Abstract 14599: Survival From Sudden Cardiac Arrest During the COVID-19 Pandemic: Two-Year Prospective Evaluation in a Large US Community

Abstract

Background: Early experience in the COVID-19 pandemic indicated higher rates of out-of-hospital sudden cardiac arrest (SCA) and worse outcomes. There is little data from subsequent surges of Delta and Omicron variants. Hypothesis: All surges in the COVID-19 pandemic affected SCA incidence and outcomes. Methods: In Ventura County CA (pop. 848,112), all SCA cases with likely cardiac etiology and resuscitation attempted by emergency medical services (EMS) were prospectively identified (2015-). Comparisons were conducted between two years of the pandemic period (Feb 1, 2020-Jan 31, 2022) and the corresponding 2y pre-pandemic period (2018-2020) and during COVID surges (>3000 COVID cases / month in the county) vs. non-surge times during the pandemic (<3000 cases / month). COVID monthly incidence was obtained from US CDC data (Fig. red curve). Results: Pre-pandemic there were 671 SCA cases (40/100,000, mean age 70.9 yrs, 63% male) with an increase in the pandemic period (p<0.001) to 894 cases (53/100,000, mean age 69.6 yrs, 65% male). During the pandemic there was significant reduction in SCA survival (16.4% to 9.1%, p <0.001). Survival decreased consistently with each COVID surge. The mean SCA survival during surges (Fig. blue curve) was significantly lower than pre-pandemic (6.3% vs 16.4% dotted blue curve, p <0.001) as well as during non-surge periods (6.3% vs 11.4%, p=0.008). Comparing pre-pandemic to COVID surge periods, the proportion of SCA calls with ambulance response time < 4 min declined from 27.1% to 9.4% (p<0.001) as did the proportion of SCAs with shockable rhythm (26.2% to 18.6%, p=0.004), and bystander CPR (56.9% to 47.9%, p=0.004). Conclusion: SCA rates continue to be higher during the COVID-19 pandemic with persisting significant reductions in survival outcomes at 2y, that are exaggerated during each surge. These findings have implications for ongoing community public health and EMS response planning during the pandemic.