Outcomes of In-Hospital Cardiac Arrest Poor in COVID-19 Patients
MONDAY, Sept. 28, 2020 — None of 54 patients hospitalized with COVID-19 with in-hospital cardiac arrest who underwent cardiopulmonary resuscitation (CPR) survived to discharge, according to a research letter published online Sept. 28 in JAMA Internal Medicine.
Shrinjaya B. Thapa, M.D., from the William Beaumont Hospital in Royal Oak, Michigan, and colleagues identified patients who underwent CPR for cardiac arrest among 1,309 patients with a diagnosis of COVD-19 admitted to Beaumont Health.
The researchers found that 60 of the patients (4.6 percent) developed in-hospital cardiac arrest and underwent CPR. Following exclusion of six patients for lack of documentation, 54 were included in further analysis. In 52 patients, the initial rhythm was unshockable, with 44 with pulseless electrical activity and eight with asystole (81.5 and 14.8 percent, respectively). None of the patients developed ventricular fibrillation and two developed pulseless ventricular tachycardia. Twenty-nine patients (53.7 percent) achieved return of spontaneous circulation (ROSC), with a median time to ROSC of eight minutes. Of those who achieved ROSC, 15 (51.7 percent) had their code status changed to do not resuscitate, while 14 were recoded, received additional CPR, and died. The overall median duration was 10 minutes for CPR. None of the patients survived to discharge.
“These outcomes warrant further investigation into the risks and benefits of performing prolonged CPR in this subset of patients, especially because the resuscitation process generates aerosols that may place health care personnel at a higher risk of contracting the virus,” the authors write.
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