研究纳入了韩国OHCA成年患者，经历了3个不同的1年时期：流行病前期（2019年1月至12月），大流行早期阶段(从2020年7月到2021年6月)，和大流行后期（2021年7月至2022年6月）。我们提取并对比了OHCA患者的特征，院前时间因素，以及这三个时期患者的结果。主要结果是生存至入院和生存至出院。次要结果是良好的神经系统结果。
结果：从3个指定时段来看，共有9031例OHCA成年患者符合分析条件(大流行前:n=2728;大流行早期:n=2954;大流行晚期:n=3349).在大流行期间，目击逮捕（P<.001）和在家中或住所逮捕（P=.001）的频率明显高于流行前期，在大流行的早期阶段，旁观者使用自动体外除颤器的比例低于其他时期。随着大流行的进展，首次监测的可电击心律（P=.10）和院前气管插管（P<.001）的发生率显着降低。从心脏骤停认知到急诊到达的时间依次增加(大流行前:33分钟;大流行早期:35分钟;大流行晚期:36分钟;P<.001)。随着大流行的进展，生存和神经系统的结果都恶化了，生存至出院显示最大的统计学差异(前流行:385/2728,14.1%;早期大流行:355/2954,12%;晚期大流行:392/3349,11.7%;P=.01).此外,大流行早期和晚期的结局没有显著差异(所有P>.05)。
结论：在大流行期间，特别是在社区COVID-19激增的情况下，OHCA的发病率增加,而出院时的生存率和良好的神经系统预后降低.院前OHCA因素，与OHCA预后直接相关，受到大流行的不利影响。需要不断进行讨论，以在发生新的大流行时维持生存链。
背景：ClinicalTrials.govNCT03222999;https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
目的：我们旨在调查和比较发病率，结果，使用来自全国多中心OHCA注册的数据，以及流行前和大流行期间OHCA的特征。
方法：我们进行了多中心，回顾性,使用韩国心脏骤停复苏联盟（KoCARC）注册的数据进行观察性研究。这项研究纳入了韩国OHCA成年患者，经历了3个不同的1年时期：流行病前期（2019年1月至12月），大流行早期阶段(从2020年7月到2021年6月)，和大流行后期（2021年7月至2022年6月）。我们提取并对比了OHCA患者的特征，院前时间因素，以及这三个时期患者的结果。主要结果是生存至入院和生存至出院。次要结果是良好的神经系统结果。
结果：从3个指定时段来看，共有9031例OHCA成年患者符合分析条件(大流行前:n=2728;大流行早期:n=2954;大流行晚期:n=3349).在大流行期间，目击逮捕（P<.001）和在家中或住所逮捕（P=.001）的频率明显高于流行前期，在大流行的早期阶段，旁观者使用自动体外除颤器的比例低于其他时期。随着大流行的进展，首次监测的可电击心律（P=.10）和院前气管插管（P<.001）的发生率显着降低。从心脏骤停认知到急诊到达的时间依次增加(大流行前:33分钟;大流行早期:35分钟;大流行晚期:36分钟;P<.001)。随着大流行的进展，生存和神经系统的结果都恶化了，生存至出院显示最大的统计学差异(前流行:385/2728,14.1%;早期大流行:355/2954,12%;晚期大流行:392/3349,11.7%;P=.01).此外,大流行早期和晚期的结局没有显著差异(所有P>.05)。
结论：在大流行期间，特别是在社区COVID-19激增的情况下，OHCA的发病率增加,而出院时的生存率和良好的神经系统预后降低.院前OHCA因素，与OHCA预后直接相关，受到大流行的不利影响。需要不断进行讨论，以在发生新的大流行时维持生存链。
背景：ClinicalTrials.govNCT03222999;https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
