Association of COVID-19 Infection With Survival After In-Hospital Cardiac Arrest Among US Adults

Abstract

IntroductionEarly on in the COVID-19 pandemic, investigators reported poor survival rates (<3%) after in-hospital cardiac arrest (IHCA) among patients with COVID-19 infection in the US and China. [1][2][3] These findings have prompted discussions regarding universal do-not-resuscitate orders for patients with COVID-19. 4 However, these results were from single-center studies that comprised only 295 patients with COVID-19 in hospitals that were overwhelmed early during the pandemic. Whether the poor IHCA survival rate reported in earlier studies is broadly representative of patients with COVID-19 in US hospitals remains unknown. This study examined the association of COVID-19 infection with survival outcomes of US adults after IHCA. MethodsThis cohort study was approved by the Saint Luke's Hospital Institutional Review Board. The board waived the requirement for informed consent because only deidentified data were used. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.The study used data from the American Heart Association Get With the Guidelines-Resuscitation (GWTG-R) registry, which contains detailed information on patients who experience cardiac arrest at participating hospitals in the United States. Within the GWTG-R registry, we identified all adults (aged Ն18 years) who developed IHCA during March to December 2020. Race and ethnicity were self-reported by the study patients, and these data were collected in the GWTG-R registry to examine disparities in care and outcomes of IHCA patients. We constructed multivariable hierarchical regression models to compare survival to discharge and return of spontaneous circulation (ROSC) for 20 minutes or more among patients with and without a suspected or confirmed COVID-19 infection. These models included hospital site as a random intercept and patient variables and calendar month as fixed effects. We used a Poisson link to directly estimate rate ratios.Data are presented as relative risks (RRs) with 95% CIs. Details on the GWTG-R registry, study cohort, study variables, and statistical analyses are included in the eMethods in the Supplement. All statistical analysis was performed in SAS version 9.4 (SAS Institute). ResultsThis study included 24 915 patients with IHCA from 286 hospitals who had a mean (SD) age of 64.7 (15.2) years. There were 9848 women (39.5%) and 15 066 men (60.5%), with sex missing for 1 patient. In terms of race and ethnicity, 6170 patients (24.8%) were Black, 15 223 (61.1%) were White, 949 (3.8%) were of other race or ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, and other races and ethnicities), and 2573 (10.3%) were of unkown race or ethnicity. A suspected or confirmed COVID-19 infection was present in 5916 patients (23.7%). Patients with COVID-19 were younger, more frequently men and of Black race, and more likely to have an initial

Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Results were consistent with 43% lower odds of initial shockable rhythm in the COVID-19 group (OR = 0.53; 95% CI = 0.40 to 0.70; n = 2495; I 2 = 0%) (Supplementary Material S2; Figure S2). A sensitivity analysis was performed excluding the studies with more than 5000 or less than 50 sample sizes in each group [12,17]. Results were consistent with 43% lower odds of initial shockable rhythm in the COVID-19 group (OR = 0.53; 95% CI = 0.40 to 0.70; n = 2495; I 2 = 0%) (Supplementary Material S2; Figure S2).…”

“…Girotra et al [12] was the largest (n = 24,915) among all the included studies. This study compared the survival to discharge and ROSC for 20 min between COVID-19 and The patients included in all the forementioned studies were followed for at least1 month in average to report 30-day mortality.…”

“…Girotra et al [12] was the largest (n = 24,915) among all the included studies. This study compared the survival to discharge and ROSC for 20 min between COVID-19 and non-COVID-19 IHCA groups.…”

Nationwide Analysis of Cardiac Arrest Outcomes During the COVID-19 Pandemic

“… 16 The higher prevalence of COVID-19 among cardiac arrest patients reported in the current study is likely related to our inclusion of in-hospital cardiac arrests, which were also more common during the COVID-19 pandemic. 17 …”

Outcomes of patients with cardiac arrest with and without COVID-19 in the United States

“…[ 1 , 2 , 3 ] Over the last three years, the widespread prevalence of COVID-19 infection has been associated with a significant parallel rise in the incidence of CA. [ 1 , 2 , 3 , 4 ] We aimed to assess 1) the incidence of COVID-19 infection in patients hospitalized with cardiac arrest and 2) the impact of concomitant COVID-19 and cardiac arrest on in-hospital mortality in the United States.…”