The impact of the COVID-19 pandemic on adult out-of-hospital cardiac arrest incidence, community response, and outcomes in England: An interrupted time series analysis.

Abstract

Aim of the study: The COVID-19 pandemic had an important effect on the incidence, treatment, and outcomes from out-of-hospital cardiac arrest. Previous studies have focused on the immediate impact of the pandemic. We aimed to explore key changes in out-of-hospital cardiac arrest epidemiology in England over the time-course of the COVID-19 pandemic.

Methods: We extracted data from the UK Out-of-Hospital Cardiac Arrest Outcomes registry on adult out-of-hospital cardiac arrest patients between January 2019 and November 2021 who were treated by an English Emergency Medical Service (EMS). We segmented data into five epochs, of which two epochs were identified as COVID-19 peaks. We explored changes over time in a multiple interrupted-time series model. Pre-specified outcomes were EMS-treated cardiac arrest incidence (per 100,000 population), rate of bystander cardiopulmonary resuscitation, rate of shockable rhythm, and survival rate.

Results: We included 86,891 cases from 10 English Emergency Medical Service systems. There were immediate step changes with increased rates of incidence and bystander cardiopulmonary resuscitation and decreased rates of shockable rhythms and survival at the start of the first peak in March 2020. Subsequently, trend changes within epochs and at each epoch change were variable across the four outcomes. Between peaks and following the second peak, outcomes tended to normalise towards pre-pandemic level.

Conclusion: In England, COVID-19 peaks were associated with an immediate effect on key outcomes. At the end of each peak, rates seemed to return toward baseline levels.