Phattharapornjaroen Phatthranit, Nimnuan Waratchaya, Sanguanwit Pitsucha, Atiksawedparit Pongsakorn, Phontabtim Malivan, Mankong Yahya
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, 10540, Thailand.
Int J Emerg Med. 2022 Sep 9;15(1):46. doi: 10.1186/s12245-022-00444-2.
Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand.
This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital's emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected.
A total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period).
During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups.
This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.
院外心脏骤停（OHCA）仍是全球主要死因之一，旁观者进行心肺复苏（CPR）并使用公众可获取的除颤器可改善OHCA的生存结局。新型冠状病毒肺炎（COVID-19）大流行给紧急医疗服务（EMS）带来了诸多挑战，包括仅进行胸外按压复苏的建议以及对全套个人防护装备的推荐，这造成了操作困难并延长了响应时间。然而，大流行期间影响OHCA结局的危险因素尚不明确。本研究旨在评估泰国COVID-19大流行之前和期间OHCA患者的特征及结局。
这项单中心回顾性队列研究使用了电子病历和EMS纸质记录中的数据。确定了所有在COVID-19之前（2018年3月至2019年12月）和COVID-19期间（2020年3月至2021年12月）前往拉玛蒂博迪医院急诊科的OHCA患者，并收集了泰国COVID-19大流行之前和期间OHCA患者的急诊科自主循环恢复（ED-ROSC）数量及特征。
共纳入136例患者（78例男性[59.1%]；平均[标准差]年龄为67.9[18]岁）；其中60例在COVID-19期间（2020年3月开始），76例在COVID-19之前。两组之间存在显著差异的总体基线特征是旁观者目击情况和胸外按压方式（p值分别<0.001和<0.001）。COVID-19期间的ED-ROSC显著低于COVID-19之前（26.67%对46.05%，调整后比值比0.21，p值<0.001）。COVID-19期间和之前入院时的生存率存在显著差异（分别为25.00%和40.79%，调整后比值比0.26，p值0.005）。然而，30天生存率无显著差异（COVID-19期间为3.3%，COVID-19之前为10.53%）。
在泰国的COVID-19大流行期间，院外心脏骤停患者的ED-ROSC和入院生存率显著降低。此外，两组之间的旁观者反应和胸外按压方式差异很大。
本试验于2021年12月7日在泰国临床试验注册中心进行回顾性注册，识别号为TCTR20211207006。
