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Published on: April 26, 2015
Impact of pandemic-related movement restriction on public access defibrillation in Japan: a retrospective cohort
Kentaro Omatsu1, Akira Yamashita2, Hideo Inaba3,4
1Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan omatsu@nuhw.ac.jp.
Objectives:
To analyse monthly changes in public access defibrillation (PAD) incidence and outcomes of out-of-hospital cardiac arrest (OHCA) during the 2020-2021 COVID-19 pandemic compared with those during the 2016-2019 prepandemic period with consideration of pandemic-related movement restriction.
Design:
Retrospective cohort study.
Setting:
An extended database was created by combining and reconciling the nationwide Utstein-style OHCA and the emergency medical service (EMS) transportation databases in Japan.
Participants:
We analysed 226 182 EMS-witnessed, non-newborn and out-of-home OHCA cases in Japan.
Primary And Secondary Outcome Measures:
The primary outcomes were the PAD incidence and neurologically favourable 1-month survival rate. The secondary outcomes were bystander cardiopulmonary resuscitation (CPR) provision and dispatcher-assisted CPR attempts.
Results:
The proportion of out-of-home OHCA cases slightly decreased during the pandemic (from 33.7% to 31.9%). Although the pandemic was associated with a decreased PAD incidence, 2-year trend analyses by an interaction test showed that the PAD incidence was lower during the first nationwide declaration of a state of emergency (p<0.001) and in the pandemic's second year (p<0.01). Regardless of location, delays in basic life support (BLS) actions and EMS contact with patients were more common and the rate of PAD-induced return of spontaneous circulation was lower during the pandemic. PAD incidence reduction was significant only in locations with a recommendation of automated external defibrillator placement (p<0.001). In other locations, a pronounced delay in BLS was found during the pandemic. The neurologically favourable survival rate was reduced in parallel with the reduced PAD incidence during the pandemic (r=0.612, p=0.002).
Conclusions:
Prolonged and repeated movement restrictions during the COVID-19 pandemic worsened the OHCA outcomes concurrently with disturbed BLS actions, including the reduced PAD incidence in out-of-home settings. Maintaining BLS training, re-arranging automated external defibrillator placement and establishing a local alert system for recruiting well-trained citizens to the scene are essential.
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