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The initiation of CPR by bystanders or family members (pre-EMS CPR) mitigates oxygen starvation in the brain and heart and helps fulfill the second component of the cardiac arrest chain of survival.
Pre-EMS CPR requires individuals adequately trained in CPR being both available and willing to assist an out-of-hospital cardiac arrest victim. Many have speculated that the COVID-19 pandemic could dramatically lower rates of pre-EMS CPR – perhaps, because bystanders might worry about contracting COVID-19.
To examine if rates of pre-EMS CPR changed during the early stages of the COVID-19 pandemic, we queried the National Emergency Medical Services Information System (NEMSIS), a database of millions of EMS calls. Inclusion criteria were cardiac arrest calls where providers documented if pre-EMS CPR was provided. We specifically compared cardiac arrest calls during April to August of both 2019 and 2020. Months in 2019 served as a non-pandemic control sample, while months in 2020 represented early stages of the pandemic.
A total of 672,691 cardiac arrests met inclusion criteria. When compared with 2019, there were more cardiac arrests in 2020 across all months, and rates of pre-EMS CPR were significantly lower in 2020 across all months (p < 0.001) (Fig. 1). Averaging cardiac arrests across all months, we noted a 8.94% reduction in the incidence of pre-EMS CPR between 2019 and 2020. Individual months’ differences were also found to be statistically significant (p < 0.001). The greatest reduction in pre-EMS CPR took place for July (−10.4%), while the shallowest reduction took place in August (−7.3%).
Fig. 1Shows the significant reductions in rates of pre-EMS CPR when comparing March through August in 2019 and 2020. Months during non-pandemic times (2019) were associated with fewer cardiac arrests and, more importantly, significantly higher rates of pre-EMS CPR (p < 0.001).
These data show significant reductions in the rates of pre-EMS CPR took place during the first six months of the COVID-19 pandemic. Two hypotheses behind these reductions include: bystanders might be less willing to perform CPR on cardiac arrest victims out of fear of being exposed to COVID-19 or cardiac arrest victims might be less likely to be in a public location where a trained individual might be able to intervene during a pandemic. The increased number of cardiac arrests might be due to individuals hesitating to seek medical attention and experiencing worse outcomes. Our findings align with many pandemic-specific trends that have been previously reported, including an increase in cardiac arrests and poorer outcomes.
One explanation for the poorer cardiac arrest outcomes that have been reported could be significant decreases in pre-EMS CPR. Further research should seek to better understand why individuals might be concerned to perform pre-EMS CPR during a pandemic and ways to mitigate pathogen transmission during pre-EMS CPR and, as always, urgent efforts should be directed at improving the availability of CPR-trained individuals.
Funding
None.
Conflicts of interest
None.
References
Ritter G.
Wolfe R.A.
Goldstein S.
et al.
The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims.
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