Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, South Korea.
Department of Emergency Medicine, Seoul National University Boramae Medical Center, South Korea.
Am J Emerg Med. 2023 Jan;63:61-68. doi: 10.1016/j.ajem.2022.10.023. Epub 2022 Oct 21.
In many communities, out-of-hospital cardiac arrest (OHCA) survival outcomes decreased after the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify and compare the impacts of each survival chain factor on the change of survival outcomes after COVID-19.
Using a Korean out-of-hospital cardiac arrest registry, we analyzed OHCA patients whose arrest was not witnessed by emergency medical service (EMS) providers between 2017 and 2021. Because lack of hospital and survival information in 2021, the 2021 data were used only to identify the expected trend. We developed a prediction model for survival to discharge using patients from 2017 to 2019 (Pre-COVID-19 set) and validated it using patients from 2020 (post-COVID-19 set). Using Utstein elements, a stepwise logistic regression model was constructed, and discrimination and calibration were evaluated by c-statistics and scaled Brier score. Using the distribution change of predictors from one year before the pandemic (2019) to post-COVDI-19, we calculated the magnitude of survival difference according to each predictor's distribution change using the marginal standardization method.
Among 83,273 patients (mean age 67.2 years and 64.3% males), 61,180 and 22,092 patients belonged to pre-COVOD-19 and post-COVID-19 sets. Survival to discharge was 5019 (8.2%) in pre-COVID-19 set and 1457 (6.6%) in post-COVID-19 set. The proportion of bystander cardiopulmonary resuscitation was 59.0% in the pre-COVID-19 set and 61.0% in the post-COVID-19 set. The median (interquartile range) response time was 7 (5-9) minutes in the pre-COVID-19 set and 8 (6-10) minutes in the post-COVID-19 set. The area under the receiver operating characteristic (AUROC) curve (95% confidence interval) was 0.907 (0.902-0.912) in the pre-COVID-19 set, and 0.924 (0.916-0.931) in the post-COVID-19 set, and scaled Brier score were 0.39 in pre-COVID-19 sets, and 0.40 in the post-COVID-19 set. Among various predictors, EMS factors showed the highest impact. Response time and on-scene management of EMS showed the highest impact on decreased survival. A similar trend was also expected in the 2021.
The effort to create a rapid response system for OHCA patients could have priority for the recovery of survival outcomes in OHCA patients in the post-COVID-19 period. Further studies to recover survival outcomes of OHCA are warranted.
在许多社区，2019 年冠状病毒病（COVID-19）大流行后，院外心脏骤停（OHCA）的生存结果下降。本研究旨在确定并比较每个生存链因素对 COVID-19 后生存结果变化的影响。
使用韩国院外心脏骤停登记处，我们分析了 2017 年至 2021 年期间未被紧急医疗服务（EMS）提供者目击的 OHCA 患者。由于 2021 年缺乏医院和生存信息，仅使用 2021 年的数据来确定预期趋势。我们使用 2017 年至 2019 年的患者（COVID-19 前组）开发了一个用于出院生存的预测模型，并使用 2020 年的患者（COVID-19 后组）对其进行验证。使用 utstein 要素，构建了一个逐步逻辑回归模型，并通过 c 统计量和缩放 Brier 评分评估了区分度和校准度。使用大流行前一年（2019 年）到 COVID-19 后的预测因子分布变化，我们使用边际标准化方法根据每个预测因子的分布变化计算生存差异的幅度。
在 83273 名患者中（平均年龄 67.2 岁，男性占 64.3%），61180 名和 22092 名患者分别属于 COVID-19 前组和 COVID-19 后组。COVID-19 前组出院生存率为 5019 例（8.2%），COVID-19 后组为 1457 例（6.6%）。COVID-19 前组旁观者心肺复苏的比例为 59.0%，COVID-19 后组为 61.0%。COVID-19 前组的中位数（四分位距）反应时间为 7（5-9）分钟，COVID-19 后组为 8（6-10）分钟。COVID-19 前组和 COVID-19 后组的受试者工作特征曲线下面积（95%置信区间）分别为 0.907（0.902-0.912）和 0.924（0.916-0.931），COVID-19 前组的缩放 Brier 分数为 0.39，COVID-19 后组为 0.40。在各种预测因子中，EMS 因素的影响最大。EMS 的反应时间和现场管理对降低生存率的影响最大。预计 2021 年也会出现类似趋势。
为 OHCA 患者创建快速反应系统的努力可能应优先考虑恢复 COVID-19 后 OHCA 患者的生存结果。有必要进一步研究以恢复 OHCA 的生存结果。
