Survival After Out-of-Hospital Cardiac Arrest in Black and Hispanic Communities Since the COVID-19 Pandemic

During the early phases of the COVID-19 pandemic, survival after out-of-hospital cardiac arrest (OHCA) had substantially worsened, eroding survival gains during the past decade. Because COVID-19 is no longer a public health emergency, we wanted to determine 1) whether the initial decline in survival with the onset of the pandemic was larger in majority Black or Hispanic communities, 2) whether survival rates have returned to baseline levels, and 3) if these changes since 2020 were similar across community types.

To answer these questions, we analyzed >500,000 patients with OHCA in the Cardiac Arrest Registry to Enhance Survival (CARES). We found that initial decline in OHCA survival in 2020 was larger in majority Black or Hispanic communities. Survival rates in 2021-2022 remained persistently lower than pre-pandemic levels (9.1% survival to hospital discharge, from 9.9% during the years before the pandemic [2015-2019]). Although survival improvement after the onset of the pandemic in majority Black and Hispanic communities was larger, survival rates in these communities remained lower than in white communities at all time points.

To further address these disparities in OHCA survival, we are currently conducting a mixed-methods study called “Reducing Ethnic-Racial Disparities in Cardiac Arrest Survival Outcomes” (RED-CASO). This study includes conducting site visits to several emergency medical service (EMS) agencies achieving high survival for cardiac arrest victims, especially those working in majority Black or Hispanic communities. The goal is to better understand how these EMS agencies overcome barriers that most other agencies working in such communities face and identify best practices for improving cardiac arrest survival and reducing disparities.