270 Changes in Treatment of Out of Hospital Cardiac Arrest during COVID-19 Outbreak in Japan

Abstract

On December 31, 2019, China has reported about a cluster of pneumonia cases caused by unknown infection which would later be identified as coronavirus disease 2019 (COVID-19). The first case in Japan was diagnosed on January 28, 2020. On March 11, 2020, COVID-19 was qualified as a global pandemic by the World Health Organization (WHO). It was reported that there was possibility of increased risk of out-of-hospital cardiac arrest (OHCA) in patients with SARS-CoV-2. American Heart Association has issued guidelines to help rescuers treat cardiac arrest patients with suspected or confirmed COVID-19. Physicians had to deal with OHCA patients having no detailed history of COVID-19 during pandemic. This may cause the changes in treatment of OHCA patients and their families. However, little we knew about the changes occurred in Japan. Therefore, our purpose was to investigate and clarify the changes in treatment of OHCA patients. This was a Web-based questionnaire survey. We developed a questionnaire to evaluate the changes in OHCA patients care. The questionnaire consisted of two sections and 21 questions. In the first section, we collected data about sex, post-graduate-year (PGY) and specialty. Physicians were also asked to indicate prefectures where they work. In the second part of questionnaire, we asked about the month when they started noticing COVID-19. We also asked them to answer with “Yes” or “No” if they have made changes to “Algorithm,” “Personal Protective Equipment (PPE)” and “Patient’s family support” for OHCA patients with details of particular changes for each question. In addition, we asked to indicate their stress level from these changes [Likert scale; 1 ∼ 10, 1: No Stress, 10: Severe Stress]”. We have distributed the questionnaire among Emergency Medicine Alliance (https://www.emalliance.org/) mailing list members (total 3233 physicians registered as of May 23, 2020). The period of responses to questionnaire was from May 22 to June 5 of 2020. During the study period, 110 physicians (3.4% out of total 3233 registered) with a median PGY of 12 (IQR 7-19) have submitted questionnaires, including 90 male (81.8%), 86 emergency physicians (78.2%), 16 internists (14.5%), 3 intensivists (2.7%) and 5 others (4.5%). Physicians were from the 30 prefectures of Japan (total 48 prefectures in Japan). The rate of answers about changes made to “Algorithm” was 78.2 %, “PPE” - 96.4%, “Family support” - 54.9 %. The stress level due to the changes to “Algorithm” was 7 [IQR 5 - 8], “PPE” - 8 [IQR 6 - 9], “Family support” - 7 [5 - 8.5]. We conclude that the way of treatment of OHCA patients might be changed and physicians might feel stress. We will report our survey results with more details.