Background In-hospital cardiac arrest (IHCA) carries a high mortality and providing resuscitation to COVID-19 patients presents additional challenges for emergency physicians. Our objective was to describe outcomes of COVID-19 patients suffering IHCA at a rural hospital in Southern California. Methods Single-center retrospective observational study. A hospital registry of COVID-19 patients was queried for all patients who suffered IHCA and received cardiopulmonary resuscitation (CPR) between May 1st and July 31st, 2020. A manual chart review was performed to obtain patient demographics, oxygen requirement prior to cardiac arrest (CA), details of the resuscitation including presence of an emergency physician, and final disposition. Results Twenty-one patients were identified, most of whom were Hispanic, male, and aged 50–70. The most common medical comorbidities were diabetes and hypertension. Most patients suffered respiratory arrest, with an initial rhythm of pulseless electrical activity or asystole. Return of spontaneous circulation (ROSC) was achieved in 3/9 patients already receiving mechanical ventilation, but all 3 expired within the following 24 h. ROSC was achieved in 10/12 patients not already intubated, though most also expired within a few days. The only 2 patients who survived to discharge suffered respiratory arrest after their oxygen delivery device dislodged. Conclusion At a small rural hospital with limited resources and a predominantly Hispanic population, cardiac arrest in a COVID-19 patient portends an extremely poor prognosis. A better appreciation of these outcomes should help inform emergency providers and patients when discussing code status and attempts at resuscitation, particularly in resource limited settings.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has necessitated a significant reassessment of the approach to resource allocation. There is limited data on survivability after inhospital cardiac arrest (IHCA) for patients with coronavirus disease 2019 (COVID-19), particularly in rural and resource-limited settings. In this study, we describe the characteristics and outcomes for COVID-19 patients suffering IHCA at a rural hospital in Southern California. Methods: This was a single-center retrospective observational study performed at a rural situated community hospital in Southern California. A hospital registry of COVID-19 patients was queried for all patients who suffered IHCA and received cardiopulmonary resuscitation (CPR) between May 1st 2020 and July 31st 2020. A manual chart review was performed to confirm cardiac arrest (CA), COVID-19 positivity, as well as to obtain patient demographics, medical comorbidities, COVID-19 specific therapies administered, oxygen requirement prior to CA, details of the resuscitation, and final disposition. Results: We identified twenty one patients who suffered IHCA and received CPR. The majority of these patients were Hispanic, male, and aged 50-70, and the most common medical comorbidities were diabetes and hypertension. Many patients received COVID-19 specific therapies, including dexamethasone, remdesivir, or convalescent plasma. 20/21 patients suffered respiratory arrest, with an initial rhythm of pulseless electrical activity or asystole. Return of spontaneous circulation (ROSC) was achieved in 3/9 patients already receiving mechanical ventilation, but all 3 expired within the following 24 hours. ROSC was achieved in 10/12 patients not already intubated, though most also expired within a few days. The only 2 patients who survived to discharge suffered respiratory arrest after their oxygen delivery dislodged. Conclusion: To our knowledge, this is the first study of COVID-19 cardiac arrests specifically in a rural setting in the United States. In this study at a small community hospital with limited resources and a predominantly Hispanic population, we found low survivability after IHCA in COVID-19 patients. While more is being learned about the disease, and treatment modalities are improving, cardiac arrest portends an extremely poor prognosis. A better appreciation of these outcomes should help inform providers and patients when discussing code status and attempts at resuscitation, particularly in resource limited settings.
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