Article Data

  • Views 354
  • Dowloads 134

Original Research

Open Access

Impact of COVID-19 pandemic on bystander CPR in patient with OHCA: a registry-based before and after study in Daegu, Korea

  • Haewon Jung1
  • Jung Ho Kim2,*,
  • Hyun Wook Ryoo1
  • Jong-Yeon Kim3
  • Jae Yun Ahn1
  • Sungbae Moon1
  • Won Kee Lee4
  • Sang-Hun Lee5

1Department of Emergency Medicine, School of Medicine, Kyungpook National University, 41944 Daegu, Republic of Korea

2Department of Emergency Medicine, Yeungnam University College of Medicine, 42415 Daegu, Republic of Korea

3Department of Public Health, Kyungpook National University Hospital, 41944 Daegu, Republic of Korea

4Department of Medical Informatics, Kyungpook National University School of Medicine, 41944 Daegu, Republic of Korea

5Department of Emergency Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 42601 Daegu, Republic of Korea

DOI: 10.22514/sv.2023.116

Submitted: 13 May 2023 Accepted: 10 August 2023

Online publish date: 15 November 2023

*Corresponding Author(s): Jung Ho Kim E-mail:


Bystander cardiopulmonary resuscitation (BCPR) is a significant factor in the chain of survival; however, various potential barriers are observed. We aimed to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on BCPR. This retrospective observational study used Daegu out-of-hospital cardiac arrest (OHCA) registry data of patients aged over 18 years with cardiac etiology in Daegu, Korea from 18 February 2019 to 17 February 2021. We divided BCPR into self-led (SBCPR) and dispatcher-assisted BCPR (DACPR). To determine changes in the effect of BCPR on OHCA outcomes from the COVID-19 pandemic, we performed multivariable logistic regression analyses by BCPR type. Furthermore, we performed the Wald test to identify differences in logistic regression analysis results between the two periods. A total of 1680 OHCAs were included (before-pandemic, 804; during pandemic, 876). The BCPR rate was not different between the two periods (DACPR, 43.9% vs. 42.0%; SBCPR, 18.7% vs. 18.4; p = 0.643). SBCPR showed effectiveness for OHCA outcomes before the pandemic (adjusted odds ratio (aOR), 2.59; 95% confidence interval (CI), 1.09–6.18 for survival to hospital discharge; aOR, 2.58; 95% CI, 1.03–6.46 for favorable neurological outcomes); however, it disappeared after the pandemic (aOR, 1.88; 95% CI, 0.88–4.00 for survival to hospital discharge; aOR, 1.67; 95% CI, 0.69–4.05 for favorable neurological outcomes). However, no statistical difference was observed in the Wald test (survival to hospital discharge, p = 0.586; favorable neurologic outcomes, p = 0.504). A decreasing trend in the effect of SBCPR on OHCA outcomes was observed during the COVID-19 pandemic; however, no statistically significant difference was observed compared with that before the pandemic.


Bystander cardiopulmonary resuscitation; COVID-19; Outcomes; Out-of-hospital cardiac arrest; Pandemic

Cite and Share

Haewon Jung,Jung Ho Kim,Hyun Wook Ryoo,Jong-Yeon Kim,Jae Yun Ahn,Sungbae Moon,Won Kee Lee,Sang-Hun Lee. Impact of COVID-19 pandemic on bystander CPR in patient with OHCA: a registry-based before and after study in Daegu, Korea. Signa Vitae. 2023.doi:10.22514/sv.2023.116.


[1] Habas K, Nganwuchu C, Shahzad F, Gopalan R, Haque M, Rahman S, et al. Resolution of coronavirus disease 2019 (COVID-19). Expert Review of Anti-Infective Therapy. 2020; 18: 1201–1211.

[2] Rosenbaum L. The untold toll—the pandemic’s effects on patients without Covid-19. The New England Journal of Medicine. 2020; 382: 2368–2371.

[3] Ahn JY, Ryoo HW, Cho JW, Kim JH, Lee SH, Jang TC. Impact of the COVID-19 outbreak on adult out-of-hospital cardiac arrest outcomes in Daegu, South Korea: an observational study. Clinical and Experimental Emergency Medicine. 2021; 8: 137–144.

[4] Lim ZJ, Ponnapa Reddy M, Afroz A, Billah B, Shekar K, Subramaniam A. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: a systematic review and meta-analysis. Resuscitation. 2020; 157: 248–258.

[5] Nishiyama C, Kiyohara K, Kitamura T, Hayashida S, Maeda T, Kiguchi T, et al. Impact of the COVID-19 pandemic on prehospital intervention and survival of patients with out-of-hospital cardiac arrest in Osaka City, Japan. Circulation Journal. 2022; 86: 1579–1585.

[6] 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.

[7] Matsuyama T, Scapigliati A, Pellis T, Greif R, Iwami T. Willingness to perform bystander cardiopulmonary resuscitation: a scoping review. Resuscitation Plus. 2020; 4: 100043.

[8] Chong KM, Chen JW, Lien WC, Yang MF, Wang HC, Liu SS, et al. Attitude and behavior toward bystander cardiopulmonary resuscitation during COVID-19 outbreak. PLOS ONE. 2021; 16: e0252841.

[9] Becker TK, Gul SS, Cohen SA, Maciel CB, Baron-Lee J, Murphy TW, et al. Public perception towards bystander cardiopulmonary resuscitation. Emergency Medicine Journal. 2019; 36: 660–665.

[10] Lim KT, Ahn KO, Park JH, Park CH, Lim J, Lee K. Bystander cardiopulmonary resuscitation in public locations before and after the coronavirus disease 2019 pandemic in the Republic of Korea. The American Journal of Emergency Medicine. 2022; 56: 271–274.

[11] Min C, Lee DE, Ryoo HW, Jung H, Cho JW, Kim YJ, et al. Neurologic outcomes of prehospital mechanical chest compression device use during transportation of out-of-hospital cardiac arrest patients: a multicenter observational study. Clinical and Experimental Emergency Medicine. 2022; 9: 207–215.

[12] Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, et al. Part 4: CPR overview: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010; 122: S676–S684.

[13] Kim JH, Ryoo HW, Kim JY, Ahn JY, Moon S, Lee DE, et al. Application of a dual-dispatch system for out-of-hospital cardiac arrest patients: will more hands save more lives? Journal of Korean Medical Science. 2019; 34: e141.

[14] Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004; 110: 3385–3397.

[15] Kim MW, Kim TH, Song KJ, Shin SD, Kim CH, Lee EJ, et al. Comparison between dispatcher-assisted bystander CPR and self-led bystander CPR in out-of-hospital cardiac arrest (OHCA). Resuscitation. 2021; 158: 64–70.

[16] Daegu City. Trend of COVID-19 confirmed cases. 2023. Available at: (Accessed: 01 May 2023).

[17] Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S366–S468.

[18] Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European resuscitation council guidelines 2021: basic life support. Resuscitation. 2021; 161: 98–114.

[19] Brown E, Chan LM. Should chest compressions be considered an aerosol-generating procedure? A literature review in response to recent guidelines on personal protective equipment for patients with suspected COVID-19. Clinical Medicine. 2020; 20: e154–e159.

[20] Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. The Lancet Public Health. 2020; 5: e437–e443.

[21] Grunau B, Bal J, Scheuermeyer F, Guh D, Dainty KN, Helmer J, et al. Bystanders are less willing to resuscitate out-of-hospital cardiac arrest victims during the COVID-19 pandemic. Resuscitation Plus. 2020; 4: 100034.

[22] Shibahashi K, Kawabata H, Sugiyama K, Hamabe Y. Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan. Emergency Medicine Journal. 2022; 39: 583–588.

[23] Fothergill RT, Smith AL, Wrigley F, Perkins GD. Out-of-hospital cardiac arrest in London during the COVID-19 pandemic. Resuscitation Plus. 2021; 5: 100066.

[24] Uny I, Angus K, Duncan E, Dobbie F. Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review. Perspectives in Public Health. 2023; 143: 43–53.

[25] South Korea Ministry of Health and Welfare (MOHW)—Central Disaster Management Headquarters. Coronavirus disease 19—press release. 2021. Available at: (Accessed: 20 November 2022).

[26] Bielski K, Szarpak A, Jaguszewski MJ, Kopiec T, Smereka J, Gasecka A, et al. The Influence of COVID-19 on out-hospital cardiac arrest survival outcomes: an updated systematic review and meta-analysis. Journal of Clinical Medicine. 2021; 10: 5573.

[27] Edwards JM, Nolan JP, Soar J, Smith GB, Reynolds E, Carnall J, et al. Impact of the COVID-19 pandemic on in-hospital cardiac arrests in the UK. Resuscitation. 2022; 173: 4–11.

[28] Park GJ, Song KJ, Shin SD, Lee KW, Ahn KO, Lee EJ, et al. Timely bystander CPR improves outcomes despite longer EMS times. The American Journal of Emergency Medicine. 2017; 35: 1049–1055.

[29] Sondergaard KB, Wissenberg M, Gerds TA, Rajan S, Karlsson L, Kragholm K, et al. Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest. European Heart Journal. 2019; 40: 309–318.

[30] Sato N, Matsuyama T, Kitamura T, Hirose Y. Disparities in bystander cardiopulmonary resuscitation performed by a family member and a non-family member. Journal of Epidemiology. 2021; 31: 259–264.

[31] Takei Y, Nishi T, Matsubara H, Hashimoto M, Inaba H. Factors associated with quality of bystander CPR: the presence of multiple rescuers and bystander-initiated CPR without instruction. Resuscitation. 2014; 85: 492–498.

[32] Son JW, Ryoo HW, Moon S, Kim JY, Ahn JY, Park JB, et al. Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey. Clinical and Experimental Emergency Medicine. 2017; 4: 80–87.

[33] Park GJ, Kong SYJ, Song KJ, Shin SD, Kim TH, Ro YS, et al. The effectiveness of a new dispatcher-assisted basic life support training program on quality in cardiopulmonary resuscitation performance during training and willingness to perform bystander cardiopulmonary resuscitation: a cluster randomized controlled study. Simulation in Healthcare. 2020; 15: 318–325.

[34] Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, et al. 2021 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; neonatal life support; education, implementation, and teams; first aid task forces; and the COVID-19 working group. Circulation. 2022; 145: e645–e721.

[35] Hwang BN, Lee EH, Park HA, Park JO, Lee CA. Effects of positive dispatcher encouragement on the maintenance of bystander cardiopulmonary resuscitation quality. Medicine. 2020; 99: e22728.

[36] Chen KY, Ko YC, Hsieh MJ, Chiang WC, Ma MH. Interventions to improve the quality of bystander cardiopulmonary resuscitation: a systematic review. PLOS ONE. 2019; 14: e0211792.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time