Background: Those individuals who have sur;\vived an OHCA, which is one of the main reasons for mortality across the globe, have been shown to have a gre\ater chance of survival if bystander CPR is performed in conjunction with public-access defibrillation. This was discovered through research conducted in the United States. Due to the COVID pandemic, emergency medical services (EMS) have been forced to overcome a variety of challenges. These challenges include the demand for comprehensive personal protection equipment as well as the proposal of compression-only resuscitation, both of which have led to operational issues and a lengthened reaction time. However, risk elements that were present during the COVID and which influenced the results of OHCA are not fully known. This study's objective was to investigate the pandemic patterns of COVID-19 in OHCA patients in Pakistan both before and during the epidemic. Methods: This retrospective cohort study made use of the information included within paper EMS records, in addition to the data contained inside electronic medical records. During the COVID that occurred in Pakistan, data on ED ROSC and OHCA was collected from 15 March 2018 through 14 December 2019 and 15 March 2020 through 14 December 2021, respectively. Results: Sixty participants were enrolled in the study during the COVID-19 era (which began in mid of March 2020), while 84 patients were enrolled in the trial prior to the COVID phase, (mean age, 66.8 years). The only two characteristics that were substantially different between the two groups at the beginning of the study were the presence of a bystander witness and the method that was used to do the chest compressions, (p 0.001 for each). The ED ROSC was 44.74% at the time before COVID, while it was just 25.00% during the COVID-19 era. The adjusted odds ratio (OR) was 0.20, and the significance level was 0.001. During the COVID-19 era, survival rates at the time of hospital admission were substantially lower than they had been before (23.33 percent vs 39.47 percent, adjusted the odds ratio of 0.25, p0.005). On the other hand, none of the 30-day survival rates differed from one another in a way that could be considered statistically significant (5 percent during the pandemic and 11.54 percent before the pandemic. Conclusions: We come to the conclusion that the prevalence of the COVID-19 virus in Pakistan led to a considerable decrease in the number of patients surviving during their admission to the hospital after experiencing an out-of-hospital cardiac arrest (OHCA). In terms of witness responses and chest compression methods, there was also a significant gap between the two groups of people.