Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis

BACKGROUND: Improving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. METHODS: Prospectively collected nationwide, population-based records concerning 166 538 working-age individuals (men, 20–68 years; women, 20–62 years) with OHCA between 2017 and 2020 were assessed. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017–2019) and the pandemic year 2020. The primary outcome was neurologically favourable 1-month survival (cerebral performance category 1 or 2). Secondary outcomes were bystander cardiopulmonary resuscitation (BCPR), dispatcher-assisted instruction for cardiopulmonary resuscitation (DAI-CPR), bystander-provided defibrillation (public access defibrillation (PAD)) and 1-month survival. We examined variations in bystander resuscitation efforts and outcomes among pandemic phase and regional classifications. RESULTS: Among 149 300 OHCA cases, 1-month survival (2020, 11.2%; 2017–2019, 11.1% (crude OR (cOR) 1.00, 95% CI 0.97 to 1.05)) and 1-month neurologically favourable survival (7.3%–7.3% (cOR 1.00, 95% CI 0.96 to 1.05)) were unchanged; however, the neurologically favourable 1-month survival rate decreased in 12 of the most COVID-19-affected prefectures (7.2%–7.8% (cOR 0.90, 95% CI 0.85 to 0.96)), whereas it increased in 35 other prefectures (7.5%–6.6% (cOR 1.15, 95% CI 1.07 to 1.23)). Favourable outcomes decreased for OHCAs of presumed cardiac aetiology (10.3%–10.9% (cOR 0.94, 95% CI 0.90 to 0.99)) but increased for OHCAs of non-cardiac aetiology (2.5%–2.0% (cOR 1.27, 95% CI 1.12 to 1.44)). BCPR provision increased from 50.7% of arrests prepandemic to 52.3% (crude OR 1.07, 95% CI 1.04 to 1.09). Compared with 2017–2019, home-based OHCAs in 2020 increased (64.8% vs 62.3% (crude OR 1.12, 95% CI 1.09 to 1.14)), along with DAI-CPR attempts (59.5% vs 56.6% (cOR 1.13, 95% CI 1.10 to 1.15)) and multiple calls to determine a destination hospital (16.4% vs 14.5% (cOR 1.16, 95% CI 1.12 to 1.20)). PAD use decreased from 4.0% to 3.7% but only during the state of emergency period (7 April–24 May 2020) and in prefectures significantly affected by COVID-19. CONCLUSIONS: Reviewing automated external defibrillator (AED) locations and increasing BCPR through DAI-CPR may help prevent pandemic-associated decreases in survival rates for patients with cardiac OHCAs.