The number of cardiac arrests doubled in the Paris region at the peak of the Covid-19 epidemic, which fell during confinement, with a reduction of almost half 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 are 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 17 to April 26) in particular at the peak of the epidemic (March 23 to April 5).
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).
"The profile of the patients is the same as usual (2/3 of men, around 69 years old)," AFP Eloi Marijon of the Cardiovascular Research Center of Paris (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 stops took place at home, with witnesses, most often the family, who started 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).
The diagnosis of Covid-19 was confirmed and / or suspected in 299 patients included in the study (admitted alive and / or having 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.
- Several hypotheses -
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 the cardiac, even, "perhaps also in a small number of cases" of possible deleterious effects of drugs taken by the patients to treat the Covid-19 disease. "There were probably difficulties in reaching the emergency services on 15 (Samu) and 18 (firefighters) with longer waiting times," he added.
"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.
The results of the study "allow us to better understand the consequences of this crisis, the lessons to be learned, also to better react in the event of a second wave," says Nicole Karam. She considers it "necessary to find a balance" between taking charge of the epidemic and monitoring other patients.
An increase in the incidence of cardiac arrests has been observed elsewhere, in New York, California, and in Italy, in particular in Lombardy, which was faced with an overwhelming overload of health care, therefore in a different context. of the Paris region, underlines the researcher.
Cardiologists have already been alarmed by the collateral damage from the epidemic and confinement when they saw patients with complications from myocardial infarction arriving, who did not consult for suspicious chest pain.
© 2020 AFP