Outcomes for in-hospital cardiac arrest for COVID-19 patients at a rural hospital in Southern California

Abstract

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.

Use of sotrovimab in vaccinated versus unvaccinated COVID‐19 patients in a resource‐limited emergency department during the omicron surge

“…The county had one of the highest rates of COVID-19 infection in the country, 11 which placed significant strain on hospital resources. 12 Our patient population is predominantly Hispanic, with high rates of comorbidities that place patients at increased risk of progression of disease, especially obesity, diabetes, and heart disease 13 . Our patient population also had a good response to the COVID-19 vaccination campaign, with over 80% of eligible patients fully vaccinated by the end of 2021.…”

“…El Centro Regional Medical Center (ECRMC)is located on the Southern California border, 120 miles east of San Diego. The county had one of the highest rates of COVID‐19 infection in the country, 11 which placed significant strain on hospital resources 12 . Our patient population is predominantly Hispanic, with high rates of comorbidities that place patients at increased risk of progression of disease, especially obesity, diabetes, and heart disease 13 .…”

Cardiac Registries During the COVID-19 Pandemic: Lessons Learned

“…Up to 74% of these in-hospital cardiac arrests occur in ICU patients [ 41 •]. Prior history of coronary artery disease, atrial fibrillation/flutter, cerebrovascular disease, hypertension, HF, chronic kidney disease [ 41 •, 42 , 43 ], and diabetes mellitus [ 43 , 44 ] are major risk factors for patients with in-hospital CA. The 30-day mortality rate was lower among in-hospital CA patients than out of hospital CA patients with COVID-19 [ 44 ].…”

Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings

“…As of February 23, 2022, 429 million cases have been diagnosed worldwide with 5.9 million deaths [ 13 ]. In the COVID-19 pandemic era, cardiac arrest is occurring more often and is associated with an extremely high mortality rate (as much as 100% for COVID-19 patients experiencing IHCA) and poor resultant functional status (6.3% with good neurologic outcomes at 30 days; 95% confidence interval [CI] 0.4–9.7%) [ [14] , [15] , [16] , [17] , [18] ].…”