Abstract 222: Effects of the COVID-19 Pandemic on Care of Out-of-Hospital Cardiac Arrests in Detroit

Abstract

Introduction: March 10 th , 2020 marked the first positive case of SARS-CoV-2 in Detroit. EMS protocol changes were implemented by March 25 th , 2020 in response to the virus. These modifications restricted intubation and allowed medical control to terminate resuscitation in cases of suspected COVID-19 after 10 minutes of CPR without ROSC. Due to global changes in pre-hospital cardiac arrest care caused by COVID-19, we conducted an analysis to determine OHCA characteristics of patients and fatality rates in the COVID-19 era. Methods: CARES data was analyzed between March 10 th , 2019 - April 30 th , 2019 and March 10 th , 2020 - April 30 th, 2020 for comparison before and during the pandemic. Patient demographics, location of arrest, initial rhythms, bystander CPR, EMS interventions and field termination were compared between the two time points. No major factors occurred in 2019 that would potentially skew that data. Descriptive statistics were utilized. Results: A total of 475 CARES patients were included during the study period. Total arrests surged in the COVID-19 era from 180 to 295. OHCA for individuals greater than 50 increased from 130 to 243. An initial rhythm of PEA tripled (10 to 30) during COVID-19, possibly due to hypoxia. The percentage of patients with a shockable rhythm declined (7.8 to 5.1). Bystander CPR decreased from 28.9% (52) to 18.3% (54), secondary to an increase of arrests being in non-public places and concern about disease transmission. Nursing home cardiac arrests increased during COVID from 19 to 73, from the previous year. Placement of an endotracheal tube or supraglottic airway by a basic or advanced unit decreased from 68.3% (123) in pre-COVID-19 era to 37.0% (109) in the current state of the pandemic. Termination of resuscitation in the field occurred over 3-fold from the previous year, an absolute increase from 64 to 204. Conclusion: There was a 61% increase in cardiac arrests during COVID-19 in Detroit. The pandemic and subsequent protocol changes greatly altered practice. COVID-19 has likely directly and indirectly, due to fear of going to the hospital, affected the number of out-of-hospital cardiac arrests. Additional review is being conducted to further delineate arrest etiologies.