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In-hospital cardiac arrest in patients with coronavirus 2019

Oscar J L Mitchell1, Eugene Yuriditsky2, Nicholas J Johnson3

  • 1Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, United States; Center for Resuscitation Science, University of Pennsylvania, United States.

Resuscitation
|January 30, 2021
PubMed

Insights

Survival after in-hospital cardiac arrest (IHCA) for COVID-19 patients was low at 12.3%. Outcomes varied significantly between hospitals, suggesting a need for standardized care protocols for these critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Infectious Diseases

Background:

  • Coronavirus Disease 2019 (COVID-19) has caused significant global mortality.
  • Clinical outcomes for hospitalized COVID-19 patients experiencing in-hospital cardiac arrest (IHCA) remain poorly understood.
  • Understanding IHCA in COVID-19 is crucial for improving patient care and survival rates.

Purpose of the Study:

  • To characterize clinical outcomes of IHCA in patients with active COVID-19.
  • To identify patient- and hospital-level factors associated with 30-day survival after IHCA in COVID-19 patients.

Main Methods:

  • Multicenter retrospective cohort study involving 11 U.S. academic medical centers.
  • Included adult patients with documented positive Severe Acute Respiratory Syndrome Coronavirus 2 tests who underwent CPR/defibrillation for IHCA between March 1, 2020, and May 31, 2020.
  • Primary outcome was 30-day survival post-IHCA.

Main Results:

  • 260 IHCAs occurred in COVID-19 patients; median age 69, 71.5% male.
  • Common presenting rhythms were pulseless electrical activity (45.0%) and asystole (44.6%).
  • Return of spontaneous circulation (ROSC) was 22.3%, 11.9% survived to discharge, and 12.3% survived to 30 days. Hospitals with higher IHCA volume showed considerably lower ROSC and 30-day survival rates.

Conclusions:

  • Achieved ROSC and 30-day survival rates were 22.3% and 12.3%, respectively.
  • Significant variations in center-level outcomes were observed.
  • These variations may explain previously reported poor survival rates in COVID-19 patients with IHCA.
Abstract

Keywords:
COVID-19Cohort studyIn-hospital cardiac arrest

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