Characteristics and Outcomes of In-Hospital Cardiac Arrest Events During the COVID-19 Pandemic

Abstract

Background : Patients hospitalized for severe COVID-19 infection are at risk for in-hospital cardiac arrest (IHCA). It is unknown whether certain characteristics of cardiac arrest care and outcomes of IHCAs during the COVID-19 pandemic differed compared to a pre-COVID-19 period. Methods : All patients who experienced an IHCA at our hospital from March 1st through May 15th 2020, during the peak of the COVID-19 pandemic, and those who had an IHCA from January 1st 2019 to December 31st 2019 were identified. All patient data was extracted from our hospital's Get With The Guidelines-Resuscitation (GWTG-R) registry, a prospective hospital-based archive of IHCA data. Baseline characteristics of patients, interventions and overall outcomes of IHCAs during the COVID-19 pandemic were compared to IHCAs in 2019, prior to the COVID-19 pandemic. Results : There were 125 IHCAs during a 2.5-month period at our hospital during the peak of the COVID-19 pandemic compared to 117 IHCAs in all of 2019. IHCAs during the COVID-19 pandemic occurred more often on general medicine wards than in intensive care units (46% vs 33%; 19% vs 60% in 2019, p<0.001), were overall shorter in duration (median time of 11 min (8.5-26.5) vs 15 min (7.0-20.0), p=0.001), led to fewer endotracheal intubations (52% vs 85%, p<0.001) and had overall worse survival rates (3% vs 13%, p=0.007) compared to IHCAs prior to the COVID-19 pandemic. Conclusions : Patients who experienced an IHCA during the COVID-19 pandemic had overall worse survival compared to those who had an IHCA prior to the COVID-19 pandemic. Our findings highlight important differences between these two time periods. Further study is needed on cardiac arrest care in patients with COVID-19.

Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis

“… Design (country) Setting Population a Presenting rhythm Outcomes Qualitative assessment b Bhatla et al (2020) 18 Single centre retrospective study (US) Both ICU and non-ICU 9 ICU patients with COVID-19 (PCR testing) who developed IHCA and received CPR ICU : 100% (9/9) Non-shockable: 89% (8/9) Shockable: 11% (1/9) In-hospital mortality: 44% (4/9) ROSC: 66% (6/9) Discharged alive : 22 % (2/9) Still hospitalized: 33% (3/9) 12/16 Hayek et al (2020) 13 Multicentre retrospective study (US) 68 ICUs 400 ICU patients with COVID-19 (laboratory confirmed) who developed IHCA and received CPR ICU : 100% (400/400) Age: 61 ± 14 y.o. Male: 66.5% (266/400) SOFA: 5.9 ± 3.3 On vasopressors : 56.5% (226/400) On IMV: 64% (257/400) Non-shockable: 73% (294/400) Shockable: 12% (48/400) In-hospital mortality: 88% (352/400) ROSC: 34% (135/400) Favorable c neurological status: 7% (28/400) 14/16 Miles et al (2020) 21 d Single centre retrospective study (US) Both ICU and non-ICU 125 patients who developed IHCA and received CPR during pandemic (99 COVID-19 positive at PCR testing, 12 negative, 14 indeterminate) ICU: 33% (41/125) Age: 67 (IQR 57–76) Male: 66% (82/125) Non-shockable: 90% (113/125) Shockable: 3% (4/125) Unknown: 6% (8/125) In-hospital mortality: 98% (97/99) ROSC: 3.6% (45/125) 13/16 Mitchell et al (2020) 16 ...…”

“…After the exclusion of duplicates and not relevant records, ten articles were included, evaluating a total of 1179 COVID-19 patients after IHCA and attempted CPR. 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 The process of inclusion and exclusion, detailed in a the PRISMA flow diagram, is presented as Fig. S1 in Supplementary material 2.…”

“… 13 All the studies specifically included patients with COVID-19, but three studies also reported data on historical cohorts of non COVID-19 patients. 15 , 19 , 21 …”

“…Six studies had 13/16 as overall qualitative assessment score, 5 , 14 , 15 , 16 , 19 , 21 three studies had 12/16 17 , 18 , 20 and one had 14/16. 13 The detailed qualitative assessment with individual domain score per study is provided as Table S3, Supplementary material 2.…”

In-hospital cardiac arrest in patients with coronavirus 2019

“…A recently published study of all-cause IHCA during the COVID-19 pandemic in NYC showed that hospital survival decreased substantially during the pandemic when compared to the year before, with no reported difference in outcomes between COVID-19 patients and those without the virus, suggesting that centre-wide changes in IHCA management may have impacted outcomes. 31 It has been hypothesized that particularly high volumes of IHCA may be an indicator for hospitals with stretched resources and less developed capacities for identification of patient deterioration and post-arrest care. 30 As COVID-19 surges and overwhelms hospitals with a challenging volume of critically ill patients, patient care teams have been required to practice in unprecedented circumstances.…”