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Open accessJournal ArticleDOI: 10.1016/J.RESPLU.2021.100105

Out-of-hospital cardiac arrests and mortality in Swiss Cantons with high and low COVID-19 incidence: A nationwide analysis

02 Mar 2021-Vol. 6, pp 100105-100105
Abstract: Aims Many countries reported an increase of out-of-hospital cardiac arrests (OHCAs) and mortality during the COVID-19 pandemic. However, all these data refer to regional settings and national data are still missing. We aimed to assess the OHCA incidence and population mortality during COVID-19 pandemic in whole Switzerland and in the different regions (Cantons) according to the infection rate. Methods We considered OHCAs and deaths which occurred in Switzerland after the first diagnosed case of COVID-19 (February 25th) and for the subsequent 65 days and in the same period in 2019. We also compared Cantons with high versus low COVID-19 incidence. Results A 2.4% reduction in OHCA cases was observed in Switzerland. The reduction was particularly high (−21.4%) in high-incidence COVID-19 cantons, whilst OHCAs increased by 7.7% in low-incidence COVID-19 cantons. Mortality increased by 8.6% in the entire nation: a 27.8% increase in high-incidence cantons and a slight decrease (−0.7%) in low-incidence cantons was observed. The OHCA occurred more frequently at home, CPR and AED use by bystander were less frequent during the pandemic. Conversely, the OHCAs percentage in which a first responder was present, initiated the CPR and used an AED, increased. The outcome of patients in COVID-19 high-incidence cantons was worse compared to low-incidence cantons. Conclusions During the COVID-19 pandemic in Switzerland mortality increased in Cantons with high-incidence of infection, whilst not in the low-incidence ones. OHCA occurrence followed an opposite trend showing how variables related to the health-system and EMS organization deeply influence OHCA occurrence during a pandemic.

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Topics: Population (51%)
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Journal ArticleDOI: 10.1080/10903127.2021.1967535
Abstract: Introduction: COVID-19 pandemic overwhelmed healthcare systems and diverted resources allocated for other conditions. This systematic review and meta-analysis aimed to analyse how the pandemic impacted the system-of-care of out-of-hospital cardiac arrest.Methods: We searched PubMed and Embase up to May 31, 2021, for studies comparing out-of-hospital cardiac arrests that occurred during the COVID-19 pandemic versus a non-pandemic period. Survival at hospital discharge or at 30 days was the primary outcome.Results: We included 24 studies for a total of 75,952 patients. Out-of-hospital cardiac arrests during COVID-19 pandemic had lower survival (19 studies; 603/11,666 [5.2%] vs. 1320/17,174 [7.7%]; OR = 0.54; 95% CI, 0.44-0.65; P = 0.001) and return of spontaneous circulation (4370/24353 [18%] vs. 7401/34510 [21%]; OR = 0.64; 95% CI, 0.55-0.75; P < 0.001) compared with non-pandemic periods. Ambulance response times (10.1 vs 9.0 minutes, MD = 1.01; 95% CI, 0.59-1.42; P < 0.001) and non-shockable rhythms (18,242/21,665 [84%] vs. 19,971/24,817 [81%]; OR = 1.27; 95% CI, 1.10-1.46; P < 0.001) increased. Use of supraglottic airways devices increased (2853/7645 [37%] vs. 2043/17521 [12%]; OR = 1.97; 95% CI, 1.42-2.74; P < 0.001).Conclusions: The COVID-19 pandemic affected the system-of-care of out-of-hospital cardiac arrest, and patients had worse short-term outcomes compared to pre-pandemic periods. Advanced airway management strategy shifted from endotracheal intubation to supraglottic airway devices. REVIEW REGISTRATION: PROSPERO CRD42021250339.

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1 Citations


Open accessJournal ArticleDOI: 10.1016/J.IJCHA.2021.100824
Abstract: Background an increase in the time from the symptoms onset to first medical contact and to primary percutaneous coronary intervention (pPCI) has been observed in countries with high-incidence of COVID-19 cases. We aimed to verify if there was any change in the patient delay and in the EMS response times up to the pPCI for STEMI patients in Swiss Ticino Canton. Methods We assessed STEMI management including time from symptoms onset to EMS call, time of EMS response, time to pPCI in Swiss Canton Ticino. Data were retrieved from the Acute-Coronary-Syndrome-Ticino-Registry. We considered the patients included in the registry from March to May 2020 (pandemic period) and then from June to August 2020 (post-pandemic period) in whom a pPCI was performed. We compared these patients to those undergoing a pPCI in the same months in the year 2016-2019. Results During the pandemic period, the time from symptoms onset to pPCI significantly increased compared to non-pandemic periods. This was due to a significant prolongation of the time from symptoms onset to EMS call, that nearly tripled. In contrast, after the pandemic period, there was a significantly shorter time from symptom onset to EMS call compared to non-pandemic years, whereas all other times remained unchanged. Conclusion Patients delay the call to EMS despite symptoms of myocardial infarction during the COVID-19 pandemic also in a region with a relatively low incidence of COVID-19.

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Open accessJournal ArticleDOI: 10.1016/J.AUEC.2021.11.006
Ho Sub Chung1, Ho Sub Chung2, Myeong Namgung2, Dong Hoon Lee2  +2 moreInstitutions (2)
Abstract: Background The coronavirus disease 2019 (COVID-19) pandemic has prompted many changes. Revised cardiopulmonary resuscitation (CPR) recommendations were issued including increased requirement for personal protective equipment (PPE) during CPR and isolation rooms. We hypothesized that these changes might have affected transport times and distance. Accordingly, we investigated any differences in transport time and distance and their effect on patient neurologic outcomes at hospital discharge. Methods This retrospective study was conducted among patients who experienced cardiopulmonary arrest and were admitted to an emergency department during specific periods — pre-COVID-19 (January 1 to December 31, 2019) and COVID-19 (March 1, 2020, to February 28, 2021). Result The mean transport distance was 3.5±2.1km and 3.7±2.3km during the pre-COVID-19 and COVID-19 periods, respectively (p=0.664). The mean total transport time was 30.3±6.9min and 35.6±9.3min during the pre-COVID-19 and COVID-19 periods, respectively (p Conclusion Total transport time, including activation time for out-of-hospital cardiac arrest patients, increased owing to increased PPE requirements. However, there was no significant difference in the neurological outcome at hospital discharge.

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Journal ArticleDOI: 10.2139/SSRN.3802501
Baldi E, Roberto Primi, S Bendotti, A Currao  +19 moreInstitutions (1)
Abstract: Background: it is unknown if a correlation between the OHCA and COVID-19 daily incidence is present both during the first and second pandemic wave at a provincial level. Methods: We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided study period into period 1, the first 157 days after the outbreak and including the first pandemic wave (21/02/2020-26/07/2020) and period 2, the second 158 days including the second pandemic wave (27/07/2020-31/12/2020). We calculated the cumulative, daily and 7-days incidence of OHCA and COVID-19 expressed per 100,000 inhabitants for the whole territory and for each province separately for both periods. Findings: A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCA was observed both during the first and the second pandemic period in the whole territory (R=0.4, p<0.001 for period 1 and 2) and only in those provinces in which the cumulative incidence of COVID-19 overcame those of the whole territory (period 1: Cremona R=0.3, p=0.001; Lodi R=0.4, p<0.001; Pavia R=0.3; p=0.01; period 2: Varese R=0.4, p<0.001). Interpretation: Our results highlight how the COVID-19 burden in a given area could impact on the OHCAs occurrence. Our results stress the importance of strictly monitoring the pandemic trend to predict which territories will be more likely to experience an OHCA increase. That could serve as a guide to re-consider the pre-hospital resources allocation and tailored information campaigns in the future pandemic waves. Trial Registration: Lombardia Cardiac Arrest Registry (Lombardia CARe: NCT03197142) Funding Statement: Lombardia CARe is partially funded by the Fondazione Banca del Monte di Lombardia. Dr Baldi’s salary was partially funded by grant 733381 from the European Union Horizon 2020 Research and Innovation Program of ESCAPE-NET Declaration of Interests: None to disclose. Ethics Approval Statement: It was approved by the Ethical Committee of the Fondazione IRCSS Policlinico San Matteo (proc. 20140028219), where the registry is hosted, and by all the others involved in the territory.

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Topics: European union (52%)

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25 results found


Open accessJournal ArticleDOI: 10.1161/01.CIR.0000147236.85306.15
Ian N. Jacobs1, Vinay M. Nadkarni1, J. Bahr1, Robert A. Berg1  +30 moreInstitutions (1)
23 Nov 2004-Circulation
Abstract: Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002, a task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (ie, essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, emergency medical services system, and community.

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2,122 Citations


Open accessJournal ArticleDOI: 10.1056/NEJMC2009166
Abstract: Acute Coronary Syndrome during Covid-19 Outbreak During the Covid-19 outbreak in northern Italy, the daily rate of admissions for acute coronary syndrome at 15 hospitals was significantly lower tha...

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Topics: Outbreak (52%)

593 Citations


01 Jan 2010-Health
Abstract: This special edition of Health at a Glance focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey. It gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries.Its 42 indicators present comparable data covering a wide range of topics, including health status, risk factors, health workforce and health expenditure. Each indicator in the book is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicators and any limitations in data comparability. An annex provides additional information on the demographic and economic context within which health systems operate. This publication is the result of collaboration between the OECD and the European Commission, with the help of national data correspondents from the 31 countries.

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Topics: European union (59%)

563 Citations


Open accessJournal ArticleDOI: 10.1056/NEJMC2010418
Abstract: Out-of-Hospital Cardiac Arrest and Covid-19 From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy. During...

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Topics: Outbreak (52%)

357 Citations


Open accessJournal ArticleDOI: 10.1056/NEJMP2004211
Wendy E. Parmet1, Michael S. Sinha1Institutions (1)
Abstract: Covid-19 — The Law and Limits of Quarantine Community transmission of the new coronavirus is occurring in several parts of the United States, and travel bans and mandatory quarantines alone cannot ...

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246 Citations