Outcomes for Out-of-Hospital Cardiac Arrest in the United States During the Coronavirus Disease 2019 Pandemic
Outcomes for Out-of-Hospital Cardiac Arrest in the United States During the Coronavirus Disease 2019 Pandemic
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DOI：
10.1001/jamacardio.2020.6210
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发表时间：
2020-11-14
期刊：
影响因子：
24
通讯作者：
McNally, Bryan
中科院分区：
文献类型：
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作者：
Chan, Paul S.;Girotra, Saket;McNally, Bryan
重要性最近来自受2019冠状病毒病（COVID-19）大流行严重影响的社区的报告发现，院外心脏骤停（OHCA）的持续自主循环恢复（ROSC）率较低。疫情是否对OHCA的结果产生了更广泛的影响尚不清楚。目的评估COVID-19大流行与OHCA结果之间的关联，包括在COVID-19疾病负担低和中等的地区。这项研究使用了一个大型的美国OHCA登记处，比较了2020年3月16日至4月30日大流行期间的结果，以及2019年3月16日至4月30日的结果。病例按美国各县进行地理编码，各县的COVID-19死亡率被分类为极低（每百万居民0-25人）、低（每百万居民26-100人）、中等（每百万居民101-250人）、高（每百万居民251-500人）或极高（每百万居民>500人）。作为额外的对照，该研究比较了大流行前（1月至2月）和大流行期间（3月1日至15日）的OHCA结果。2019冠状病毒病疫情。主要结果和测量持续ROSC（>= 20分钟），出院生存率和OHCA发生率。结果在这两年的3月16日至4月30日期间，共发生了19303例OHCA，其中2020年为9863例（平均[SD]年龄，62.6 [19.3]岁; 6040例男性[61.3%]），2019年为9440例（平均[SD]年龄，62.2 [19.2]岁; 5922例男性[62.7%]）。在大流行期间，持续ROSC的发生率低于2019年（23.0% vs 29.8%;调整后的比率为0.82 [95%CI，0.78-0.87]; P < .001）。持续的ROSC率降低了21%（2020年1429人中有286人[20.0%]，2019年1130人中有305人[27.0%];校正RR，0.79 [95% CI，0.65-0.97]）和33%（2020年863人中有149人[17.3%]，2019年667人中有192人[28.8%];调整后RR为0.67 [95%CI为0.56-0.80]），分别发生在COVID-19死亡率高或非常高的社区;然而，持续遵守安全和安保标准的比率也下降了11（2020年为2317人中的583人[25.2%]，2019年为2549人中的740人[29.0%];校正RR，0.89 [95% CI，0.81-0.98]）至15%（2020年3495人中有889人[25.4%]，2019年3532人中有1109人[31.4%];调整后RR为0.85 [95%CI为0.78-0.93]）。在有完整医院生存数据的紧急医疗服务机构中（共7085名患者），与2019年相比，大流行期间的出院生存率较低（6.6% vs 9.8%;调整后RR，0.83 [95% CI，0.69-1.00]; P = .048），主要是在COVID-19死亡率中等至非常高的社区（相互作用P = .049）。OHCA的发病率高于2019年，但这种增加主要出现在COVID-19死亡率高（调整后的平均差异，每百万居民38.6 [95%CI，37.1-40.1]）和COVID-19死亡率非常高（调整后的平均差异，每百万居民28.7 [95%CI，26.7-30.6]）的社区。相比之下，2020年和2019年大流行前和大流行期间的持续ROSC率或出院生存率没有差异。结论和相关性在大流行期间的早期，即使在COVID-19死亡率较低的社区，美国各地OHCA的持续ROSC率也较低。总体生存率较低，主要是在COVID-19死亡率中等或较高的社区。这项基于登记的研究比较了2020年2019冠状病毒病大流行前几周的院外心脏骤停结果与2019年同期的结果。（COVID-19）大流行和院外心脏骤停（OHCA）在美国的结果？这项登记研究发现，自发循环的恢复率总体上比大流行前低18%，其中在COVID-19死亡率较低的社区低11%至15%。存活至出院的比率较低17%，主要是在COVID-19死亡率中等至较高的社区，OHCA的发病率较高，但主要是在COVID-19死亡率较高的社区。在美国COVID-19大流行的最初几周，OHCA的结果更糟，这不仅在病死率高的地区观察到，而且在病死率较低的地区也观察到。
Importance Recent reports from communities severely affected by the coronavirus disease 2019 (COVID-19) pandemic found lower rates of sustained return of spontaneous circulation (ROSC) for out-of-hospital cardiac arrest (OHCA). Whether the pandemic has affected OHCA outcomes more broadly is unknown. Objective To assess the association between the COVID-19 pandemic and OHCA outcomes, including in areas with low and moderate COVID-19 disease burden. Design, Setting, and Participants This study used a large US registry of OHCAs to compare outcomes during the pandemic period of March 16 through April 30, 2020, with those from March 16 through April 30, 2019. Cases were geocoded to US counties, and the COVID-19 mortality rate in each county was categorized as very low (0-25 per million residents), low (26-100 per million residents), moderate (101-250 per million residents), high (251-500 per million residents), or very high (>500 per million residents). As additional controls, the study compared OHCA outcomes during the prepandemic period (January through February) and peripandemic period (March 1 through 15). Exposure The COVID-19 pandemic. Main Outcomes and Measures Sustained ROSC (>= 20 minutes), survival to discharge, and OHCA incidence. Results A total of 19 303 OHCAs occurred from March 16 through April 30 in both years, with 9863 cases in 2020 (mean [SD] age, 62.6 [19.3] years; 6040 men [61.3%]) and 9440 in 2019 (mean [SD] age, 62.2 [19.2] years; 5922 men [62.7%]). During the pandemic, rates of sustained ROSC were lower than in 2019 (23.0% vs 29.8%; adjusted rate ratio, 0.82 [95% CI, 0.78-0.87]; P < .001). Sustained ROSC rates were lower by between 21% (286 of 1429 [20.0%] in 2020 vs 305 of 1130 [27.0%] in 2019; adjusted RR, 0.79 [95% CI, 0.65-0.97]) and 33% (149 of 863 [17.3%] in 2020 vs 192 of 667 [28.8%] in 2019; adjusted RR, 0.67 [95% CI, 0.56-0.80]) in communities with high or very high COVID-19 mortality, respectively; however, rates of sustained ROSC were also lower by 11% (583 of 2317 [25.2%] in 2020 vs 740 of 2549 [29.0%] in 2019; adjusted RR, 0.89 [95% CI, 0.81-0.98]) to 15% (889 of 3495 [25.4%] in 2020 vs 1109 of 3532 [31.4%] in 2019; adjusted RR, 0.85 [95% CI, 0.78-0.93]) in communities with very low and low COVID-19 mortality. Among emergency medical services agencies with complete data on hospital survival (7085 total patients), survival to discharge was lower during the pandemic compared with 2019 (6.6% vs 9.8%; adjusted RR, 0.83 [95% CI, 0.69-1.00]; P = .048), primarily in communities with moderate to very high COVID-19 mortality (interaction P = .049). Incidence of OHCA was higher than in 2019, but the increase was largely observed in communities with high COVID-19 mortality (adjusted mean difference, 38.6 [95% CI, 37.1-40.1] per million residents) and very high COVID-19 mortality (adjusted mean difference, 28.7 [95% CI, 26.7-30.6] per million residents). In contrast, there was no difference in rates of sustained ROSC or survival to discharge during the prepandemic and peripandemic periods in 2020 vs 2019. Conclusions and Relevance Early during the pandemic, rates of sustained ROSC for OHCA were lower throughout the US, even in communities with low COVID-19 mortality rates. Overall survival was lower, primarily in communities with moderate or high COVID-19 mortality.This registry-based study compares out-of-hospital cardiac arrest outcomes in the first few weeks of the coronavirus disease 2019 pandemic in 2020 with outcomes in the same period in 2019.Question What is the association between the coronavirus disease 2019 (COVID-19) pandemic and out-of-hospital cardiac arrest (OHCA) outcomes in the US? Findings This registry study found that rates of return of spontaneous circulation were 18% lower overall than before the pandemic, including 11% to 15% lower in communities with low COVID-19 mortality. Rates of survival to discharge were 17% lower, primarily in communities with moderate to high COVID-19 mortality, and incidence of OHCA was higher, but largely in communities with high COVID-19 mortality. Meaning The outcomes of OHCA were worse during the first weeks of the COVID-19 pandemic in the US, and this was observed not only in areas with high case-fatality rates but also ones with lower rates.