Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy

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; Bua, Davide; Rizzi, Ugo; Bussi, Daniele; Ruggeri, Simone; Visconti, Luigi Oltrona; Savastano, Simone

doi:10.1056/nejmc2010418

Cited by 587 publications

(704 citation statements)

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“…It can be assumed by a stabile incidence of patients having an ACS that patients abstain from seeing a doctor despite symptoms of acute myocardial ischemia. This is in line with the increasing number of outof-hospital cardiac arrest in Italy compared with the same period in 2019 [4]. In COVID-19 patients, cardiac injury is a common feature whereby the mechanisms have not yet been nally clari ed [14].…”

Section: Discussionmentioning

confidence: 64%

“…In addition to hygiene advices, the World Health Organization (WHO) strongly recommends limiting face-to-face contact with others via social distancing [2]. Subsequently, changes in the pattern of hospital admissions have been observed [3][4][5][6]. Valuable time passes with the ubiquitous differential diagnosis of respiratory insu ciency caused by which is frequently aimed to exclude before detailed examinations (e.g., physical examination, ultrasound, computed tomography, coronary angiography) take place [7].…”

Section: Introductionmentioning

confidence: 99%

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Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Schwarz

Mahfoud

Lauder

et al. 2020

Preprint

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Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome (ACS) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina, Δ -25% (p=0.42) for myocardial infarction with ST-elevation and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack: Δ -32% (p=0.18), ischemic stroke: Δ -23% (p=0.48), intracerebral haemorrhage: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Schwarz

Mahfoud

Lauder

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…We examined recent changes in population mortality following the outbreak of Covid- 19 For the European countries included and New York, we extracted reports of the numbers of deaths related to Covid-19 published by national agencies and death registration authorities that had been publicly reported by 6 th May 2020. [9][10][11][12][13] Data on the number of deaths due to Covid-19, and the total number of deaths registered in the population over the same period were collected.…”

Section: Methodsmentioning

confidence: 99%

Excess deaths during the Covid-19 pandemic: An international comparison

Docherty

2020

Preprint

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Background: With the global pandemic of coronavirus disease 2019 there has been disruption to normal clinical activity in response to the increased demand on health services. There are reports of a reduction in non-Covid-19 emergency presentations. Consequentially, there are concerns that deaths from non-Covid-19 causes could increase. We examined recent reported population-based mortality rates, compared with expected rates, and compared any excess in deaths with the number of deaths attributed to Covid-19.Methods: National agency and death registration reports were searched for numbers of deaths attributed to Covid-19 and overall mortality that had been publicly reported by 06 May 2020. Data on the number of deaths attributed to Covid-19, the total number of deaths registered in the population and the historical average over at least 3 years were collected. Data were available for 4European countries (England & Wales, Scotland, Netherlands and Italy) and New York State, United States of America.Results: There was an increase in observed, compared with expected, mortality in Scotland (+68%), England and Wales (+74%), the Netherlands (+58%), Italy (+39%) and New York state (+49%). Of these deaths, only 73% in Scotland, 71 % in England and Wales, 53% in the Netherlands, 54% in Italy and 79% in New York state were attributed to Covid-19 leaving a number of excess deaths not attributed to Covid-19. In the 5-week period of study, Scotland, 10% of the excess of deaths were attributed to dementia/Alzheimer's disease and 7% to cardiovascular causes.

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“…Out-of-hospital deaths represent an important facet of total excess mortality, which may be particularly suited for measurement using EMS data. One recent report from the Lombardy region of Italy used EMS records to show an increase of 58% compared to prior year values, during the peak of the epidemic 8 . It is unclear, however, how this phenomenon would play out in LMICs with relatively weaker health systems [9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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Objective: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods:We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14 th -May 11 th ) and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2).Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas.Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.

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Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy

Cited by 587 publications

References 4 publications

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

Excess deaths during the Covid-19 pandemic: An international comparison

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

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