Impact of COVID-19 pandemic on bystander CPR in patient with OHCA: a registry-based before and after study in Daegu, Korea

Bystander cardiopulmonary resuscitation (BCPR) is a significant factor in the chain of survival; however, various potential barriers are observed. We aimed to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on BCPR. This retrospective observational study used Daegu out-of-hospital cardiac arrest (OHCA) registry data of patients aged over 18 years with cardiac etiology in Daegu, Korea from 18 February 2019 to 17 February 2021. We divided BCPR into self-led (SBCPR) and dispatcher-assisted BCPR (DACPR). To determine changes in the effect of BCPR on OHCA outcomes from the COVID-19 pandemic, we performed multivariable logistic regression analyses by BCPR type. Furthermore, we performed the Wald test to identify differences in logistic regression analysis results between the two periods. A total of 1680 OHCAs were included (before-pandemic, 804; during pandemic, 876). The BCPR rate was not different between the two periods (DACPR, 43.9% vs. 42.0%; SBCPR, 18.7% vs. 18.4; p = 0.643). SBCPR showed effectiveness for OHCA outcomes before the pandemic (adjusted odds ratio (aOR), 2.59; 95% confidence interval (CI), 1.09- 6.18 for survival to hospital discharge; aOR, 2.58; 95% CI, 1.03-6.46 for favorable neurological outcomes); however, it disappeared after the pandemic (aOR, 1.88; 95% CI, 0.88-4.00 for survival to hospital discharge; aOR, 1.67; 95% CI, 0.69-4.05 for favorable neurological outcomes). However, no statistical difference was observed in the Wald test (survival to hospital discharge, p = 0.586; favorable neurologic outcomes, p = 0.504). A decreasing trend in the effect of SBCPR on OHCA outcomes was observed during the COVID-19 pandemic; however, no statistically significant difference was observed compared with that before the pandemic.