In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

Abstract

Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19). Design Multicenter cohort study. Setting Intensive care units at 68 geographically diverse hospitals across the United States. Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19. Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality. Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older. Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

In-hospital cardiac arrest in patients with coronavirus 2019

“…Our findings contrast with the uniformly poor outcomes seen in single-centre studies of IHCA in patients with COVID-19 but are consistent with those of another published multicentre IHCA study. 11 …”

“… 9 More recently, a multicentre observational study of 400 patients with COVID-19 who were admitted to the ICU demonstrated a 33.8% ROSC rate and a 12.0% survival to hospital discharge, with lower rates of survival in older patients. 11 The low survival rates in these studies and concern for stretched ICU resources have spurred discussions of expanded do-not-resuscitate orders for patients with COVID-19 and concern for futility of resuscitation in this population. 24 , 25 , 26 …”

“… 9 , 10 More recently a multicentre collaborative published a report of 400 patients admitted across 86 ICUs who suffered IHCA, with a rate of ROSC of 33.8% and 12.0% survival to hospital discharge. 11 These studies have raised questions regarding the utility of resuscitating COVID-19 patients with IHCA, particularly when balancing risks to providers. Whether these early reports are broadly generalizable and should inform practice, particularly in patients outside of the ICU, remains unclear, nor is it known to what extent these results were confounded by conditions during the early phase of the pandemic.…”

Uncertain evolution of untreated coronary syndromes during covid-19 pandemic

“…Hayek and colleagues found that cardiac arrest is common and associated with poor survival in patients critically ill with covid-19 1…”

“…Although the excess death rate from untreated coronary syndromes is difficult to quantify, it is likely to be substantial 4. A drop in admissions for coronary syndromes is a risk factor for increased in-hospital cardiac arrest in the covid-19 pandemic (as Hayek and colleagues present1) as well as out-of-hospital mortality3 and morbidity, leading to a predictably higher rate of heart failure in a “third wave” of this pandemic. Primary care can play a critical role by encouraging patients with symptoms compatible with coronary syndromes—infected with SARS-CoV-2 or not—to proceed urgently to receive treatment.…”