COVID-19 impact ‘substantial’ on outcomes for in-hospital cardiac arrest
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The rate of survival after in-hospital cardiac arrest was lower during the initial surge of COVID-19 compared with prior years, even among patients hospitalized without confirmed COVID-19, researchers reported.
According to data published in Circulation: Cardiovascular Quality and Outcomes, resuscitation times for in-hospital cardiac arrests were shorter during the initial surge of the pandemic and delayed epinephrine treatment was more prevalent compared with years before the pandemic.
“New guidance recommending donning personal protective equipment before entering patient rooms, avoiding bag-mask ventilation before intubation to reduce aerosol generation, and limiting the number of responders in a patient’s room, may have been implemented broadly irrespective of patients’ underlying COVID-19 infection status,” Paul S. Chan, MD, MSc, cardiologist at Saint Luke’s Mid America Heart Institute, and colleagues wrote. “Yet, the extent to which the COVID-19 pandemic has affected processes of care and survival outcomes for all patients with an in-hospital cardiac arrest, including those without COVID-19 infection, and whether these changes were sustained beyond the initial pandemic months, is unknown and critical to understand as COVID-19 will likely be endemic in the United States with recurrent surges over time.”
Therefore, Chan and colleagues conducted a retrospective study to compare survival of in-hospital cardiac arrest during the COVID-19 pre-surge (Jan. 1-Feb. 29, 2020), surge (March 1-May 15, 2020) and immediate post-surge (May 16-June 30, 2020) compared with survival in 2015 through 2019.
County-level COVID-19 mortality was categorized as low (0 to 10 deaths per 1 million), moderate (11 to 50 deaths per 1 million), high (51 to 100 deaths per 1 million) or very high (> 100 deaths per 1 million).
In-hospital cardiac arrest in pandemic
Researchers identified 61,586 in-hospital cardiac arrests that occurred from 2015 to 2020.
During the pre-surge period, 24.2% of patients who experienced in-hospital cardiac arrest survived to discharge compared with 24.7% from 2015 to 2019 (adjusted OR = 1.12; 95% CI, 1.02-1.22). However, researchers observed lower survival during the surge period, with 19.6% surviving to discharge compared with 26% from 2015 to 2019 (aOR = 0.81; 95% CI, 0.75-0.88).
Lower survival rate was most pronounced in counties with higher monthly COVID-19 mortality rates, with 28% lower survival in high COVID-19 mortality areas and 42% lower survival in very high COVID-19 mortality areas (P for interaction < .001), according to the researchers.
During the post-surge period, survival to discharge rates were not different compared with the rates from 2015 to 2019 (22.3% vs. 25.8%; aOR = 0.93; 95% CI, 0.83-1.04), and also no longer differed in communities with higher COVID-19 mortality rates compared with communities with low COVID-19 mortality rates (P for interaction = .16)
Researchers reported that during the COVID-19 surge period in 2020, resuscitation times were shorter (median, 22 vs. 25 minutes; P < .001) and delayed epinephrine was more prevalent (11.3% vs. 9.9%; P = .004).
When researchers excluded patients with confirmed or suspected COVID-19 infection, survival to discharge remained lower during the surge period compared with 2015 to 2019, especially in communities with high and very high COVID-19 mortality (P for interaction = .004).
Impact of COVID-19
“Survival rates for in-hospital cardiac arrest were lower during the initial COVID-19 pandemic surge in 2020, even in patients without suspected or confirmed COVID-19 infection,” the researchers wrote. “Although overall survival was lower in communities with high COVID-19 mortality rates, rates of return of spontaneous circulation were lower in all communities, including those with low COVID-19 disease burden. Our findings highlight the substantial impact of COVID-19 on in-hospital resuscitation outcomes during the initial months of the pandemic.”
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