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Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest?
Priyank Shah1,2, Hallie Smith2,3, Ayodeji Olarewaju4
1Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, GA.
Insights
Outcomes for coronavirus disease 2019 patients experiencing in-hospital cardiac arrest were grim, with a 100% mortality rate observed. This study highlights the critical need for improved management strategies for these critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiology
Background:
- Limited data exists on outcomes for coronavirus disease 2019 (COVID-19) patients experiencing in-hospital cardiac arrest (IHCA).
- No prior studies have specifically reported IHCA outcomes in COVID-19 patients within the United States.
Purpose of the Study:
- To describe the characteristics and outcomes of COVID-19 patients who suffered IHCA in rural Southwest Georgia.
- To analyze factors associated with IHCA in a US-based COVID-19 cohort.
Main Methods:
- Retrospective cohort study conducted at a single, multi-hospital center.
- Included consecutive COVID-19 patients who experienced IHCA with attempted resuscitation using advanced cardiac life support (ACLS).
- Analyzed patient demographics, comorbidities, presenting symptoms, hospital course, arrest characteristics, and mortality.
Main Results:
- Sixty-three COVID-19 patients with IHCA were analyzed; the majority were African American (90.5%) with a median age of 66.
- Common comorbidities included hypertension (88.9%), obesity (69.8%), and diabetes (60.3%).
- High rates of septic shock (66.7%) and acute respiratory distress syndrome (84.1%) were observed. 100% in-hospital mortality was recorded, with return of spontaneous circulation being brief in all cases.
Conclusions:
- COVID-19 patients experiencing IHCA demonstrated a 100% in-hospital mortality rate in this cohort.
- Mortality was uniformly high irrespective of baseline comorbidities, illness severity, or the location of the cardiac arrest.
- These findings underscore the severe prognosis for COVID-19 patients who arrest during hospitalization.
Objectives:
There is limited data regarding outcomes after in-hospital cardiac arrest among coronavirus disease 2019 patients. None of the studies have reported the outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in the United States. We describe the characteristics and outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in rural Southwest Georgia.
Design:
Retrospective cohort study.
Setting:
Single-center, multihospital.
Patients:
Consecutive coronavirus disease 2019 patients who experienced in-hospital cardiac arrest with attempted resuscitation.
Interventions:
Attempted resuscitation with advanced cardiac life support.
Measurement And Main Results:
Out of 1,094 patients hospitalized for coronavirus disease 2019 during the study period, 63 patients suffered from in-hospital cardiac arrest with attempted resuscitation and were included in this study. The median age was 66 years, and 49.2% were males. The majority of patients were African Americans (90.5%). The most common comorbidities were hypertension (88.9%), obesity (69.8%), diabetes (60.3%), and chronic kidney disease (33.3%). Eighteen patients (28.9%) had a Charlson Comorbidity Index of 0-2. The most common presenting symptoms were shortness of breath (63.5%), fever (52.4%), and cough (46%). The median duration of symptoms prior to admission was 14 days. During hospital course, 66.7% patients developed septic shock, and 84.1% had acute respiratory distress syndrome. Prior to in-hospital cardiac arrest, 81% were on ventilator, 60.3% were on vasopressors, and 39.7% were on dialysis. The majority of in-hospital cardiac arrest (84.1%) occurred in the ICU. Time to initiation of advanced cardiac life support protocol was less than 1 minute for all in-hospital cardiac arrest in the ICU and less than 2 minutes for the remaining patients. The most common initial rhythms were pulseless electrical activity (58.7%) and asystole (33.3%). Although return of spontaneous circulation was achieved in 29% patients, it was brief in all of them. The in-hospital mortality was 100%.
Conclusions:
In our study, coronavirus disease 2019 patients suffering from in-hospital cardiac arrest had 100% in-hospital mortality regardless of the baseline comorbidities, presenting illness severity, and location of arrest.
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