Changes in out-of-hospital cardiac arrest resuscitation quality during and after the COVID-19 pandemic.

Aim: The impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia.

Methods: We performed a retrospective cohort study of adult OHCA patients of medical aetiology who received attempted resuscitation. The study consisted of three periods; a pre-COVID-19 period (1st March 2019 to 15th March 2020), the COVID-19 period (16th March 2020 to 12th October 2022) and a post-COVID-19 period (13th October 2022 to 30th June 2023). Multivariable quantile and logistic regression were used to examine changes in CPR metrics and time to resuscitation interventions across the three periods.

Results: We included 8,956 patients (2,389 pre-COVID-19, 4,935 during COVID-19 and 1,632 post-COVID-19). A number of CPR quality metrics deteriorated during the COVID-19 period compared to the pre-COVID-19 period, including: chest compression fraction (median difference [MD] -0.81 percentage points; 95% CI -1.07,-0.56), release velocity (MD -5.26 mm per second; 95% CI -9.79, -0.72) and resuscitation duration (MD -2.2 min; 95% CI -3.39, -1.05). The COVID-19 period was also associated with longer post-shock pauses (MD 0.22 s; 95% CI 0.05, 0.38), and a reduction in the risk-adjusted odds of receiving adrenaline administration within 5 mins (AOR 0.72, 95% CI 0.63 - 0.82) and laryngeal mask insertion within 10 mins of arrival (AOR 0.83, 95% CI 0.74 - 0.94). These factors, with the exception of resuscitation duration and time to larygeal mask insertion, remained significantly different from baseline for the post-COVID-19 period.

Conclusion: Several CPR quality metrics declined during the COVID-19 period and some remain below pre-pandemic levels. Further research is needed to understand these impacts on OHCA outcomes.