Abstract Body (Do not enter title and authors here): Background: The COVID-19 pandemic in 2020 was marked by a sharp decrease in out-of-hospital cardiac arrest (OHCA) survival. Whether OHCA survival has recovered to pre-pandemic levels, and whether changes in OHCA survival are similar across communities of different racial and ethnic composition, is unknown.

Methods: We included adult patients with non-traumatic OHCA from 2015-2022 in the Cardiac Arrest Registry to Enhance Survival registry. Using hierarchical multivariable regression, we calculated risk-adjusted rates of survival to hospital discharge during 2015-2019 (reference period) and compared this to survival rates during 2020, 2021, and 2022. We also examined whether the trajectory of survival over this period differed based on the racial/ethnic composition of the community served by the emergency medical service (EMS) agency, defined as predominantly White (>80% White residents), majority Black or Hispanic (>50% Black or Hispanic residents), or integrated (neither).

Results: Of 485,079 patients with OHCA, mean age was 61.9 years; 64% were male, and 22% were of Black race with 7% of Hispanic ethnicity. Overall, risk-adjusted survival rates to hospital discharge for OHCA decreased from 10.1% in 2015-2019 to 8.4% in 2020 (P<0.0001). The relative decrease was similar at EMS agencies serving predominantly Black and Hispanic communities (-17.2%) as compared to predominantly White (-17.5%) or integrated communities (-16.8%). Risk-adjusted survival rates recovered partially in 2021 (8.7%) and 2022 (8.9%) but remained below the pre-pandemic period. As of 2022, OHCA survival in majority Black and Hispanic communities was still 9.7% lower, as compared to pre-pandemic years, whereas it was 10.9% lower in integrated communities and 13.6% lower in predominately White communities. Moreover, the survival disparity for OHCAs in Black/Hispanic vs. White communities narrowed to 0.4% (8.4% vs. 8.8%) in 2022, as compared to 1.0% (9.3% vs. 10.3%) prior to the pandemic.

Conclusions: OHCA survival has improved in the U.S. since the initial pandemic year of 2020, but remains lower than the pre-pandemic years. The survival disparity for OHCAs occurring in majority Black and Hispanic relative to predominately White communities decreased since 2020, although absolute survival remained lower in majority Black and Hispanic communities throughout the study period.