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Raised mortality from cardiac arrest in people with COVID-19

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Sudden cardiac arrest is more often fatal in people with COVID-19, a new study shows. Those responsible for the research see the results as a wake-up call for the public and care providers alike.

The survey now published in the European Heart Journal is a register-based observation study. It covers all 3,026 cases of sudden cardiac arrest that were reported to the Swedish Registry for Cardiopulmonary Resuscitation in the period from 1 January to 20 July 2020 — that is, both before and during the pandemic.

The Registry’s statistics show that, in Sweden, there are 6,000 cases of sudden cardiac arrest annually in which the person is not admitted to hospital. Some 600 of these people survive. The corresponding figures for cardiac arrest during inpatient care are 2,500 cases and 900 survivors.

The study results indicate that mortality from sudden cardiac arrest is higher if the person has COVID-19, but that different patient groups show divergent differences in mortality rates.

Mortality differences

During the study period, 1,946 cases of sudden cardiac arrest outside of hospitals were registered. In 10 percent of the cases in this group, the person had COVID-19, and the risk of a fatal outcome proved to be 3.4 times higher for these people than for the other group members.

Of the 1,080 cases of sudden cardiac arrest that took place in hospitals, COVID-19 was present in 16 percent. Among the patients with COVID-19, mortality was 2.3 times higher than for the others in this group.

The largest mortality difference was noted in the group of women who were already receiving inpatient care at the time of their cardiac arrest. In these women, ongoing COVID-19 infection was associated with nine times the risk of a fatal outcome during the initial months and a sevenfold risk from April onward.

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The study, carried out by researchers at the Swedish Registry for Cardiopulmonary Resuscitation and the University of Gothenburg, received financial support from the Swedish Heart-Lung Foundation. This Foundation’s prompt funding action was crucial for the implementation, emphasizes Araz Rawshani, registrar and researcher at the Faculty of Medicine, Sahlgrenska Academy, who also works at Sahlgrenska University Hospital.

Higher awareness

“We hope our results can help to raise awareness of COVID-19 complications among the public, care providers, and decision-makers. That could improve care and mobilize resources for high-risk patients,” he says.

Kristina Sparreljung is the Secretary-General of the Swedish Heart-Lung Foundation.

“We hope these results will help to enable more lives to be saved. This study is a direct result of the emergency grant provided by the Heart-Lung Foundation for research on COVID-19 connected with cardiopulmonary disease back in spring 2020,” she says.

The survival rate for cardiac arrest has risen successively in recent years, but mortality remains high. Surviving a sudden cardiac arrest outside of hospital requires, pending arrival of an ambulance, immediate action in the form of cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED).

Title: Cardiac Arrest in COVID-19: Characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation