Abstract 12051: Impact of COVID-19 on Barriers to Dispatcher-Assisted Cardiopulmonary Resuscitation in Adult Out-of-Hospital Cardiac Arrests in Singapore

Objective: Reduced rates of bystander cardiopulmonary resuscitation (BCPR) in out-of-hospital cardiac arrest (OHCA) were observed during the Coronavirus Disease-2019 (COVID-19) pandemic in many regions. We investigated the impact of COVID-19 on barriers to Dispatcher-Assisted Cardiopulmonary Resuscitation (DA-CPR) in Singapore. Methods: This nationwide retrospective cohort study involved all calls to our national 995 call center for adult (≥ 18 years old) OHCA not witnessed by Emergency Medical Services. We reviewed audio recordings during the pandemic (January-June 2020) and pre-pandemic (January-June 2019) periods to compare the OHCA characteristics, and the types of “barriers” to DA-CPR — the reason why DA-CPR was not performed. Our primary outcome was the presence/absence of barriers to DA-CPR. Multivariable logistics regression was used to estimate the adjusted odds ratio (aOR) for the likelihood of barriers to DA-CPR accounting for patient and event characteristics. The effect of COVID-19 on DA-CPR rates was evaluated using interrupted time series analysis. Results: There were 1481 OHCA during the pandemic (median age 73 years, 62.7% male), and 1400 prior to the pandemic (median age 72 years, 63.6% male). Residential OHCA and witnessed OHCA increased during the pandemic (78.9% vs 75.5%, p=0.03 and 56.1% vs 39.9%, p<0.01 respectively), but not BCPR and DA-CPR (64.3% vs 65.6%, p=0.44, and 49.1% vs 48.1%, p=0.57 respectively). There were increased barriers to DA-CPR during the pandemic — ‘patient status changed’ (difficulty with recognition) and ‘caller not with patient’ (witnesses calling family rather than 995) doubled in proportion during COVID-19. ‘afraid to do CPR’ fell to 3.8% during the pandemic, while the fear of COVID-19 transmission made up 0.5% of the barriers. Logistic regression showed that females and OHCAs occurring in home residences were more likely to have barriers to DA-CPR (aOR 1.27 and 2.63 respectively). COVID-19 did not have an impact on the trend of DA-CPR rates (p=0.49). Conclusion: COVID-19 did not affect callers’ willingness to perform DA-CPR. Distancing measures led to more residential arrests with an increase in proportion with barriers to DA-CPR, highlighting opportunities for public education and intervention.