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 2015-2022 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.