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Multicenter Study
. 2021 Mar:160:72-78.
doi: 10.1016/j.resuscitation.2021.01.012. Epub 2021 Jan 27.

In-hospital cardiac arrest in patients with coronavirus 2019

Oscar J L Mitchell  1 , Eugene Yuriditsky  2 , Nicholas J Johnson  3 , Olivia Doran  4 , David G Buckler  5 , Stacie Neefe  6 , Raghu R Seethala  7 , Sergey Motov  8 , Ari Moskowitz  9 , Jarone Lee  10 , Kelly M Griffin  11 , Michael G S Shashaty  12 , James M Horowitz  2 , Benjamin S Abella  13 ; Coronavirus 2019 In-Hospital Cardiac Arrest (COVID IHCA) Study Group
Collaborators, Affiliations
Multicenter Study

In-hospital cardiac arrest in patients with coronavirus 2019

Oscar J L Mitchell et al. Resuscitation. 2021 Mar.

Abstract

Background: Coronavirus Disease 2019 (COVID-19) has caused over 1 200 000 deaths worldwide as of November 2020. However, little is known about the clinical outcomes among hospitalized patients with active COVID-19 after in-hospital cardiac arrest (IHCA).

Aim: We aimed to characterize outcomes from IHCA in patients with COVID-19 and to identify patient- and hospital-level variables associated with 30-day survival.

Methods: We conducted a multicentre retrospective cohort study across 11 academic medical centres in the U.S. Adult patients who received cardiopulmonary resuscitation and/or defibrillation for IHCA between March 1, 2020 and May 31, 2020 who had a documented positive test for Severe Acute Respiratory Syndrome Coronavirus 2 were included. The primary outcome was 30-day survival after IHCA.

Results: There were 260 IHCAs among COVID-19 patients during the study period. The median age was 69 years (interquartile range 60-77), 71.5% were male, 49.6% were White, 16.9% were Black, and 16.2% were Hispanic. The most common presenting rhythms were pulseless electrical activity (45.0%) and asystole (44.6%). ROSC occurred in 58 patients (22.3%), 31 (11.9%) survived to hospital discharge, and 32 (12.3%) survived to 30 days. Rates of ROSC and 30-day survival in the two hospitals with the highest volume of IHCA over the study period compared to the remaining hospitals were considerably lower (10.8% vs. 64.3% and 5.9% vs. 35.7% respectively, p < 0.001 for both).

Conclusions: We found rates of ROSC and 30-day survival of 22.3% and 12.3% respectively. There were large variations in centre-level outcomes, which may explain the poor survival in prior studies.

Keywords: COVID-19; Cohort study; In-hospital cardiac arrest.

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Figures

Fig. 1
Fig. 1
Flow diagram of number of participants at each stage of the study. IHCA: in-hospital cardiac arrest, CPR: cardiopulmonary resuscitation.
Fig. 2
Fig. 2
Rates of ROSC and 30-day survival by hospital. Unadjusted rates of ROSC and 30-day survival by hospital against the volume of COVID-19 IHCA per hospital over the study period. Abbreviations: ROSC: Return of Spontaneous Circulation; IHCA: In-Hospital Cardiac Arrest.
See this image and copyright information in PMC

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