Sudden death in the out-of-hospital setting in times of covid-19

ABSTRACT

One in five adult deaths in developed countries is due to cardiovascular causes. Half of these deaths occur suddenly and a large percentage in the out-of-hospital setting. Numerous studies have demonstrated that the access of the general population to learn-ing simple and pragmatic cardiopulmonary resuscitation maneuvers and the presence of automated external defibrillators translate into a large increase in survival without sequelae in victims of sudden out-of-hospital cardiac death. Today the special situation represented by the COVID-19 pandemic questions all we have learned so far and faces us with two extremely complex situations. On the one hand, the cardiovascular involvement and the consequent increase in malignant ventricular arrhythmias generated by this infection, both in healthy patients and in those with pre-existent diseases, have led to an increase in the incidence of sudden out-of-hospital death. On the other hand, it forces us to rethink all the actions set in motion at the moment a patient presents with an episode of sudden out-of-hospital cardiac death, as the possibility of transmission of this highly contagious disease is now added during the resuscitation maneuvers. Finding a risk-benefit balance that allows increasing the patient’s survival with the least pos-sible risk for the person who is performing the resuscitation is the real challenge we are encountering today.