Abstract
This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended adult OHCA during the pandemic (January–May 2020) and pre-pandemic (January–May 2018 and 2019) periods. Pre-hospital return of spontaneous circulation (ROSC) was the primary outcome. Binary logistic regression was used to calculate the adjusted odds ratios (aOR) for the characteristics of OHCA. Of the 3893 OHCA patients (median age 72 years, 63.7% males), 1400 occurred during the pandemic period and 2493 during the pre-pandemic period. Compared with the pre-pandemic period, OHCAs during the pandemic period more likely occurred at home (aOR: 1.48; 95% CI: 1.24–1.75) and were witnessed (aOR: 1.71; 95% CI: 1.49–1.97). They received less bystander CPR (aOR: 0.70; 95% CI: 0.61–0.81) despite 65% of witnessed arrests by a family member, and waited longer for EMS (OR ≥ 10 min: 1.71, 95% CI 1.46–2.00). Pre-hospital ROSC was less likely during the pandemic period (aOR: 0.67; 95% CI: 0.53–0.84). The pandemic saw increased OHCA incidence and worse outcomes in Singapore, likely indirect effects of COVID-19.
Highlights
Compared with the pre-pandemic period, of-hospital cardiac arrest (OHCA) during the pandemic period had higher odds of occurring at home (OR: 1.28; 95% CI: 1.10–1.49) and being witnessed (OR: 1.64; 95% CI: 1.44–1.88)
Adjusting for clinical, circumstantial and interventional characteristics of an OHCA patient, odds of experiencing pre-hospital return of spontaneous circulation (ROSC) were lower during the pandemic period compared with the pre-pandemic period
Singapore saw an increase in adult OHCAs during the COVID-19 pandemic, with more arrests occurring at home
Summary
Coronavirus Disease 2019 (COVID-19) has resulted in unprecedented health, economic, and social consequences. Declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [1], it has since spread to 219 countries as of 31st December 2020, exceeding 82 million infections and 1.8 million deaths globally [2]. Public health efforts to reduce transmissions in afflicted countries have included changes in healthcare provision and delivery, as well as compulsory confinement and restriction of movement of people, which may result in systematic delays and negatively influence health-seeking behavior. Paradoxical declines in hospitalizations for acute cardiovascular illness have been reported, accompanied by delayed presentations and higher rates
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