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Confirmation of COVID-19 in Out-of-Hospital Cardiac Arrest Patients and Postmortem Management in the Emergency
Changho Kim1, In Hwan Yeo2, Jong Kun Kim1
1Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Insights
A screening tool combining fever or abnormal chest X-rays can help identify coronavirus disease 2019 (COVID-19) in out-of-hospital cardiac arrest patients. This aids emergency response during outbreaks.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Lack of evidence-based guidelines for out-of-hospital cardiac arrest (OHCA) during emerging infectious diseases.
- Need for tools to predict disease confirmation in OHCA patients during outbreaks.
Purpose of the Study:
- Develop and validate a multimodal screening tool for predicting COVID-19 in OHCA patients.
- Aid emergency situations and postmortem evaluations during a COVID-19 outbreak.
Main Methods:
- Retrospective, multicenter observational study of adult OHCA patients.
- Logistic regression used to identify predictors for screening tools.
- Validation of screening variables on a separate patient cohort.
Main Results:
- Advanced age, fever, and abnormal chest X-ray (CXR) were significant predictors.
- Fever before OHCA was more common in COVID-19 positive patients (55.6% vs 16.9%).
- Abnormal CXR (pneumonic infiltration) was present in 88.9% of COVID-19 positive cases.
Conclusions:
- Screening tools combining fever or abnormal CXR show good discriminatory ability for COVID-19 in OHCA patients.
- Recommend suspecting COVID-19 and testing if OHCA patients have fever or abnormal postmortem CXR findings.
- Highlights the importance of clinical and radiological signs in diagnosing COVID-19 in critical care settings.
Background:
There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak.
Materials And Methods:
We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA.
Results:
Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 - 100) and a specificity of 22.5% (95% CI: 13.5 - 34.0).
Conclusion:
The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
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