Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study

Abstract

Background Although mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods. MethodsWe did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area. Findings Comparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12-17, 2012-19), the maximum weekly OHCA incidence increased from 13•42 (95% CI 12•77-14•07) to 26•64 (25•72-27•53) per million inhabitants (p<0•0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69•7 years [SD 17] vs 68•5 [18], 334 males [64•4%] vs 1826 [59•9%]), there was a higher rate of OHCA at home (460 [90•2%] vs 2336 [76•8%]; p<0•0001), less bystander cardiopulmonary resuscitation (239 [47•8%] vs 1165 [63•9%]; p<0•0001) and shockable rhythm (46 [9•2%] vs 472 [19•1%]; p<0•0001), and longer delays to intervention (median 10•4 min [IQR 8•4-13•8] vs 9•4 min [7•9-12•6]; p<0•0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22•8% to 12•8% (p<0•0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0•36, 95% CI 0•24-0•52; p<0•0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic.Interpretation A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.

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

“…1-2). OHCAs during the COVID-19 pandemic were more likely to occur at home in Italy (90% during the pandemic vs. 83% in the non-pandemic period; P = 0.005) 6 and France (90% vs. 77%; P < 0.001) 7 while in the other studies were similar 9 , 10 , 23 (Supplemental Fig. 3).…”

“…Survival at hospital discharge was reported in three studies 6 , 7 , 23 and survival with good neurologic outcome only in one. 23 In France, patients suffering an OHCA during the COVID-19 pandemic were less likely to survive: rates of survival at hospital discharge declined from 5.4% to 3.1% ( P < 0.001).…”

“…In Lombardy, Northern Italy, 5 , 6 Paris, France, 7 and New York City, USA, 8 the incidence of out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic markedly increased compared with previous years and was associated with high mortality. In contrast, other areas of Northern Italy 9 and the USA 10 did not experience the same variations.…”

Cardiopulmonary Resuscitation during COVID-19 Pandemic: Outcomes, Risks, and Protective Strategies for the Healthcare Workers and Ethical Considerations

“…Marijon et al reported that the over a period of 4.5 weeks, weekly OHCA incidence doubled to 26.64 from 13.42, per million inhabitants, in the beginning of pandemic, before returning to baseline. 8 The increase in OHCAs was mostly due to 30% increase in COVID-19 cases. Marijon et al speculated that poor outcomes were caused by lockdown, behavior changes in bystanders, and an overwhelmed EMS.…”

“…The reports from China, France, and Italy suggest that outcomes of COVID-19 patients, who suffer either inhospital or out-of-hospital arrest, are poor. 5 – 8 Since many components of CPR generate aerosol, the WHO has listed CPR as an aerosol-generating procedure (AGP). 9 Infected HCWs pose a “triple threat” in current circumstances, loss of a HCWs to, and addition of a new patient (the HCW) to the overburdened healthcare systems, and a source of infection to coworkers and community.…”