Outcomes of in-hospital cardiac arrest in patients with COVID-19 in New York City

Abstract

Cardiopulmonary resuscitation (CPR) in patients with in-hospital cardiac arrest (IHCA) has been associated with poor overall survival and neurologic recovery. 1 The coronavirus 2019 (COVID-19) global pandemic carries a high mortality rate with high risk of cardiopulmonary arrest. 2 Clear policies for crisis standards of care and CPR are essential in light of limited Intensive Care Unit (ICU) resources and aerosolized transmission among code team members. 3 There is limited literature regarding the survival outcomes and effectiveness of CPR in patients with COVID-19 who suffer cardiac arrest. 4 Here, we describe our experience with performing CPR in patients with COVID-19 who developed IHCA.This retrospective case series included patients 18 years of age or older with confirmed COVID-19 who subsequently had an IHCA between March 1st and May 18th, 2020, at a 500-bed teaching hospital in Manhattan. COVID-19 cases were confirmed using a reverse-transcriptase polymerase chain reaction assay. Data were manually abstracted from electronic health records with the use of a standardized abstraction process. We identified 31 patients who met the inclusion criteria. Patients were grouped based on whether they suffered a cardiac arrest in ICU or non-ICU setting.Of the 31 patients, the median age was 69 (IQR 57À76) years, 71% were male, and 55% had cardiovascular disease (Table 1). 24 patients (77%) developed IHCA in the ICU and 7 (23%) in a non-ICU setting. The initial rhythm was PEA in 18 (58%) patients, asystole in 9

Clinical characteristics and outcomes of in-hospital cardiac arrest among patients with and without COVID-19

“…Similarly, poor outcomes were demonstrated in a cohort of 31 patients with COVID-19 suffering cardiac arrest at a New York City institution; 42% of patients achieved ROSC while no patient survived to hospital discharge. 7 …”

“…Decreased survival has been demonstrated among COVID-19 patients with IHCA as well as out-of-hospital cardiac arrest (OHCA). 7 , 11 , 12 Cardiac arrest among COVID-19 patients is more likely to be related to a non-shockable rhythm; a known factor associated with worse prognosis. 6 , 11 In OHCA, the rate of bystander CPR has been demonstrated to be significantly lower with delayed emergency medical arrival by contrast to the pre-pandemic period potentially explaining worse outcomes.…”

“… 6 Similarly, a retrospective study of 31 patients with COVID-19 suffering IHCA at a New York City institution found that none survived to hospital discharge. 7 …”

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

“…2 A single center study from New York City that included 31 patients with in-hospital cardiac arrest found that no patient survived to hospital discharge. 3 As a result of the lack of comprehensive data on outcomes after in-hospital cardiac arrest in patients with covid-19, implementation of DNACPR (do not attempt cardiopulmonary resuscitation) policies in this setting has been controversial. Some have argued that DNACPR should be considered when the supply of intensive care unit beds is limited and also owing to the risk of covid-19 transmission to healthcare workers during cardiopulmonary resuscitation.…”

COVID-19 disease: Resuscitation

“…The evidence gathering related to in-hospital cardiac arrest outcomes for COVID-19 patients is ongoing. Current studies have demonstrated outcomes for COVID-19 positive cardiac arrest cases range from 13.2% to 42% ROSC rate 47 , 48 , with one study in Wuhan, China reporting a 2.9% survival at 30 days. 47 However, a case series in USA reported no patients survived to hospital discharge .…”