Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence

Abstract

Background The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. Aim To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. Methods We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. Results A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Conclusions Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs’ increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.

Occurrence and Temporal Variability of Out-of-Hospital Cardiac Arrest during COVID-19 Pandemic in Comparison to the Pre-Pandemic Period in Poland—Observational Analysis of OSCAR-POL Registry

“…This period overlaps with the highest rates of OHCA cases, which were significantly higher compared to the pre-pandemic period. The observation stays in line with the previous studies showing a correlation between increased OHCA cases and increased SARS-CoV-2 infection rates [17,35].…”

“…To date, the majority of published studies focused on the OHCA occurrence during the first wave of the COVID19 outbreak and little is known about later developments of the pandemic. Baldi et al [ 35 ] analyzed all OHCA cases in the provinces of Pavia, Lodi, Cremona, Mantua, and Varese in Italy between February and December 2020 and divided this period into two, reflecting the first and second wave of the pandemic. The authors observed a significant positive correlation between increased COVID-19 incidence and the incidence of OHCA cases.…”

Cardiac arrest and coronavirus disease 2019

“…Concerning this aspect, the first evidence about the weight of COVID-19 in explaining this regional variation came from the USA, where the higher the county-level of COVID-19 mortality rate per million residents, a surrogate of COVID-19 incidence, the higher the OHCA incidence [ 17 ▪▪ ]. Similar results were reached in the Lombardy Region [ 33 ▪ ], where the correlation between OHCA and COVID-19 incidence was confirmed not only during the first, but also during the second pandemic wave, highlighting how this correlation was found to be statistically significant only in those provinces whose cumulative incidence of COVID-19 overcame those of the whole territory. This trend stressed the importance of the burden of COVID-19 cases in a given area on the occurrence of OHCAs.…”

“…This was perfectly in line both with the reports concerning the reduced rate of hospital admissions for acute coronary syndrome (ACS) during the COVID-19 outbreak [ 80 ▪ , 81 , 82 ] and concerning the impressive reduction in emergency department (ED) patient attendance during lockdown period [ 83 ]. This fear of in-hospital infection is probably more evident in the areas with high-incidence of COVID-19 cases, as the population knew the load of people hospitalized for COVID-19 in the hospital of their area [ 33 ▪ ]. Such a behavior may have led to at-home deterioration of time-dependent diseases until the OHCA occurrence, stressing the importance of information campaigns focusing on the importance of early EMS activation in case of real need to prevent COVID-19 from being a disease that kills at home.…”

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

“…Fifth, we compared ROSC of patients with OHCA of presumed cardiac etiology, but COVID-19 could have changed the etiology of OHCA. 61 62 63 Actually, during the COVID-19 period, the number of patients withholding resuscitation cases increased from 32,236 to 37,931. 49 64 Further research is needed in this portion because of the limitations of our study dataset.…”