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In-Hospital Cardiac Arrest (IHCA) and Outcomes in Patients Admitted With COVID-19 Infection

Rahul Khosla1, Joseph Delio2, Lisa N Glass2

  • 1Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, USA.

Cureus
|July 9, 2021
PubMed

Insights

Patients with COVID-19 experiencing in-hospital cardiac arrest (IHCA) and undergoing cardiopulmonary resuscitation (CPR) had a 0% survival rate. This highlights the poor prognosis for COVID-19 patients requiring CPR for IHCA.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Hospitalized patients with COVID-19 often face poor outcomes, particularly those experiencing in-hospital cardiac arrest (IHCA).
  • Previous reports indicate a generally poor prognosis for IHCA patients.
  • The COVID-19 pandemic necessitated understanding outcomes for critical events like IHCA.

Purpose of the Study:

  • To evaluate the survival outcomes of patients with COVID-19 who underwent cardiopulmonary resuscitation (CPR) for IHCA.
  • To analyze the characteristics of IHCA events in COVID-19 patients.
  • To inform discussions about advanced care options, including CPR, for COVID-19 patients.

Main Methods:

  • A single-center, retrospective, observational study at a Veterans Affairs Medical Center.
  • Inclusion criteria: hospitalized COVID-19 patients who underwent CPR for IHCA (laboratory-confirmed positive PCR test).
  • Exclusion criteria: patients with do-not-resuscitate (DNR) orders, comfort care, or hospice enrollment.

Main Results:

  • Of 29 eligible COVID-19 patients in the MICU who experienced IHCA, 100% (10/10) died after CPR without return of spontaneous circulation (ROSC).
  • All IHCA events occurred with non-shockable initial rhythms: 70% pulseless electrical activity (PEA) and 30% asystole.
  • No patients with COVID-19 and IHCA survived CPR in this cohort.

Conclusions:

  • COVID-19 patients experiencing in-hospital cardiac arrest (IHCA) and undergoing cardiopulmonary resuscitation (CPR) had a 0% survival rate in this study.
  • The initial cardiac rhythm was consistently non-shockable (PEA or asystole) in these patients.
  • Discussions regarding advanced care options, including CPR, are crucial for COVID-19 patients due to the poor prognosis associated with IHCA.

Keywords:
cardiac arrest outcomecovid 19critical care and hospital medicinein hospital cardiac arrestveterans affairs

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