Out-of-hospital cardiac arrest survival drops during COVID-19 with racial disparities

Survival rates for out-of-hospital cardiac arrest (OHCA) fell during the early years of the COVID-19 pandemic, with Black and Hispanic patients experiencing larger decreases in survival, according to a study led by UT Southwestern Medical Center researchers published in Resuscitation.

Our results show that the pandemic largely eroded gains in cardiac arrest survival that had been achieved during the 10 years before the pandemic and exacerbated disparities."

Saket Girotra, M.D., Senior Author, Associate Professor of Internal Medicine, Division of Cardiology at UT Southwestern

Before the pandemic began in March 2020, OHCA survival rates had been steadily improving due to increased public awareness, faster emergency response times, and broader access to automated external defibrillators (AEDs). In 2019, the average overall survival rate stood at 9.9%, though it was lower in majority Black and Hispanic communities.

But overall survival dropped to 9% in 2020, with larger declines in majority Black and Hispanic communities. Through 2022, those racial/ethnic disparities persisted.

To assess OHCA trends after the pandemic began, Dr. Girotra and his colleagues analyzed data from the Cardiac Arrest Registry to Enhance Survival (CARES) - the largest national database tracking out-of-hospital cardiac arrest outcomes, with full data from 30 states and selected communities in 16 additional states. Researchers compared survival rates after cardiac arrest before the pandemic (2015-2019) to each of the years after the start of the pandemic (2020, 2021, and 2022).

"Our expectation was that survival after cardiac arrest had likely bounced back by 2022 to pre-pandemic levels," said lead author Eric Hall, M.D., a clinical fellow in the Division of Cardiology at UT Southwestern. "What we found instead is that it remained 8%-10% lower, which suggests there were still some lingering effects of the pandemic on emergency cardiac care."

The study cohort included 506,419 OHCA patients served by 1,313 emergency medical service (EMS) agencies. Not only were pre-pandemic survival rates lower in majority Black/Hispanic (7.9%) and integrated (10.7%) communities versus predominantly white communities (11.1%), they also fell more, with Black/Hispanic survival rates decreasing 16.5% in 2020, compared with the drop in white (8.1%) and integrated (6.5%) communities.

"These findings highlight the urgent need to address long-standing racial and ethnic differences in cardiac arrest outcomes," Dr. Girotra said. "Our team is continuing to study how EMS agencies provide OHCA care in their communities to identify and share best practices." 

One factor in the rise of OHCA during the pandemic was an increase in cases related to drug overdoses. The study found that the number of drug-related OHCA cases continued to rise through the end of the study.

"The pandemic phase of COVID-19 may be over, but many of the health impacts remain," Dr. Girotra said. 

Other UTSW researchers who contributed to the study are James de Lemos, M.D., Professor of Internal Medicine and Chief of the Division of Cardiology; Anezi Uzendu, M.D., Assistant Professor of Internal Medicine in the Division of Cardiology; and Qiang Li, M.Sc., Biostatistical Consultant.

The study was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HL160734).