To the Editor,
The coronavirus disease (COVID-19) pandemic has disturbed health organisations globally
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and requires permanent and rapid adaptation of practices. In adults, the association between COVID-19 and changes in out-of-hospital cardiac arrest (OHCA) management has been established.2
In France, the emergency medical system overload did not significantly affect pre-hospital management of adult patients with cardiac arrest.3
However, it is unclear whether the pre-hospital management of children was different during the COVID-19 outbreak.Using the French National OHCA Registry (RéAC), we compared OHCA occurrence in children (<18 years) in France during the initial days of the COVID-19 outbreak (1 February 2020–15 May 2020) with OHCA occurrence in children during the same period of 2019 (Supplementary file). We identified COVID-19 cases in compliance with the World Health Organization definition.
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Organization WH. Global surveillance for COVID-19 caused by human infection with COVID-19 virus: interim guidance, 20 March 2020. Published online March 20, 2020. Accessed May 3, 2020. https://apps.who.int/iris/handle/10665/331506.
We compared the rate of patients with cardiopulmonary resuscitation initiated by witnesses, cause of OHCA, duration of no flow, time between cardiac arrest and the mobile medical team’s (MMT) arrival, return of spontaneous circulation (ROSC) rate, and survival rate during hospital admission.
We included 53 OHCAs reported in 2019 and 32 in the 2020 pandemic period (men: 64.2% and 59.4%, respectively) with a median age of 9 years (range: 1–15 years) and 6 years (range: 1–14 years), respectively. During the COVID-19 pandemic, two OHCA patients were affected by COVID-19. OHCA aetiology between the two periods was not different. No difference was observed for the no flow duration and rate of initiation of basic life support (BLS) by a bystander. First aid provider’s resuscitation (BLS implementation or automated external defibrillator AED use) was not different between both the periods. No differences were observed regarding the rate of advanced life support by MMT and the intubation. The time between T0 and first aid provider and between T0 and MMT arrival were not different between both the periods. The rate of ROSC and survival at hospital admission were not different (Table 1).
Table 1Populations characteristics.
| 2019 (N = 53) | 2020 (N = 32) | ||
|---|---|---|---|
| Context of the OHCA | |||
| Age y - median [Q1–Q3] | 9 [1−15] | 6 [0−14] | 0.323 |
| Sex (male) - no. (%) | 34/53 (64.2) | 19/32 (59.4) | 0.818 |
| OHCA at home - no. (%) | 32/47 (68.1) | 27/31 (87.1) | 0.065 |
| COVID-19 status (probable or confirmed) - no. (%) | NA | 2/32 (6.3) | NA |
| Medical history - no. (%) | |||
| - Diabetes | 0/53 (0.0) | 0/32 (0.0) | NA |
| - Cardiovascular | 3/53 (5.7) | 2/32 (6.3) | 1.000 |
| - Respiratory | 2/53 (3.8) | 2/32 (6.3) | 0.630 |
| - End of Life | 1/53 (1.9) | 0/32 (0.0) | 1.000 |
| - Other | 14/53 (26.4) | 6/32 (18.8) | 0.598 |
| - Unremarkable | 18/53 (34.0) | 12/32 (37.5) | 0.816 |
| Cause of the OHCA - no. (%) | 0.339 | ||
| - Cardiac cause | 9/53 (17.0) | 4/32 (12.5) | |
| - Respiratory cause | 3/53 (5.7) | 3/32 (9.4) | |
| - Other medical cause | 22/53 (41.5) | 17/32 (53.1) | |
| - Traumatic cause | 11/53 (20.8) | 2/32 (6.3) | |
| - Other cause | 8/53 (15.0) | 6/32 (18.7) | |
| Bystander presence (at collapse) - no. (%) | 24/53 (45.3) | 13/32 (40.6) | 0.822 |
| - Immediate bystander BLS - no. (%) | 13/24 (54.2) | 8/13 (61.5) | 0.739 |
| Resuscitation | |||
| Bystander BLS - no. (%) | 24/53 (45.3) | 19/32 (59.4) | 0.265 |
| Bystander AED use - no. (%) | 1/53 (1.9) | 0/32 (0.0) | NA |
| BLS by first aid providers - no. (%) | 44/53 (83.0) | 27/32 (84.4) | 1.000 |
| First aid providers AED use no. (%) | 39/42 (92.9) | 19/21 (90.5) | 1.000 |
| ALS by the MMT - no. (%) | 37/53 (69.8) | 25/32 (78.1) | 0.459 |
| First recorded cardiac rhythm - no. (%) | 0.245 | ||
| - Asystole | 47/53 (88.7) | 23/32 (71.9) | |
| - VF/pulseless VT | 2/53 (3.8) | 2/32 (6.3) | |
| - PEA | 2/53 (3.8) | 4/32 (12.5) | |
| - ROSC during BLS | 2/53 (3.8) | 3/32 (9.4) | |
| Intubation – no. (%) | 35/37 (94.6) | 24/28 (85.7) | 0.390 |
| Times | |||
| Time between T0 and first aid provider arrival (min) - median [Q1–Q3] | 9 [5−12] | 10 [2−12] | 0.832 |
| Time between T0 and MMT arrival (min) - median [Q1–Q3] | 17 [11−25] | 16 [12−25) | 0.771 |
| Time between T0 and ROSC or death (min) - median [Q1–Q3] | 42 [25−58] | 46 [25−58] | 0.902 |
| No-flow (min) - median [Q1–Q3] | 9 [2−14] | 10 [0−17] | 0.931 |
| Survival | |||
| ROSC - no. (%) | 9/53 (17.0) | 9/32 (28.1) | 0.277 |
| Survival at hospital admission - no. (%) | 7/49 (14.3) | 8/32 (25.0) | 0.253 |
OHCA: out-of-hospital cardiac arrest; BLS: basic life support; AED: automated external defibrillator; MMT: mobile medical team; ALS: advanced life support; VF: ventricular fibrillation; VT: ventricular tachycardia; PEA: pulseless electrical activity; ROSC: return of spontaneous circulation.
a If the OHCA was witnessed by a bystander.
b On arrival of the MMT.
The emergency medical management of paediatric patients with OHCA in France does not seem to have been affected by the overload of pre-hospital emergency medical services.
The recent worldwide COVID-19 pandemic has put health care systems to the test, most of which have been overburdened. To prevent and avoid malfunctioning of critical services, many countries have established a COVID-19 rapid response infrastructure to prevent reaching capacity.
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Even if COVID-19 among paediatric patients seemed to be milder, with better prognosis than adults, the risk of COVID-19 contamination forced the teams to take the same precautions during adults and children OHCA. The fear of COVID-19 has not led to a reduction of witness-initiated CPR. Despite the low incidence of paediatric OHCA during the 2020 pandemic provides a lack of statistical power, we hypothesised that paediatric OHCA is always an event, which is fortunately rare, but shocking to everyone involved, thus prompting all the stages of management to address such cases effectively even in the midst of the COVID-19 pandemic.Contributors’ statement
Dr. Recher conceptualized the study, drafted the initial manuscript, reviewed, and revised the manuscript; Mme Baert conceptualized the study, conducted the initial analyses, reviewed, and revised the manuscript; Prof. Leteurtre conceptualized the study, reviewed and revised the manuscript; Prof. Hubert conceptualized the study, reviewed, and revised the manuscript. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding
None declared.
Conflicts of interest
None declared.
Appendix A. Supplementary data
The following is Supplementary data to this article:
References
- Urgences préhospitalières: crise COVID-19.Rev Med Suisse. 2020; 16: 810-814
- Out-of-hospital cardiac arrest during the covid-19 outbreak in Italy.N Engl J Med. 2020; 383: 496-498
- Collateral consequences of COVID-19 epidemic in Greater Paris.Resuscitation. 2020; 151: 6-7
Organization WH. Global surveillance for COVID-19 caused by human infection with COVID-19 virus: interim guidance, 20 March 2020. Published online March 20, 2020. Accessed May 3, 2020. https://apps.who.int/iris/handle/10665/331506.
- Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy [published online ahead of print, 2020 Apr 6].JAMA. 2020; 323: 1574-1581
Article info
Publication history
Published online: August 11, 2020
Received:
July 28,
2020
Identification
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© 2020 Elsevier B.V. All rights reserved.
