Published May 27, 2020 | Version v1
Journal article Open

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

Authors/Creators

  • 1. 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;
  • 2. Paris- Sudden Death Expertise Center, Paris, France; Paris Fire Brigade, Paris, France
  • 3. Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris- Sudden Death Expertise Center, Paris, France
  • 4. Paris Fire Brigade, Paris, France
  • 5. Paris- Sudden Death Expertise Center, Paris, France
  • 6. 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

Description

Summary


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

Notes

Acknowledgements We thank the Paris-SDEC for providing the logistical support that allowed us to access and analyse the necessary data for the manuscript in such a short period, and the Paris-SDEC collaborators for their multidisciplinary expertise that allows an optimal approach in the fight against sudden cardiac death through this collaborative network since 2011. The Paris-SDEC activities are supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), University of Paris, Assistance Publique-Hôpitaux de Paris, Fondation Coeur et Artères, Global Heart Watch, Fédération Française de Cardiologie, Société Française de Cardiologie, Fondation Recherche Medicale, as well as unrestricted grants from industrial partners (Medtronic, Abbott, Boston Scientific, MicroPort, Biotronik, and Zoll). SDEC Executive Committee is part of the ESCAPE-NET project (Horizon2020 programme). We would like to aknowledge the huge effort of the Paris Fire Brigade in prospectively providing all data regarding OHCA in a real-time manner, and despite the overwhelming COVID-19 pandemic.

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Additional details

Funding

European Commission
ESCAPE-NET - European Sudden Cardiac Arrest network: towards Prevention, Education and NEw Treatment 733381