The influence of changes in-hospital infection control protocols and cardiopulmonary resuscitation environment to treatment outcomes on out-of-hospital cardiac arrest due to the COVID-19 pandemic: a single center retrospective observational study

Oh, Hyo Seok; Choi, Woo Sung; Lim, Yong Su; Cho, Jin-Seong; Woo, Jae-Hyug; Jang, Jae Ho; Choi, Jae Yeon; Choi, Kang-Kook

J Korean Soc Emerg Med > Volume 34(1); 2023 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2023;34(1): 1-9.

COVID-19 대유행으로 인한 병원 내 감염관리 프로토콜 및 심폐소생술 시행 환경의 변화가 심정지 환자의 치료결과에 미치는 영향: 단일기관 후향적 관찰연구

오효석¹

¹가천대학교 길병원 응급의학과
²가천대학교 의과대학 응급의학과
³가천대학교 의과대학 외상외과

The influence of changes in-hospital infection control protocols and cardiopulmonary resuscitation environment to treatment outcomes on out-of-hospital cardiac arrest due to the COVID-19 pandemic: a single center retrospective observational study

¹Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea
²Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
³Department of Traumatology, Gachon University College of Medicine, Incheon, Korea

Correspondence

Woo Sung Choi ,Tel: 032-460-3901, Fax: 032-460-3019, Email: naoki98@naver.com,

Received: March 29, 2022; Revised: May 25, 2022 Accepted: June 27, 2022. Published online: February 28, 2023.

ABSTRACT

Objective:
Coronavirus disease 2019 (COVID-19) pandemic has been affecting the safety of hospital healthcare workers and the outcome of out-of-hospital cardiac arrest patients. This study aimed to analyze the influence of the changes inhospital infection control protocols (ICP) and cardiopulmonary resuscitation (CPR) environment on the treatment outcomes of out-of-hospital cardiac arrest patients.
Method:
The medical records of patients who visited the emergency room were retrospectively reviewed for the period from March 13, 2019 to March 13, 2021. Patient data were analyzed before and after March 13, 2020, when the “in-hospital CPR guidelines related to COVID-19 infection” was recommended by the Korean Society of Emergency Medicine. We performed a comparison and analysis of the first epinephrine administration time and the intubation time with other CPR-related factors in both groups. The in-hospital return of spontaneous circulation (ROSC) and the over 24-hour survival rate were defined as treatment outcomes.
Results:
A total number of 453 patients were included in the study. After ICP, the in-hospital ROSC was increased (29.8% vs. 42.1%, P=0.006), whereas the over 24-hour survival rate was decreased (67.2% vs. 40.6%, P=0.001). The time intervals from the hospital visit to the first epinephrine administration—1.0 (0-1.0) vs. 1.0 (0-2.0), P=0.007—and tracheal intubation—1.0 (0-1.0) vs. 1.0 (1.0-2.8), P<0.001—were statistically significantly higher than those before ICP application. In our multivariable analysis, the ICP application and pre-hospital emergency medical service (EMS) response time were factors associated with the treatment outcome.
Conclusion:
After the application of the ICP, both the first epinephrine administration time and the tracheal intubation time from the patient’s hospital visit were prolonged. The application of ICP and the delayed EMS response time were factors associated with the treatment outcome.

Key words: COVID-19; Out-of-hospital cardiac arrest; Personal protective equipment