1
|
Jaskiewicz F, Timler W, Panasiuk J, Starosta K, Cierniak M, Kozlowski R, Borzuchowska M, Nadolny K, Timler D. Willingness and Barriers to Undertaking Cardiopulmonary Resuscitation Reported by Medical Students after the SARS-CoV-2 Pandemic-Single-Center Study. J Clin Med 2024; 13:438. [PMID: 38256572 PMCID: PMC10816474 DOI: 10.3390/jcm13020438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Most of the studies in the field of willingness and barriers to resuscitation (CPR) were conducted before the SARS-CoV-2 pandemic. The aim of the study was to assess the number and types of barriers to CPR among medical students after the pandemic ended. This study was based on a survey. The data was collected from 12 April 2022 to 25 May 2022. A total of 509 complete questionnaires were obtained. The number of barriers depending on the time elapsed from the last CPR course did not differ significantly (Me = 4 [IQR 2-6] vs. Me = 5 [IQR 3-7]; p = 0.054, respectively). The number of all barriers reported by respondents differed significantly and was higher in those reporting fear of coronavirus (Me = 4 [IQR 2-6] vs. Me = 7 [IQR 4-9]; p < 0.001, respectively). A total of 12 out of all 23 barriers were significantly more frequent in this group of respondents. Barriers to CPR are still common among medical students, even despite a high rate of CPR training. The pandemic significantly affected both the number and frequency of barriers. The group of strangers and children, as potential cardiac arrest victims, deserve special attention. Efforts should be made to minimize the potentially modifiable barriers.
Collapse
Affiliation(s)
- Filip Jaskiewicz
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (K.S.); (M.C.); (D.T.)
| | - Wojciech Timler
- Department of Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Jakub Panasiuk
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (K.S.); (M.C.); (D.T.)
| | - Katarzyna Starosta
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (K.S.); (M.C.); (D.T.)
| | - Marcin Cierniak
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (K.S.); (M.C.); (D.T.)
| | - Remigiusz Kozlowski
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (R.K.); (M.B.)
| | - Monika Borzuchowska
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland; (R.K.); (M.B.)
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Faculty of Medicine, Silesian Academy in Katowice, 40-555 Katowice, Poland;
| | - Dariusz Timler
- Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland; (J.P.); (K.S.); (M.C.); (D.T.)
| |
Collapse
|
2
|
Böckler B, Preisner A, Bathe J, Rauch S, Ristau P, Wnent J, Gräsner JT, Seewald S, Lefering R, Fischer M. Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry. Resuscitation 2024; 194:110060. [PMID: 38013146 DOI: 10.1016/j.resuscitation.2023.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.
Collapse
Affiliation(s)
- Bastian Böckler
- Clinic for Anaesthesiology, Klinikum Großhadern/Innenstadt, Ludwig-Maximilians-Universität München, Munich, Germany; Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Achim Preisner
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany; Women's Clinic with Gynaecology and Obstetrics, Alb Fils Kliniken, Göppingen, Germany
| | - Janina Bathe
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Stefan Rauch
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Patrick Ristau
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Jan Wnent
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Jan-Thorsten Gräsner
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Stephan Seewald
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Rolf Lefering
- Universität Witten/Herdecke Institute for Research in Operative Medicine (IFOM), Cologne, Germany
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany.
| |
Collapse
|
3
|
Lafrance M, Recher M, Javaudin F, Chouihed T, Wiel E, Helft G, Hubert H, Canon V. Bystander basic life support and survival after out-of-hospital cardiac arrest: A propensity score matching analysis. Am J Emerg Med 2023; 67:135-143. [PMID: 36871482 DOI: 10.1016/j.ajem.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/25/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In out-of-hospital cardiac arrest, early recognition, calling for emergency medical assistance, and early cardiopulmonary resuscitation are acknowledged to be the three most important components in the chain of survival. However, bystander basic life support (BLS) initiation rates remain low. The objective of the present study was to evaluate the association between bystander BLS and survival after an out-of-hospital cardiac arrest (OHCA). METHODS We conducted a retrospective cohort study of all patients with OHCA with a medical etiology treated by a mobile intensive care unit (MICU) in France from July 2011 to September 2021, as recorded in the French National OHCA Registry (RéAC). Cases in which the bystander was an on-duty fire fighter, paramedic, or emergency physician were excluded. We assessed the characteristics of patients who received bystander BLS vs. those who did not. The two classes of patient were then matched 1:1, using a propensity score. Conditional logistic regression was then used to probe the putative association between bystander BLS and survival. RESULTS During the study, 52,303 patients were included; BLS was provided by a bystander in 29,412 of these cases (56.2%). The 30-day survival rates were 7.6% in the BLS group and 2.5% in the no-BLS group (p < 0.001). After matching, bystander BLS was associated with a greater 30-day survival rate (odds ratio (OR) [95% confidence interval (CI)] = 1.77 [1.58-1.98]). Bystander BLS was also associated with greater short-term survival (alive on hospital admission; OR [95%CI] = 1.29 [1.23-1.36]). CONCLUSIONS The provision of bystander BLS was associated with a 77% greater likelihood of 30-day survival after OHCA. Given than only one in two OHCA bystanders provides BLS, a greater focus on life saving training for laypeople is essential.
Collapse
Affiliation(s)
- Martin Lafrance
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France.
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - François Javaudin
- Department of Emergency Medicine, CHU Nantes, F-44000 Nantes, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, F-54000 Nancy, France; INSERM, UMRS 1116, University Hospital of Nancy, F-54000 Nancy, France
| | - Eric Wiel
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France; SAMU du Nord and Emergency Department for Adults, Lille University Hospital, F-59000 Lille, France
| | - Gérard Helft
- Cardiology Department, Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, F-75013 Paris, France
| | - Hervé Hubert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
| | - Valentine Canon
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
| | -
- French National Out-of-Hospital Cardiac Arrest Registry, RéAC, F-59000 Lille, France
| |
Collapse
|
4
|
Shibahashi K, Kawabata H, Sugiyama K, Hamabe Y. Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan. Emerg Med J 2022; 39:emermed-2021-212212. [PMID: 35705365 PMCID: PMC9240453 DOI: 10.1136/emermed-2021-212212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic. METHODS This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes. RESULTS The witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes. CONCLUSION The COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.
Collapse
Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | | | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| |
Collapse
|
5
|
Munot S, Rugel EJ, Von Huben A, Marschner S, Redfern J, Ware S, Chow CK. Out-of-hospital cardiac arrests and bystander response by socioeconomic disadvantage in communities of New South Wales, Australia. Resusc Plus 2022; 9:100205. [PMID: 35199073 PMCID: PMC8844775 DOI: 10.1016/j.resplu.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/21/2021] [Accepted: 01/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background & aim Bystander response to out-of-hospital cardiac arrest (OHCA) may relate to area-level factors, including socioeconomic status (SES). We aimed to examine whether OHCA among individuals in more disadvantaged areas are less likely to receive bystander cardiopulmonary resuscitation (CPR) compared to those in more advantaged areas. Methods We analysed data on OHCAs in New South Wales, Australia collected prospectively through a statewide, population-based register. We excluded non-medical arrests; arrests witnessed by a paramedic; occurring in a medical centre, nursing home, police station; or airport, and among individuals with a Do-Not-Resuscitate order. Area-level SES for each arrest was defined using the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage and its relationship to likelihood of receiving bystander CPR was examined using hierarchical logistic regression models. Results Overall, 39% (6622/16,914) of arrests received bystander CPR (71% of bystander-witnessed). The OHCA burden in disadvantaged areas was higher (age-standardised incidence 76–87/100,000/year in more disadvantaged quintiles 1–4 versus 52 per 100,000/year in most advantaged quintile 5). Bystander CPR rates were lower (38%) in the most disadvantaged quintile and highest (42%) in the most advantaged SES quintile. In adjusted models, younger age, being bystander-witnessed, arresting in a public location, and urban location were all associated with greater likelihood of receiving bystander CPR; however, the association between area-level SES and bystander CPR rate was not significant. Conclusions There are lower rates of bystander CPR in less advantaged areas, however after accounting for patient and location characteristics, area-level SES was not associated with bystander CPR. Concerted efforts to engage with communities to improve bystander CPR in novel ways could improve OHCA outcomes.
Collapse
Affiliation(s)
- Sonali Munot
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emily J. Rugel
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amy Von Huben
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Sandra Ware
- NSW Ambulance, Sydney, New South Wales, Australia
| | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Corresponding author at: Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, The University of Sydney, Westmead Hospital, Westmead, New South Wales 2145, Australia.
| |
Collapse
|
6
|
Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep 2022; 12:800. [PMID: 35039578 PMCID: PMC8764072 DOI: 10.1038/s41598-021-04749-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Bystander cardiopulmonary resuscitation (BCPR), early defibrillation and timely treatment by emergency medical services (EMS) can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of the COVID-19 pandemic on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR 1.38, 95% CI 1.11–1.71, p = 0.0069). BCPR did not differ during and before the COVID-19 pandemic (OR 0.94, 95% CI 0.80–1.11, p = 0.4631), although bystander defibrillation was significantly lower during the COVID-19 pandemic (OR 0.65, 95% CI 0.48–0.88, p = 0.0107). EMS call-to-arrival time was significantly higher during the COVID-19 pandemic (SMD 0.27, 95% CI 0.13–0.40, p = 0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.
Collapse
|
7
|
Lim ZJ, Ponnapa Reddy M, Afroz A, Billah B, Shekar K, Subramaniam A. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis. Resuscitation 2020; 157:248-258. [PMID: 33137418 PMCID: PMC7603976 DOI: 10.1016/j.resuscitation.2020.10.025] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/29/2022]
Abstract
Background The impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA. Methods A systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale. Results Ten studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p = 0.036). While mortality (OR = 0.67, 95%-CI 0.49−0.91) and supraglottic airway use (OR = 0.36, 95%-CI 0.27−0.46) was higher during the pandemic, automated external defibrillator use (OR = 1.78 95%-CI 1.06–2.98), return of spontaneous circulation (OR = 1.63, 95%CI 1.18-2.26) and intubation (OR = 1.87, 95%-CI 1.12-–3.13) was more common before the pandemic. More patients survived to hospital admission (OR = 1.75, 95%-CI 1.42–2.17) and discharge (OR = 1.65, 95%-CI 1.28–2.12) before the pandemic. Bystander CPR (OR = 1.18, 95%-CI 0.95-1.46), unwitnessed OHCA (OR = 0.84, 95%-CI 0.66–1.07), paramedic-resuscitation attempts (OR = 1.19 95%-CI 1.00–1.42) and mechanical CPR device use (OR = 1.57 95%-CI 0.55–4.55) did not defer significantly. Conclusions The incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required. Review registration PROSPERO (CRD42020203371).
Collapse
Affiliation(s)
- Zheng Jie Lim
- Department of Anaesthesia and Intensive Care Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Calvary Hospital, Canberra, Australian Capital Territory, Australia
| | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland University of Technology Brisbane and Bond University, Gold Coast, Queensland, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
8
|
Pechmajou L, Marijon E, Perrot D, Jouven X, Karam N. [Out-of-hospital sudden cardiac arrest and COVID-19 pandemic]. Ann Cardiol Angeiol (Paris) 2020; 69:365-369. [PMID: 33071022 PMCID: PMC7543748 DOI: 10.1016/j.ancard.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 11/22/2022]
Abstract
Depuis l’apparition de la pandémie de la COVID-19, la mortalité due à l’infection à la COVID-19 a été tracée partout dans le monde, avec un recensement quotidien de nombre de décès. Des mesures ont été prises concernant le fonctionnement social et professionnel, et les systèmes de santé ont été réorganisés afin de limiter la propagation du virus, et permettre une prise en charge de l’affût de patients dans les hôpitaux. Des questions se sont posées quant à l’impact indirect de la pandémie, avec notamment des inquiétudes concernant les potentiels retards de prise en charge des maladies non liées à la COVID-19, avec le confinement, la diminution voire l’arrêt des consultations et interventions médicales non urgentes et la diminution des examens pour dépistage. La mort subite a pu être impactée par tous ces changements, et constitue généralement un bon marqueur de santé publique. Dans cet article nous détaillerons l’impact de la pandémie de la COVID-19 sur l’épidémiologie des morts subites.
Collapse
Affiliation(s)
- Louis Pechmajou
- Inserm, PARCC, université de Paris, 75015 Paris, France; Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Inserm, PARCC, université de Paris, 75015 Paris, France; Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - David Perrot
- Inserm, PARCC, université de Paris, 75015 Paris, France; Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Inserm, PARCC, université de Paris, 75015 Paris, France; Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Inserm, PARCC, université de Paris, 75015 Paris, France; Service de cardiologie, hôpital européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France.
| |
Collapse
|
9
|
Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, Sharifzadehgan A, Waldmann V, Beganton F, Narayanan K, Lafont A, Bougouin W, Jouven X. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. LANCET PUBLIC HEALTH 2020; 5:e437-e443. [PMID: 32473113 PMCID: PMC7255168 DOI: 10.1016/s2468-2667(20)30117-1] [Citation(s) in RCA: 343] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/21/2023]
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. METHODS We 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. FUNDING The French National Institute of Health and Medical Research (INSERM).
Collapse
Affiliation(s)
- Eloi Marijon
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France.
| | - Nicole Karam
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, Paris, France; Paris Fire Brigade, Paris, France
| | - David Perrot
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France
| | | | | | - Ardalan Sharifzadehgan
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Victor Waldmann
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Frankie Beganton
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France
| | | | - Antoine Lafont
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Wulfran Bougouin
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Xavier Jouven
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| |
Collapse
|