Shibahashi Keita, Kawabata Hiromitsu, Sugiyama Kazuhiro, Hamabe Yuichi
Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
Tokyo Fire Department, Chiyoda-ku, Tokyo, Japan.
Emerg Med J. 2022 Jun 15. doi: 10.1136/emermed-2021-212212.
The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic.
This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes.
The witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes.
The COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.
新型冠状病毒肺炎（COVID-19）大流行对院外心脏骤停（OHCA）旁观者心肺复苏（CPR）的影响尚不清楚。本研究旨在调查在东京因COVID-19大流行宣布进入紧急状态初期，旁观者心肺复苏率及患者预后是否发生变化。
本回顾性研究使用了东京消防局维护的基于人群的院外心脏骤停数据库中的数据。通过比较2020年2月18日至4月6日（紧急状态宣布前）和2020年4月7日至5月25日（紧急状态宣布期间）的数据，我们估计了旁观者心肺复苏率、院前自主循环恢复情况以及院外心脏骤停1个月后的生存和神经功能预后的变化，并考虑了2019年的预后趋势。我们进行了多变量回归分析，以评估紧急状态与这些预后之间关联的潜在机制。
2020年宣布期前后目睹心脏骤停的比例分别为42.5%和45.1%，而2019年相应时期分别为44.1%和44.7%。考虑到2019年的趋势，2020年这两个时期之间的差异无统计学意义。2020年宣布期前后旁观者心肺复苏率从34.4%显著提高到43.9%，在调整2019年的趋势后增加了8.3%。即使在调整了患者和旁观者特征以及紧急医疗服务反应后，这一发现仍具有统计学意义。其他研究预后在这两个时期之间无显著差异。
COVID-19大流行与东京旁观者心肺复苏率的提高相关，同时患者预后得以维持。患者和旁观者特征方面与大流行相关的变化并不能完全解释其潜在机制；在大流行期间，社区对公共紧急情况的反应可能还有其他机制。
