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Recent reports suggest that higher COVID-19 incidence may be associated with higher out-of-hospital sudden cardiac arrest (SCA) burden and worse outcomes.
Objective
To compare SCA incidence and outcomes during the COVID-19 pandemic (March 1 - Dec 31, 2020) to the corresponding period in 2019 in a US community.
Methods
All out of hospital SCA cases with likely cardiac etiology attended by emergency medical services (EMS) were prospectively identified during the COVID-19 pandemic period in Ventura County, CA (pop. 848,112). We compared SCA incidence, resuscitation variables (Utstein elements) and outcomes in 2020 to 2019. COVID monthly counts were obtained from US Centers for Disease Control data.
Results
In 2019 there were 314 SCA cases in Ventura County (average 31.4 per month), corresponding to a 10-month incidence of 36.9 per 100,000. In 2020 there were 410 SCA cases (41.0 per month; 30% higher than 2019 average), for a 10-month incidence of 48.2 per 100,000 (p<0.001). A spike in both COVID and SCA incidence was observed in December 2020 (Figure). The proportion of SCAs with shockable rhythm also declined (25% to 19%, p=0.05), as did survival to hospital discharge (14.7% to 8.8%, p=0.01). There were no significant differences in the percent with witnessed arrest (48% to 43%, p=0.20), bystander CPR (54% to 48%, p=0.10), and return of spontaneous circulation (33% to 28%, p=0.15).
Conclusion
SCA incidence was significantly higher and survival outcomes lower during the COVID-19 pandemic period, with evidence of overlap between the two conditions. These findings have implications for community public health and EMS response planning during the pandemic and subsequent outbreaks.
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