Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Department of Paramedicine, Monash University, Victoria, Australia.
Centre for Research & Evaluation, Ambulance Victoria, Victoria, Australia; Jordan University of Science and Technology, Irbid, Jordan.
Resuscitation. 2023 Jun;187:109770. doi: 10.1016/j.resuscitation.2023.109770. Epub 2023 Mar 17.
We sought to examine the impact of the COVID-19 pandemic on the incidence and survival outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) in Victoria, Australia.
We performed an interrupted time-series analysis of adult EMS-witnessed OHCA patients of medical aetiology. Patients treated during the COVID-19 period (1st March 2020 to 31st December 2021) were compared to a historical comparator period (1st January 2012 and 28th February 2020). Multivariable poisson and logistic regression models were used to examine changes in incidence and survival outcomes during the COVID-19 pandemic, respectively.
We included 5,034 patients, 3,976 (79.0%) in the comparator period and 1,058 (21.0%) in the COVID-19 period. Patients in the COVID-19 period had longer EMS response times, fewer public location arrests and were significantly more likely to receive mechanical CPR and laryngeal mask airways compared to the historical period (all p < 0.05). There were no significant differences in the incidence of EMS-witnessed OHCA between the comparator and COVID-19 periods (incidence rate ratio 1.06, 95% CI: 0.97-1.17, p = 0.19). Also, there was no difference in the risk-adjusted odds of survival to hospital discharge for EMS-witnessed OHCA occurring during COVID-19 period compared to the comparator period (adjusted odd ratio 1.02, 95% CI: 0.74-1.42; p = 0.90).
Unlike the reported findings in non-EMS-witnessed OHCA populations, changes during the COVID-19 pandemic did not influence incidence or survival outcomes in EMS-witnessed OHCA. This may suggest that changes in clinical practice that sought to limit the use of aerosol generating procedures did not influence outcomes in these patients.
我们旨在研究 COVID-19 大流行对澳大利亚维多利亚州急救医疗服务（EMS）见证的院外心脏骤停（OHCA）发生率和生存结局的影响。
我们对成人 EMS 见证的 OHCA 患者进行了医疗病因的中断时间序列分析。将在 COVID-19 期间（2020 年 3 月 1 日至 2021 年 12 月 31 日）接受治疗的患者与历史对照期（2012 年 1 月 1 日至 2020 年 2 月 28 日）进行比较。使用多变量泊松和逻辑回归模型分别检查 COVID-19 大流行期间发生率和生存结局的变化。
我们纳入了 5034 名患者，其中 3976 名（79.0%）在对照期，1058 名（21.0%）在 COVID-19 期。与历史时期相比，COVID-19 期间患者的 EMS 反应时间更长，公共位置逮捕更少，并且更有可能接受机械心肺复苏和喉罩气道（所有 p<0.05）。在对照期和 COVID-19 期之间，EMS 见证的 OHCA 的发生率没有显着差异（发生率比 1.06，95%CI：0.97-1.17，p=0.19）。此外，与对照期相比，COVID-19 期间发生的 EMS 见证 OHCA 的存活至出院的风险调整 odds 没有差异（调整后的优势比 1.02，95%CI：0.74-1.42；p=0.90）。
与非 EMS 见证的 OHCA 人群的报告结果不同，COVID-19 大流行期间的变化并未影响 EMS 见证的 OHCA 的发生率或生存结局。这可能表明，旨在限制使用气溶胶生成程序的临床实践变化并未影响这些患者的结局。
