EXCESS MORTALITY: Only a third of these cardiac arrests are directly linked to the coronavirus
The number of cardiac arrests doubled in the Paris region at the peak of the Covid-19 epidemic, with a reduction of almost half of the survival of the patients concerned, according to researchers. According to their study published in The Lancet Public Health, only about a third of these “additional” cardiac arrests recorded during this period is directly associated with Covid-19.
Over the past nine years, the number of cardiac arrests has remained stable in Paris and its suburbs (6.8 million inhabitants), but increased sharply during the first six weeks of confinement (from March 17th to April 26th) in particular at the peak of the epidemic (March 23rd to April 5th). Thus, 521 cardiac arrests outside the hospital were identified in the Paris region, representing a rate of 26.6 arrests per million inhabitants. Between 2012 and 2019 at the same period, this rate was 13.4 cardiac arrests per million inhabitants. This work is based on the Ile-de-France register (Paris and Hauts de-Seine, Seine-Saint-Denis and Val-de-Marne) of the Mort Subite Expertise Center (Paris-CEMS).
90% of cardiac arrests in the home
“The patient profile is the same as usual [2/3 of men, around 69 years of age],” AFP Eloi Marijon of the Paris Cardiovascular Research Center (Inserm / University of Paris) told AFP. conducted the study with his colleague Nicole Karam, in collaboration with Daniel Jost ( Paris Fire Brigade ). On the other hand, continues the cardiologist, more than 90% of the cardiac arrests took place at home, with witnesses, most often the family, who practised much less a cardiac massage, and longer rescue services to arrive despite the empty roads.
Basically, survival was halved upon arrival at the hospital. During the period studied, only 12.8% of the identified patients were alive on arrival at the hospital, compared to 22.8% at the same period in previous years. However, according to previous studies by this team, people who have a cardiac arrest are eight times more likely to survive when a witness is able to quickly perform cardiopulmonary resuscitation (including cardiac massage).
A break in medical monitoring of patients
The diagnosis of Covid-19 was confirmed and/or suspected in 299 patients included in the study (admitted alive and/or have developed cardiac arrest in the presence of witnesses). About 33% of the excess death observed is directly associated with Covid-19, according to the researchers. To explain the other two-thirds, several hypotheses are put forward (saturation of the healthcare system, poorly or not accessible city medicine, stress, etc.)
“There was a breakdown in the medical follow-up of the patients, because they were unable to consult, because they feared to interfere, resulting in a delay in the call, or fear, for some, of being contaminated in the hospital, ”explains Professor Marijon. He thus evokes the less regular monitoring of cardiac patients, and even, “perhaps also in a small number of cases” of possible deleterious effects of drugs taken by patients to treat Covid-19 disease. “There were probably difficulties in reaching the emergency services on 15 (Samu) and 18 (firefighters) with longer waiting times,” he adds.
“This increase in the incidence of out-of-hospital cardiac arrests highlights collateral deaths, not taken into account in the Covid-19 death statistics”, according to the authors for whom this should be taken into account in the future in public health strategies.