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2020 ; 5
(8
): e437-e443
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Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a
population-based, observational study
#MMPMID32473113
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
Lancet Public Health
2020[Aug]; 5
(8
): e437-e443
PMID32473113
show ga
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).