Vol 28, No 1 (2021)
Original Article
Published online: 2020-10-22

open access

Page views 3693
Article views/downloads 1769
Get Citation

Connect on Social Media

Connect on Social Media

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

Magdalena J. Borkowska1, Jacek Smereka23, Kamil Safiejko1, Klaudiusz Nadolny45, Maciej Maslanka36, Krzysztof J. Filipiak7, Milosz J. Jaguszewski8, Lukasz Szarpak13
Pubmed: 33140396
Cardiol J 2021;28(1):15-22.


Background: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especially
in the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing full
personal protective equipment. This study aims were to assess the characteristics and outcomes of adults
who suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams.

All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed.
The retrospective EMS database was conducted. EMS interventions performed between March 1,
and April 30, 2020 were retrospectively screened.

In the study period EMS operated 527 times for OHCA cases. The average age of patients
with OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%).
298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitated
patients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% of
patients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonary
resuscitation was ineffective and death was determined.

The present study found that OHCA incidence rate in the Masovian population (central
region of Poland) in March–April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneous
circulation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockable
rhythms was associated with better prognosis. The prehospital mortality, even though it was high, did
not differ from those reported by other studies.

Article available in PDF format

View PDF Download PDF file


  1. Ong ME, Perkins GD, Cariou A. Out-of-hospital cardiac arrest: prehospital management. Lancet. 2018; 391(10124): 980–988.
  2. Malysz M, Kacprzak P. Is low voltage ventricular fibrillation still a diagnostic problem? Disaster Emerg Med J. 2019; 4(1): 31–32.
  3. Gräsner JT, Bossaert L. Epidemiology and management of cardiac arrest: what registries are revealing. Best Pract Res Clin Anaesthesiol. 2013; 27(3): 293–306.
  4. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016; 133(4): e38–360.
  5. Gach D, Nowak JU, Krzych ŁJ. Epidemiology of out-of-hospital cardiac arrest in the Bielsko-Biala district: a 12-month analysis. Kardiol Pol. 2016; 74(10): 1180–1187.
  6. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998; 98: 2334–2351.
  7. Smereka J, Szarpak L. The use of personal protective equipment in the COVID-19 pandemic era. Am J Emerg Med. 2020; 38(7): 1529–1530.
  8. Smereka J, Szarpak L, Filipiak K. Modern medicine in COVID-19 era. Disaster Emerg Med J. 2020; 5(2): 103–105.
  9. Szarpak L, Ruetzler K, Dabrowski M, et al. Dilemmas in resuscitation of COVID-19 patients based on current evidence. Cardiol J. 2020; 27(3): 327–328.
  10. Ruetzler K, Smereka J, Ludwin K, et al. Respiratory protection among healthcare workers during cardiopulmonary resuscitation in COVID-19 patients. Am J Emerg Med. 2020 [Epub ahead of print].
  11. Malysz M, Dabrowski M, Böttiger BW, et al. Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial. Cardiol J. 2020 [Epub ahead of print].
  12. Koo A, Walsh R, Knutson T, et al. Comparison of intubation using personal protective equipment and standard uniform in simulated cadaveric models. Mil Med. 2018; 183(suppl_1): 216–218.
  13. Taylor SR, Pitzer M, Goldman G, et al. Comparison of intubation devices in level C personal protective equipment: A cadaveric study. Am J Emerg Med. 2018; 36(6): 922–925.
  14. Suyama J, Knutsen CC, Northington WE, et al. IO versus IV access while wearing personal protective equipment in a HazMat scenario. Prehosp Emerg Care. 2007; 11(4): 467–472.
  15. Smereka J, Szarpak L, Filipiak KJ, et al. Which intravascular access should we use in patients with suspected/confirmed COVID-19? Resuscitation. 2020; 151: 8–9.
  16. Dzieciatkowski T, Szarpak L, Filipiak KJ, et al. COVID-19 challenge for modern medicine. Cardiol J. 2020; 27(2): 175–183.
  17. Ruetzler K, Szarpak L, Filipiak K, et al. The COVID-19 pandemic — a view of the current state of the problem. Disaster Emerg Med J. 2020; 5(2): 106–107.
  18. Jacobs I, Nadkarni V, Bahr J, et al. International Liaison Committee on Resuscitation, American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa, ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004; 110(21): 3385–3397.
  19. Baldi E, Sechi GM, Mare C, et al. Out-of-hospital cardiac arrest during the COVID-19 outbreak in Italy. N Engl J Med. 2020; 383(5): 496–498.
  20. Shao F, Xu S, Ma X, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020; 151: 18–23.
  21. Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020; 5(8): e437–e443.
  22. Pranata R, Lim MA, Yonas E, et al. Out-of-hospital cardiac arrest prognosis during the COVID-19 pandemic. Intern Emerg Med. 2020; 15(5): 875–877.
  23. Bhatla A, Mayer MM, Adusumalli S, et al. COVID-19 and cardiac arrhythmias. Heart Rhythm. 2020; 17(9): 1439–1444.
  24. Wibrandt I, Norsted K, Schmidt H, et al. Predictors for outcome among cardiac arrest patients: the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study. BMC Emerg Med. 2015; 15: 3.
  25. Sasson C, Rogers MAM, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010; 3(1): 63–81.
  26. Shimamoto T, Kiyohara K, Matsuyama T, et al. Impact of bystander cardiopulmonary resuscitation and dispatcher assistance on survival after out-of-hospital cardiac arrest among adult patients by location of arrest. Int Heart J. 2020; 61(1): 46–53.
  27. Lukić A, Lulić I, Lulić D, et al. Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study. Croat Med J. 2016; 57(6): 591–600.
  28. Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc. 2014; 3(3): e000499.