Variance of the COVID-19 occurrence in the community: influence on the emergency medical service and the survival of out-of-hospital cardiac arrest patients

Objective@#This study evaluates the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency medical service (EMS) responses and out-of-hospital cardiac arrest (OHCA) outcomes. @*Methods@#This is a retrospective comparison study analyzing the OHCA data of a university medical center in Seoul during the COVID-19 pandemic period (January 2020-January 2021) and non-pandemic period (January 2019-January 2020). The EMS response time and OHCA outcomes were compared between both periods. Based on the weekly mean number of confirmed cases and their EMS response time, patients were classified into six groups and OHCA outcomes were compared. @*Results@#This study evaluated 309 OHCA patients (non-pandemic period of 146, pandemic period of 163). Significant delays in the EMS response and transport time were observed during the pandemic period. However, no significant differences were obtained in the rate of return of spontaneous circulation (ROSC) and survival at discharge (12.4% in pandemic vs. 13.8% in non-pandemic; P=0.722). According to the weekly mean COVID-19 incidence when patients were over 100, there was a significant increase in the EMS response and transport time, whereas ROSC and survival rate were dramatically decreased. @*Conclusion@#During the pandemic, the EMS service for OHCA patients was worse than before, with delayed and reduced survival for OHCA patients. We further determined that an increase in the number of COVID-19 cases (especially when weekly mean numbers were over 100) dramatically delayed the EMS response time. This resulted in a very low survival rate of OHCA patients.

Acute Subdural Hematoma Developed During Anticoagulant or Thrombolytic Therapy in Patients with Cerebral Infarction

Patients with cardiogenic embolic stroke may experience an early, recurrent cerebral embolism. Fortunately, limited evidence suggests that anticoagulatory agents or thrombolytic agents may prevent recurrent cardiogenic emboli and halt progression of so-called "progressing stroke" However, because of the possibility of the intracerebral hemorrhage, use of such agents has generally been considered cautiously with timing, dosage and patient selection. Serious complications of anticoagulation for presumed embolic stroke are hemorrhage in the area of infarction. We experienced two patients with nonseptic cerebral embolism of cardiac origin. They were managed with anticoagulant or thrombolytic therapy, but resulted in clinical deterioration or death from spontaneous subdural hemorrhage. In each patient, an initial CT scan excluded the presence of hemorrhage but a second CT scan after clinical deterioration, documented subdural hemorrhage.

Comparison of Admission Pattern and Management of Subarachnoid Hemorrhage Patients Over a 5-year Interval

Aneurysmal subarachnoid hemorrhage is a neurosurgical emergency. Early and intensive medical intervention is important for minimizing the occurrence of rebleeding and vasospasm. The purpose of this study was to document and compare the admission or referral pattern, management outcome and attitude of the general public of subarachnoid hemorrhage(SAH) patients over a five year interval of 1987 and 1992. The authors analysed 229 SAH cases diagnosed by computerized tomography(CT) or lumbar puncture;106 cases diagnosed in 1987 were compared to 123 cases diagnosed in 1992. The results of the study showed that 1) the performance rate of angiography and operation have increased in 1992 as compared to 1987. 2) Early admission rate(within 0~1 day after the onset of SAH) have increased in 1992(84%) as compared to 1987(38%), and delayed admission rate(more than 2 days after the onset of SAH) have decreased in 1992 as compared to 1987. 3) Overall management mortality have decreased from 34% to 20% and operative mortality, from 12% to 4% in 1987 and in 1992, respectirely, It is concluded that the rate of early admission and operation of SAH patients have improved in 1992 as compared to 1987.