Abstract 11901: CPR Quality During the COVID-19 Pandemic - More Evidence of Collateral Damage During Out-of-Hospital Cardiac Arrest

Abstract

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses <6 seconds, post-shock pauses <5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p<0.001) as did the proportion with pre-shock pauses <6 seconds (54% vs 62%, p=0.019) and post-shock pauses <5 seconds (68% vs 82%, p<0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p<0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses<6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses<5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.