Perspective:

The COVID-19 pandemic has wreaked havoc around the world affecting everyone, from the poor to the rich. Due to myriad factors, the rates of confirmed infections vary widely, as do confirmed mortality rates across populations. One way to assess the impact of the pandemic is to examine excess OHCAs. The present study from northern Italy suggests that they increased by a stunning 52%, which is additive to the increased mortality observed in hospitals. The increase in OHCA is likely due to a combination of respiratory failure and pulmonary embolism known to be associated with COVID-19. Other studies reported rapid progression toward acute respiratory distress syndrome, even in patients who were apparently stable a few hours earlier, a finding that comports with the acute nature of the OHCA. Other putative causes include arrhythmic sudden cardiac death due to myocardial injury, perhaps intrinsic infection-related QT interval prolongation, or one related to the administration of QT-prolonging drugs to treat the infection. There may also be indirect causes of OHCA due to the avoidance and/or delay in seeking medical care, or prolonged wait times for emergency medical services, for both COVID-19 and non-COVID conditions (acute myocardial infarction).