Out-of-hospital cardiac arrest survival in Black & Hispanic communities since the COVID-19 pandemic

Resuscitation. 2025 Apr:209:110579. doi: 10.1016/j.resuscitation.2025.110579. Epub 2025 Mar 12.

Abstract

Background: Survival after out-of-hospital cardiac arrest (OHCA) decreased sharply in 2020 during the COVID-19 pandemic. It is unknown if survival recovered to pre-pandemic levels, or how recovery varied by community racial and ethnic composition.

Methods: We analyzed adults with non-traumatic OHCA from 2015 to 2022 in the Cardiac Arrest Registry to Enhance Survival using multivariable regression models with generalized estimation equations to calculate risk-adjusted rates of survival to discharge during 2015-2019 (pre-pandemic period) versus 2020, 2021, and 2022. We also examined survival rates based on community racial/ethnic composition, defined as predominantly White (≥80% White residents), majority Black or Hispanic (≥50% Black or Hispanic residents), or integrated (neither).

Results: The cohort included 506,419 OHCA patients (mean age 61.9y; 64% male, 22% Black race, 7% Hispanic ethnicity). Pre-pandemic survival was 9.9%, with lower survival in majority Black/Hispanic (7.9%) and integrated (10.7%) versus predominantly White communities (11.1%). In 2020, survival decreased to 9.0% overall (relative change -9.1% vs pre-pandemic; P < 0.001), with a larger decrease in majority Black/Hispanic (-16.5%) than predominantly White (-8.1%) or integrated (-6.5%) communities (P for interaction: 0.07). Overall, survival rates remained largely unchanged in 2021-2022 (9.1%), with modest improvements in majority Black/Hispanic communities. However, absolute survival remained lower in these communities at all times compared to other communities.

Conclusions: OHCA survival improved minimally in 2021 and 2022 following a significant decline in 2020. The initial decline was larger in majority Black or Hispanic communities; despite some improvement in 2021 and 2022, absolute survival in these communities remained lower throughout the study period.

Keywords: Healthcare disparities; Out-of-hospital cardiac arrest; Pandemic.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Black or African American* / statistics & numerical data
  • COVID-19* / epidemiology
  • COVID-19* / ethnology
  • Cardiopulmonary Resuscitation* / statistics & numerical data
  • Female
  • Hispanic or Latino* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest* / ethnology
  • Out-of-Hospital Cardiac Arrest* / mortality
  • Out-of-Hospital Cardiac Arrest* / therapy
  • Pandemics
  • Registries
  • SARS-CoV-2
  • Survival Rate
  • United States / epidemiology
  • White