Outcomes of In- and Out-of-Hospital Cardiac Arrest in COVID-19

Quick Takes

  • During the pandemic phase, COVID-19 was involved in ≥10% of all out-of-hospital cardiac arrests (OHCAs) and 16% of in-hospital cardiac arrests (IHCAs).
  • Among COVID-19 cases, 30-day mortality was increased 3.4-fold in OHCA and 2.3-fold in IHCA.

Study Questions:

What are the characteristics and outcomes among cardiac arrest cases with coronavirus disease (COVID-19), and what are the differences between the pre-pandemic and the pandemic period in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA)?

Methods:

All patients reported to the Swedish Registry for Cardiopulmonary Resuscitation from January 1, 2020 to the local appearance of the pandemic on March 16, 2020 were compared with cardiac arrest patients reported from March 16, 2020–July 20, 2020.

Results:

There were a total of 1,946 cases of OHCA and 1,080 cases of IHCA. During the pandemic, 88 (10%) OHCAs and 72 (16%) IHCAs had COVID-19. With regard to OHCA during the pandemic, the odds ratio for 30-day mortality in COVID-19-positive cases, compared with COVID-19-negative cases, was 3.4; the hazard ratio was 1.45 (95% confidence interval [CI], 1.13–1.85). Adjusted 30-day survival was 4.7% for patients with COVID-19, 9.8% for patients without COVID-19, and 7.6% in the pre-pandemic period. With regard to IHCA during the pandemic, the odds ratio for COVID-19-positive cases, compared with COVID-19-negative cases, was 2.3 (95% CI, 1.27–4.24); the hazard ratio was 1.48 (95% CI, 1.09–2.01). Adjusted 30-day survival was 23% in COVID-19-positive cases, 40% in patients without COVID-19, and 36% in the pre-pandemic period.

Conclusions:

During the pandemic phase, COVID-19 was involved in ≥10% of all OHCAs and 16% of IHCAs, and, among COVID-19 cases, 30-day mortality was increased 3.4-fold in OHCA and 2.3-fold in IHCA.

Perspective:

During the COVID-19 pandemic, an increased risk of OHCA has been observed, and the pandemic has affected the cardiac arrest patient profile. COVID-19 is a multiorgan disease, affecting not only the pulmonary system, but also notably the cardiovascular system, coagulation, and others. Cardiac arrest in a COVID-19 patient is associated with higher incidence of nonshockable rhythm and appears to be associated with higher mortality than among non-COVID-19 patients, highlighting the importance of measures to prevent cardiac arrest. Interestingly, the study showed an 8% increase in bystander-witnessed arrests and remarkably 47% increase in bystander defibrillations, which may be related to social factors arising from the pandemic. The impact of the increase in defibrillation, however, has been blunted by significantly higher rates of respiratory arrest during the pandemic.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Coronavirus, COVID-19, Electric Countershock, Heart Arrest, Heart Failure, Out-of-Hospital Cardiac Arrest, Secondary Prevention


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