Advertisement

Consequences of coronavirus disease outbreak on paediatric out-of-hospital cardiac arrest in France

  • Morgan Recher
    Correspondence
    Corresponding author at: Réanimation et Surveillance continue Pédiatriques, Hôpital Jeanne de Flandre, CHU de Lille, 59037 Lille Cedex, France.
    Affiliations
    University of Lille, CHU Lille, ULR 2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
    Search for articles by this author
  • Valentine Baert
    Affiliations
    University of Lille, CHU Lille, ULR 2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France

    French National Out-Of-Hospital Cardiac Arrest Registry, Lille, France
    Search for articles by this author
  • Stéphane Leteurtre
    Affiliations
    University of Lille, CHU Lille, ULR 2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
    Search for articles by this author
  • Hervé Hubert
    Affiliations
    University of Lille, CHU Lille, ULR 2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France

    French National Out-Of-Hospital Cardiac Arrest Registry, Lille, France
    Search for articles by this author
      To the Editor,
      The coronavirus disease (COVID-19) pandemic has disturbed health organisations globally
      • Maudet L.
      • Sarasin F.
      • Dami F.
      • Carron P.N.
      • Pasquier M.
      Urgences préhospitalières: crise COVID-19.
      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.
      • Baldi E.
      • Sechi G.M.
      • Mare C.
      • et al.
      Out-of-hospital cardiac arrest during the covid-19 outbreak in Italy.
      In France, the emergency medical system overload did not significantly affect pre-hospital management of adult patients with cardiac arrest.
      • Lapostolle F.
      • Agostinucci J.M.
      • Alhéritière A.
      • Petrovic T.
      • Adnet F.
      Collateral consequences of COVID-19 epidemic in Greater Paris.
      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.

      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. (%)NA2/32 (6.3)NA
      Medical history - no. (%)
       - Diabetes0/53 (0.0)0/32 (0.0)NA
       - Cardiovascular3/53 (5.7)2/32 (6.3)1.000
       - Respiratory2/53 (3.8)2/32 (6.3)0.630
       - End of Life1/53 (1.9)0/32 (0.0)1.000
       - Other14/53 (26.4)6/32 (18.8)0.598
       - Unremarkable18/53 (34.0)12/32 (37.5)0.816
      Cause of the OHCA - no. (%)0.339
       - Cardiac cause9/53 (17.0)4/32 (12.5)
       - Respiratory cause3/53 (5.7)3/32 (9.4)
       - Other medical cause22/53 (41.5)17/32 (53.1)
       - Traumatic cause11/53 (20.8)2/32 (6.3)
       - Other cause8/53 (15.0)6/32 (18.7)
      Bystander presence (at collapse) - no. (%)24/53 (45.3)13/32 (40.6)0.822
       - Immediate bystander BLS
      If the OHCA was witnessed by a bystander.
      - 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
      On arrival of the MMT.
      - no. (%)
      0.245
       - Asystole47/53 (88.7)23/32 (71.9)
       - VF/pulseless VT2/53 (3.8)2/32 (6.3)
       - PEA2/53 (3.8)4/32 (12.5)
       - ROSC during BLS2/53 (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.
      • Grasselli G.
      • Zangrillo A.
      • Zanella A.
      • et al.
      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].
      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

        • Maudet L.
        • Sarasin F.
        • Dami F.
        • Carron P.N.
        • Pasquier M.
        Urgences préhospitalières: crise COVID-19.
        Rev Med Suisse. 2020; 16: 810-814
        • Baldi E.
        • Sechi G.M.
        • Mare C.
        • et al.
        Out-of-hospital cardiac arrest during the covid-19 outbreak in Italy.
        N Engl J Med. 2020; 383: 496-498
        • Lapostolle F.
        • Agostinucci J.M.
        • Alhéritière A.
        • Petrovic T.
        • Adnet F.
        Collateral consequences of COVID-19 epidemic in Greater Paris.
        Resuscitation. 2020; 151: 6-7
      1. 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.

        • Grasselli G.
        • Zangrillo A.
        • Zanella A.
        • et al.
        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