Preparedness of personal protective equipment and implementation of new CPR strategies for patients with out-of-hospital cardiac arrest in the COVID-19 era
Preparedness of personal protective equipment and implementation of new CPR strategies for patients with out-of-hospital cardiac arrest in the COVID-19 era
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DOI：
10.1016/j.resplu.2020.100015
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发表时间：
2020-09-01
影响因子：
2.4
通讯作者：
Kim, Changho
中科院分区：
文献类型：
--
作者：
Cho, Jae Wan;Jung, Haewon;Kim, Changho
工作背景：于二零二零年二月及三月，韩国大邱的医疗服务提供者及市民经历了大规模社区COVID-19疫情的冲击。这对经历院外心脏骤停（OHCA）的患者产生了深远的影响。方法：我们基于多中心WinCOVID登记对171例OHCA患者进行了回顾性观察研究。对人口统计学和临床特征、总生存率、COVID-19相关数据以及COVID-19爆发期间使用的个人防护设备（PPE）和复苏技术进行了评估，并与2018年历史队列（n = 158）的结果进行了比较。在发言中，引入了高水平的PPE，标准心肺复苏术改为使用机械装置进行胸部按压。所有OHCA患者均被视为确诊或疑似COVID-19，无论症状如何。此外，由于采用了隔离复苏单位，急诊中心完全或部分关闭，需要自我隔离的医务人员人数减少。然而，生存出院和良好神经功能结局的校正比值比和95%置信区间为0.51（0.25-0.97）和0.45（0.21-1.07）与2018年历史队列相比。结论：应对COVID-19大流行的措施包括改变当前的PPE策略和引入隔离复苏单位;后一种干预措施减少了COVID-19爆发初期意外关闭和紧急资源被挪用的次数。考虑到未来爆发的可能性，我们需要修改复苏策略，并有能力为OHCA患者征用紧急资源。
Background: In February and March 2020, healthcare providers and citizens in Daegu, South Korea, experienced the onslaught of a large-scale community epidemic of COVID-19. This had a profound impact on patients who experienced out-of-hospital cardiac arrest (OHCA).Methods: We conducted a retrospective observational study of 171 OHCA patients based on the multicenter WinCOVID registry. Demographic and clinical characteristics, overall survival, COVID-19 related data, as well as personal protective equipment (PPE) and resuscitation techniques used during the COVID-19 outbreak were evaluated and compared with outcomes from a 2018 historical cohort (n = 158).Results: Among the interventions, high-level PPE was introduced and standard cardiopulmonary resuscitation was changed to chest compressions using mechanical devices. All OHCA patients were treated as confirmed or suspicious for COVID-19 regardless of symptoms. Furthermore, complete or partial closures of emergency centers and the number of medical personnel requiring self-isolation decreased in response to the introduction of isolated resuscitation units. However, the adjusted odds ratio and 95% confidence intervals for survival discharge and favorable neurologic outcome were 0.51 (0.25-0.97) and 0.45 (0.21-1.07) compared with those in the 2018 historical cohort.Conclusions: Responses to the COVID-19 pandemic included changes to current PPE strategies and introduction of isolated resuscitation units; the latter intervention reduced the number of unexpected closures and quarantines of emergency resources early on during the COVID-19 outbreak. Given the possibility of future outbreaks, we need to have revised resuscitation strategies and the capacity to commandeer emergency resources for OHCA patients.