ArticleThe American journal of emergency medicine2023
The impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: Which survival chain factor contributed the most?
Article in The American journal of emergency medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 13 citations in OpenAlex.
- Out-of-Hospital Cardiac Arrest Before, During, and After the Pandemic of COVID-19.Journal of clinical medicine · 2026Article
- Effects of Post-Hospital Arrival Factors on Out-of-Hospital Cardiac Arrest Outcomes During the COVID-19 Pandemic.Critical care explorations · 2024Article
- Establishing the Korean Out-of-Hospital cardiac arrest registry (KOHCAR).Resuscitation plus · 2024Review
- Family history, socioeconomic factors, comorbidities, health behaviors, and the risk of sudden cardiac arrest.Scientific reports · 2023Article
- What Else Is Needed to Improve Survival from Out-of-Hospital Cardiac Arrest to Hospital Admission? Data from a Prospective Registry for the Years 2020-2023 in the Italian Province of Varese.Journal of clinical medicine · 2023Article
- Lack of compensation for COVID-19-related overtime work and its association with burnout among EMS providers in Korea.Epidemiology and health · 2023Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIn 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.
methodsUsing 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.
resultsAmong 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.
conclusionThe 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.
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