Excess Cardiac Arrest in the Community During the COVID-19 Pandemic

Holland, Matthew; Burke, James; Hulac, Steven; Morris, Michael; Bryskiewicz, Gary; Goold, Audrey; McVaney, Kevin; Rappaport, Lara; Stauffer, Brian L.

doi:10.1016/j.jcin.2020.06.022

Cited by 21 publications

(20 citation statements)

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“…Early reports of significantly lower hospitalisations for common CV conditions such as acute myocardial infarction and higher rates of out of hospital cardiac arrest suggest a potential avoidance of care on the part of patients owing to reduced caregiver access or fear of acquiring COVID-19 in-hospital. [14][15][16][17][18] These aversion behaviours may ultimately lead to greater CV morbidity and mortality than during similar historical time periods. Coupled with reduced hospitalisation rates would be a decline in appropriate CV procedural activity.…”

Section: Defining Elective CV Procedures and Their Clinical Ecosystemsmentioning

confidence: 99%

Elective cardiovascular care in the era of the COVID-19 pandemic: managing tragic choices

et al. 2020

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The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed ‘elective’ have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.

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Section: Defining Elective CV Procedures and Their Clinical Ecosystemsmentioning

confidence: 99%

Elective cardiovascular care in the era of the COVID-19 pandemic: managing tragic choices

et al. 2020

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“…Now a second outbreak has begun. Albeit a close relationship between the pandemic trend and the incidence of out-of-hospital cardiac arrest (OHCA) has been documented during the first surge in different countries such as Italy 1 , 2 the United States 3 , 4 and France, 5 some elements still remain unclarified.…”

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confidence: 99%

Out-of-hospital cardiac arrest incidence in the different phases of COVID-19 outbreak

et al. 2021

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Out-of-hospital cardiac arrest incidence in the different phases of COVID-19 outbreakTo the editor, Last February, Europe was affected by the first wave of the COVID-19 pandemic. Now a second outbreak has begun. Albeit a close relationship between the pandemic trend and the incidence of out-ofhospital cardiac arrest (OHCA) has been documented during the first surge in different countries such as Italy 1,2 the United States 3,4 and France, 5 some elements still remain unclarified.Our aims were (1) to confirm the correlation between the incidence of OHCA and COVID-19 across a longer time period including the downward phase of the pandemic; (2) to compare the incidence of OHCA in the post-and pre-pandemic peak and (3) to verify whether the incidence OHCA correlated more closely with daily COVID-19 diagnoses or with the rate of ICU admissions. We considered all events of OHCA enrolled in the out-of-hospital cardiac arrest register of the Lombardy region (Lombardia CARe; ClinicalTrials.gov Identifier: NCT03197142) from January 1st, 2020 to October 9th, 2020 that have occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese (total area 9061 km 2 ; total population of 2,435,939 inhabitants). The daily new cases of COVID-19 in the entire Lombardy region, as well as the daily count of COVID patients admitted in the intensive care units (ICU), were collected from National Department of Civil Protection (http://www.protezionecivile.gov.it/). During the study period, 2488 OHCAs occurred and resuscitation was attempted in 1629 of them (65.5%). The median age was 78 years (IQR 66À86 years); the event occurred at home in 1392 (85.5%); a medical aetiology was found in 1519 (93%); the event was witnessed in 756 (46.4%); the rhythm was non-shockable in 1393 (85.5%) and bystander CPR occurred in 519 (32%). As shown in Fig. 1, the trend of OHCA has followed the trend of the pandemic during both the ascending and the descending phase. A statistically significant correlation was found across the 283 days of observation, reinforcing the deep relationship between the pandemic and OHCA incidence. The

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“…Recently published data in regions with high prevalence of COVID-19 show significant increases in OHCA incidence and changes in the Utstein factors associated with survival. [1] , [2] , [3] , [4] , [5] Of particular significance are the consistent findings that more cardiac arrests are occurring at home, fewer cardiac arrests are witnessed, emergency medical services (EMS) response times are longer and there is a decrease in bystander cardiopulmonary resuscitation (CPR) rates. [1] , [2] , [3] , [4] , [5] Given the significance of these factors in the chain of survival, it is hardly surprising that these regions are also reporting decreases in shockable rhythms, attempted resuscitation by emergency medical personnel and rates of survival.…”

mentioning

confidence: 99%

“… [1] , [2] , [3] , [4] , [5] Of particular significance are the consistent findings that more cardiac arrests are occurring at home, fewer cardiac arrests are witnessed, emergency medical services (EMS) response times are longer and there is a decrease in bystander cardiopulmonary resuscitation (CPR) rates. [1] , [2] , [3] , [4] , [5] Given the significance of these factors in the chain of survival, it is hardly surprising that these regions are also reporting decreases in shockable rhythms, attempted resuscitation by emergency medical personnel and rates of survival. [1] , [2] , [3] , [4] , [5] , [6] Interestingly, two studies from regions with lower prevalence of COVID-19 appear to be conflicting in changes to characteristics and outcomes, but both appear to report no change to rates of bystander CPR.…”

mentioning

confidence: 99%

“… [1] , [2] , [3] , [4] , [5] Given the significance of these factors in the chain of survival, it is hardly surprising that these regions are also reporting decreases in shockable rhythms, attempted resuscitation by emergency medical personnel and rates of survival. [1] , [2] , [3] , [4] , [5] , [6] Interestingly, two studies from regions with lower prevalence of COVID-19 appear to be conflicting in changes to characteristics and outcomes, but both appear to report no change to rates of bystander CPR. 6 , 7…”

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confidence: 99%

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