Impact of COVID-19 on mortality in out-of-hospital cardiac arrest patients with return of spontaneous circulation: a retrospective cohort study

TL;DR

This study found that while fewer out-of-hospital cardiac arrest patients with COVID-19 died in the short term, they had higher long-term mortality compared to non-COVID-19 patients.

Contribution

The study reveals a paradoxical short-term survival benefit but long-term increased mortality risk for OHCA patients with COVID-19.

Findings

COVID-19 patients had lower 14-day mortality but higher 90-day mortality compared to non-COVID-19 patients.

Mortality was higher in younger and older male COVID-19 patients compared to non-COVID-19 patients.

Higher mortality rates were observed during the Alpha and Delta variant periods for COVID-19 patients.

Abstract

This study aims to compare the mortality rates of OHCA patients with and without COVID-19 infection across different follow-up periods and explores the factors may play a significant role in determining OHCA outcomes.

This study utilized data from the US Collaborative Network in TriNetX. A total of 25,271 hospitalized OHCA patients were recruited from records spanning from January 1, 2020, to December 31, 2023. Study population divided into two groups, COVID-19 positive and COVID-19 negative groups. The mortality risk of the two groups was observed based on different follow-up periods. Subgroup analyses on sex, age, antivirals use, COVID-19 virus variant epidemic period were also conducted.

Our study included 2,776 patients in each group (COVID vs. non-COVID). The primary outcome was mortality at 14-day and 90-day follow-ups. COVID-19 patients had a lower 14-day mortality (HR 0.82, 95% CI: 0.76–0.88) but higher 90-day mortality (HR 1.16, 95% CI: 1.09–1.24) compared to non-COVID-19 patients. Secondary outcomes included higher mortality in COVID-19 patients under 65, and this trend persisted in those aged 65 and over. Male COVID-19 patients had elevated mortality risk. The Alpha and Delta variant period showed a higher mortality rate for COVID-19 patients than non-COVID-19 patients.

COVID-19 was associated with a higher risk of mortality in OHCA patients.

The online version contains supplementary material available at 10.1186/s13049-025-01395-2.

Figures