Keywords
Resuscitation
Emergency medical system
environmental pollution
Emergency medical system
environmental pollution
Abstract
Out-hospital cardiac arrest (OHCA) is a multifactor disease. Many studies have correlated OHCA with a patient's lifestyle; unfortunately, less evidence highlights the correlation with meteorological factors. Methods: We analysed 23959 OHCA rescue performed by the emergency medical system (EMS) of Lombardy Region, the most Italian populated region, in 2018 and 2019, the pre-pandemic era. The aim was to evaluate the probability of Return of spontaneous circulation (ROSC) in different months. In March and April, we highlight an increase of ROSC (OR: 1.20 IC 95% 1.04 - 1.31; p<0.001) compared to other months. During March and April, we highlight an increase of public access defibrillation (PAD) (3,5% vs 2,5%; p<0.001), and a reduction of overage time of first vehicle on scene (11,5 vs 11,8; p<0,001) and age of patient (73,5 vs 74,2; p<0,01). Finally, we highlight a slight reduction of cancer patient (1,6% vs 1,1%; p=0,01). the significant difference didn't register in the other nine variables analysed. We highlight a difference in ROSC probability during the first month of spring. We register few differences in patient characteristics and EMS rescue, though just PAD use and age clinically impact OHCA patients.
In this study, we are unable to fully understand the modification of the probability of ROSC in these months. Even though four variables have a statistically significant difference, they can't fully explain this modification. Different variables like meteorological and seasonal factor must be considered. We propose more research on this item.
References
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[13] Stirparo G, Bellini L, Fagoni N, Compatti S, Botteri M, Villa GF, Sironi S, Signorelli C, Sechi GM, Zoli A. Missed training, collateral damage from COVID 19? Disaster Med Public Health Prep. 2022 Jan 10:1-8. doi: 10.1017/dmp.2022.14.
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[15] Diegoli H, Magalhães PSC, Martins SCO, Moro CHC, França PHC, Safanelli J, Nagel V, Venancio VG, Liberato RB, Longo AL. Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era. Stroke. 2020 Aug;51(8):2315-2321. doi: 10.1161/STROKEAHA.120.030481.
[16] Fagoni N, Perone G, Villa GF, Celi S, Bera P, Sechi GM, Mare C, Zoli A, Botteri M. The Lombardy Emergency Medical System Faced with COVID-19: The Impact of Out-of-Hospital Outbreak. Prehosp Emerg Care. 2021 Jan-Feb;25(1):1-7. doi: 10.1080/10903127.2020.1824051.
[17] Stirparo G, Bellini L, Ristagno G, Bonora R, Pagliosa A, Migliari M, Andreassi A, Signorelli C, Sechi GM, Fagoni N. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A Three-Year Study. J Clin Med. 2022 Sep 27;11(19):5718. doi: 10.3390/jcm11195718.
[18] 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, Savastano S; Lombardia CARe Researchers. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020 Jul 30;383(5):496-498. doi: 10.1056/NEJMc2010418.
[19] 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, Savastano S; all the Lombardia CARe researchers. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: A 100 days experience from the Lombardy region. PLoS One. 2020 Oct 22;15(10):e0241028. doi: 10.1371/journal.pone.0241028.
[20] Scquizzato T, Landoni G, Paoli A, Lembo R, Fominskiy E, Kuzovlev A, Likhvantsev V, Zangrillo A. Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review. Resuscitation. 2020 Dec;157:241-247. doi: 10.1016/j.resuscitation.2020.10.020.
[21] Stirparo G, Fagoni N, Bellini L, Oradini-Alacreu A, Migliari M, Villa GF, Botteri M, Signorelli C, Sechi GM, Zoli A. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand. 2022 Oct;66(9):1124-1129. doi: 10.1111/aas.14117.
[22] Cheng FJ, Wu KH, Hung SC, Lee KH, Lee CW, Liu KY, Hsu PC. Association between ambient air pollution and out-of-hospital cardiac arrest: are there potentially susceptible groups? J Expo Sci Environ Epidemiol. 2020 Jul;30(4):641-649. doi: 10.1038/s41370-019-0140-7.
[23] Kim JH, Hong J, Jung J, Im JS. Effect of meteorological factors and air pollutants on out-of-hospital cardiac arrests: A time series analysis. Heart. 2020;106(16):1218-1227. doi:10.1136/heartjnl-2019-316452
[24] Haikerwal A, Akram M, Del Monaco A, Smith K, Sim MR, Meyer M, Tonkin AM, Abramson MJ, Dennekamp M. Impact of Fine Particulate Matter (PM2.5) Exposure During Wildfires on Cardiovascular Health Outcomes. J Am Heart Assoc. 2015 Jul 15;4(7):e001653. doi: 10.1161/JAHA.114.001653.
[25] Gentile FR, Primi R, Baldi E, Compagnoni S, Mare C, Contri E, Reali F, Bussi D, Facchin F, Currao A, Bendotti S, Savastano S; Lombardia CARe researchers. Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence. PLoS One. 2021 Aug 25;16(8):e0256526. doi: 10.1371/journal.pone.0256526.
[26] Botteri M, Celi S, Perone G, Prati E, Bera P, Villa GF, Mare C, Sechi GM, Zoli A, Fagoni N. Effectiveness of massive transfusion protocol activation in pre-hospital setting for major trauma. Injury. 2022 May;53(5):1581-1586. doi: 10.1016/j.injury.2021.12.047.
[27] Stirparo G, Gambolò L, Bellini L, Medioli F, Bertuol M, Guasconi M, Sulla F, Artioli G, Sarli L. Satisfaction evaluation for ACLS training. Acta Biomed. 2022 Jul 1;93(3):e2022260. doi: 10.23750/abm.v93i3.13337.
[28] Sechi GM, Migliori M, Dassi G, Pagliosa A, Bonora R, Oradini-Alacreu A, Odone A, Signorelli C, Zoli A, Response Team AC. Business Intelligence applied to Emergency Medical Services in the Lombardy region during SARS-CoV-2 epidemic. Acta Biomed. 2020 May 11;91(2):39-44. doi: 10.23750/abm.v91i2.9557.
[2] Lim GH, Seow E. Resuscitation for patients with out-of-hospital cardiac arrest: Singapore. Prehosp Disaster Med. 2002 Apr-Jun;17(2):96-101. doi: 10.1017/s1049023x00000248. PMID: 12500733.
[3] Mayr NP, Mayr T, Tassani P, Martin K. Use of automated external defibrillators in the occupational setting in Germany: a pilot study. J Occup Environ Med. 2012;54(7):789-791. doi:10.1097/JOM.0b013e318256f65c
[4] Villa GF, Kette F, Balzarini F, Riccò M, Manera M, Solaro N, Pagliosa A, Zoli A, Migliori M, Sechi GM, Odone A, Signorelli C. Out-of-hospital cardiac arrest (OHCA) Survey in Lombardy: data analysis through prospective short time period assessment. Acta Biomed. 2019 Sep 13;90(9-S):64-70. doi: 10.23750/abm.v90i9-S.8710.
[5] Tay PJM, Pek PP, Fan Q, Ng YY, Leong BS, Gan HN, Mao DR, Chia MYC, Cheah SO, Doctor N, Tham LP, Ong MEH. Effectiveness of a community based out-of-hospital cardiac arrest (OHCA) interventional bundle: Results of a pilot study. Resuscitation. 2020 Jan 1;146:220-228. doi: 10.1016/j.resuscitation.2019.10.015.
[6] Lukić A, Lulić I, Lulić D, Ognjanović Z, Cerovečki D, Telebar S, Mašić I. Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study. Croat Med J. 2016 Dec 31;57(6):591-600. doi: 10.3325/cmj.2016.57.591.
[7] Fukuda T, Ohashi-Fukuda N, Kondo Y, Hayashida K, Kukita I. Association of Prehospital Advanced Life Support by Physician With Survival After Out-of-Hospital Cardiac Arrest With Blunt Trauma Following Traffic Collisions: Japanese Registry-Based Study. JAMA Surg. 2018;153(6):e180674. doi:10.1001/jamasurg.2018.0674
[8] Ong MEH, Chan YH, Ang HY, Lim SH, Tan KL. Resuscitation of out-of-hospital cardiac arrest by Asian primary health-care physicians. Resuscitation. 2005;65(2):191-195. doi:10.1016/j.resuscitation.2004.11.021
[9] Tobaldini E, Iodice S, Bonora R, Bonzini M, Brambilla A, Sesana G, Bollati V, Montano N. Out-of-hospital cardiac arrests in a large metropolitan area: synergistic effect of exposure to air particulates and high temperature. Eur J Prev Cardiol. 2020 Mar;27(5):513-519. doi: 10.1177/2047487319862063.
[10] Zhao B, Johnston FH, Salimi F, Kurabayashi M, Negishi K. Short-term exposure to ambient fine particulate matter and out-of-hospital cardiac arrest: a nationwide case-crossover study in Japan. Lancet Planet Health. 2020;4(1):e15-e23. doi:10.1016/S2542-5196(19)30262-1
[11] Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, Signorelli C, Sechi GM, Zoli A. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf). 2022 Mar 7;44(1):e149-e152. doi: 10.1093/pubmed/fdab212.
[12] Signorelli C, Odone A, Stirparo G, Cereda D, Gramegna M, Trivelli M, Rezza G. SARS-CoV-2 transmission in the Lombardy Region: the increase of household contagion and its implication for containment measures. Acta Biomed. 2020 Nov 20;91(4):e2020195. doi: 10.23750/abm.v91i4.10994
[13] Stirparo G, Bellini L, Fagoni N, Compatti S, Botteri M, Villa GF, Sironi S, Signorelli C, Sechi GM, Zoli A. Missed training, collateral damage from COVID 19? Disaster Med Public Health Prep. 2022 Jan 10:1-8. doi: 10.1017/dmp.2022.14.
[14] Caminiti C, Maglietta G, Meschi T, Ticinesi A, Silva M, Sverzellati N. Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study. Journal of Clinical Medicine. 2021;10(4):880. doi:10.3390/jcm10040880
[15] Diegoli H, Magalhães PSC, Martins SCO, Moro CHC, França PHC, Safanelli J, Nagel V, Venancio VG, Liberato RB, Longo AL. Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era. Stroke. 2020 Aug;51(8):2315-2321. doi: 10.1161/STROKEAHA.120.030481.
[16] Fagoni N, Perone G, Villa GF, Celi S, Bera P, Sechi GM, Mare C, Zoli A, Botteri M. The Lombardy Emergency Medical System Faced with COVID-19: The Impact of Out-of-Hospital Outbreak. Prehosp Emerg Care. 2021 Jan-Feb;25(1):1-7. doi: 10.1080/10903127.2020.1824051.
[17] Stirparo G, Bellini L, Ristagno G, Bonora R, Pagliosa A, Migliari M, Andreassi A, Signorelli C, Sechi GM, Fagoni N. The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A Three-Year Study. J Clin Med. 2022 Sep 27;11(19):5718. doi: 10.3390/jcm11195718.
[18] 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, Savastano S; Lombardia CARe Researchers. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020 Jul 30;383(5):496-498. doi: 10.1056/NEJMc2010418.
[19] 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, Savastano S; all the Lombardia CARe researchers. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: A 100 days experience from the Lombardy region. PLoS One. 2020 Oct 22;15(10):e0241028. doi: 10.1371/journal.pone.0241028.
[20] Scquizzato T, Landoni G, Paoli A, Lembo R, Fominskiy E, Kuzovlev A, Likhvantsev V, Zangrillo A. Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: A systematic review. Resuscitation. 2020 Dec;157:241-247. doi: 10.1016/j.resuscitation.2020.10.020.
[21] Stirparo G, Fagoni N, Bellini L, Oradini-Alacreu A, Migliari M, Villa GF, Botteri M, Signorelli C, Sechi GM, Zoli A. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand. 2022 Oct;66(9):1124-1129. doi: 10.1111/aas.14117.
[22] Cheng FJ, Wu KH, Hung SC, Lee KH, Lee CW, Liu KY, Hsu PC. Association between ambient air pollution and out-of-hospital cardiac arrest: are there potentially susceptible groups? J Expo Sci Environ Epidemiol. 2020 Jul;30(4):641-649. doi: 10.1038/s41370-019-0140-7.
[23] Kim JH, Hong J, Jung J, Im JS. Effect of meteorological factors and air pollutants on out-of-hospital cardiac arrests: A time series analysis. Heart. 2020;106(16):1218-1227. doi:10.1136/heartjnl-2019-316452
[24] Haikerwal A, Akram M, Del Monaco A, Smith K, Sim MR, Meyer M, Tonkin AM, Abramson MJ, Dennekamp M. Impact of Fine Particulate Matter (PM2.5) Exposure During Wildfires on Cardiovascular Health Outcomes. J Am Heart Assoc. 2015 Jul 15;4(7):e001653. doi: 10.1161/JAHA.114.001653.
[25] Gentile FR, Primi R, Baldi E, Compagnoni S, Mare C, Contri E, Reali F, Bussi D, Facchin F, Currao A, Bendotti S, Savastano S; Lombardia CARe researchers. Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence. PLoS One. 2021 Aug 25;16(8):e0256526. doi: 10.1371/journal.pone.0256526.
[26] Botteri M, Celi S, Perone G, Prati E, Bera P, Villa GF, Mare C, Sechi GM, Zoli A, Fagoni N. Effectiveness of massive transfusion protocol activation in pre-hospital setting for major trauma. Injury. 2022 May;53(5):1581-1586. doi: 10.1016/j.injury.2021.12.047.
[27] Stirparo G, Gambolò L, Bellini L, Medioli F, Bertuol M, Guasconi M, Sulla F, Artioli G, Sarli L. Satisfaction evaluation for ACLS training. Acta Biomed. 2022 Jul 1;93(3):e2022260. doi: 10.23750/abm.v93i3.13337.
[28] Sechi GM, Migliori M, Dassi G, Pagliosa A, Bonora R, Oradini-Alacreu A, Odone A, Signorelli C, Zoli A, Response Team AC. Business Intelligence applied to Emergency Medical Services in the Lombardy region during SARS-CoV-2 epidemic. Acta Biomed. 2020 May 11;91(2):39-44. doi: 10.23750/abm.v91i2.9557.