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Outcomes of In-Hospital Cardiac Arrest in COVID-19
Quick Takes
- Nonshockable rhythm was the presenting rhythm for 96% of COVID-19 patients who experienced in-hospital cardiac arrest.
- None of the patients with COVID-19–related in-hospital cardiac arrest survived to discharge.
Study Questions:
What is the in-hospital cardiac arrest (IHCA) survival to discharge in patients with coronavirus disease 2019 (COVID-19)?
Methods:
Among hospitalized patients with a diagnosis of COVID-19, chart review was performed to identify those who underwent cardiopulmonary resuscitation (CPR) for cardiac arrest.
Results:
Among 1,309 patients hospitalized with COVID-19, 60 (4.6%) developed IHCA and underwent CPR. Complete chart information was available in 54 patients. The initial rhythm was nonshockable for 52 patients (96.3%), with 44 (81.5%) with pulseless electrical activity and eight (14.8%) with asystole. Two patients (3.7%) developed pulseless ventricular tachycardia, and none developed ventricular fibrillation. Return of spontaneous circulation was achieved in 29 patients (53.7%). Fifteen of twenty-nine patients (51.7%) who achieved return of spontaneous circulation had their code status changed to do not resuscitate, while 14 patients (48.3%) were recoded, received additional CPR, and died. The survival to discharge was 0 of 54 (95% confidence interval, 0-6.6). At the time of cardiac arrest, 43 patients (79%) were receiving mechanical ventilation, 18 (33%) kidney replacement therapy, and 25 (46.3%) vasopressor support.
Conclusions:
There was a 100% mortality rate among COVID-19 patients who experienced an IHCA.
Perspective:
In this sobering research letter from a tertiary medical center in the United States, none of the COVID-19 patients who experienced an IHCA survived to discharge. An overwhelming majority had nonshockable rhythm, which is an ominous sign in general. At the time of cardiac arrest, 79% of patients were receiving mechanical ventilation, 33% kidney replacement therapy, and 46% vasopressor support. This contrasts with overall survival to discharge before the outbreak of 25%. Given the futility of the CPR and the risk of aerosolization of the infectious particles during the code, it is not clear whether the risk of CPR is justified. This report analyzed outcomes in the very early phase of the COVID-19 outbreak, and one wonders if the outcomes are better with several more months of experience of treating extremely ill COVID-19 patients.
Clinical Topics: Arrhythmias and Clinical EP, COVID-19 Hub, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Coronavirus, COVID-19, Heart Arrest, Outcome Assessment, Health Care, Renal Replacement Therapy, Respiration, Artificial, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Survival Analysis, Tachycardia, Ventricular, Ventricular Fibrillation
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