Sudden death in the pre-hospital setting in the time of COVID-19

Resuscitation

In the course of the last year, humanity has been hit by a pandemic crisis declared on January 30 of 2020, caused by the SARS-CoV-2 virus or commonly known as COVID -19. This virus affects, causes and even increases diseases related to the respiratory system and can affect the cardiovascular system, causing cardiac arrest and even death. Currently, and without taking COVID-19 into account, in Spain, there are around 30,000 cardiac arrests per year, which is reflected in the fact that one out of every five in developed countries such as Spain is caused by cardiovascular conditions, being the highest occurrence in out-of-hospital settings. 

Due to the situation, healthcare has been affected by the collapse in certain areas, reducing response time and making out-of-hospital care even more difficult. In the case of cardiac arrest, every minute that passes is vital to ensure the patient’s potentially recoverable activity, so the main determinant of survival is early intervention with CPR and defibrillation.

Initially, the success of defibrillation is greater than 90% but it decreases 7-10% for every minute without CPR, this confirms the importance of a rapid response to the emergency. Likewise, due to COVID-19, the slow response and the fact that many rescuers and health professionals refrain from applying CPR for fear of contagion, makes it difficult for patients to survive. 

According to an article published this year that talks about Sudden Death In The Prehospital Setting At The Time Of COVID-19, they affirm that “A maneuver that is discouraged is the use of mouth-to-mouth ventilation measures. In studies before the COVID-19 pandemic, it was observed that the “hands-only” CPR technique, considered in the latest guidelines as the preferred technique, has led to an increase in “hands-only” attempts of CPR ”and entails a lower risk of contagion for the spectator in the context of this pandemic”. The foregoing confirms that in light of the COVID-19 pandemic, new guidelines have been implemented for the performance of CPR without the need to use the mouth-to-mouth maneuver (Mouth to mouth maneuver) to help viewers to treat victims of cardiac arrest, to provide the best chances of survival without compromising the safety of rescuers. 

Fitz Maurice, M., DI Tomasso, F., Formica Mazraani, N., Agüero, P., Sastre, P. and Hirschson Prado, A., 2020. Sudden Death In The Prehospital Setting During COVID-19.

sudden death covid 19
Figure: Adult CPR and new guidelines for COVID-19