COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests

Baldi, Enrico; Sechi, Giuseppe Maria; Mare, Claudio; Canevari, Fabrizio; Brancaglione, Antonella; Primi, Roberto; Klersy, Catherine; Palo, Alessandra; Contri, Enrico; Ronchi, Vincenza; Beretta, Giorgio; Reali, Francesca; Parogni, Pierpaolo; Facchin, Fabio; Rizzi, Ugo; Bussi, Daniele; Ruggeri, Simone; Visconti, Luigi Oltrona; Savastano, Simone; Compagnoni, Sara; Fracchia, Rosa; Cuzzoli, Antonio; Pagliosa, Andrea; Matiz, Guido; Russo, Alessandra; Vecchi, Andrea; Fantoni, Cecilia; Fava, Cristian; Franzosi, Cinzia; Vimercati, C; D, Franchi; Storti, Enrico; Taravelli, Erika; Giovenzana, Fulvio Lorenzo Francesco; Buetto, Giovanni; Garzena, Guido; Iotti, Giorgio; Villa, Guido; Botteri, Marco; Caico, Salvatore Ivan; Cominesi, Irene Raimondi; Carnevale, L; Caresani, Matteo; Luppi, Mario; Migliori, Maurizio; Centineo, Paola; Genoni, Paola; Bertona, Roberta; Ponti, Roberto De; Osti, Riccardo; Buratti, Stefano; Danzi, Gian Battista; Marioni, Arianna; Pirro, Antonella De; Molinari, Simone; Sgromo, Vito; Musella, Valeria; Paglino, Martina; Mojoli, Francesco; Lusona, Bruno; Pagani, Michele; Curti, Moreno

doi:10.1093/eurheartj/ehaa508

Cited by 205 publications

(327 citation statements)

References 41 publications

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“…3 A). Similarly, important reductions in bystander-CPR during the pandemic were observed in Italy (35% vs. 45%, P = 0.02) 6 and France (48% vs. 64%, P < 0.001) 7 while in studies conducted in the USA 8 , 10 and South Korea 23 remained similar ( Fig. 3 B).…”

Section: Resultsmentioning

confidence: 57%

“…1-2). OHCAs during the COVID-19 pandemic were more likely to occur at home in Italy (90% during the pandemic vs. 83% in the non-pandemic period; P = 0.005) 6 and France (90% vs. 77%; P < 0.001) 7 while in the other studies were similar 9 , 10 , 23 (Supplemental Fig. 3).…”

Section: Resultsmentioning

confidence: 74%

“…Survival at hospital discharge was reported in three studies 6 , 7 , 23 and survival with good neurologic outcome only in one. 23 In France, patients suffering an OHCA during the COVID-19 pandemic were less likely to survive: rates of survival at hospital discharge declined from 5.4% to 3.1% ( P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Patients with COVID-19 symptoms were less likely to receive bystander-CPR (-19%) when compared with patients not diagnosed or suspected in Italy. 6

Fig. 3 Forest plot for rates of bystander-witnessed out-of-hospital cardiac arrests (A) and bystander-initiated cardiopulmonary resuscitation (B) with subgroup analysis by continent.…”

Section: Resultsmentioning

confidence: 99%

“…In Lombardy, Northern Italy, 5 , 6 Paris, France, 7 and New York City, USA, 8 the incidence of out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic markedly increased compared with previous years and was associated with high mortality. In contrast, other areas of Northern Italy 9 and the USA 10 did not experience the same variations.…”

Section: Introductionmentioning

confidence: 99%

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Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

et al. 2020

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Introduction In addition to the directly attributed mortality, COVID-19 is also likely to increase mortality indirectly. In this systematic review, we investigate the direct and indirect effects of COVID-19 on out-of-hospital cardiac arrests. Methods We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled Trials for studies comparing out-of-hospital cardiac arrests occurring during the pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool. The primary endpoint was return of spontaneous circulation. Secondary endpoints were bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge, and survival with favourable neurological outcome. Results We identified six studies. In two studies, rates of return of spontaneous circulation and survival to hospital discharge decreased significantly during the pandemic. Especially in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation and resuscitation attempted by emergency medical services were reduced during the pandemic. Also, ambulance response times were significantly delayed across all studies and patients presenting with non-shockable rhythms increased in two studies. In 2020, 3.9-5.9% of tested patients were SARS-CoV-2 positive and 4.8-26% had suggestive symptoms (fever and cough or dyspnoea). Conclusions Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect effects from lockdown and disruption of healthcare systems. Patients at high risk of deterioration should be identified outside the hospital to promptly initiate treatment and reduce fatalities. Study registration PROSPERO CRD42020195794.

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Section: Resultsmentioning

confidence: 57%

Section: Resultsmentioning

confidence: 74%

Section: Resultsmentioning

confidence: 99%

“…Patients with COVID-19 symptoms were less likely to receive bystander-CPR (-19%) when compared with patients not diagnosed or suspected in Italy. 6

Fig. 3 Forest plot for rates of bystander-witnessed out-of-hospital cardiac arrests (A) and bystander-initiated cardiopulmonary resuscitation (B) with subgroup analysis by continent.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

et al. 2020

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A Comparative Analysis of In-Hospital Mortality per Disease Groups in Germany Before and During the COVID-19 Pandemic From 2016 to 2020

et al. 2022

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IMPORTANCE Throughout the ongoing SARS-CoV-2 pandemic, it has been critical to understand not only the viral disease itself but also its implications for the overall health care system. Reports about excess mortality in this regard have mostly focused on overall death counts during specific pandemic phases.OBJECTIVE To investigate hospitalization rates and compare in-hospital mortality rates with absolute mortality incidences across a broad spectrum of diseases, comparing 2020 data with those of prepandemic years.

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Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic

Ruiz Azpiazu,

Fernández del Valle,

Echarri Sucunza

et al. 2024

JAMA Netw Open

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ImportanceOut-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery.ObjectiveTo determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels.Design, Setting, and ParticipantsThis observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder.ExposureThe pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection.Main Outcome and MeasuresThe main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance.ResultsA total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P &lt; .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P &lt; .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P &lt; .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P &lt; .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P &lt; .001).Conclusions and RelevanceIn this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.

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COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests

Cited by 205 publications

References 41 publications

Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review

A Comparative Analysis of In-Hospital Mortality per Disease Groups in Germany Before and During the COVID-19 Pandemic From 2016 to 2020

Out-of-Hospital Cardiac Arrest Following the COVID-19 Pandemic

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