Out-of-hospital cardiac arrest in COVID-19 era. A single center experience

Abstract

Introduction In the COVID-19 pandemic several adverse cardiovascular sequelae (myocarditis, AMI and heart failure) has been reported but it is unclear whether there is an influence of COVID-19 on incidence of out-of-hospital sudden death (OHCA) and its management by emergency medical services (EMS) Aim The aim of the study was to evaluate these items comparing OHCA during COVID-19 pandemic to that of pre-COVID era using the Progetto Vita Registry. Method We compared (OHCA) that occurred in Piacenza province during the first three months of COVID-19 outbreak (from February to April 2020, Period A) with those that occurred during the same period in 2019 (from February to April 2019, Period B) We collected data from the electronic database of the emergency medical system to identify patients affected by COVID-19, including both patient with symptoms suggestive of infection (history of fever before out-of-hospital cardiac arrest, with cough, dyspnea, or both) and patients with positive results of pharyngeal swabs test to detect SARS-CoV-2 obtained before the event or after death. Results 1. Demographic characteristics of patients were similar in both periods (Period A 70/156 Female, mean age 79.2±5 yrs, Period B 39 Female, mean age 81.5±4 years,) 2. An higher number of OHCA were observed in the Period A vs Period B (A 156 cases vs B 78 cases, p 0.005). 68 cases (43%) of OHCA were associated with a COVID-19 disease 3. The EMS response time was longer in Period A vs B (A 16.4±4 min, vs B 11.1±3 min, p 0.05) 4. Initial cardiac rhythm was shockable in 10 subjects in the Period A (6,4%) and in 15 subjects in Period B (19.2%, p 005), possibly related to longer EMS response time 5. The global survival rate was higher in Period B vs A (B 5 patients, 6.4% vs 0 patients 0% p 0.05) 6. No one received cardiopulmonary resuscitation from bystanders in Period B. Conclusion During COVID-19 pandemic in Piacenza there was an increase in OCHA compared to the pre-COVID era. The COVID 19 Pandemic influences the bystanders attitude to practice an early cardiopulmonary resuscitation intervention and the performance of EMS, worsening the outcome of patients. Funding Acknowledgement Type of funding sources: None.

Impact of COVID-19 on Cardiovascular Disease

“…Possible proposed reasons include increased time from symptoms to first medical contact due to patient fear of intra-hospital SARS-CoV-2 infection and reluctance to consult primary healthcare institutions during the pandemic [ 69 , 70 , 71 ]. In addition, it has been speculated that an increase in out-of-hospital cardiac arrest with fatal outcome due to ACS may have led to less hospital admissions for ACS [ 72 , 73 ]. Furthermore, increased intra-hospital mortality due to ACS was reported in some but not all studies [ 66 , 74 , 75 ].…”