CPR During Covid..

CARES Annual Report Shows COVID-19’s Impact On Resuscitation Practices And Outcomes​

Without a doubt, the pandemic has posed many challenges for healthcare, including the area of resuscitation. Both healthcare and EMS workers have had to adapt their resuscitation practices.

The pandemic’s impact on resuscitation practices in the U.S. is evident in the national dataset collected and presented in the Cardiac Arrest Registry to Enhance Survival (CARES) 2020 Annual Report. CARES helps communities measure standard outcomes for out-of-hospital cardiac arrest, allowing for local quality improvement and benchmarking capability to improve care and survival. AHA is a supporter of CARES.

In the U.S., overall survival for out-of-hospital cardiac arrest (OHCA) dropped by 14% in 2020 compared with 2019 (10.5% to 9.0%) and bystander CPR decreased by 2% (41.2% to 40.2%), according to CARES.

Below is a summary that captures trends in key OHCA indicators in 2020 that reflect COVID-19’s impact. You can also read this information on page 41.

• Public location of arrest decreased from 17.4% to 11.4% over the period from February to April, returning to pre-pandemic levels in June and decreasing once again in November during the second major surge in deaths.

• The proportion of presenting shockable cases followed a similar trend, showing a significant decrease in April and a second dip in November.

• Bystander CPR remained relatively constant throughout the year but varied by arrest location. Bystander CPR in residential settings remained static (range: 38.4–41.2%). In contrast, bystander CPR in public locations decreased significantly from 47.4% in February to 35.7% in April. While the public bystander CPR rate rebounded to 45.3% in June, it remained below pre-pandemic levels for the remainder of the year.

• Public AED use decreased from 13.8% to 6.3% during the initial lockdown period, also remaining below prepandemic levels for the remainder of the year.

• Field Termination of Resuscitation (TOR) increased significantly from 37.5% in January to 49.7% in April, with the sharpest increase occurring between March and April. While the TOR rate decreased to 41.9% by June, it remained elevated compared to pre-pandemic levels, showing a more gradual increase during the second surge in late fall.

Time to CPR and Defibrillation

Many healthcare professionals and Instructors are familiar with the adage that time is heart. For every minute that passes without CPR and defibrillation, the chances of survival decrease by 7–10%.

In March 2020, the average time from cardiac arrest to initial CPR was 6.8 minutes. However, as the pandemic worsened in late summer/early fall, the average time to initial CPR peaked to 8.9 minutes in September, according to CARES.

The average time from arrest to defibrillation from January through March 2020 closely followed 2019 levels and began to increase in April 2020. Average time to defibrillation was longer in 2020 compared with 2019 from May to the remainder of the year, per CARES.

Patient Outcomes

The data in the report shows how the pandemic may have dramatically impacted OHCA survival that may be attributed to factors such as fewer arrests happening in public places, lower rates of bystander CPR, etc.

The report notes how 2020 survival rates remained stable from January through March, closely following 2019 rates. However, the report further states the following: overall survival from April 2020 onwards was considerably lower than in 2019, decreasing from a rate of 9.8% in March to a yearly low of 7.1% in December. Notably, the sharpest decrease occurred between March and April, during the onset of the pandemic.

Beyond the Pandemic and Knowing Your Community’s Numbers

Insights from EMS agencies in three communities and how they adapted their resuscitation practices are featured on page 19 of the report. The lessons learned by these groups – and many other agencies - will likely shape their future resuscitation strategies and practices, which will hopefully result in increased survival rates.

To make improvements in OHCA outcomes, it’s crucial that EMS and hospital leaders first know their numbers for key indicators such as bystander interventions and patient outcomes. The data for these indicators submitted to CARES by participating agencies helps EMS and hospital leaders in communities understand how they’re performing compared to others as well as help them determine whether their quality improvement efforts are working.

Below are the main questions that CARES helps local EMS administrators and community leaders determine:

• Who is affected in my community?
• When and where are cardiac events happening?
• What parts of the system are working well?
• What parts of the system could work better?
• How can we improve emergency cardiac arrest treatment?

EMS agencies that are interested in participating in the registry can complete a form on the CARES website at https://mycares.net/sitepages/questionnaire.jsp.

About CARES
The Cardiac Arrest Registry to Enhance Survival (CARES) is a secure web-based data management system (https://mycares.net) that links the three sources of information that define the continuum of emergency care for out-of-hospital cardiac arrest (OHCA) events: 1) 911 dispatch centers, 2) emergency medical services (EMS) providers, and 3) receiving hospitals, to create a single record for an OHCA event. Registry data collection is critical to improving patient care and survival rates. It allows communities and public health organizations to monitor quality of care, measure and benchmark performance for effective research, and creates a platform for intervention implementation.

Communities that participate in CARES can confidentially compare their EMS or hospital system performance using de-identified aggregate statistics at the local, state, or national level to improve their performance in emergency cardiac care. CARES currently includes 29 state-based registries and more than 50 community sites in an additional 15 states, representing a catchment area of approximately 167 million people, nearly 51% of the U.S. population.

To read more click here: CARES Annual Report Shows COVID-19’s Impact On Resuscitation Practices And Outcomes