Introduction
Methods
Study setting
Study population and data
Endpoints
Statistical analysis
Ethics
Results
Patients
Baseline patient descriptions and comparisons
All patients N = 2625 | COVID-19 period N = 1005 | Non-COVID-19 period N = 1620 | p-value | |
---|---|---|---|---|
Age, mean ± SD, y | 68 ± 17 | 68 ± 17 | 69 ± 17 | 0.137 |
Sex (Male), No./total (%) | 1747/2625 (66.6) | 676/1005 (67.3) | 1071/1620 (66.1) | 0.552 |
Medical history, No./total (%) | ||||
- Diabetes | 395/2625 (15.0) | 156/1005 (15.5) | 239/1620 (14.8) | 0.613 |
- Cardiovascular | 1249/2625 (47.6) | 478/1005 (47.6) | 771/1620 (47.6) | 1.000 |
- Respiratory | 409/2625 (15.6) | 160/1005 (15.9) | 249/1620 (15.2) | 0.740 |
- Other | 746/2625 (28.4) | 262/1005 (26.1) | 484/1620 (29.9) | 0.036 |
- None | 155/2625 (5.9) | 46/1005 (4.6) | 109/1620 (6.7) | 0.026 |
OHCA location (home), No./total (%) | 1975/2483 (75.5) | 819/971 (84.4) | 1156/1512 (76.5) | < 0.001 |
OHCA cause, No./total (%) | 0.002 | |||
- Cardiac | 2001/2625 (76.2) | 726/1005 (72.2) | 1275/1620 (78.7) | |
- Respiratory | 470/2625 (17.9) | 210/1005 (20.9) | 260/1620 (16.0) | |
- Neurological | 44/2625 (1.7) | 19/1005 (1.9) | 25/1620 (1.5) | |
- Other medical cause | 110/2625 (4.2) | 50/1005 (5.0) | 60/1620 (3.7) | |
Survival ROSC, No./total (%) | 604/2615 (23.1) | 195/999 (19.5) | 409/1616 (25.3) | 0.001 |
D30 Survival, No./total (%) | 125/2483 (5.1) | 26/937 (2.8) | 99/1546 (6.4) | 0.001 |
Basic life support
All patients N = 2625 | COVID-19 period N = 1005 | Non-COVID-19 period N = 1620 | p-value | |
---|---|---|---|---|
By bystander | ||||
Bystander present (at collapse), No./total (%) | 1683/2625 (64.1) | 648/1005 (64.5) | 1035/1620 (63.9) | 0.770 |
Immediate BLS, No./total No. (%) | 928/2625 (35.4) | 343/1005 (34.1) | 585/1620 (36.1) | 0.314 |
No Flow Duration, mean ± SD, mina | 13 ± 15 | 15 ± 18 | 12 ± 13 | < 0.001 |
Bystander BLS, No./total (%) | 1389/2625 (52.9) | 500/1005 (49.8) | 889/1620 (54.9) | 0.011 |
CC only (CO-CPR) | 988/1389 (71.1) | 362/500 (72.4) | 626/889 (70.4) | 0.075 |
CC + MtM (S-CPR) | 396/1389 (28.5) | 134/500 (26.8) | 262/889 (29.5) | |
MtM only | 5/1389 (0.4) | 4/500 (0.8) | 1/889 (0.1) | |
AED use, No./total (%) | 194/2625 (7.4) | 75/1005 (7.5) | 119/1620 (7.5) | 0.939 |
AED shock, No./total (%) | 57/2625 (2.2) | 21/1005 (2.1) | 36/1620 (2.2) | 0.897 |
By first aid provider | ||||
Time between T0 and first aid providers arrival, mean ± SD, min | 12 ± 10 | 12 ± 11 | 11 ± 9 | 0.010 |
First aid provider BLS, No./total (%) | 2277/2618 (87.0) | 845/1003 (84.3) | 0.001 | 0.001 |
- CC | 2271/2278 (99.6) | 842/846 (99.5) | 1429/1432 (99.7) | 0.479 |
- Ventilation | 2131/2277 (93.6) | 795/845 (94.1) | 1336/1432 (93.3) | 0.480 |
AED use, No./total (%) | 1863/2625 (71.0) | 662/1005 (66.0) | 1200/1620 (74.1) | < 0.001 |
AED shock, No./total (%) | 454/2625 (17.3) | 154/1005 (15.3) | 300/1620 (18.5) | 0.038 |
Advanced life support
All patients N = 2625 | COVID-19 period N = 1005 | Non-COVID-19 period N = 1620 | p-value | |
---|---|---|---|---|
Times, mean ± SD, min | ||||
Time between T0 and MMT arrival | 22 ± 15 | 23 ± 18 | 22 ± 13 | 0.461 |
Time between T0 and intubation | 28 ± 13 | 28 ± 13 | 28 ± 13 | 0.568 |
Time between T0 and epinephrine | 26 ± 12 | 27 ± 13 | 26 ± 13 | 0.400 |
Time between T0 and ROSC or death | 42 ± 22 | 44 ± 24 | 42 ± 21 | 0.342 |
Resuscitation practices | ||||
First recorded cardiac rhythm, No./total (%) | 0.226 | |||
- Asystole | 2041/2618 (72.0) | 796/1003 (79.4) | 1245/1615 (77.1) | |
- VF/pulseless VT | 232/2618 (8.8) | 87/1003 (8.7) | 145/1615 (9.0) | |
- PEA | 206/2618 (7.8) | 78/1003 (7.8) | 128/1615 (7.9) | |
- ROSC due to BLS | 139/2618 (5.3) | 42/1003 (4.2) | 97/1615 (6.0) | |
ALS implemented, No./total (%) | 1891/2625 (72.0) | 676/1005 (67.3) | 1215/1620 (75.0) | < 0.001 |
Epinephrine injected, No./total (%) | 1720/2623 (65.6) | 620/1004 (61.8) | 1100/1619 (67.9) | 0.001 |
Total dose of epinephrine, mean ± SD, mg | 5 ± 4 | 5 ± 3 | 5 ± 4 | 0.189 |
Injection route, No./total (%) | < 0.001 | |||
- PIV | 1632/2625 (62.2) | 582/1005 (57.9) | 1050/1620 (64.8) | |
- IO | 199/2625 (7.6) | 71/1005 (7.1) | 128/1620 (7.9) | |
- Other | 16/2625 (0.6) | 8/1005 (0.8) | 8/1620 (0.5) | |
- None | 778/2625 (29.6) | 344/1005 (34.2) | 434/1620 (26.8) | |
Tracheal intubation, No./total (%) | 1738/2625 (66.2) | 619/1005 (61.6) | 1119/1620 (69.1) | < 0.001 |
Impossible intubation, No./total (%) | 46/1053 (4.4) | 15/375 (4.0) | 31/678 (4.6) | 0.754 |
Shock by AED, No./total (%) | 394/2625 (15.0) | 143/1005 (14.2) | 251/1620 (15.5) | 0.038 |
COVID-19 and OHCA victims
COVID-19 patients N = 197 | Non-COVID-19 patients N = 808 | p-value | |
---|---|---|---|
Age, mean ± SD, y | 67 ± 18 | 69 ± 16 | 0.520 |
Sex (Male), No./total (%) | 117/197 (59.4) | 559/808 (69.2) | 0.011 |
Medical history, No./total (%) | |||
- Diabetes | 31/197 (15.7) | 125/808 (15.5) | 0.913 |
- Cardiovascular | 85/197 (43.1) | 393/808 (48.6) | 0.177 |
- Respiratory | 46/197 (23.4) | 114/808 (14.1) | 0.002 |
- Other | 51/197 (25.9) | 211/808 (26.1) | 1.000 |
- None | 10/197 (5.1) | 36/808 (4.5) | 0.704 |
OHCA location (home), No./total (%) | 173/197 (87.8) | 646/774 (83.5) | 0.153 |
OHCA cause, No./total (%) | < 0.001 | ||
- Cardiac | 67/197 (34.0) | 659/808 (81.6) | |
- Respiratory | 112/197 (56.9) | 98/808 (12.1) | |
- Neurological | 2/197 (1.0) | 17/808 (2.1) | |
- Other medical cause | 16/197 (8.1) | 34/808 (4.2) | |
Bystander presence, No./total (%) | 126/197 (64.0) | 522/808 (64.6) | 0.868 |
Immediate BLS, No./total (%)a | 67/197 (34.0) | 276/808 (34.2) | 1.000 |
Bystander BLS, No./total (%) | 99/197 (50.3) | 401/808 (49.6) | 0.937 |
First aid provider BLS, No./total (%) | 162/197 (82.2) | 683/806 (84.7) | 0.382 |
Times; No Flow duration, mean ± SD, minb | 18 ± 22 | 14 ± 17 | 0.009 |
Time between T0 and first aid providers arrival, mean ± SD, min | 16 ± 18 | 12 ± 9 | 0.095 |
Time between T0 and MMT arrival, mean ± SD, min | 25 ± 22 | 23 ± 17 | 0.346 |
Time between T0 and ROSC or death, mean ± SD, min | 48 ± 27 | 43 ± 23 | 0.025 |
ALS | |||
First recorded cardiac rhythm, No./total (%) | 0.073 | ||
- Asystole | 163/197 (82.7) | 633/806 (78.5) | |
- VF/pulseless VT | 8/197 (4.1) | 79/806 (9.8) | |
- PEA | 18/197 (9.1) | 60/806 (7.5) | |
- ROSC due to BLS | 8/197 (4.1) | 34/806 (4.2) | |
ALS implemented, No./total (%) | 128/197 (65.0) | 548/808 (67.8) | 0.447 |
ROSC, No./total (%) | 34/196 (17.3) | 161/803 (20.0) | 0.423 |
D30 survival, No./total (%) | 0/192 (0.0) | 26/745 (3.5) | < 0.001 |