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Original Research

Open Access Special Issue

Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea

  • Jun Her1
  • Youngsuk Cho1,2,*,†,
  • Gyu Chong Cho1,†

1Department of Emergency Medicine, Kangdong Sacred Heart Hospital, 05355 Seoul, Republic of Korea

2Graduate School, Department of Biomedical Engineering, College of Medicine, Hanyang University, 04763 Seoul, Republic of Korea

DOI: 10.22514/sv.2022.081

Submitted: 02 October 2022 Accepted: 09 November 2022

Online publish date: 15 December 2022

*Corresponding Author(s): Youngsuk Cho E-mail: faith2love@kdh.or.kr

† These authors contributed equally.

Abstract

The incidence of out-of-hospital cardiac arrest (OHCA) gradually increased during the coronavirus disease 2019 (COVID-19) pandemic, and the number of cases requiring termination of resuscitation (TOR) also rose. This study aimed to analyze the reasons for TOR of OHCA cases over 2 years (2019–2020). This retrospective observational study was conducted using data gathered from prehospital emergency medical service (EMS) care reports generated in Seoul between 01 January 2019, and 31 December 2020. We included OHCA cases reported to the EMS system in this study. Patients who experienced cardiac arrest for a non-medical cause and received cardiopulmonary resuscitation (CPR) from EMS paramedics at the scene were excluded. The variables of demographics and comorbidities, arrest location, identity of the bystander, cause of cardiac arrest, first monitored electrocardiographic (ECG) rhythm, and reason for TOR were investigated. We compared data for 1 year before and after the start of the COVID-19 pandemic. A total of 10,872 OHCAs with TOR were included in this study; of these, 6238 cardiac arrest cases were terminated without resuscitation attempts during the COVID-19 period compared to 4634 during the pre-COVID-19 period. During the COVID-19 period, the proportion of women in the total population decreased, while the median age increased (p < 0.001). Patients with comorbidities, the frequency of asystole rhythm at first monitoring, and the number of witnessed cardiac arrests significantly increased (p < 0.001). The proportion of TOR cases due to decisions made by a medical director and refusal of CPR by family members also significantly increased, while that due to clear evidence of death decreased (p < 0.001). In conclusion, there was a significant change in the reason for TOR before and after the COVID-19 pandemic in Korea.


Keywords

Cardiac arrest; Cardiopulmonary resuscitation; COVID-19; Emergency medical services; Termination of resuscitation


Cite and Share

Jun Her,Youngsuk Cho,Gyu Chong Cho. Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea. Signa Vitae. 2023.doi:10.22514/sv.2022.081.

References

[1] Roh SY, Choi JI, Park SH, Kim YG, Shim J, Kim JS, et al. The 10-year trend of out-of-hospital cardiac arrests: a Korean nationwide population-based study. Korean Circulation Journal. 2021; 51: 866–874.

[2] Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. The New England Journal of Medicine. 2015; 372: 2307–2315.

[3] Kim TH, Shin SD, Ahn KO, Lee T, Jun C, Cha WC, et al. Linear planning and simulation for allocation of ambulances in a two-tiered emergency medical service system. Journal of The Korean Society of Emergency Medicine. 2011; 22: 1–8.

[4] Park JH, Song KJ, Shin SD, Hong KJ. Does second EMS unit response time affect outcomes of OHCA in multi-tiered system? A nationwide observational study. The American Journal of Emergency Medicine. 2021; 42: 161–167.

[5] Holmén J, Herlitz J, Ricksten S, Strömsöe A, Hagberg E, Axelsson C, et al. Shortening ambulance response time increases survival in out-of-hospital cardiac arrest. Journal of the American Heart Association. 2020; 9: e017048

[6] Bürger A, Wnent J, Bohn A, Jantzen T, Brenner S, Lefering R, et al. The effect of ambulance response time on survival following out-of-hospital cardiac arrest. Deutsches Arzteblatt International. 2018; 115: 541–548.

[7] Tataris KL, Richards CT, Stein-Spencer L, Ryan S, Lazzara P, Weber JM. EMS provider perceptions on termination of resuscitation in a large, urban EMS system. Prehospital Emergency Care. 2017; 21: 610–615.

[8] Bailey ED, Wydro GC, Cone DC. Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehospital Emergency Care. 2000; 4: 190–195.

[9] Stockinger ZT, McSwain NE Jr. Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field. Journal of the American College of Surgeons. 2004; 198: 227–231.

[10] World Health Organization. Third round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic. 2022. Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2022.1 (Accessed: 31 October 2022).

[11] Al Amiry A, Maguire BJ. Emergency medical services (EMS) calls during COVID-19: early lessons learned for systems planning (a narrative review). Open Access Emergency Medicine. 2021; 13: 407–414.

[12] 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.

[13] Jung H, Lee MJ, Cho JW, Lee SH, Lee SH, Mun YH, et al. External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021; 29: 19.

[14] Chavez S, Huebinger R, Chan HK, Gill J, White L, Mendez D, et al. The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas. The American Journal of Emergency Medicine. 2022; 57: 1–5.

[15] Teoh SE, Masuda Y, Tan DJH, Liu N, Morrison LJ, Ong MEH, et al. Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Annals of Intensive Care. 2021; 11: 169.

[16] Mathew S, Harrison N, Chalek AD, Gorelick D, Brennan E, Wise S, et al. Effects of the COVID-19 pandemic on out-of-hospital cardiac arrest care in Detroit. The American Journal of Emergency Medicine. 2021; 46: 90–96.

[17] Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: a 100 days experience from the Lombardy region. PLoS One. 2020; 15: e0241028.

[18] Chan PS, Girotra S, Tang Y, Al-Araji R, Nallamothu BK, McNally B. Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic. JAMA Cardiology. 2021; 6: 296–303.

[19] Lee MJ, Shin TY, Lee CH, Moon JD, Roh SG, Kim CW, et al. 2020 Korean guidelines for cardiopulmonary resuscitation. Part 9. Education and system implementation for enhanced chain of survival. Clinical and Experimental Emergency Medicine. 2021; 8: S116–S124.

[20] Hutton G, Kawano T, Scheuermeyer FX, Panchal AR, Asamoah-Boaheng M, Christenson J, et al. Out-of-hospital cardiac arrests terminated without full resuscitation attempts: Characteristics and regional variability. Resuscitation. 2022; 172: 47–53.


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