The need to adapt the rescue chain for out-of-hospital cardiac arrest during the COVID-19 pandemic: Experience from the Paris Fire Brigade Basic Life Support and Advanced Life Support teams

Jost, Daniel; Derkenne, Clément; Kedzierewicz, Romain; Briche, Frédérique; Frattini, Benoît; Bertho, Kilian; Prunet, Bertrand; Lemoine, Frédéric; Lanoë, Vincent; Jouffroy, Romain; Lemoine, Sabine; Lesaffre, Xavier; Delhaye, Ludovic; Prieux, Laurent; Ha, Vivien Hong Tuan; Trichereau, Julie; Gauyat, Eric; Stibbe, Olivier; Travers, Stéphane; Diegelmann, Pascal; Bihannic, René

doi:10.1016/j.resuscitation.2020.06.005

Cited by 15 publications

(16 citation statements)

References 5 publications

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“…Furthermore, smartphone applications to alerts citizens first responders 29 were suspended in Paris, France and Switzerland due to the absence of PPE. 30 , 31…”

Section: Discussionmentioning

confidence: 99%

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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“…Furthermore, smartphone applications to alerts citizens first responders 29 were suspended in Paris, France and Switzerland due to the absence of PPE. 30 , 31…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…However, the transit time from EMS departure to arrival at the scene generally decreased due to a reduction in vehicle traffic. In Paris, BLS teams were limited to one person per patient to reduce exposure and to increase distribution of first responders [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…Lockdowns, as a result of COVID-19, led to unique circumstances for EMS personnel. Jost et al noted that “laypeople” who would ordinarily help with CPR were no longer available to support EMS efforts and emergency response teams [ 25 ]. Many automatic external defibrillators (AED) stations were inaccessible with the closure of most public places.…”

Section: Resultsmentioning

confidence: 99%

An international perspective of out-of-hospital cardiac arrest and cardiopulmonary resuscitation during the COVID-19 pandemic

Ong

O’Connell

Mazer‐Amirshahi

et al. 2021

The American Journal of Emergency Medicine

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Background Out-of-hospital cardiac arrest (OHCA) accounts for a substantial proportion of sudden cardiac events globally, with hundreds of thousands of cases reported annually in the United States. The mortality rate of patients who suffer OHCA remains high despite extensive utilization of resources. Objectives We aim to describe the current landscape of OHCA during the COVID-19 pandemic and provide an overview of the logistical challenges and resuscitation protocols amongst emergency medical service (EMS) personnel. Discussion Recent studies in Italy, New York City, and France characterized a significant increase in OHCA incidence in conjunction with the arrival of the 2019 coronavirus disease (COVID-19) pandemic. The presence of the pandemic challenged existing protocols for field resuscitation of cardiac arrest patients as the pandemic necessitated prioritization of EMS personnel and other healthcare providers' safety through stringent personal protective equipment (PPE) requirements. Studies also characterized difficulties encountered by the first responder system during COVID-19, such as dispatcher overload, increased response times, and adherence to PPE requirements, superimposed on PPE shortages. The lack of guidance by governmental agencies and specialty organizations to provide unified safety protocols for resuscitation led to the development of different resuscitative protocols globally. Conclusions The ongoing COVID-19 pandemic modified the approach of first responders to OHCA. With the rise in OCHA during the pandemic in several geographic regions and the risks of disease transmission with superimposed equipment shortages, novel noninvasive, adjunct tools, such as point of care ultrasound, warrant consideration. Further prehospital studies should be considered to optimize OHCA and resource management while minimizing risk to personnel.

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“…Clinical concern regarding the risk of transmission of COVID-19 infection risk to the bystander drove modifications to changes in cardiac arrest clinical guidelines and the personal protective equipment (PPE) worn by pre-hospital responders and dispatchers. 20 , 21 , 22 The requirement to wear this PPE was identified as leading to potential delays in both the dispatch process as well as the medical response. 2 This concern may also have contributed to reduced incidence of bystander CPR.…”

mentioning

confidence: 99%

COVID-19 and the global OHCA crisis: An urgent need for system level solutions

Christian

Couper

2020

Resuscitation

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The need to adapt the rescue chain for out-of-hospital cardiac arrest during the COVID-19 pandemic: Experience from the Paris Fire Brigade Basic Life Support and Advanced Life Support teams

Cited by 15 publications

References 5 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

An international perspective of out-of-hospital cardiac arrest and cardiopulmonary resuscitation during the COVID-19 pandemic

COVID-19 and the global OHCA crisis: An urgent need for system level solutions

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