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. 2021 Apr 5;20(1):38.
doi: 10.1186/s12940-021-00722-1.

Extreme temperature and out-of-hospital-cardiac-arrest. Nationwide study in a hot climate country

Hannan Kranc  1 , Victor Novack  2   3 , Alexandra Shtein  4 , Rimma Sherman  5 , Lena Novack  6   7
Affiliations

Extreme temperature and out-of-hospital-cardiac-arrest. Nationwide study in a hot climate country

Hannan Kranc et al. Environ Health. .

Abstract

Background: Out-of-hospital-cardiac arrest (OHCA) is frequently linked to environmental exposures. Climate change and global warming phenomenon have been found related to cardiovascular morbidity, however there is no agreement on their impact on OHCA occurrence. In this nationwide analysis, we aimed to assess the incidence of the OHCA events attended by emergency medical services (EMS), in relation to meteorological conditions: temperature, humidity, heat index and solar radiation.

Methods: We analyzed all adult cases of OHCA in Israel attended by EMS during 2016-2017. In the case-crossover design, we compared ambient exposure within 72 h prior to the OHCA event with exposure prior to the four control times using conditional logistic regression in a lag-distributed non-linear model.

Results: There were 12,401 OHCA cases (68.3% were pronounced dead-on-scene). The patients were on average 75.5 ± 16.2 years old and 55.8% of them were males. Exposure to 90th and 10th percentile of temperature adjusted to humidity were positively associated with the OHCA with borderline significance (Odds Ratio (OR) =1.20, 95%CI 0.97; 1.49 and OR 1.16, 95%CI 0.95; 1.41, respectively). Relative humidity below the 10th percentile was a risk factor for OHCA, independent of temperature, with borderline significance (OR = 1.16, 95%CI 0.96; 1.38). Analysis stratified by seasons revealed an adverse effect of exposure to 90th percentile of temperature when estimated in summer (OR = 3.34, 95%CI 1.90; 3.5.86) and exposure to temperatures below 10th percentile in winter (OR = 1.75, 95%CI 1.23; 2.49). Low temperatures during a warm season and high temperatures during a cold season had a protective effect on OHCA. The heat index followed a similar pattern, where an adverse effect was demonstrated for extreme levels of exposure.

Conclusions: Evolving climate conditions characterized by excessive heat and low humidity represent risk factors for OHCA. As these conditions are easily avoided, by air conditioning and behavioral restrictions, necessary prevention measures are warranted.

Keywords: Climate change; Humidity; Meteorology; OHCA; Solar radiation; Temperature.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
An association of temperature with OHCA events, adjusted to relative humidity. Figures in the upper row represent the incremental effect of exposure to temperature below the 10th percentile (11.5 °C) and above the 90th percentile (28.7 °C) as compared to the median value of 21 °C over the course of 72 h prior to the event onset. The figures in the second row show the cumulative effect of the respective exposures. The bottom figure represents an incremental effect of exposure to temperature at 12 h prior to the onset
Fig. 2
Fig. 2
An association of relative humidity with OHCA events, adjusted to ambient temperature. Figures in the upper row represent the incremental effect of exposure to relative below the 10th percentile (33.9%) and above the 90th percentile (82.5%) as compared to the median value of 62.4% over the course of 72 h prior to the event onset. The figures in the second row show the cumulative effect of the respective exposures. The bottom figure represents an incremental effect of exposure to humidity at 2 h prior to the onset
Fig. 3
Fig. 3
An association of heat index with OHCA events. Figures in the upper row represent the incremental effect of exposure to heat index below the 10th percentile (10) and above the 90th percentile (25.8) as compared to the median value of 18.4 over the course of 72 h prior to the event onset. The figures in the second row show the cumulative effect of the respective exposures. The bottom figure represents an incremental effect of exposure to heat index at 6 h prior to the onset
Fig. 4
Fig. 4
An association of solar radiation with OHCA events. Upper figure represents the incremental effect of exposure to solar radiation above the 90th percentile (73.2) as compared to the median value of 29.7 over the course of 72 h prior to the event onset. The figure in the middle shows the cumulative effect of the respective exposure. The bottom figure represents an incremental effect of exposure to solar radiation at 24 h prior to the onset
Fig. 5
Fig. 5
A cumulative effect of exposure to various meteorological conditions as compared to median value. Subgroup analyses by demographical, clinical, temporal and geographical factors
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