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In-Hospital Cardiac Arrest in Critically Ill Patients With COVID-19
Quick Takes
- In-hospital cardiac arrest was common in critically ill patients with COVID-19 and associated with poor survival, even with CPR, particularly among older patients.
- About 50% of patients had do not attempt resuscitation orders at the time of the arrest and did not undergo CPR.
Study Questions:
What are the risk factors, incidence, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation (CPR) in critically ill adults with coronavirus disease 2019 (COVID-19)?
Methods:
Critically ill adults with laboratory-confirmed COVID-19 were enrolled in intensive care units (ICUs) at 68 hospitals in the United States.
Results:
Among 5,019 critically ill patients with COVID-19, 14% experienced in-hospital cardiac arrest. Only 57% received CPR. Patients who had in-hospital cardiac arrest were older, had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of ICU beds. The most common arrhythmias were pulseless electrical activity (50%) and asystole (24%). Only 12% of patients who received CPR survived to hospital discharge. Survival to hospital discharge differed by age, with 21% of patients <45 years surviving compared with 3% of those aged ≥80 years.
Conclusions:
Cardiac arrest is common in critically ill patients with COVID-19 and is associated with poor survival, particularly among older patients.
Perspective:
While poor outcomes in in-hospital cardiac arrests in COVID-19 patients have previously been reported, this very large study in the United States confirmed the very low chances of survival to discharge. Nonshockable rhythm was noted in about 75% of the arrest victims, which suggests that noncardiac was the main driver of mortality. About half of the patients had a do not attempt resuscitation order at the time of the arrest and did not undergo resuscitation. These data may inform decision making by patients, families, and physicians, as well as policies for treatment during the COVID-19 pandemic.
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, Critical Illness, Heart Arrest, Intensive Care Units, Patient Discharge, Resuscitation Orders, Risk Factors, Secondary Prevention, severe acute respiratory syndrome coronavirus 2
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