11-Severe Escalation of Out-of-Hospital Cardiac Arrests in SARS-CoV-2-Immersed Metropolitan Cities
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Resuscitation, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Paul E. Pepe, MD, MPH, MACP

Introduction/Hypothesis: Following COVID-19 stay-at-home directives in March 2020, many EMS systems worldwide observed 30-40% decreases in total call volumes. Simultaneously, most metropolitan cities severely impacted by COVID-19 also reported marked increases in out-of-hospital cardiac arrest (OHCA) cases. The study aim was to quantify the change in OHCA numbers observed in large urban centers during the onset of the COVID-19 crisis.

Methods: Major city EMS systems covering ~one-quarter of the U.S. population (n=45), and millions of others in major European/Australian cities, were surveyed for their monthly EMS OHCA numbers during the first 6 months of 2020. Data were compared to averaged corresponding monthly periods in 2018 and 2019. Considering normal variation and the complexities of OHCA cases (risk, significant personnel/resource utilization and protracted time away from other 9-1-1 responses), >10% increase/decrease was considered, a priori, a highly-significant difference, especially in terms of operational impact.

Results: Of the 45 major U.S. cities studied, large escalations in OHCA were associated with the relative prevalence of COVID-19. During April, 32 cities with high rates of COVID-19 had >15% increases in OHCA vs. prior years. Among 13 cities with >50% (1.5-fold) increases, 3 widely-recognized COVID-19 epicenters had >double their usual OHCA numbers (2.5-fold in NYC). Conversely, despite lockdowns, cities with relatively lower COVID-19 cases, had no change from prior years (n=6) or even fewer cases (n=6). Inclusive of all 45 cities, the mean number of OHCA cases/city rose in April by 62%, from 149 to 241 (p=0.037). By June, cities with the highest rates of OHCA, like NYC, returned to or approached pre-COVID levels after mitigating spread, while initial low impact cities with lower OHCA rates in April (eg, Phoenix, Charleston) experienced marked increases in June as local COVID-19 cases rose substantially. European/Australian cities mirrored the U.S. experience.

Conclusions: Metropolitan cities have experienced marked increases in OHCA during 2020 paralleling the prevalence of COVID-19 in their respective jurisdictions placing significant operational strains on affected 9-1-1 systems. These on-going observations are now part of a work in progress to elucidate the underlying etiologies.


Meta Tag
Content Type Presentation
Knowledge Area Resuscitation
Knowledge Area Crisis Management
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Tag Cardiac Arrest
Year 2021
out-of-hospital cardiac arrest
COVID-19 pandemic
lockdown period
metropolitan cities
hypercoagulopathy and clotting


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