Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence.

Francesca Romana Gentile,Daniele Bussi,Francesca Reali,Enrico Contri,Alessia Currao,Claudio Mare,Sara Bendotti,Enrico Baldi,Roberto Primi,Simone Savastano,Fabio Facchin,Sara Compagnoni,Elena Cavarretta

doi:10.1371/journal.pone.0256526

Abstract

Pollution has been suggested as a precipitating factor for cardiovascular diseases. However, data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. By collecting data both in the OHCA registry and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region, all medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 1550000 inhabitants). Days were divided into high or low incidence of OHCA according to the median value. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend. After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined. All the pollutants were also strongly associated with high incidence of OHCA in multivariable analysis with correction for temperature, humidity, and day-to-day concentration changes. Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models for the organization of emergency medical services.

Highlights

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in industrialized countries
The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend
After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in industrialized countries. Both in Europe and the United States more than 350.000 OHCA occur annually [1, 2] In Italy, an average of 60000 OHCA occur per year, with an incidence of 1 per 1000 inhabitants. Due to the high mortality rate, the identification of factors that may precipitate cardiac arrest represents a major challenge and efforts in the field of primary prevention and risk assessment are needed. Air pollution has been established as a potential trigger for OHCA. Data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial

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Conclusion