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Cardiac arrest outside the hospital during the peak of the COVID-19 epidemic: studies highlight pulmonary embolism as the main determinant

Cardiac arrest outside the hospital during the peak of the Covid-19 pandemic could be partly due to massive pulmonary embolism© Adobe Stock

French investigators from the Paris Medico-Legal Institute, the radiology department of the Sainte-Anne hospital / GHU Paris, the anesthesia-resuscitation department of the AP-HP hospitals Saint-Louis and Lariboisière, the University of Paris, Inserm and CNRS have hypothesized that cardiac arrests outside the hospital during the peak of the COVID-19 pandemic could be partly due to massive pulmonary embolism. The details of this work were published on May 28, 2020 in the European Journal of Heart Failure .

The Forensic Institute of Paris and the radiology department of Sainte-Anne hospital use whole-body scanners for examinations requested by the justice authorities. These scanners were compared between the two-week period corresponding to the epidemic peak (March 23 to April 7, 2020) and all of 2019. The elements sought on the scanner were the presence of signs of pulmonary infection suggestive of COVID-19, phlebitis of the lower limbs and proximal pulmonary embolism, responsible for cardiac arrest.

This study shows that requests for forensic autopsies for unexplained sudden death were 14 times more frequent during the epidemic peak than in 2019.

The vast majority of unexplained sudden deaths during the epidemic peak had lung lesions suspected of Covid-19 infection.

The age of the deceased patients ranged from 27 to 99 years. Most people died at home, some had fever and / or cough, and the majority suddenly lost contact with family or emergency services 30 minutes to a few hours before the onset of cardiac arrest.

CT analysis shows a 3 times higher frequency of proximal pulmonary embolism and phlebitis during the epidemic peak compared to all of 2019.

These results suggest that a significant proportion of the victims of sudden death during the epidemic peak were probably linked to proximal pulmonary embolism which must be quickly referred to cardiogenic shock treatment centers. This study also confirms the vital role of intensive prevention of thrombosis in patients with COVID-19 infection.

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Excess out-of-hospital deaths during COVID-19 outbreak: evidence of pulmonary embolism as a main determinant

Joseph Benzakoun MD; Ghazi Hmeydia MD; Tania Delabarde MS,PhD; Lilia Hamza MD; Jean-François Meder MD,PhD; Bertrand Ludes MD,PhD; Alexandre Mebazaa MD,PhD