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Cardiac Arrest During COVID-19

COVID-19 is commonly seen as a respiratory disease, but its effects aren’t limited to the respiratory system. Since the pandemic began, doctors and researchers have observed a number of unexpected outcomes in patients, including damage to the cardiovascular system. In fact, research out of Italy, France, and the United States has revealed an alarming trend: COVID-19 appears to be increasing the number of cardiac arrest incidences and deaths worldwide.

Cardiac Arrest & COVID-19 by the Numbers

It’s still not fully understood why cardiac arrest rates are increasing in light of COVID-19, but researchers in different corners of the world have uncovered some clues that are helping us to better understand what’s happening.

The Research in Italy

The most prominent research into cardiac arrest and COVID-19 has come from the Lombardy region of Italy. There, researchers compiled out-of-hospital cardiac arrest (OHCA) numbers from the provinces of Lodi, Cremona, Pavia, and Mantua during the first 40 days of the outbreak. They then compared those numbers to the same time period last year.

In 2020, the region documented 362 cases of OHCA during the examined time period. During the same 40 days in 2019, the number of cases was only 229. In other words, the COVID-19 period was associated with a 58% increase in cardiac arrest cases, with spikes observed across all four provinces.

The Research in France

French researchers funded by the French National Institute of Health and Medical Research (INSERM) conducted a population-based observational study to examine OHCA events over a 6-week period during the pandemic. Just like the Italian researchers, the French team did a year-over-year comparison to get a full picture of how COVID-19 has impacted cardiac arrest rates.

The researchers found that the COVID-19 period was associated with a two-fold increase in OHCA. There were especially significant spikes in the number of cases related to unwitnessed cardiac arrests and those taking place in the home.

The researchers noted that, while COVID-19 infections may be partly to blame, there are also some possible indirect causes that should be observed. For example, the lockdown has resulted in more people remaining in the home, often unsupervised. People are also receiving less medical attention, as clinical resources are largely being allocated toward the pandemic. These factors may likewise be contributing to the increase in cardiac arrest cases and deaths.

The Research in New York

A recent population study published in JAMA Cardiology observed the number of patients receiving cardiac arrest treatment in New York during the height of the pandemic. According to the report, cardiac arrest cases were a full three times higher than they were in the same period in 2019 (47.5 vs 15.9 per 100,000 patients). What’s worse, the mortality rate was above 90%.

The researchers looked at 5,235 patients in the COVID-19 era and found that:

  • The patients tend to be older (especially senior-aged)
  • More minorities than whites are affected
  • Many patients have comorbidities and pre-existing conditions

The findings mirror many of the conclusions from France and Italy. Cardiac arrest numbers are on the rise, and much of the cause seems to be related to the pandemic as well as its impact on our way of life.

The Research on the West Coast

Mortality rates have always been high with sudden cardiac arrest, but the pandemic appears to be making the problem worse. A recent study from the Smidt Heart Institute at Cedars-Sinai uncovered a nearly two-fold increase in SCA mortality rates during the pandemic:

  • 7.9% survival rate to hospital discharge during the pandemic
  • 14.7% survival rate to hospital discharge before the pandemic

Much of the data was pulled from the Oregon Sudden Unexpected Death Study (a multiyear assessment of cardiac deaths in the Portland area) and the Ventura Prediction of Sudden Death in Multi-Ethnic Communities Study (based in Ventura, California), so the data is limited to those two regions. As with the aforementioned studies, this one compared cardiac arrest incidents during the same time period in 2019 and 2020 (March 1st to May 31st in this case).

The researchers also found that:

  • Before the pandemic, 61% of OHCA sufferers received bystander CPR before EMS arrival. During the pandemic, only 51% of sufferers received bystander CPR.
  • Before the pandemic, emergency services took an average of 6.6 minutes to arrive at the scene of a cardiac crisis. During the pandemic, the average time was 7.6 minutes.

Once again, these issues may play a significant role in the rising mortality rate. Bystander CPR has been shown to double a patient’s chances of survival following a cardiac crisis, and rapid defibrillation is essential. For each minute that passes without treatment, the patient’s prognosis declines by about 10%. That’s why we recommend that families keep an automated external defibrillator (AED) in the home. An intuitive AED like the LIFEPAK CR2 can guide the user through both CPR and defibrillation, eliminating delays during those crucial minutes.

Does COVID-19 Cause Cardiac Arrest?

We know that there’s a correlation between cardiac arrest cases and COVID-19, but doctors and researchers are still scrambling to understand the exact relationship. While much of the aforementioned research has focused on date-range comparisons and the differences in response times, we do have some additional data that looks more closely at the cause and effect.

Reports from India and China reveal that approximately 1 in 5 COVID-19 patients ends up with heart damage. This suggests that the problem isn’t limited to delayed EMS response or more time spent at home. The degree of heart damage has, in some cases, contributed to heart failure, and the outcome is not limited to patients with pre-existing conditions.

The problem may be related in part to the ACE-2 enzyme (angiotensin-converting enzyme 2). This protein protects cells in both the heart and lungs, and it’s also the pathway through which COVID-19 penetrates cells and multiplies.

If—as some researchers suspect—the coronavirus weakens or disables the ACE-2 enzyme, it may leave the heart more vulnerable to attack as the immune system responds to the viral threat.

Researchers have noted that oxygen deprivation may also play a role in the increased prevalence of OHCA in COVID-19 patients. This raises concerns for younger COVID-19 patients, as hypoxia (oxygen deprivation) is the most common cause of cardiac arrest in infants and children. Fortunately, the existing research hasn’t suggested a significant increase in pediatric cardiac arrest events up to this point.

The important thing is that you take steps to avoid infection while also keeping your heart healthy and strong. Follow CDC guidelines to minimize your chance of infection, see your doctor if you notice any heart irregularities, and focus on living a heart-healthy lifestyle. If you’ve previously experienced a cardiac crisis, you’ll need to be especially cautious; survivors often experience multiple cardiac arrests in their lifetime.

The pandemic is only temporary, but a healthy heart will serve you well into your golden years.

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