# Impact of the COVID-19 Pandemic on Out-of-Hospital Cardiac Arrests Occurring in the Workplace

## TL;DR

This study found that the COVID-19 pandemic did not significantly affect survival rates of cardiac arrests at workplaces in Japan, but increased bystander CPR efforts.

## Contribution

The study provides new insights into how the pandemic affected workplace cardiac arrest outcomes and bystander responses in Japan.

## Key findings

- No significant changes were observed in OHCA incidence or survival rates during the pandemic.
- Bystander CPR, especially compression-only CPR, increased significantly during the pandemic.
- PAD rates decreased in high-infection burden regions during the pandemic.

## Abstract

Background

The impact of the coronavirus disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) occurring in this setting remains unclear.

Objective

The objective of this study is to elucidate the impact of the COVID-19 pandemic on the prehospital characteristics and outcomes of OHCA occurring in the workplace.

Methods

This nationwide observational study in Japan was a retrospective analysis and included 16,364 non-emergency medical service witnessed and adult workplace OHCAs. The characteristics and outcomes of workplace OHCAs were compared between the pre-pandemic period (2016-2019) and the pandemic period (2020-2021). Furthermore, subgroup analyses were performed for workplace location (office vs. non-office) and infection burden region.

Results

During the pandemic period, no significant changes were observed in incidence, public access defibrillation (PAD) provision rates, one-month survival rates, or neurologically favorable survival rates. However, increases were observed for bystander cardiopulmonary resuscitation (CPR) (crude odds rate (cOR), 95% confidence interval (CI): 1.10, 1.02-1.16; P<0.001), particularly compression-only CPR. The multivariable analysis revealed that the impact of the pandemic was similarly seen in an increase in bystander CPR (adjusted OR, 95% CI: 1.14, 1.06-1.22; P<0.001). Furthermore, the monthly changes in only PAD were altered biennially (PAD: P=0.02, bystander CPR: P=0.52, one-month survival: P=0.26, and neurologically favorable one-month survival: P=0.48). Analysis restricted to high-infection burden regions revealed that only the PAD rate decreased (P=0.03).

Conclusion

The COVID-19 pandemic had no impact on OHCA survival in workplaces and had a limited positive impact on bystander responses. This may be attributed to previous positive CPR training experiences and routine preparation for health crises.