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1. Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence

Author

Gentile, F. R., Primi, R., Baldi, E., Compagnoni, S., Mare, C., Contri, E., Reali, F., Bussi, D., Facchin, F., Currao, A., Bendotti, S., Savastano, S., Cuzzoli, A., Pagliosa, A., Matiz, G., Russo, A., Vecchi, A. L., Fantoni, C., Parogni, P., Fava, C., Franzosi, C., Vimercati, C., Franchi, D., Storti, E., Rizzi, U., Ruggeri, S., Taravelli, E., Giovenzana, F., Buetto, G., Villa, G. F., Botteri, M., Caico, S. I., Bergamini, G., Cominesi, I. R., Carnevale, L., Caresani, M., Luppi, M., Migliori, M., Centineo, P., Genoni, P., Bertona, R., De Ponti, R., Buratti, S., Danzi, G. B., Marioni, A., Palo, A., De Pirro, A., Molinari, S., Sgromo, V., Musella, V., Paglino, M., Mojoli, F., Lusona, B., Pagani, M., Curti, M., Klersy, C., Campi, S., Castiglioni, B., Piccolo, U., Cazzaniga, M., Passarelli, I., Perone, G., Panni, G., Ghiraldin, D., Bettari, L., Moschini, L., and Zanotti, L.

Subjects
Atmospheric Science, Meteorological Concepts, Epidemiology, Air pollution, Cardiovascular Medicine, Logistic regression, medicine.disease_cause, Geographical locations, chemistry.chemical_compound, Medical Conditions, Medicine and Health Sciences, Cardiac Arrest, Emergency medical services, Medicine, media_common, Air Pollutants, Multidisciplinary, Geography, Organic Compounds, Incidence, Incidence (epidemiology), Pollution, Europe, Chemistry, Italy, Cardiovascular Diseases, Physical Sciences, Research Article, media_common.quotation_subject, Science, Cardiology, Meteorology, Air Pollution, Environmental health, Humans, Nitrogen dioxide, European Union, Air quality index, Pollutant, business.industry, Ecology and Environmental Sciences, Organic Chemistry, Chemical Compounds, Humidity, Benzene, Environmental Exposure, Logistic Models, chemistry, Medical Risk Factors, Earth Sciences, Out-of-Hospital Cardiac Arrest, People and places, business
Abstract

Background Pollution has been suggested as a precipitating factor for cardiovascular diseases. However, data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. Methods By collecting data both in the OHCA registry and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region, all medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 1550000 inhabitants). Days were divided into high or low incidence of OHCA according to the median value. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. Results The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend. After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined. All the pollutants were also strongly associated with high incidence of OHCA in multivariable analysis with correction for temperature, humidity, and day-to-day concentration changes. Conclusions Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models for the organization of emergency medical services.

Published
2021

2. Out-of-hospital cardiac arrest during the COVID-19 outbreak in Italy

Author

Baldi, E., Sechi, G. M., Mare, C., Canevari, F., Brancaglione, A., Primi, R., Klersy, C., Palo, A., Contri, E., Ronchi, V., Beretta, G., Reali, F., Parogni, P., Facchin, F., Bua, D., Rizzi, U., Bussi, D., Ruggeri, S., Visconti, L. O., Savastano, S., and Vecchi, ANDREA LORENZO

Subjects
Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, 030204 cardiovascular system & hematology, Out of hospital cardiac arrest, First Responder, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, AED, Aged, Aged, 80 and over, COVID-19, Coronavirus Infections, Female, Humans, Incidence, Italy, Out-of-Hospital Cardiac Arrest, Pandemics, SARS-CoV-2, Pandemic, 80 and over, Medicine, 030212 general & internal medicine, Viral, Letter to the Editor, biology, business.industry, Incidence (epidemiology), Outbreak, General Medicine, Pneumonia, biology.organism_classification, 3. Good health, Emergency medicine, cardiovascular system, business
Abstract

Despite the risk of rapid respiratory failure1 and cardiac complications2 due to Covid-19, it is unclear whether there is an association between Covid-19 and out-of-hospital cardiac arrest. The Lombardy region of Italy was among the first areas to have an outbreak of Covid-19 outside China,3 and the first case there was diagnosed on February 20, 2020, in Lodi Province.4

Published
2020

3. Amplitude spectrum area to guide defibrillation a validation on 1617 patients with ventricular fibrillation

Author

Ristagno, G, Mauri, T, Cesana, G, Li, Y, Finzi, A, Fumagalli, F, Rossi, G, Grieco, N, Migliori, M, Andreassi, A, Latini, R, Fornari, C, Pesenti, A, Bozzola, M, Pagliosa, A, Valoti, O, Carrara, P, Mare, C, Arrighini, F, Volonté, M, Piccolo, U, Rizzi, U, Ruggeri, S, Villa, GF, Mosca, F, Castelli, G, Cita, M, Caresani, M, Marcora, B, Sesana, G, Sangalli, F, Raimondi, M, Canevari, F, Della Torre, P, Orsini, B, Garzena, G, Calcagno, F, Ristagno, G, Mauri, T, Cesana, G, Li, Y, Finzi, A, Fumagalli, F, Rossi, G, Grieco, N, Migliori, M, Andreassi, A, Latini, R, Fornari, C, Pesenti, A, Bozzola, M, Pagliosa, A, Valoti, O, Carrara, P, Mare, C, Arrighini, F, Volonté, M, Piccolo, U, Rizzi, U, Ruggeri, S, Villa, G, Mosca, F, Castelli, G, Cita, M, Caresani, M, Marcora, B, Sesana, G, Sangalli, F, Raimondi, M, Canevari, F, Della Torre, P, Orsini, B, Garzena, G, and Calcagno, F

Subjects
Electric, Male, medicine.medical_specialty, Survival, Defibrillation, medicine.medical_treatment, Electric Countershock, cardiac arrest, Return of spontaneous circulation, Defibrillator, Electrocardiography, Retrospective Studie, Physiology (medical), Internal medicine, medicine, Humans, Derivation, Retrospective Studies, Aged, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, ventricular fibrillation, Frequency spectrum, Ventricular fibrillation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, defibrillation, electric, Defibrillators, Human
Abstract

Background— This study sought to validate the ability of amplitude spectrum area (AMSA) to predict defibrillation success and long-term survival in a large population of out-of-hospital cardiac arrests. Methods and Results— ECGs recorded by automated external defibrillators from different manufacturers were obtained from patients with cardiac arrests occurring in 8 city areas. A database, including 2447 defibrillations from 1050 patients, was used as the derivation group, and an additional database, including 1381 defibrillations from 567 patients, served as validation. A 2-second ECG window before defibrillation was analyzed, and AMSA was calculated. Univariable and multivariable regression analyses and area under the receiver operating characteristic curve were used for associations between AMSA and study end points: defibrillation success, sustained return of spontaneous circulation, and long-term survival. Among the 2447 defibrillations of the derivation database, 26.2% were successful. AMSA was significantly higher before a successful defibrillation than a failing one (13±5 versus 6.8±3.5 mV-Hz) and was an independent predictor of defibrillation success (odds ratio, 1.33; 95% confidence interval, 1.20–1.37) and sustained return of spontaneous circulation (odds ratio, 1.22; 95% confidence interval, 1.17–1.26). Area under the receiver operating characteristic curve for defibrillation success prediction was 0.86 (95% confidence interval, 0.85–0.88). AMSA was also significantly associated with long-term survival. The following AMSA thresholds were identified: 15.5 mV-Hz for defibrillation success and 6.5 mV-Hz for defibrillation failure. In the validation database, AMSA ≥15.5 mV-Hz had a positive predictive value of 84%, whereas AMSA ≤6.5 mV-Hz had a negative predictive value of 98%. Conclusions— In this large derivation-validation study, AMSA was validated as an accurate predictor of defibrillation success. AMSA also appeared as a predictor of long-term survival.

Published
2015

4. Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence.

Author

Baldi E, Primi R, Bendotti S, Currao A, Compagnoni S, Gentile FR, Sechi GM, Mare C, Palo A, Contri E, Ronchi V, Bergamini G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Campi S, Centineo P, De Ponti R, Oltrona Visconti L, and Savastano S

Subjects
Aged, Aged, 80 and over, Epidemiological Monitoring, Female, Humans, Incidence, Italy, Male, Middle Aged, COVID-19 epidemiology, Out-of-Hospital Cardiac Arrest epidemiology
Abstract

Background: The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak., Aim: To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level., Methods: We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods., Results: A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001)., Conclusions: Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs' increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves., Competing Interests: No authors have competing interests.

Published
2021
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6. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: A 100 days experience from the Lombardy region.

Author

Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni PP, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, and Savastano S

Subjects
Aged, Aged, 80 and over, Amiodarone administration & dosage, COVID-19, Cardiopulmonary Resuscitation, Coronavirus Infections virology, Defibrillators, Epinephrine administration & dosage, Female, Humans, Incidence, Italy, Longitudinal Studies, Male, Pandemics, Pneumonia, Viral virology, Prospective Studies, Registries, SARS-CoV-2, Time Factors, Vasoconstrictor Agents administration & dosage, Vasodilator Agents administration & dosage, Betacoronavirus, Coronavirus Infections epidemiology, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy, Pneumonia, Viral epidemiology
Abstract

Introduction: 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., Methods: 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., Results: 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., Conclusion: 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., Competing Interests: The authors have declared that no competing interests exist.

Published
2020
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7. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy.

Author

Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Bua D, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, and Savastano S

Subjects
Aged, Aged, 80 and over, Betacoronavirus, COVID-19, Female, Humans, Incidence, Italy epidemiology, Male, Pandemics, SARS-CoV-2, Coronavirus Infections epidemiology, Out-of-Hospital Cardiac Arrest epidemiology, Pneumonia, Viral epidemiology
Published
2020
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8. COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests.

Author

Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, and Savastano S

Subjects
Aged, Aged, 80 and over, COVID-19, Coronavirus Infections epidemiology, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Male, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest therapy, Pneumonia, Viral epidemiology, Prospective Studies, SARS-CoV-2, Betacoronavirus, Cardiopulmonary Resuscitation methods, Coronavirus Infections complications, Emergency Medical Services statistics & numerical data, Out-of-Hospital Cardiac Arrest epidemiology, Pandemics, Pneumonia, Viral complications
Abstract

Aims: An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve., Methods and Results: We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (ρ 0.87, P < 0.001) and for each province separately (Lodi: ρ 0.98, P < 0.001; Cremona: ρ 0.98, P < 0.001; Pavia: ρ 0.87, P < 0.001; Mantova: ρ 0.81, P < 0.001)., Conclusion: The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Published
2020
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