119 EMS Division, National Fire Agency 119, Sejong, Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2023 Mar 27;38(12):e92. doi: 10.3346/jkms.2023.38.e92.
Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database.
We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC.
The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96-1.09]).
This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
2019 年冠状病毒病（COVID-19）是一场全球性的公共卫生危机，对紧急医疗服务（EMS）产生了重大影响。有几项研究报告称，由于 COVID-19，院外心脏骤停（OHCA）的发生率增加，生存率降低，但这些研究仅限于短时间内或在某些地区报告。本研究旨在使用全国性数据库调查 COVID-19 对 OHCA 患者的影响。
我们纳入了 2019 年 1 月 19 日至 2021 年 1 月 20 日期间由 EMS 提供者治疗的成年 OHCA 患者。韩国首例确诊病例前后的年份分别设为非 COVID-19 期和 COVID-19 期。主要暴露因素为 COVID-19 期，主要结局为院前自主循环恢复（ROSC）。比较 COVID-19 大流行前后的其他 OHCA 变量并进行分析。我们进行了多变量逻辑回归分析，以了解 COVID-19 期对院前 ROSC 的独立影响。
最终分析纳入了 51921 名符合条件的患者，其中非 COVID-19 期 25355 例（48.8%），COVID-19 期 26566 例（51.2%）。COVID-19 期间院前 ROSC 恶化（10.2%比 11.1%， = 0.001）。在主要分析中，COVID-19 期与非 COVID-19 期院前 ROSC 的调整后优势比（AOR）无显著差异（AOR [95%置信区间]，1.02 [0.96-1.09]）。
本研究发现，COVID-19 期间院前 ROSC 的比例低于非 COVID-19 期间，但在调整潜在混杂因素后无统计学意义。需要持续努力恢复院前生存链的中断，提高 OHCA 患者的生存率。
