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Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy

The Authors explored the incidence and characteristics of out of hospital cardiac arrests (OHCA) in 4 regions of the Lombardy region of Northern Italy using the Lombardia Cardiac Arrest Registry for the first 40 days of the outbreak between 2/21/2020 (first regional case 2/20/2020) to 3/31/2020. These statistics were compared to the same 40 days in 2019. There findings are as follows:

Key Points:

  • During the 2020 Period 362 cases OHCA were identified, compared with 229 cases in 2019 (an increase of 58%).
  • Medical causes and at home events increased 6.5 and 7.3% respectively with a 11.3% increase in unwitnessed OHCA.
  • In 2020, median EMS arrival time was 3 minutes longer.
  • Bystander CPR was 15.6% lower in 2020.
  • In patients with an EMS resuscitation attempt in 2020, out of hospital death was 14.9% higher.
  • The cumulative incidence of OHCA was highly associated with the COVID – 19 cumulative incidences.
  • Overall there were 133 additional OHCA events in 2020 of which 103 were suspected COVID patients (87) or known COVID patients (16).
  • Thus, the 77.4% increased incidence of OHCA in 2020 was reasonably accounted for by COVID – 19 infection.
  • Nearly one fourth of the OHCA events otherwise not accounted for in the Lombardia Region are likely attributable in part to acute STEMI (and potentially other potentially lethal acute events). It is likely that most of this increase in mortal events reflect patients not seeking prompt medical attention for acute symptoms because of fear of COVID – 19 exposure if seen at a hospital.