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Effects of Post-Hospital Arrival Factors on Out-of-Hospital Cardiac Arrest Outcomes During the COVID-19 Pandemic
Yasuyuki Kawai1, Koji Yamamoto, Keita Miyazaki
1All authors: Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.
Insights
During the COVID-19 pandemic, post-hospital arrival factors significantly worsened out-of-hospital cardiac arrest outcomes. Improving healthcare system response during outbreaks is crucial for better patient prognosis.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- The impact of post-hospital arrival factors on out-of-hospital cardiac arrest (OHCA) outcomes is not well understood.
- The COVID-19 pandemic presented unique challenges to emergency medical services and hospital care.
Purpose of the Study:
- To evaluate the influence of post-hospital arrival factors on OHCA outcomes during the COVID-19 pandemic.
- To assess the performance of a prediction model for OHCA outcomes before and during the pandemic.
Main Methods:
- A cohort study utilized data from the All-Japan Utstein Registry (2015-2021).
- Included 541,781 adult patients with OHCA of cardiac origin.
- Compared predicted versus actual neurologic outcomes using a validated prediction model.
Main Results:
- The prediction model accurately reflected 2019 outcomes (AUC=0.96).
- A significant divergence between predicted and actual outcomes occurred in 2020 and 2021.
- Deterioration in OHCA outcomes was linked to both pre- and post-hospital arrival factors during the pandemic.
Conclusions:
- Post-hospital arrival factors were as critical as pre-hospital factors in OHCA prognosis during the pandemic.
- Enhanced healthcare system responses are necessary during infectious disease outbreaks to improve patient outcomes.
Importance:
The relationship between post-hospital arrival factors and out-of-hospital cardiac arrest (OHCA) outcomes remains unclear.
Objectives:
This study assessed the impact of post-hospital arrival factors on OHCA outcomes during the COVID-19 pandemic using a prediction model.
Design, Setting, And Participants:
In this cohort study, data from the All-Japan Utstein Registry, a nationwide population-based database, between 2015 and 2021 were used. A total of 541,781 patients older than 18 years old who experienced OHCA of cardiac origin were included.
Main Outcomes And Measures:
The primary exposure was trends in COVID-19 cases. The study compared the predicted proportion of favorable neurologic outcomes 1 month after resuscitation with the actual outcomes. Neurologic outcomes were categorized based on the Cerebral Performance Category score (1, good cerebral function; 2, moderate cerebral function).
Results:
The prediction model, which had an area under the curve of 0.96, closely matched actual outcomes in 2019. However, a significant discrepancy emerged after the pandemic began in 2020, where outcomes continued to deteriorate as the virus spread, exacerbated by both pre- and post-hospital arrival factors.
Conclusions And Relevance:
Post-hospital arrival factors were as important as pre-hospital factors in adversely affecting the prognosis of patients following OHCA during the COVID-19 pandemic. The results suggest that the overall response of the healthcare system needs to be improved during infectious disease outbreaks to improve outcomes.
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