COVID-19 confers worse outcomes in patients with in-hospital cardiac arrest
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Among patients with in-hospital cardiac arrest, those with COVID-19 had worse rates of survival and return of spontaneous circulation compared with those who did not, according to a research letter published in JAMA Network Open.
However, those with COVID-19 and in-hospital cardiac arrest in this cohort, spanning March to December 2020, had a higher rate of survival than those with COVID-19 and in-hospital cardiac arrest included in reports from the beginning of the pandemic.
Saket Girotra, MD, SM, associate professor of internal medicine at the University of Iowa Carver College of Medicine, and colleagues analyzed 24,915 patients (mean age, 65 years; 40% women; 25% Black) from 286 hospitals participating in the American Heart Association’s Get With the Guidelines – Resuscitation registry. All patients had in-hospital cardiac arrest from March to December 2020.
Among the cohort, 23.7% had COVID-19, according to the researchers.
Compared with those without COVID-19, those with it were younger, more likely to be male, more likely to be Black, more likely to have an initial unshockable rhythm, more likely to be taking IV vasopressors and more likely to be on mechanical ventilation, the researchers wrote.
Those with COVID-19 had lower rates of survival to hospital discharge (11.9% vs. 23.5%; adjusted RR = 0.65; 95% CI, 0.6-0.71; P < .001) and return of spontaneous circulation (53.7% vs. 63.6%; aRR = 0.86; 95% CI, 0.83-0.9; P < .001) than those without COVID-19, Girotra and colleagues found.
In addition, patients with COVID-19 were more likely than patients without it to have received delayed defibrillation (27.7% vs. 36.6%; RR = 1.3; 95% CI, 1.09-1.55; P = .003), but there was no difference between the groups in delayed epinephrine treatment, according to the researchers.
Survival and return of spontaneous circulation rates favored the cohort without COVID-19 among those with nonsurgical diagnoses, those in the ICU and those who received prompt defibrillation or epinephrine treatment, the researchers wrote.
Although the 11.9% survival rate in patients with COVID-19 and in-hospital cardiac arrest was low, it was higher than rates of 0% to 3% seen in reports during the beginning of the pandemic, “which likely represented the isolated experience of health systems overwhelmed early during the pandemic,” Girotra and colleagues wrote.
Because the survival rate is higher than previously reported, “we believe that COVID-19 infection alone should not be used as a criterion for withholding resuscitation care from hospitalized patients,” the researchers wrote.
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