Temporal trends of suicide-related non-traumatic out-of-hospital cardiac arrest characteristics and outcomes with the COVID-19 pandemic.

Background: Jurisdictions have reported COVID-19-related increases in the incidence and mortality of non-traumatic out-of-hospital cardiac arrest (OHCA). We hypothesized that changes in suicide incidence during the COVID-19 pandemic may have contributed to these changes. We investigated whether the COVID-19 pandemic was associated with changes in the: (1) incidence of suicide-related OHCA, and (2) characteristics and outcomes of such cases. Methods: We used the provincial British Columbia Cardiac Arrest Registry, including non-traumatic emergency medical system (EMS)-assessed OHCA, to compare suicide-related OHCA (defined as clear self-harm or a priori communication of intent) one-year prior to, and one year after, the start of the COVID-19 pandemic (March 15, 2020). We calculated differences in incidence (with 95% CI), overall and within subgroups of mechanism (hanging, suffocation, poisoning, or unclear mechanism), and in case characteristics and hospital-discharge favourable neurological outcomes (CPC 1-2). Results: Of 13,785 EMS-assessed OHCA, we included 274/6430 (4.3%) pre-pandemic and 221/7355 (3.0%) pandemic-period suicide-related cases. The median age was 43 years (IQR 30-57), 157 (32%) were female, and 7 (1.4%) survived with favourable neurological status. Suicide-related OHCA incidence decreased from 5.4 pre-pandemic to 4.3 per 100 000 person-years (-1.1, 95% CI -2.0 to -0.28). Hanging-related OHCA incidence also decreased. Patient characteristics and hospital discharge outcomes between periods were similar. Conclusion: Suicide-related OHCA incidence decreased with the COVID-19 pandemic and we did not detect changes in patient characteristics or outcomes, suggesting that suicide is not a contributor to increases in COVID-related OHCA incidence or mortality. Overall suicide-related OHCA outcomes in both time periods were poor.

A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest.

OBJECTIVES: Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival among patients with refractory out-of-hospital cardiac arrest (OHCA). We evaluated outcomes after incorporating ECPR into a conventional resuscitation system. METHODS: We introduced a prehospital-activated ECPR protocol for select refractory OHCAs into one of four metropolitan regions in British Columbia. We prospectively identified ECPR-eligible patients in both the ECPR region and the three other regions to serve as the control group. We compared the proportion with favorable neurological outcomes at hospital discharge (cerebral performance category ≤2) and used logistic regression to estimate the association with treatment region. RESULTS: The study was terminated prematurely due to changes in hospital protocols and COVID-19. In the ECPR region, 15/58 (25.9%) patients had favourable neurological outcomes owing to conventional resuscitation and 2/58 (3.4%) owing to ECPR, for a total of 17/58 (29.3%). In the control regions, 67/250 (26.8%) patients had a favourable outcome owing to conventional resuscitation, for a between-group difference of 2.5% (95% CI -10 to 15%). We did not detect a statistically significant association between treatment region and outcomes. CONCLUSION: In this prematurely-terminated study of ECPR for refractory OHCA, we did not detect an association between a regional ECPR protocol and neurologically favorable outcomes. However, our data suggests that outcomes owing to conventional resuscitation were similar, with the potential for additional survivors due to ECPR therapies.

Integration of virtual physician visits into a provincial 8-1-1 health information telephone service during the COVID-19 pandemic: a descriptive study of HealthLink BC Emergency iDoctor-in-assistance (HEiDi).

BACKGROUND: British Columbia, like many jurisdictions, has a health information telephone service (8-1-1) to provide callers with information by registered nurses and help them decide whether to attend an emergency department or primary care clinic, or manage their concern at home. We describe a new service, HealthLink BC Emergency iDoctor-in-assistance (HEiDi), that partnered physicians available by videoconferencing with 8-1-1 registered nurses to support callers. METHODS: From Apr. 6 to Aug. 2, 2020, all callers to the 8-1-1 telephone service (available to anyone in BC) categorized as "seek care within 24 hours" by registered nurses were eligible for referral to HEiDi. HEiDi physicians ("virtual physicians") connected directly with callers via desktop videoconferencing software, assessed their health complaint, provided advice and suggested care disposition. We conducted a descriptive study and collected demographic characteristics, health concern and disposition determined by the virtual physician. RESULTS: HEiDi virtual physicians provided 7687 consultations. Most patients (n = 4439, 57.8%) were in the 20-64 age range, and 4814 (62.9%) were female. Common health concerns were related to gastroenterology (n = 1275, 16.6%), respiratory (n = 877, 11.4%) and dermatology (n = 874, 11.4%). From the 7531 calls with available data, 2548 (33.8%) callers were advised to attempt home treatment, 2885 (38.3%) to contact a primary care physician within 1 week, 1131 (15.0%) to attend an emergency department immediately and 538 (7.1%) to attend their primary provider now. INTERPRETATION: We found that virtual physicians were able to advise nearly 3 out of 4 (72.1%) patients away from in-person emergency or clinic assessment and 1 in 7 (15.0%) to seek immediate emergency department care. Virtual physicians can provide an effective complement to a provincial health telephone system.

Decrease in emergency medical services utilization during early stages of the COVID-19 pandemic in British Columbia.

OBJECTIVE: To date in the COVID-19 pandemic, there has been a decrease in patients accessing emergency health services, (EHS) but research has been conducted in areas with a very high incidence of COVID-19. In an area with a low COVID-19 incidence, we estimate changes in EHS use. METHODS: We compared EHS encounters in British Columbia from March 15 (the date of school and business closures) to May 15, 2020, when compared to the same period in 2019. We categorized EHS encounters into 18 presenting complaints and prespecified critical care complaints including major trauma, cardiac arrest, stroke, and ST-elevation myocardial infarction. We analyzed by descriptive methods. RESULTS: Comparing 2019 to 2020, total EHS encounters decreased from 83,925 (incidence rate 834 per 100,000 person-months) to 71,611 (incidence rate 701 per 100,000 person-months) for a decrease of 133 per 100,000 person-months (95% CI 126-141). The top 18 codes had a significant decrease in every category except respiratory and anxiety. Encounters for critically ill patients decreased significantly overall from 3019 to 2753 (incidence rate difference 3.1 per 100,000 person-months, 95% CI 1.6-4.5), including stroke, trauma, and STEMI, but the incidence of OHCA appeared stable. CONCLUSION: In a single province with a low incidence of COVID-19, there was a 15% reduction in overall EHS use and a 9% reduction in critical illness. EHS planners will need to match patient need with available resources.

RéSUMé: OBJECTIFS: Jusqu'à présent dans la pandémie de Covid-19, il y a eu une diminution du nombre de patients ayant accès aux services de santé d'urgence, mais des recherches ont été menées dans des zones à très forte incidence de Covid-19. Dans une zone à faible incidence de Covid-19, nous estimons les changements dans l'utilisation des services de santé d'urgence. MéTHODES: Nous avons comparé les cas des services de santé d'urgence en Colombie-Britannique du 15 mars (date de fermeture des écoles et des entreprises) au 15 mai 2020, par rapport à la même période en 2019. Nous avons classé les cas des services de santé d'urgence en 18 plaintes de présentation et des plaintes de soins intensifs pré-spécifiées, y compris un traumatisme majeur, un arrêt cardiaque, un accident vasculaire cérébral et un infarctus du myocarde avec élévation du segment ST. Nous avons analysé par des méthodes descriptives. RéSULTATS : En comparant 2019 à 2020, le nombre total des cas des services de santé d'urgence est passé de 83 925 (taux d'incidence de 834 pour 100 000 personnes-mois) à 71 611 (taux d'incidence de 701 pour 100 000 personnes-mois) pour une diminution de 133 pour 100 000 personnes-mois (IC à 95 % 126 à 141). Les 18 codes principaux ont connu une diminution significative dans toutes les catégories, sauf respiratoire et anxiété. Les cas chez les patients gravement malades ont globalement diminué de manière significative de 3 019 à 2 753 (différence de taux d'incidence de 3,1 pour 100 000 personnes-mois, IC à 95 % de 1,6 à 4,5), y compris les accidents vasculaires cérébraux, les traumatismes et les STEMI, mais l'incidence des arrêts cardiaque hors hôpital semble stable. CONCLUSIONS: Dans une seule province avec une faible incidence de Covid-19, il y a eu une réduction de 15 % de l'utilisation globale des services de santé d'urgence et une réduction de 9 % des maladies graves. Les organisateurs des services de santé d'urgence devront faire correspondre les besoins des patients avec les ressources disponibles.

Bystanders are less willing to resuscitate out-of-hospital cardiac arrest victims during the COVID-19 pandemic.

AIM: The COVID-19 pandemic may influence the willingness of bystanders to engage in resuscitation for out-of-hospital cardiac arrest. We sought to determine if and how the pandemic has changed willingness to intervene, and the impact of personal protective equipment (PPE). METHODS: We distributed a 12-item survey to the general public through social media channels from June 4 to 23, 2020. We used 100-point scales to inquire about participants' willingness to perform interventions on "strangers or unfamiliar persons" and "family members or familiar persons", and compared mean willingness during time periods prior to and during the COVID-19 pandemic using paired t-tests. RESULTS: Survey participants (n = 1360) were from 26 countries; the median age was 38 years (IQR 24-50) and 45% were female. Compared to prior to the pandemic, there were significant decreases in willingness to check for breathing or a pulse (mean difference -10.7% [95%CI -11.8, -9.6] for stranger/unfamiliar persons, -1.2% [95%CI -1.6, -0.8] for family/familiar persons), perform chest compressions (-14.3% [95%CI -15.6, -13.0], -1.6% [95%CI -2.1, -1.1]), provide rescue breaths (-19.5% [95%CI -20.9, -18.1], -5.5% [95%CI -6.4, -4.6]), and apply an automated external defibrillator (-4.8% [95%CI -5.7, -4.0], -0.9% [95%CI -1.3, -0.5]) during the COVID-19 pandemic. Willingness to intervene increased significantly if PPE was available (+8.3% [95%CI 7.2, 9.5] for stranger/unfamiliar, and +1.4% [95%CI 0.8, 1.9] for family/familiar persons). CONCLUSION: Willingness to perform bystander resuscitation during the pandemic decreased, however this was ameliorated if simple PPE were available.