Review Article   

Minerva Anestesiologica 2022 Apr 05

DOI: 10.23736/S0375-9393.22.15994-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

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

Luca FONTANELLI ¹ ✉, Claudio SANDRONI ^{2, 3}, Markus B. SKRIFVARS ⁴

¹ Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy; ² Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Rome, Italy; ³ Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; ⁴ Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

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.

KEY WORDS: COVID-19; Sars-Cov-2; Out-of-hospital cardiac arrest; In-hospital cardiac arrest