Emergency Medical Services Responses to Out-of-Hospital Cardiac Arrest and Suspected ST-Segment-Elevation Myocardial Infarction
Authors:
Journal: Journal of the American Heart Association
Publication Type: Comparative Study
Date: 2021
DOI: PMC8477893
ID: 34058862
Abstract
Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment‒elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay-at-home order. Methods and Results We conducted a population-based cross-sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI-OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; <0.001) while PI-STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; =0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI-OHCA and decreased PI-STEMI, the increase in PI-OHCA observed after March 19, 2020 remained significant (=0.02). The proportion of PI-OHCA who received defibrillation (16% versus 23%; risk difference [RD], -6.91%; 95% CI, -9.55% to -4.26%; <0.001) and had return of spontaneous circulation (17% versus 29%; RD, -11.98%; 95% CI, -14.76% to -9.18%; <0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay-at-home order (<0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI-OHCA and decreased PI-STEMI following the stay-at-home order. The increased PI-OHCA was not fully explained by the reduction in PI-STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.
Reference List
- Hartnett KP, Kite‐Powell A, DeVies J, Coletta MA, Boehmer TK, Adjemian J, Gundlapalli AV. Impact of the COVID‐19 pandemic on Emergency Department Visits—United States, January 1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:699–704. DOI: 10.15585/mmwr.mm6923e1.|||Lange SJ, Ritchey MD, Goodman AB, Dias T, Twentyman E, Fuld J, Schieve LA, Imperatore G, Benoit SR, Kite‐Powell A, et al. Potential indirect effects of the COVID‐19 pandemic on use of emergency departments for acute life‐threatening conditions—United States, January–May 2020. MMWR Morb Mortal Wkly Rep. 2020;69:795–800. DOI: 10.15585/mmwr.mm6925e2.|||Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA, Dixon S, Rade JJ, Tannenbaum M, Chambers J, et al. Reduction in ST‐segment elevation cardiac catheterization laboratory activations in the United States during COVID‐19 pandemic. J Am Coll Cardiol. 2020;75:2871–2872. DOI: 10.1016/j.jacc.2020.04.011.|||Garcia S, Stanberry L, Schmidt C, Sharkey S, Megaly M, Albaghdadi MS, Meraj PM, Garberich R, Jaffer FA, Stefanescu Schmidt AC, et al. Impact of COVID‐19 pandemic on STEMI care: an expanded analysis from the United States. Catheter Cardiovasc Interv. 2020;1:1–6. Online ahead of print. DOI: 10.1002/ccd.29154.|||Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, Mattu A, Kirtane AJ, Jauhar R, Meraj P, et al. Management of acute myocardial infarction during the COVID‐19 pandemic: a position statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). J Am Coll Cardiol. 2020;76:1375–1384. DOI: 10.1016/j.jacc.2020.04.039.|||Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing Covid‐19 fear to encourage sick patients to seek emergency care. NEJM Catal. Published online May 14, 2020. Available at: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0193. Accessed April 1, 2021.|||Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, Ambrosy AP, Sidney S, Go AS. The Covid‐19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020;383:691–693. DOI: 10.1056/NEJMc2015630.|||Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, et al. Out‐of‐hospital cardiac arrest during the Covid‐19 outbreak in Italy. N Engl J Med. 2020;383:496–498. DOI: 10.1056/NEJMc2010418.|||Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, Sharifzadehgan A, Waldmann V, Beganton F, Narayanan K, et al. Out‐of‐hospital cardiac arrest during the COVID‐19 pandemic in Paris, France: a population‐based, observational study. Lancet Public Health. 2020;5:e437–e443. DOI: 10.1016/S2468-2667(20)30117-1.|||Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig‐Owens R, Hall CB, Prezant DJ. Characteristics associated with out‐of‐hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City. JAMA Cardiol. 2020;5:1154–1163. DOI: 10.1001/jamacardio.2020.2488.|||Published online. SAS Institute Inc. SAS [Computer Program]. 2014.|||R Foundation . R: a language and environment for statistical computing [Computer Program]. Published online 2013.|||Ball J, Nehme Z, Bernard S, Stub D, Stephenson M, Smith K. Collateral damage: hidden impact of the COVID‐19 pandemic on the out‐of‐hospital cardiac arrest system‐of‐care. Resuscitation. 2020;156:157–163. DOI: 10.1016/j.resuscitation.2020.09.017.|||Sayre MR, Barnard LM, Counts CR, Drucker CJ, Kudenchuk PJ, Rea TD, Eisenberg MS. Prevalence of COVID‐19 in out‐of‐hospital cardiac arrest: implications for bystander cardiopulmonary resuscitation. Circulation. 2020;142:507–509. DOI: 10.1161/CIRCULATIONAHA.120.048951.|||Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, et al. COVID‐19 kills at home: the close relationship between the epidemic and the increase of out‐of‐hospital cardiac arrests. Eur Heart J. 2020;41:3045–3054. DOI: 10.1093/eurheartj/ehaa508.|||Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess deaths from COVID‐19 and other causes, March‐April 2020. JAMA. 2020;324:510–513. DOI: 10.1001/jama.2020.11787.|||Weinberger DM, Chen J, Cohen T, Crawford FW, Mostashari F, Olson D, Pitzer VE, Reich NG, Russi M, Simonsen L, et al. Estimation of Excess deaths associated with the COVID‐19 pandemic in the United States, March to May 2020. JAMA Intern Med. 2020;180:1336–1344. DOI: 10.1001/jamainternmed.2020.3391.|||Schwartz BG, Qualls C, Kloner RA, Laskey WK. Relation of total and cardiovascular death rates to climate system, temperature, barometric pressure, and respiratory infection. Am J Cardiol. 2015;116:1290–1297. DOI: 10.1016/j.amjcard.2015.07.050.|||Kloner RA, Poole WK, Perritt RL. When throughout the year is coronary death most likely to occur? Circulation. 1999;100:1630–1634. DOI: 10.1161/01.CIR.100.15.1630.