5 Burden of Out of Hospital Cardiac Arrest in New York City during the COVID-19 Pandemic

Study Objectives: As of June 10, 2020, there have been 17,300 confirmed and an additional 4,693 suspected COVID related-deaths in New York City (NYC) While much attention was given to the overwhelming burden on hospitals and skilled nursing facilities during the pandemic, it is less well known how the pandemic impacted EMS systems and rates of out-of-hospital cardiac arrest (OOHCA) The NYC Regional Emergency Medical Advisory Committee (REMAC) is responsible for oversight and quality in out-of-hospital care in NYC This study’s primary objective was to assess the burden of cardiac arrest in during the pandemic Methods: This observational study uses aggregate data from the New York City region collected through the National EMS Information System (NEMSIS) Daily counts of cardiac arrest incidents stratified by each of the five boroughs (geographical divisions) in NYC and by final disposition (eg, transported to the hospital or pronounced on scene) were obtained for the time periods of February 2020 through April 2020, and for the same time period in the final year Descriptive statistics were used to describe and compare the daily counts of cardiac arrests and the proportion of patients pronounced in the field between the current year during the pandemic time period and the corresponding time period in 2019 This study was determined to be exempt by the Mount Sinai Institutional Review Board Results: In NYC during the COVID-19 pandemic, EMS experienced a 220% increase in cardiac arrest call responses in February - April, 2020 (8,837) compared to February - April, 2019 (4,022), peaking on April 6 at 330 cases in a single day (See Figure 1) During this period, the Bronx experienced the highest rate of increase at 243% higher in 2020 compared to Queens (238% increase), Kings (231%), New York (184%) and Richmond (143%) For all of NYC, the rate of transport for OOHCA decreased during this time period from 37% in February-April 2019 to 16% in February-April 2020 Conclusion: There was exponential growth of the rate of OOHCA during the initial phase of the pandemic in NYC and there was a sustained increase through the month April 2020 With a 220% increase in cases over the course of three months and over a 780% (42 to 330 cases) increase on the highest day of OOHCA, and in light of a concurrent burden on NYC hospitals, our EMS system experienced an unprecedented demand for critical care and resuscitation Further studies are needed to better understand to what degree the increased in OOHCA was attributed to the disease itself, or due to delaying needed care for other conditions In planning for future pandemics, strategic planning should include consideration of impacts on operations and capacity of the regional EMS system [Formula presented]