A retrospective cohort study on impact of Covid-19 outbreak on out-of-hospital cardiac arrest (OHCA) in Telangana, India: mortality trends, contributing factors, and research imperatives

Out-of-hospital cardiac arrest (OHCA) poses considerable issues, notably in the context of the COVID-19 outbreak. The objective of this study is to assess the differences in incidence rates and clinical outcomes of OHCA in Telangana, India, between the pre-pandemic, pandemic, and post-pandemic periods, focusing on factors that influence survival rate. A retrospective cohort analysis was performed on patient records from a Telangana district hospital of those who presented to hospitals after OHCA from 2019 to 2021. The data were analysed to determine OHCA outcomes and factors that influence survival. Descriptive statistics, including frequencies and percentages, were used to summarise the categorical variables. The data were analysed to assess a significance level of p < 0.05. Appropriate statistical. methods, such as chi-squared and Fisher’s exact tests, were used to analyse quantitative variables. The 95% confidence interval (CI) was determined to analyse the precise distribution of variables across three time periods. The number of OHCAs increased during the pandemic. The first wave accounted for 1,452 cases (31.34%), and the second accounted for 1,368 cases (29.53%), whereas there were 1,284 cases (27.72%) during the pre-pandemic period. The initiation rate of CPR dropped from 81.2% before the pandemic to 30.19% during the first wave and 49.02% during the second wave. Bystander-initiated CPR declined significantly. CPR was performed by laypersons in just 3.94% of cases during the first wave compared to 8.42% pre-pandemic. The time from OHCA to initiation of CPR was also significantly prolonged, with > 20-minute delays increasing from 15 to 80.3% during the first wave. ROSC rates remained tremendously low across all periods, with survival noted in just 0.26% of cases pre-pandemic and 0% across both waves of the pandemic. These findings highlight the severe impact of delayed emergency response and limited access to advanced care, as evidenced by the lack of ROSC during the epidemic. These. results demonstrate the value of early CPR and trained bystanders in the outcomes of OHCA. Individuals without this information should also be made aware of the ongoing need for public awareness and continued training in CPR, rapid EMS response times, and greater use of AEDs, especially in the context of revised guidelines and recommendations during the COVID-19 pandemic in 2020, to ensure that survival rates in such cases are improved.