Out of hospital cardiac arrests rose by 58% in Italy during the first 40 days of the COVID-19 outbreak in Italy, according to research published in the New England Journal of Medicine, compared to the same time interval a year earlier. More arrests occurred at home, more were unwitnessed, EMS took longer to respond and there were fewer instances of by-stander CPR. Of the 362 cases, 87 were suspected to have Covid-19 and 16 were confirmed with the disease, accounting for 77.4% of the increase.
Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy
With only anecdotal data available, I can tell you in Hartford we have seen at least a similar increase (my estimate would be 2-3 times the increase) in out-of-hospital cardiac arrest. Eventually United States data will be published and I would expect not only a similar rise to be documented, but I predict resuscitation success data will be grim. Here are some of the reasons that successful resuscitation rates will decline:
Fewer instances of bystander CPR (due both to fewer bystanders and likely reluctance of bystanders to risk infecting themselves.)
EMS delay due to putting on PPE (This can delay delivery of a life-saving defibrillation shock from 1-3 minutes).
Some EMS systems prohibiting the use of bag-valve-mask ventilation, and instead opting for a nonrebreather mask.
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Recently in New York, EMS crews were temprarily banned from transporting COVID cardiac arrests patients to the hospital if they were unable to resuscitate them on scene.
City’s EMS rescinds resuscitation ban for cardiac patients as NYC coronavirus cases drop
This order, which raised much protest in New York, is common practice here for most patients in cardiac arrest, regardless of COVID status, to be presumed dead on scene (after consultation with medical control) if EMS is unable to resuscitate on scene. Our protocols detail the exceptions.
