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

The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis

BACKGROUND

Public health emergencies can disrupt the provision of and access to essential health-care services, exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services in Kenya.

METHODS

Using county-level data routinely collected from the health information system from health facilities across the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care workers' strike (from December, 2020 to January, 2021).

FINDINGS

In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the pandemic was associated with statistically significant decreases in multiple indicators, including outpatient visits (28·7%; 95% CI 16·0-43·5%), cervical cancer screening (49·8%; 20·6-57·9%), number of HIV tests conducted (45·3%; 23·9-63·0%), patients tested for malaria (31·9%; 16·7-46·7%), number of notified tuberculosis cases (26·6%; 14·7-45·1%), hypertension cases (10·4%; 6·0-39·4%), vitamin A supplements (8·7%; 7·9-10·5%), and three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5-1·3%). Pneumonia cases reduced by 50·6% (31·3-67·3%), diarrhoea by 39·7% (24·8-62·7%), and children attending welfare clinics by 39·6% (23·5-47·1%). Cases of sexual violence increased by 8·0% (4·3-25·0%). Skilled deliveries, antenatal care, people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases detected were not significantly affected negatively. Although most of the health indicators began to recover during the pandemic, the health-care workers' strike resulted in nearly all indicators falling to numbers lower than those observed at the onset or during the pre-strike pandemic period.

INTERPRETATION

The COVID-19 pandemic and the associated health-care workers' strike in Kenya have been associated with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated disease burdens during such health crises.

FUNDING

Bill & Melinda Gates Foundation.

Long-term spill-over impact of COVID-19 on health and healthcare of people with non-communicable diseases: a study protocol for a population-based cohort and health economic study

INTRODUCTION

The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future.

METHODS AND ANALYSIS

This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes.

ETHICS AND DISSEMINATION

The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21-297). The study findings will be disseminated through peer-reviewed publications and international conferences.

The Correlation Between COVID-19 Hospitalizations and Emergency Medical Services Responses for Time-Sensitive Emergencies During the COVID-19 Pandemic

OBJECTIVE

COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system.

METHODS

This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman's correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma.

RESULTS

During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95).

CONCLUSION

We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions.

Thin foil body-shield resuscitation barrier device to protect from blood: an experimental study

In times of collective concern about pandemics, body-shield resuscitation barrier devices are more and more considered to protect against transmission of different pathogens between rescuers and patients. The objective of this experimental study was to investigate the characteristics of blood drops dispersed on the surface of four different foils suitable for blanketing patients during resuscitation. We analyzed run-off characteristics of blood stains depending on surface properties of polyvinyl chloride, polyethylene, polyethylene terephthalate and aluminum-coated polyethylene terephthalate. Confocal fluorescence microscopy revealed less cellular density and lack of fibrin networks in blood stains on the four foil surfaces than on paper towel. Delayed clotting went along with larger areas of contamination indicating a greater likelihood of coming into contact with potential germs but a smaller chance of contracting an infection. Space blankets as obligatory components of first aid kits are readily available for rescuers and serve as a mechanical barrier between rescuers and patients during resuscitation.

Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis

Background

In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure.

Methods

Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50).

Results

A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year.

Conclusions

ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s00392-022-02074-3.

Hospitalization, major complications and mortality in acute myocardial infarction patients during the COVID-19 era: A systematic review and meta-analysis

Since the SARS-CoV-2 pandemic began, numerous studies have reported a concerning drop in the number of acute myocardial infarction (AMI) admissions. In the present systematic review and meta-analysis, we aimed to compare the rate of AMI admissions and major complication during the pandemic, in comparison with pre-pandemic periods. Three major databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Out of 314 articles, 41 were entered into the study. Patients hospitalized for AMI were 35% less in the COVID-19 era compared with pre-pandemic periods, which was statistically significantly (OR = 0.65; 95% CI: 0.56–0.74; I² = 99%; p < 0.001; 28 studies). Patients hospitalized for STEMI and NSTEMI were 29% and 34% respectively less in the COVID-19 era compared with periods before COVID-19, which was statistically significantly (OR = 0.71; 95% CI: 0.65 –0.78; I² = 93%; p < 0.001; 22 studies, OR = 0.66; 95% CI: 0.58–0.73; I² = 95%; p < 0.001; 14 studies). The overall rate of in-hospital mortality in AMI patients increased by 26% in the COVID-19 era, which was not statistically significant (OR = 1.26; 95% CI: 1.0–1.59; I² = 22%; p < 0.001; six studies). The rate of in-hospital mortality in STEMI and NSTEMI patients increased by 15% and 26% respectively in the COVID-19 era, which was not statistically significant (OR = 1.15; 95% CI: 0.85–1.57; I² = 48%; p = 0.035; 11 studies, OR = 1.35; 95% CI: 0.64–2.86; I² = 45%; p = 0.157; 3 articles). These observations highlight the challenges in the adaptation of health-care systems with the impact of the COVID-19 pandemic.

Occurrence and Temporal Variability of Out-of-Hospital Cardiac Arrest during COVID-19 Pandemic in Comparison to the Pre-Pandemic Period in Poland-Observational Analysis of OSCAR-POL Registry

An investigation of the chronobiology of out-of-hospital cardiac arrest (OHCA) during the coronavirus disease 2019 (COVID-19) pandemic and the differences in comparison to the 6-year pre-pandemic period. A retrospective analysis of the dispatch cards from the Emergency Medical Service between January 2014 and December 2020 was performed within the OSCAR-POL registry. The circadian, weekly, monthly, and seasonal variabilities of OHCA were investigated. A comparison of OHCA occurrence between the year 2020 and the 6-year pre-pandemic period was made. A total of 416 OHCAs were reported in 2020 and the median of OHCAs during the pre-pandemic period was 379 (interquartile range 337−407) cases per year. Nighttime was associated with a decreased number of OHCAs (16.6%) in comparison to afternoon (31.5%, p < 0.001) and morning (30.0%, p < 0.001). A higher occurrence at night was observed in 2020 compared to 2014−2019 (16.6% vs. 11.7%, p = 0.001). Monthly and seasonal variabilities were observed in 2020. The months with the highest OHCA occurrence in 2020 were November (13.2%) and October (11.1%) and were significantly higher compared to the same months during the pre-pandemic period (9.1%, p = 0.002 and 7.9%, p = 0.009, respectively). Autumn was the season with the highest rate of OHCA, which was also higher compared to the pre-pandemic period (30.5% vs. 25.1%, p = 0.003). The COVID-19 pandemic was related to a higher occurrence of OHCA. The circadian, monthly, and seasonal variabilities of OHCA occurrence were confirmed. In 2020, the highest occurrence of OHCA was observed in October and November, which coincided with the highest occurrence of COVID-19 infections in Poland.

The importance of elderly people knowing basic first-aid measures

Background

In the event of a sudden illness or injury, elderly individuals are often dependent on self-help and mutual assistance from partners. With poor access to medical services during natural and other disasters, the importance of first aid knowledge of elderly individuals increases even more. We assessed the opinions of different generations of Slovenian population regarding the importance of knowing the basic first aid measures. In addition, we aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people’s health and lives, focusing on the knowledge of elderly.

Methods

A structured questionnaire was conducted with a representative Slovenian adult population (n = 1079). Statistically significant differences in average ratings of the importance of first aid knowledge were compared among different age groups with one-way ANOVA followed by a post hoc test. Significant differences in percentages of correct answers in particular cases of health conditions between different age groups were determined using the χ ² test followed by post hoc tests.

Results

Slovenes are well aware of the importance of first aid knowledge and feel personally responsible for acquiring this knowledge. The general opinion is that older retirees need less first aid knowledge than individuals in younger populations. We found a high level of knowledge about symptoms and first aid measures for some of the most common health conditions that occur in old age. The level of knowledge in the group of the oldest respondents was comparable with that of younger age groups. However, their recognition of health conditions was also somewhat worse, especially when recognising the symptoms and signs of hypoglycaemia and heart attack. Most of the tested knowledge did not depend on a person’s age but on the time since that person was last educated in first aid.

Conclusions

The knowledge of people older than 80 years is somewhat poorer than that in the younger population, mainly because too much time has passed since they were last educated in first aid. Public awareness of first aid needs to be increased and appropriate guidelines should be given with a focus on the elderly population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00675-9.

Design and testing of the safety of the SARUS-CPR hood for novice resuscitators

BACKGROUND AND AIMS

Bystanders should be protected against aerosols, droplets, saliva, blood and vomitus during resuscitation after cardiac arrest The SARUS (safer - airway - resuscitation) CPR airway hood™ is a clear plastic cover and integrated mask that envelopes the head and torso. Our objectives were to test leakage using saline aerosol generation tests, then assess the performance of the hood during mock cardio-pulmonary resuscitation on a manikin.

METHODS

A checklist was validated by comparing the performance of 10 novices against 10 experts during mock resuscitation. Thereafter, 15 novices were tested with and without the hood, in a randomised cross-over study, one week apart.

RESULTS

Laboratory analysis showed a > 99% reduction of saline particles detected 5 cm, 75 cm and 165 cm above volunteers wearing the hood. On manikins, experts scored better compared to novices, 8.5 (0.7) vs 7.6 (1.2), difference (95%CI) 0.9 (0.4-1.3), P = 0.0004. Novice performance was equivalent using the hood and standard equipment, 7.3 (1.4) vs 7.3 (1.1) respectively, difference (90%CI) 0.0 (-0.3 - 0.3), P = 0.90.

CONCLUSION

Aerosol transmission reduced in the breathing zone. Simulated resuscitation by novices was equivalent with and without the hood.

Features of the pathogenesis and course of myocardial infarction in COVID-19 patients: a descriptive review

The coronavirus disease 2019 (COVID-19) pandemic remains one of the most urgent problems for healthcare professionals due to the variety of non-pulmonary manifestations. Along with the respiratory syndrome in a significant proportion of patients, the disease course is accompanied by pronounced systemic inflammatory response and hemostasis changes. This is associated with a high risk of complications, especially in patients with concomitant cardiovascular pathology. The aim of the study was to analyze and systematize the literature data on the pathogenesis, clinical course, and outcomes of myocardial infarction (MI) in patients with COVID-19. For review, publications indexed in the PubMed, Google Scholar, Web of Science, and Cyberleninka databases were used. The search depth was 2 years, starting from 2020. The review is based on summarized data from the most relevant clinical studies, reports and systematic reviews. The literature analysis made it possible to conclude that the published data on MI in patients with COVID-19 are currently contradictory. Multiple thrombosis, sepsis, macrophage activation, increasing hypoxemia, imbalance between myocardial oxygen supply and demand in patients with severe COVID-19 have led to a high incidence of type 1 and type 2 MI. It should be especially noted that in a number of cases, MI with COVID-19 occurs in patients with intact coronary arteries, and its course is associated with a high incidence of complications, which, in turn, leads to a significant increase in short- and mid-term mortality.

A Cross-sectional Study of Assessing Knowledge, Attitude, and Practice of COVID-19 Resuscitation among Health Care Workers in a Hybrid Hospital for COVID-19 in Malaysia

Background

The COVID-19 pandemic is an international public health emergency. As hospitals receive more severe forms of COVID-19 that necessitate resuscitation, emergency health care workers (HCW) must follow interim COVID-19 resuscitation guidelines.

Objective

The aim is to evaluate the levels of knowledge, attitude, and practice among emergency HCW of the COVID-19 resuscitation protocol by the European Resuscitation Council (ERC).

Methods

A cross-sectional study using a validated questionnaire was conducted among HCW in the emergency department of University of Malaya Medical Centre (UMMC), Malaysia from April to June 2021.

Results

A total of 159 respondents were included in the analysis (89% response rate). Sixty-eight percent of respondents had adequate knowledge regarding COVID-19 resuscitation. Majority of the respondents had knowledge on airborne-precaution personal protective equipment (PPE) (99%) and infection control measures (98%). Nearly 73% were pessimistic about the COVID-19 prognosis. Seventy-three percent of respondents thought an arrested COVID-19 patient may benefit from cardiopulmonary resuscitation (CPR) and 94% were willing to administer CPR provided airborne-precaution PPE was available. Ninety percent of respondents reported adherence to resuscitation guidelines. There were significant differences in the mean knowledge scores between designation, education levels, and COVID-19 training. Overall, the respondents’ level of practice was insufficient (27%), with a mean score of 53.7% (SD = 14.7). There was a lack of practice in the resuscitation of the intubated and patients who were being prone. There was insufficient practice about ventilation technique, use of supraglottic devices, and intubation barriers. There was a positive correlation between adequate knowledge and good practice.

Conclusion

Emergency HCW have adequate knowledge, but poor compliance to the ERC COVID-19 guidelines. Emergency HCW were willing and confident to resuscitate COVID-19 patients, despite fears of nosocomial infection and expectation of poor patients’ prognosis. Ongoing education and training programs are recommended to improve their knowledge, cultivate a positive attitude, and achieve good compliance with COVID-19 resuscitation guidelines.

Treatment delay and outcomes of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention during the COVID-19 era in South Korea

BACKGROUND/AIMS

Little is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI) in Korea during the coronavirus disease 2019 (COVID-19) era. We aimed to evaluate the clinical characteristics and treatment outcomes of patients with STEMI in the COVID-19 era.

METHODS

A total of 588 consecutive patients with STEMI who underwent primary percutaneous coronary intervention were included in this study. The patients were categorized into the COVID-19 (from January 20, 2020 to December 31, 2020) and control groups (from January 20, 2019 to December 31, 2019).

RESULTS

The COVID-19 group showed pre-hospital and in-hospital delays than the control group. The control group underwent more thrombus aspiration and had a higher proportion of left main coronary artery diseases, while the COVID-19 group had a higher proportion of multivessel diseases with a marked increase in the number and total length of stents than the control group. As for the prescribed medications, the COVID-19 group was administered more beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins than the control group. The clinical outcomes were comparable between the groups, except for higher incidences of atrioventricular block and temporary pacemaker implantation in the COVID-19 group.

CONCLUSION

Reperfusion after STEMI treatment during the COVID-19 period was delayed; therefore, efforts should be made to improve on reperfusion.

Medication Adherence and Belief about Medication among Vietnamese Patients with Chronic Cardiovascular Diseases Within the Context of Implementing Measures to Prevent COVID-19

Background: Long-term adherence is crucial for optimal treatment outcomes in chronic cardiovascular diseases (CVDs), especially throughout the COVID-19 wide-spreading periods, making patients with chronic CVDs vulnerable subjects. Aim: To investigate the relationship between the characteristics, beliefs about prescribed medication, COVID-19 prevention measures, and medication adherence among patients with chronic CVDs. Methods: This is a cross-sectional study of outpatients with chronic CVDs in Southern Vietnam. The specific parts regarding the Beliefs about Medicines Questionnaires (BMQ—Specific) and the General Medication Adherence Scale (GMAS) were applied to assess the beliefs about and adherence to medication. The implementation measures to prevent COVID-19 in patients were evaluated according to the 5K message (facemask, disinfection, distance, no gathering, and health declaration) of the Vietnam Ministry of Health. A multivariable logistic regression with the Backward elimination (Wald) method was used to identify the associated factors of medication adherence. Results: A slightly higher score in BMQ-Necessity compared to BMQ-Concerns was observed. A total of 40.7% of patients were recorded as having not adhered to their medications. Patients’ behavior was most frequently self-reported by explaining their non-adherence (34.7%). Statistical associations were found between rural living place, unemployment status, no or only one measure(s) of COVID-19 prevention application, and medication adherence. Conclusion: During the COVID-19 spreading stage, patients generally showed a positive belief about medication when they rated the importance of taking it higher than its side effects. The data analysis suggested that rather than patients’ beliefs, the clinicians should consider the patient factors, including living place, employment, and the number of epidemic preventive measures applied for guiding the target patients for improving medication adherence.

Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A systematic review and meta-analysis

BACKGROUND

As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs.

METHODS

We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology.

RESULTS

Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty).

CONCLUSIONS

There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020201256 (Sept 2, 2020).

Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan

BACKGROUND

The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic.

METHODS

This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes.

RESULTS

The witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes.

CONCLUSION

The COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.

Impact of the COVID-19 outbreak on out-of-hospital cardiac arrest management and outcomes in a low-resource emergency medical service system: a perspective from Thailand

Background

The impact of the coronavirus disease 2019 (COVID-19) outbreak on out-of-hospital cardiac arrest (OHCA) has been of interest worldwide. However, evidence from low-resource emergency medical service systems is limited. This study investigated the effects of the COVID-19 outbreak on the prehospital management and outcomes of OHCA in Thailand.

Methods

This multicentered, retrospective, observational study compared the management and outcomes of OHCA for 2 periods: pre-COVID-19 (January–September 2019) and during the outbreak (January–September 2020). Study data were obtained from the Thai OHCA Network Registry. The primary outcome was survival rate to hospital discharge. Data of other OHCA outcomes and prehospital care during the two periods were also compared.

Results

The study enrolled 691 patients: 341 (49.3%) in the pre-COVID-19 period and 350 (50.7%) in the COVID-19 period. There was a significant decrease in the survival rate to discharge during the COVID-19 outbreak (7.7% vs 2.2%; adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.95). However, there were no significant differences between the 2 groups in terms of their rates of sustained return of spontaneous circulation (33.0% vs 31.3%; aOR, 1.01; 95% CI, 0.68–1.49) or their survival to intensive care unit/ward admission (27.8% vs 19.8%; aOR, 0.78; 95% CI, 0.49–1.15). The first-responder response interval was significantly longer during the COVID-19 outbreak (median [interquartile range] 5.3 [3.2–9.3] min vs 10 [6–14] min; P < 0.001). There were also significant decreases in prehospital intubation (66.7% vs 48.2%; P < 0.001) and prehospital drug administration (79.5% vs 70.6%; P = 0.024) during the COVID-19 outbreak.

Conclusion

There was a significant decrease in the rate of survival to hospital discharge of patients with OHCA during the COVID-19 outbreak in Thailand. Maintaining the first responder response quality and encouraging prehospital advanced airway insertion might improve the survival rate during the COVID-19 outbreak.

Cardiac arrest and coronavirus disease 2019

PURPOSE OF REVIEW

The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA).

RECENT FINDINGS

An increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest.

SUMMARY

Cardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.

Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany

BACKGROUND

The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region.

METHODS

Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described.

RESULTS

Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was documented more often, 66.7% (16/24) vs 38.2% (39/102) there were longer emergency medical services (EMS) response times, more resuscitation attempts terminated on scene, 62.5% (15/24) vs. 34.3% (35/102) and less patients transported to hospital (p = 0.019). Public basic life support courses, an app-based first-responder alarm system, Kids Save Lives activities and a prehospital extracorporeal CPR (eCPR) service were paused during the peak of the pandemic.

CONCLUSION

In our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital significantly decreased during the first pandemic wave. Several important parts of the resuscitation landscape were paused. The COVID-19 pandemic impedes OHCA care, which leads to additional casualties. Countermeasures should be taken.

Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study

Background

The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation.

Materials and method

All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered.

Results

A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]).

Conclusion

This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine.

•

Hospitalizations for cataract surgery, coronary angioplasty, hip and knee arthroplasties were strongly impacted by the pandemic from 2020 until the first half of 2021, without any catch-up outside the lockdown periods and despite the gradual rollout of the national COVID-19 vaccine campaign in 2021.

•

Definitive cardiac stimulation was the only surgery not really impacted.

•

Optimize surgical patient care in a pandemic setting and identify ways to improve the available capacity of surgical activity.

How effective are chest compressions when wearing mask? A randomised simulation study among first-year health care students during the COVID-19 pandemic

Background

The resuscitation guidelines provided for the COVID-19 pandemic strongly recommended wearing personal protective equipment. The current study aimed to evaluate and compare the effectiveness of chest compressions and the level of fatigue while wearing two different types of mask (surgical vs. cloth).

Methods

A randomized, non-inferiority, simulation study was conducted. Participants were randomised into two groups: surgical mask group (n = 108) and cloth mask group (n = 108). The effectiveness (depth and rate) of chest compressions was measured within a 2-min continuous chest-compression-only CPR session. Data were collected through an AMBU CPR Software, a questionnaire, recording vital parameters, and using Borg-scale related to fatigue (before and after the simulation). For further analysis the 2-min session was segmented into 30-s intervals.

Results

Two hundred sixteen first-year health care students participated in our study. No significant difference was measured between the surgical mask and cloth mask groups in chest compression depth (44.49 ± 10.03 mm vs. 45.77 ± 10.77 mm), rate (113.34 ± 17.76/min vs. 111.23 ± 17.51/min), and the level of fatigue (5.72 ± 1.69 vs. 5.56 ± 1.67) (p > 0.05 in every cases). Significant decrease was found in chest compression depth between the first 30-s interval and the second, third, and fourth intervals (p < 0.01).

Conclusion

The effectiveness of chest compressions (depth and rate) was non-inferior when wearing cloth mask compared to wearing surgical mask. However, the effectiveness of chest compressions decreased significantly in both groups during the 2-min chest-compression-only CPR session and did not reach the appropriate chest compression depth range recommended by the ERC.

European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis

AIMS

Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19.

METHODS AND RESULTS

A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19.

CONCLUSION

This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.

Interdigitated Organic Sensor in Multimodal Facemask's Barrier Integrity and Wearer's Respiration Monitoring

Facemasks are used as a personal protective equipment in medical services. They became compulsory during the recent COVID-19 pandemic at large. Their barrier effectiveness during various daily activities over time has been the subject of much debate. We propose the fabrication of an organic sensor to monitor the integrity of surgical masks to ensure individuals' health and safety during their use. Inkjet printing of an interdigitated conducting polymer-based sensor on the inner layer of the mask proved to be an efficient and direct fabrication process to rapidly reach the end user. The sensor's integration happens without hampering the mask functionality and preserving its original air permeability. Its resistive response to humidity accumulation allows it to monitor the mask's wetting in use, providing a quantified way to track its barrier integrity and assist in its management. Additionally, it detects the user's respiration rate as a capacitive response to the exhaled humidity, essential in identifying breathing difficulties or a sign of an infection. Respiration evaluations during daily activities show outstanding performance in relation to unspecific motion artifacts and breathing resolution. This e-mask yields an integrated solution for home-based individual monitoring and an advanced protective equipment for healthcare professionals.

Cardiovascular manifestations secondary to COVID-19: A narrative review

The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.

Effect of the COVID-19 Pandemic on Emergency Department Visits of Patients with an Emergent or Urgent Diagnosis

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, visits to emergency department (ED) have significantly declined worldwide. The purpose of this study was to identify the trend of visits to ED for different diseases at the peak and slack stages of the epidemic.

Patients and Methods

This was a retrospective observational study conducted in a tertiary referral medical center in northern Taiwan. We recorded weekly ED visits for myocardial infarction with or without ST-elevation (STEMI or NSTEMI), out-of-hospital cardiac arrest (OHCA), acute stroke, and congestive heart failure from 2016 to 2021. We compared the local epidemic peak periods (calendar weeks 4–18, 2020 and calendar weeks 21–31, 2021) and its corresponding slack periods (calendar weeks 4–18, 2021 and calendar weeks 21–31, 2020) with the baseline period (2016–2019) using Mann–Whitney test to identify the difference.

Results

We observed a significant decline in ED visits (median [Q1, Q3]) during the epidemic for OHCA (6 [5, 7] and 5 [4, 6], p = 0.046, for baseline and peak period, respectively, in week 4–18), acute stroke (41.5 [38, 47] and 35 [28, 39], p < 0.001, in week 4–18, 40 [35, 45] and 35 [28, 40], p = 0.039, in week 21–31) and CHF (28 [24.25, 33] and 19 [12, 23], p < 0.001, in week 4–18, 18 [16, 23] and 13 [11, 16], p = 0.001, in week 21–31). Significant difference was not observed in patients with NSTEMI and STEMI in both week 4–18 and 21–31, and cardiac arrest in week 21–31. There was a rebound in ED visits in the slack period.

Conclusion

This study revealed that ED visits significantly declined during the COVID-19 epidemic and rebounded in the slack period. The trend was significant for acute stroke and heart failure but was relatively less prominent effect for emergent events such as cardiac arrest or myocardial infarction.

The Impact of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Substance Use in the United States

The SARS-CoV-2 pandemic has been associated with dramatic increases in substance use, as marked by increased alcohol, nicotine, and cannabis sales. Lethal opioid overdoses also increased dramatically, especially during the initial phases of the epidemic when lockdowns and social isolation combined with increasing fentanyl contamination of the illicit drug supply resulted in more overdoses and fewer opportunities for rescue. Substance use, and especially inhalational drug use, increases the likelihood of both transmission and severe infection. Youth are especially vulnerable to substance use and have increased risk of long-term problems. These outcomes highlight the need for greater access to substance use treatment. Virtual treatment, which emerged as a promising format during the pandemic, may reduce access barriers. This article reviews trends in substance use during the pandemic, explores root causes of increased use and overdose, and examines the potential to increase treatment through virtual care, especially during future periods of disruption.

The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review

Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.

Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.

Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.

Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.

COVID-19 and Cardiac Arrhythmias: a Contemporary Review

Purpose of Review

A significant proportion of patients infected by the severe acute respiratory syndrome-coronavirus (SARS-CoV2) (COVID-19) also have disorders affecting the cardiac rhythm. In this review, we provide an in-depth review of the pathophysiological mechanisms underlying the associated arrhythmic complications of COVID-19 infection and provide pragmatic, evidence-based recommendations for the clinical management of these conditions.

Recent Findings

Arrhythmic manifestations of COVID-19 include atrial arrhythmias such as atrial fibrillation or atrial flutter, sinus node dysfunction, atrioventricular conduction abnormalities, ventricular tachyarrhythmias, sudden cardiac arrest, and cardiovascular dysautonomias including the so-called long COVID syndrome. Various pathophysiological mechanisms have been implicated, such as direct viral invasion, hypoxemia, local and systemic inflammation, changes in ion channel physiology, immune activation, and autonomic dysregulation. The development of atrial or ventricular arrhythmias in hospitalized COVID-19 patients has been shown to portend a higher risk of in-hospital death.

Summary

Arrhythmic complications from acute COVID-19 infection are commonly encountered in clinical practice, and COVID-19 patients with cardiac complications tend to have worse clinical outcomes than those without. Management of these arrhythmias should be based on published evidence-based guidelines, with special consideration of the acuity of COVID-19 infection, concomitant use of antimicrobial and anti-inflammatory drugs, and the transient nature of some rhythm disorders. Some manifestations, such as the long COVID syndrome, may lead to residual symptoms several months after acute infection. As the pandemic evolves with the discovery of new SARS-CoV2 variants, development and use of newer anti-viral and immuno-modulator drugs, and the increasing adoption of vaccination, clinicians must remain vigilant for other arrhythmic manifestations that may occur in association with this novel but potentially deadly disease.

Out-of-hospital and in-hospital cardiac arrest during the COVID-19 pandemic: changes in demographics, outcomes and management

During the COVID-19 pandemic, prehospital and hospital services were put under great stress because of limited resources and increased workloads. One expected effect was the increased number of out-of-hospital (OHCA) and in-hospital (IHCA) cardiac arrests that occurred during 2020 compared to previous years. Both direct and indirect mechanisms were involved. In the former case, although the exact mechanisms by which Sars-Cov-2 causes cardiac arrest (CA) are still unknown, severe hypoxia, a dysregulated immune host response and sepsis are probably implicated and are often seen in COVID-19 patients with poor outcomes. In the latter case, the strain on hospitals, changes in treatment protocols, governments' actions to limit the spread of the disease and fear of the contagion naturally affected treatment efficacy and disrupted the CA chain of survival; as expected in OHCA, only a small proportion of patients were positive to COVID-19, and yet reported outcomes were worse during the pandemic. CA patient characteristics were reported, along with modifications in patient management. In this review, we summarise the evidence to date regarding OHCA and IHCA epidemiology and management during the COVID-19 pandemic.

The role of climate on Covid-19 spread in France

This paper investigates the influence of climate on the transmission of the SARS-CoV-2 virus in France. Ordinary, time-varying, and threshold regressions of the number of cases and deaths are run on weather and government variables. The main findings support the role of climate in Covid-19 spread. The results reveal that a rise in temperatures is negatively associated with reported deaths, while an increase in relative humidity or wind and a decrease in precipitations are negatively associated with confirmed cases. These weather variables appear statistically significant only during the winter season.

Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings

Introduction

Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable.

Objective

This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest.

Discussion

COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival.

Conclusion

This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.

Impact of COVID-19 on Hospital Admissions and Healthcare Quality Indicators in Non-COVID Patients: A Retrospective Study of the First COVID-19 Year in a University Hospital in Spain

Few studies have assessed the impact of the COVID-19 pandemic on non-COVID diseases and healthcare quality. We aimed to evaluate changes in rates of hospitalisations, complications, in-hospital mortality, and readmissions among patients with non-COVID diseases during a one-year period after the pandemic onset. From March 2018 to February 2021 a retrospective observational study of hospital admissions in a university hospital in Spain was conducted. Non-COVID hospitalisations admitted through the emergency department were compared between the pre-COVID period (n = 28,622) and the COVID period (n = 11,904). We assessed rate ratios (RaR), comparing the weekly number of admissions and risk ratios (RR) to examine rates of complications, in-hospital mortality, readmissions, and severity. Statistical significance was set at p < 0.05. The weekly admission rate dropped by 20.8% during the complete lockdown. We observed significant reductions in admissions related to diseases of the respiratory system and circulatory system. Admissions for endocrine and metabolic diseases increased. The complication rates increased (RR = 1.21, 95% CI: 1.05;1.4), while in-hospital mortality rates held steady during the COVID period (RR = 1.09, 95% CI: 0.98;1.2). Hospital efforts to maintain quality and safety standards despite disruptions translated into a moderate increase in complications but not in in-hospital mortality. Reduced hospitalisations for conditions requiring timely treatment may have significant public health consequences.

European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis

AIMS

Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19.

METHODS AND RESULTS

A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19.

CONCLUSION

This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.

[The COVID-19 pandemic's impacts on adverse events associated with care]

Since early 2020, the onset of the COVID-19 pandemic, physicians have continued to report adverse events associated with care. Patients also continued to participate in the hospital satisfaction surveys. To date, no study in France has measured the impact of the pandemic on adverse events and patient satisfaction. We looked at the characteristics of these adverse events in relation to the pandemic and put patients' feelings into perspective. A qualitative and observational retrospective study of the REX and MCO48 databases was carried out. The quantitative study of the REX database was supplemented by a qualitative analysis of the declarations. The adverse events more often affects middle-aged men aged 60 years, while deaths occur in older patients with more complex pathologies and more urgent management. The nature of these events is different depending on the reporting period: Those reported in the first wave are more urgent, occur less frequently in the operating room than in the emergency room, and are considered less preventable than those reported in the second wave. The latter are more similar to the events that usually occur. The implementation of effective barriers, particularly within the teams, has made it possible to reduce the impact of the second wave on the occurrence of these events, the role of communication seems essential. The overall patient satisfaction score as well as those for medical and paramedical care has increased, which may reflect patient solidarity with caregivers. The attitude of active resilience on the part of all actors has been a major element in risk management during this crisis and it is essential to capitalize on these collaborative processes for the future.

Six Months After the Patients Stayed Home: A Nationwide Study of Cardiac Mortality and Readmissions Following the First Wave of the COVID-19 Pandemic in Malta

Background

The first COVID-19 wave resulted in a significant decline in acute cardiac admissions (ACAs) and delays to hospital presentation in Malta, as well as an excess of out-of-hospital cardiac arrests. The aim was to investigate the impact of the observed delays in presentation in 2020 on mortality and cardiac readmissions at six months.

Methods

All ACAs between 28th February and 30th April 2020 (first wave of COVID-19 in Malta) were included, and the corresponding 2019 period was used as a control. ACA was defined as an unplanned admission of an adult (aged ≥16 years) under the care of a cardiologist. Outcomes over the six months following the index ACA included death, cardiac readmission, and planned cardiac intervention at discharge. The term ‘death’ referred to all-cause mortality. Cardiac readmissions referred to unplanned admissions for acute cardiac pathology following the index ACA. During sub-analyses, ACAs were divided into acute coronary syndrome (ACS) and non-ACS. A first analysis compared the frequency of deaths, cardiac readmissions, and planned interventions between the 2019 and 2020 cohorts. A second analysis investigated differences in six-month survival and freedom from readmission between the two cohorts. Both analyses were followed by a sub-analysis.

Results

There were 330 ACAs among the 2019 cohort and 220 in 2020. There were no significant differences between the 2019 and 2020 cohorts in all-cause mortality (2019, 8.8% vs 2020, 8.2%, p=0.466) and Kaplan-Meier survival estimates at a six-month follow-up (2019, 169.06 days (95% CI 164.95-173.17) vs 2020, 168.27 days (95% CI 162.82-173.72), p=0.836), including subgroup analysis for non-ACS (2019, 168.52 days (95% CI 163.08-173.96) vs 168.11 days (95% CI 160.93-175.30), p=0.952) and ACS patients (169.81 days (95% CI 163.54-176.09) in 2019 vs 168.45 days (95% CI 160.17-176.73) in 2020, p=0.739).

A significantly higher number of patients from the 2019 cohort (75/319, 23.5%) required readmission compared to 2020 (32/212; 15.1%) (p=0.02). Similarly, there was shorter freedom from cardiac readmission among 2019 patients (mean 150.98 days (95% CI 144.63-157.33)) compared to 2020 patients (mean 158.66 days (95% CI 151.58-165.74, p=0.024). During sub-analysis, the difference in freedom from readmission was significant only for non-ACS patients (mean of 145.45 days (95% CI 136.58-154.32) in 2019 vs 158.92 days (95% CI 149.19-168.64) in 2020, p=0.018).

Analysis of cardiac interventions during the six months post-index ACA discharge showed significantly more planned cardiac interventions in 2019 (52/319; 16.3%) compared to 2020 (20/212; 9.4%) (p=0.027).

Conclusions

A delay in presentation of ACAs during COVID-19 in Malta resulted in lower readmission rates and increased freedom from readmissions, with no excess in all-cause mortality at a six-month follow-up. The reasons for the optimistic outcomes of patients admitted during the first wave of COVID-19 may be multifactorial. Reasons may include ongoing fear of hospital presentation, a more holistic approach to patients’ in-hospital care during 2020 aimed at reducing further hospital contact post-discharge, and a selection bias secondary to an excess of out-of-hospital cardiac arrests during the initial wave of COVID-19. Further studies will be required to truly assess the collateral impact of non-COVID-19-related illness. Public education on cardiovascular health is vital and must be emphasized during the pandemic.

Activation of Citizen Responders to Out‐of‐Hospital Cardiac Arrest During the COVID‐19 Outbreak in Denmark 2020

Background

Little is known about how COVID‐19 influenced engagement of citizen responders dispatched to out‐of‐hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID‐19 lockdown in 2020.

Methods and Results

All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P=0.07). Bystander defibrillation (9% versus 14%; P=0.4) or return‐of‐spontaneous circulation (23% versus 23%; P=1.0) also did not differ. A similar amount of citizen responders accepted alarms during the lockdown (6 per alarm; interquartile range, 6) compared with the nonlockdown period (5 per alarm; interquartile range, 5) (P=0.05). More citizen responders reported performing chest‐compression‐only cardiopulmonary resuscitation during lockdown compared with nonlockdown (79% versus 59%; P=0.0029), whereas fewer performed standardized cardiopulmonary resuscitation, including ventilations (19% versus 38%; P=0.0061). Finally, during lockdown, more citizen responders reported being not psychologically affected by attending an OHCA compared with nonlockdown period (68% versus 56%; P<0.0001). Likewise, fewer reported being mildly affected during lockdown (26%) compared with nonlockdown (35%) (P=0.003).

Conclusions

The COVID‐19 lockdown in Denmark was not associated with decreased bystander‐initiated resuscitation in OHCAs attended by citizen responders.

Heat-related mortality amplified during the COVID-19 pandemic

Excess mortality not directly related to the virus has been shown to have increased during the COVID-19 pandemic. However, changes in heat-related mortality during the pandemic have not been addressed in detail. Here, we performed an observational study crossing daily mortality data collected in Portugal (SICO/DGS) with high-resolution temperature series (ERA5/ECMWF), characterizing their relation in the pre-pandemic, and how it aggravated during 2020. The combined result of COVID-19 and extreme temperatures caused the largest annual mortality burden in recent decades (~ 12 000 excess deaths [~ 11% above baseline]). COVID-19 caused the largest fraction of excess mortality during March to May (62%) and from October onwards (85%). During summer, its direct impact was residual, and deaths not reported as COVID-19 dominated excess mortality (553 versus 3 968). A prolonged hot spell led mortality to the upper tertile, reaching its peak in mid-July (+ 45% deaths/day). The lethality ratio (+ 14 deaths per cumulated ºC) was higher than that observed in recent heatwaves. We used a statistical model to estimate expected deaths due to cold/heat, indicating an amplification of at least 50% in heat-related deaths during 2020 compared to pre-pandemic years. Our findings suggest mortality during 2020 has been indirectly amplified by the COVID-19 pandemic, due to the disruption of healthcare systems and fear of population in attending healthcare facilities (expressed in emergency room admissions decreases). While lockdown measures and healthcare systems reorganization prevented deaths directly related to the virus, a significant burden due to other causes represents a strong secondary impact. This was particularly relevant during summer hot spells, when the lethality ratio reached magnitudes not experienced since the 2003 heatwaves. This severe amplification of heat-related mortality during 2020 stresses the need to resume normal healthcare services and public health awareness.

COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction

OBJECTIVE

The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days).

METHODS

This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality.

RESULTS

In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic.

CONCLUSION

Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.

TRIAL REGISTRATION NUMBER

NCT04412655.

First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

Background

Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19.

Methods

To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe.

Results

We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission.

Conclusions

European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-022-00998-3.

Comparative Effectiveness of an Automated Text Messaging Service for Monitoring COVID-19 at Home

BACKGROUND

Although most patients with SARS-CoV-2 infection can be safely managed at home, the need for hospitalization can arise suddenly.

OBJECTIVE

To determine whether enrollment in an automated remote monitoring service for community-dwelling adults with COVID-19 at home ("COVID Watch") was associated with improved mortality.

DESIGN

Retrospective cohort analysis.

SETTING

Mid-Atlantic academic health system in the United States.

PARTICIPANTS

Outpatients who tested positive for SARS-CoV-2 between 23 March and 30 November 2020.

INTERVENTION

The COVID Watch service consists of twice-daily, automated text message check-ins with an option to report worsening symptoms at any time. All escalations were managed 24 hours a day, 7 days a week by dedicated telemedicine clinicians.

MEASUREMENTS

Thirty- and 60-day outcomes of patients enrolled in COVID Watch were compared with those of patients who were eligible to enroll but received usual care. The primary outcome was death at 30 days. Secondary outcomes included emergency department (ED) visits and hospitalizations. Treatment effects were estimated with propensity score-weighted risk adjustment models.

RESULTS

A total of 3488 patients enrolled in COVID Watch and 4377 usual care control participants were compared with propensity score weighted models. At 30 days, COVID Watch patients had an odds ratio for death of 0.32 (95% CI, 0.12 to 0.72), with 1.8 fewer deaths per 1000 patients (CI, 0.5 to 3.1) (P = 0.005); at 60 days, the difference was 2.5 fewer deaths per 1000 patients (CI, 0.9 to 4.0) (P = 0.002). Patients in COVID Watch had more telemedicine encounters, ED visits, and hospitalizations and presented to the ED sooner (mean, 1.9 days sooner [CI, 0.9 to 2.9 days]; all P < 0.001).

LIMITATION

Observational study with the potential for unobserved confounding.

CONCLUSION

Enrollment of outpatients with COVID-19 in an automated remote monitoring service was associated with reduced mortality, potentially explained by more frequent telemedicine encounters and more frequent and earlier presentation to the ED.

PRIMARY FUNDING SOURCE

Patient-Centered Outcomes Research Institute.

Greek BLS Certified Providers’ CPR Willingness and Skill Retention During the Pre-Vaccine Covid-19 Pandemic Period. A Survey of the Hellenic Society of Cardiology

Objective

Methods

Results

Conclusion

Resuscitation of Drowned Persons During the COVID-19 Pandemic: A Consensus Statement

IMPORTANCE

Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation.

OBJECTIVE

To develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic.

EVIDENCE REVIEW

Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps.

FINDINGS

Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training. Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation.

CONCLUSIONS AND RELEVANCE

This consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

COVID-19: A pluralistic and integrated approach for efficient management of the pandemic

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which triggered the ongoing pandemic, was first discovered in China in late 2019. SARS-CoV-2 is a respiratory virus responsible for coronavirus disease 2019 (COVID-19) that often manifests as a pneumonic syndrome. In the context of the pandemic, there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients. In addition, the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases. This raises the issue of the complexity of the work required to control or contain the pandemic. We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge. This paper proposes a comprehensive and integrative approach to COVID-19 research, prevention, control, and treatment to better address the pandemic. Thus, this literature review applies a pluralistic approach to fight the pandemic.

Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis

Bystander cardiopulmonary resuscitation (BCPR), early defibrillation and timely treatment by emergency medical services (EMS) can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of the COVID-19 pandemic on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR 1.38, 95% CI 1.11–1.71, p = 0.0069). BCPR did not differ during and before the COVID-19 pandemic (OR 0.94, 95% CI 0.80–1.11, p = 0.4631), although bystander defibrillation was significantly lower during the COVID-19 pandemic (OR 0.65, 95% CI 0.48–0.88, p = 0.0107). EMS call-to-arrival time was significantly higher during the COVID-19 pandemic (SMD 0.27, 95% CI 0.13–0.40, p = 0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.

Remdesivir and dexamethasone as tools to relieve hospital care systems stressed by COVID-19: A modelling study on bed resources and budget impact

Remdesivir and dexamethasone are the only drugs providing reductions in the lengths of hospital stays for COVID-19 patients. We assessed the impacts of remdesivir on hospital-bed resources and budgets affected by the COVID-19 outbreak. A stochastic agent-based model was combined with epidemiological data available on the COVID-19 outbreak in France and data from two randomized control trials. Strategies involving treating with remdesivir only patients with low-flow oxygen and patients with low-flow and high-flow oxygen were examined. Treating all eligible low-flow oxygen patients during the entirety of the second wave would have decreased hospital-bed occupancy in conventional wards by 4% [2%; 7%] and intensive care unit (ICU)-bed occupancy by 9% [6%; 13%]. Extending remdesivir use to high-flow-oxygen patients would have amplified reductions in ICU-bed occupancy by up to 14% [18%; 11%]. A minimum remdesivir uptake of 20% was required to observe decreases in bed occupancy. Dexamethasone had effects of similar amplitude. Depending on the treatment strategy, using remdesivir would, in most cases, generate savings (up to 722€) or at least be cost neutral (an extra cost of 34€). Treating eligible patients could significantly limit the saturation of hospital capacities, particularly in ICUs. The generated savings would exceed the costs of medications.

No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

In the Netherlands, the coronavirus disease 2019 (COVID‑19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for a complicated COVID‑19 course. The current study investigates all-cause mortality among cardiac implantable electronic device (CIED) patients during the first peak of the pandemic and compares the data to the statistics for the corresponding period in the two previous years. Data of adult CIED patients undergoing follow-up at the Leiden University Medical Centre were analysed. All-cause mortality between 1 March and 31 May 2020 was evaluated and compared to the data for the same period in 2019 and 2018. At the beginning of the first peak of the pandemic, 3,171 CIED patients (median age 70 years; 68% male; 41% ischaemic aetiology) were alive. Baseline characteristics of the 2019 (n = 3,216) and 2018 (n = 3,169) cohorts were comparable. All-cause mortality during the peak of the pandemic was 1.4% compared to 1.6% and 1.4% in the same period in 2019 and 2018, respectively (p = 0.84). During the first peak of the COVID‑19 pandemic, there was no substantial excess mortality among CIED patients in the Leiden area, despite the fact that this is group at high risk for a complicated course of a COVID‑19 infection. Strict adherence to the preventive measures may have prevented substantial excess mortality in these vulnerable patients.