COVID-19: 'Dramatic' Surge in Out-of-Hospital Cardiac Arrests in NYC

Megan Brooks

June 24, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic in New York City led to a surge in out-of-hospital cardiac arrests (OHCAs) that placed a huge burden on first responders, a new analysis demonstrates.

During the height of the pandemic in New York, there was a "dramatic increase in cardiopulmonary arrests, nearly all presented in non-shockable cardiac rhythms (>90% fatality rate) and vulnerable patient populations were most affected," David Prezant, MD, chief medical officer, Fire Department of New York (FDNY), told Medscape Medical News.

In a news release, Prezant noted that "relatively few, if any, patients were tested to confirm the presence of COVID-19," making it impossible to distinguish between cardiac arrests as a result of COVID-19 and those that may have resulted from other health conditions.

"We also can't rule out the possibility that some people may have died from delays in seeking or receiving treatment for non–COVID-19-related conditions. However, the dramatic increase in cardiac arrests compared to the same period in 2019 strongly indicates that the pandemic was directly or indirectly responsible for that surge in cardiac arrests and deaths," said Prezant.

The study was published online June 19 in JAMA Cardiology.

New York City has the largest and busiest EMS system in the US, serving a population of more than 8.4 million people and responding to more than 1.5 million calls every year.

To gauge the impact of COVID-19 on first responders, Prezant and colleagues analyzed data for adults with OHCA who received EMS resuscitation from March 1, when the first case of COVID-19 was diagnosed in NYC, through April 25, when EMS call volume had receded to pre-COVID-19 levels.

Compared with the same period in 2019, the COVID-19 period had an excess of 2653 patients with OHCA who underwent EMS resuscitation attempts (3989 in 2020 vs 1336 in 2019, P < .001), an incidence rate triple that of 2019 (47.5 vs 15.9 per 100,000).

On the worst day – Monday, April 6 – OHCAs peaked at 305 cases, an increase of nearly 10-fold compared with the same day in 2019.

Despite the surge in cases, the median response time of available EMS units to OHCAs increased by only about 1 minute over 2019, a nonsignificant difference. Although the average time varied, median response time during the COVID period was less than 3 minutes.

A More Vulnerable Group

Compared with 2019, patients suffering OHCA during the pandemic period were older (mean age 72 vs 68 years), less likely to be white (20% white vs 33%) and more likely to have hypertension (54% vs 46%), diabetes (36% vs 26%), physical limitations (57% vs 48%) and cardiac rhythms that don't respond to defibrillator shocks (92% vs 81%).

Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (18% vs 35%; P < .001) and sustained ROSC (11% vs 25%; P < .001). The case fatality rate was 90% in the COVID-19 period vs 75% a year earlier.

"The tragedy of the COVID-19 pandemic," Prezant and colleagues say, is not just the number of patients infected, but the large increase in OHCAs and deaths.

Identifying patients with the greatest risk for OHCA and death during the COVID-19 pandemic "should allow for early, targeted interventions in the outpatient setting that could lead to reductions in out-of-hospital deaths," they say.

"Vulnerable patient populations need outreach, telephonic medicine, televideo medicine, home visits, not just temperature monitoring but home O2 saturation monitoring," Prezant told Medscape Medical News. "Barriers need to be removed, not just for this pandemic but for the future — no matter what the trigger is."

Unsung Heroes

Writing in an Editor's Note, the editors of JAMA Cardiology say the American people owe a debt of gratitude to first responders for the "heroic work" triaging, resuscitating, and transporting thousands of people affected by COVID-19. 

"Although the typically bustling NYC streets remained eerily deserted, the characteristic cacophony of sounds of the 'City that Never Sleeps' was replaced by sirens wailing all hours of the night," write Robert Bonow, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues.

First responders to OHCAs in the COVID-19 era place themselves at extremely high risk, in some cases without optimal personal protective equipment, they point out. "Sadly," many first responders have fallen ill to COVID-19 infection.

As of June 1, 29 EMS workers and volunteers across the US have died of COVID-19.

They are James Villecco, Gregory Hodge, Tony Thomas, Mike Field, John Redd, Idris Bey, Richard Seaberry, and Sal Mancuso of New York; Israel Tolentino, Reuven Maroth, Liana Sá, Kevin Leiva, Frank Molinari, Robert Weber, Robert Tarrant, Solomon Donald, Scott Geiger, John Farrarella, John Careccia, Bill Nauta, and David Pinto of New Jersey; Kevin Bundy, Robert Zerman, and Jeremy Emerich of Pennsylvania; Paul Cary of Colorado; Paul Novicki of Michigan; David Martin of Mississippi; Billy Birmingham of Missouri; and John "JP" Granger of South Carolina.

"We offer their families, friends, and colleagues our sincerest condolences and honor their memory with our highest respect and gratitude," Bonow and colleagues write.

This study was supported by the City of New York and the Fire Department of the City of New York. The authors have disclosed no relevant financial relationships.

JAMA Cardiol. Published online June 19, 2020. Full text, Editor's Note

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