An extra-hospital cardiac arrest (PCEH) involves the mechanical interruption of the heart, the heart stops beating and can cause death if cardiopulmonary resuscitation (CPR) is not started immediately by bystanders with the use of a defibrillator.
In Spain there are 30.000 deaths due to extra-hospital cardiac arrest, Emergency and urgent medical services (EMS) play a vital and important role in the survival of PCEH. The rapid response of EMS and high-quality CPR improve survival rates (1,2), and initiation of CPR by bystanders can double the survival of HCPE (3).
From Proyecto Salvavidas we will analyze the possible negative impacts that COVID 19 has caused both in the response by witnesses to a cardiac arrest (early start of CPR and use of the AED), increase in the response time of the EMS (System of Medical Emergencies) and therefore in the survival of the extra-hospital cardiac arrest.
CPR performance decreases during the COVID-19 pandemic and mortality from PCHE rises
A study carried out in the United States and collected by Proyecto Salvavidas, analyzed two regions within the United States (Oregon and California). The authors observed a decrease in PCEH survival during the pandemic from an average of 14,7% (2019) to an average of 7,9% (2020). In the study, the authors evaluated the possible reason behind this and saw a decrease in both control-initiated CPR and the combined use of CPR and AED, coupled with a longer response time by emergency services. it could have affected the decreased survival of PCEH.
Increase in cardiac arrests at home
The authors also observed an increase in PCEH in homes during the pandemic, possibly due to confinement, which partly explains the decrease in CPR and use of the AED by witnesses, at home 76% of cardiac arrests occurred during the pandemic. COVID19.
(7) The study also observed an increase in cardiac arrest in younger patients (35-64 years one represented 44% of PCEH) during the COVID period compared to the pre-COVID period. (7)
As we can see in the graph:
- Fewer bystanders initiate CPR until the arrival of emergency services, a 10% decrease compared to pre-pandemic data from 61% to 51%.
- Fewer witnesses initiating cardiopulmonary resuscitation and use of a defibrillator, 5% to 1%.
- Average EMS response time has increased from 6,6 minutes to 7,6 minutes.
In Italy, France and New York the response times by the SEM increased
This study is in complete harmony with the results observed in other cities such as Lombardy (4), Paris (5) and the city of New York (7) discussed in the previous article (link previous post).
The Italian region of Lombardy increased by 58% in the incidence of PCEH (n = 362) from February 20 to March 31, 2020, compared to the same 40-day period in 2019 (n = 229), with times of longer SEM response (3 more minutes on average), less CPR by bystanders and shorter survival (4).
In Paris, France, the incidence of PCEH doubled in the first weeks of confinement. The proportion of cases admitted living in hospital decreased from 22,8% to 12,8%, respectively (5). The Paris study also reported times of longer SEM response and decreases in CPR by controls.
In New York City, the incidence of non-traumatic PCEH with resuscitation by EMS from March 1 to April 25, 2020 was 3 times higher than during the same period last year, and PCEH during the pandemic an index of Survival lower than the previous year, although the CPR rates of the controls did not change.
Conclusions on poor survival during COVID-19
Current results suggest that the pandemic may have significant effects on both the longer SEM response and a decrease in cardiopulmonary resuscitation by bystanders and / or AED use that may negatively affect survival from out-of-hospital cardiac arrest.
Rubén Campo, founder of Proyecto Salvavidas, recalls that for every minute that passes without CPR and defibrillator use, the chances of survival decrease by 10%. In times of COVID Rubén Campo reminds us that with basic protection measures the risk of contagion is very low and the chances of saving a life increase if we do CPR. Here is our poster on how to perform CPR in times of COVID-19 that you can download for free at: https://www.salvavidas.eu/images/infografias/infografia-rcp-covid.jpg
- Rea TD, Cook AJ, Stiell IG, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med 2010; 55: 249–
- Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and JAMA 2008; 300: 1423–31
- Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3: 63–
- Baldi E, Sechi GM, Mare C, et al. Out-of-hospital cardiac arrest during the covid-19 outbreak in Italy. N Engl J Med 2020; 383: 496–
- Marijon E, Karam N, Jost D, et al. Out-of- hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health 2020; 5: e437–
- Lai PH, Lancet EA, Weiden MD, et al. Char- acteristics associated with out-of-hospital cardiac arrests and resuscitations during the novel coronavirus disease 2019 pandemic in New York City. JAMA Cardiol 2020 Jun 19 [E-pub ahead of print].