Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy.
Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
PLoS One. 2020 Oct 22;15(10):e0241028. doi: 10.1371/journal.pone.0241028. eCollection 2020.
An increase in the incidence of OHCA during the COVID-19 pandemic has been recently demonstrated. However, there are no data about how the COVID-19 epidemic influenced the treatment of OHCA victims.
We performed an analysis of the Lombardia Cardiac Arrest Registry comparing all the OHCAs occurred in the Provinces of Lodi, Cremona, Pavia and Mantua (northern Italy) in the first 100 days of the epidemic with those occurred in the same period in 2019.
The OHCAs occurred were 694 in 2020 and 520 in 2019. Bystander cardiopulmonary resuscitation (CPR) rate was lower in 2020 (20% vs 31%, p<0.001), whilst the rate of bystander automated external defibrillator (AED) use was similar (2% vs 4%, p = 0.11). Resuscitation was attempted by EMS in 64.5% of patients in 2020 and in 72% in 2019, whereof 45% in 2020 and 64% in 2019 received ALS. At univariable analysis, the presence of suspected/confirmed COVID-19 was not a predictor of resuscitation attempt. Age, unwitnessed status, non-shockable presenting rhythm, absence of bystander CPR and EMS arrival time were independent predictors of ALS attempt. No difference regarding resuscitation duration, epinephrine and amiodarone administration, and mechanical compression device use were highlighted. The return of spontaneous circulation (ROSC) rate at hospital admission was lower in the general population in 2020 [11% vs 20%, p = 0.001], but was similar in patients with ALS initiated [19% vs 26%, p = 0.15]. Suspected/confirmed COVID-19 was not a predictor of ROSC at hospital admission.
Compared to 2019, during the 2020 COVID-19 outbreak we observed a lower attitude of laypeople to start CPR, while resuscitation attempts by BLS and ALS staff were not influenced by suspected/confirmed infection, even at univariable analysis.
最近有研究表明，在 COVID-19 大流行期间，OHCA 的发病率有所增加。然而，目前尚无数据表明 COVID-19 疫情如何影响 OHCA 患者的治疗。
我们对伦巴第心脏骤停登记处进行了分析，比较了在疫情爆发的前 100 天内发生在洛迪、克雷莫纳、帕维亚和曼图亚（意大利北部）的所有 OHCAs 与 2019 年同期发生的 OHCAs。
2020 年共发生 OHCAs694 例，2019 年共发生 OHCAs520 例。2020 年旁观者心肺复苏（CPR）率较低（20%比 31%，p<0.001），而旁观者自动体外除颤器（AED）使用率相似（2%比 4%，p=0.11）。2020 年急救人员对 64.5%的患者进行了复苏尝试，而 2019 年对 72%的患者进行了复苏尝试，其中 45%的患者在 2020 年和 64%的患者在 2019 年接受了 ALS。单变量分析表明，疑似/确诊 COVID-19 不是复苏尝试的预测因素。年龄、无人见证、非可除颤性表现节律、无旁观者 CPR 和急救人员到达时间是 ALS 尝试的独立预测因素。未发现复苏持续时间、肾上腺素和胺碘酮给药以及机械压迫装置使用方面的差异。2020 年普通人群入院时自主循环恢复（ROSC）率较低[11%比 20%，p=0.001]，但启动 ALS 患者的 ROSC 率相似[19%比 26%，p=0.15]。疑似/确诊 COVID-19 不是入院时 ROSC 的预测因素。
与 2019 年相比，在 2020 年 COVID-19 疫情期间，我们观察到旁观者开始 CPR 的态度较低，而 BLS 和 ALS 人员的复苏尝试不受疑似/确诊感染的影响，即使在单变量分析中也是如此。
