More out-of-hospital cardiac arrests during the COVID-19 outbreak in Lombardy, Italy compared to 2019

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

Literature - Baldi E, Sechi GM, Mare C, et al. - N Engl J Med 2020, doi: 10.1056/NEJMc2010418

Introduction and methods

Although there is a risk of respiratory failure and cardiac complication in those with COVID-19, it is unknown whether there is an increased risk of out-of-hospital cardiac arrest (OHCA) in patients with COVID-19. Outside China, the Lombardy region in Italy was one of the first areas with an outbreak of COVID-19.

The Lombardia Cardiac Arrest Registry (Lombardia CARe) was used to study the incidence of out-of-hospital cardiac arrest in the provinces of Lodi, Cremona, Pavia and Mantua in the Lombardy region in Italy during the first 40 days of the COVID-19 outbreak there (Feb 21 through March 31, 2020). Incidence of OHCA was compared to that during the same period in 2019. Symptoms suggestive of COVID-19 (fever ≥3 days before OHCA, with cough, dyspnea or both) or positive test results before OHCA or after death were recorded.

Main results

362 cases of OHCA were identified, compared to 229 cases in 2019 – a 58% increase.
Increase in OHCA in Lodi Province was 187%, in Cremona 143%, in Pavia 24% and in Mantua 18%.
Cumulative incidence of OHCA in 2020 was associated with cumulative incidence of COVID-19 (Spearman rank correlation coefficient 0.87; 95%CI: 0.83-0.91, P<0.001).
Increase OHCA cases over the number in 2019 (133 additional cases) followed the course of the COVID-19 outbreak.
103 OHCA patients were suspected for COVID-19 or had a diagnosis of COVID-19 (87 and 16 patients, respectively), accounting for 77.4% of the increase in OHCA cases.

Conclusion

There was an increase of 58% in OHCA in Lombardy, Italy during the first 40 days of the COVID-19 outbreak compared to the same period last year, with even higher increase in Lodi and Cremona provinces. This issue should be considered when government are planning strategies to deal with the COVID-19 pandemic, especially during expected recurrent outbreaks.

Find this article online at NEJM Watch the video by Enrico Baldi