The impact of the COVID-19 pandemic on bystander CPR and AED rates in Canada

Objective: To evaluate whether the COVID-19 pandemic was associated with changes in bystander CPR and automated external defibrillator (AED) application in Canada. Methods: We included adult emergency medical services (EMS)-treated out-of-hospital cardiac arrests (OHCAs) from the Canadian national cardiac arrest registry. The outcomes were bystander CPR and AED application. We fit adjusted piecewise linear segmented logistic regression models to estimate whether the peri-COVID period (February 2020-December 2021), in comparison to pre-COVID (January 2018-January 2020), was associated with a change in the odds of bystander CPR and AED application. We also examined subgroups of private and public only OHCAs. Results: Among the 24 410 OHCAs, the median age was 65 years (IQR 50,77), with 7 822 (32 %) females. In the pre-COVID (n = 11 271) and peri-COVID (n = 13 139) periods, 6 244 (55 %) and 7 924 (60 %) cases received bystander CPR (+4.9 % difference, 95 % CI 3.7, 6.2), and 502 (4.5 %) and 432 (3.3 %) were treated with bystander AEDs (-1.2 % difference, 95 % CI -1.7, -0.68) respectively. The peri-COVID period was associated with an increased odds of bystander CPR (aOR 1.15; 95 % CI 1.03, 1.27) and a decreased odds of bystander AED application (aOR 0.65; 95 % CI 0.48, 0.86). This appears to be driven by increases in private-setting bystander CPR (aOR 1.19; 95 % CI 1.06, 1.33) and decreases in public-setting AED use (aOR 0.59; 95 % CI 0.40, 0.88). Conclusions: The COVID-19 pandemic was associated with an increase in bystander CPR and a decrease in bystander AED application.