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Multicenter Study

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

Salim S Hayek et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the National Institutes of Health and the Frankel Cardiovascular Center COVID-19 Impact Research Ignitor for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flow diagram depicting study population, incidence of in-hospital cardiac arrest, cardiopulmonary resuscitation, and outcomes. Percentages in lower boxes relate to group who underwent CPR (n=400). Covid-19=coronavirus disease 2019; CPC=cerebral performance category; CPR=cardiopulmonary resuscitation
Fig 2
Fig 2
Determinants of cardiac arrest and not receiving cardiopulmonary resuscitation in critically ill patients with coronavirus disease 2019. Forest plot depicting adjusted odds ratios and 95% confidence intervals for two separate binary logistic regression models: association with in-hospital cardiac arrest, and association with not receiving cardiopulmonary resuscitation. CPR=cardiopulmonary resuscitation; mSOFA=modified sequential organ failure assessment
Fig 3
Fig 3
Proportion of patients with cardiac arrest who underwent cardiopulmonary resuscitation, and of those, proportion who survived to hospital discharge, stratified by age. Number of patients with cardiac arrest given for each age category (eg, among patients <45 years old, 68 had cardiac arrest, 76.5% of whom received cardiopulmonary resuscitation; 21.2% survived to hospital discharge). CPR=cardiopulmonary resuscitation
None
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References

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