Clinical characteristics and outcomes of in-hospital cardiac arrest among patients with and without COVID-19

Eugene Yuriditsky; Oscar J L Mitchell; Shari B Brosnahan; Nathaniel R Smilowitz; Karsten W Drus; Anelly M Gonzales; Yuhe Xia; Sam Parnia; James M Horowitz

doi:10.1016/j.resplu.2020.100054

Clinical characteristics and outcomes of in-hospital cardiac arrest among patients with and without COVID-19

Resusc Plus. 2020 Dec:4:100054. doi: 10.1016/j.resplu.2020.100054. Epub 2020 Nov 21.

Authors

Eugene Yuriditsky¹, Oscar J L Mitchell², Shari B Brosnahan³, Nathaniel R Smilowitz¹, Karsten W Drus³, Anelly M Gonzales³, Yuhe Xia⁴, Sam Parnia³, James M Horowitz¹

Affiliations

¹ Division of Cardiology, Department of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, United States.
² Division of Pulmonary, Allergy and Critical Care and the Center for Resuscitation Science, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St. Philadelphia, PA 19104, United States.
³ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, United States.
⁴ Division of Biostatistics, Department of Population Health, New York University School of Medicine, 550 First Ave, New York, NY 10016, United States.

Abstract

Aims: To define outcomes of patients with COVID-19 compared to patients without COVID-19 suffering in-hospital cardiac arrest (IHCA).

Materials and methods: We performed a single-center retrospective study of IHCA cases. Patients with COVID-19 were compared to consecutive patients without COVID-19 from the prior year. Return of spontaneous circulation (ROSC), 30-day survival, and cerebral performance category (CPC) at 30-days were assessed.

Results: Fifty-five patients with COVID-19 suffering IHCA were identified and compared to 55 consecutive IHCA patients in 2019. The COVID-19 cohort was more likely to require vasoactive agents (67.3% v 32.7%, p = 0.001), invasive mechanical ventilation (76.4% v 23.6%, p < 0.001), renal replacement therapy (18.2% v 3.6%, p = 0.029) and intensive care unit care (83.6% v 50.9%, p = 0.001) prior to IHCA. Patients with COVID-19 had shorter CPR duration (10 min v 22 min, p = 0.002). ROSC (38.2% v 49.1%, p = 0.336) and 30-day survival (20% v 32.7%, p = 0.194) did not differ. A 30-day cerebral performance category of 1 or 2 was more common among non-COVID patients (27.3% v 9.1%, p = 0.048).

Conclusions: Return of spontaneous circulation and 30-day survival were similar between IHCA patients with and without COVID-19. Compared to previously published data, we report greater ROSC and 30-day survival after IHCA in COVID-19.

Keywords: AHA, American Heart Association; CAD, Coronary artery disease; CKD, Chronic kidney disease; COVID-19; COVID-19, Coronavirus disease 2019; CPC, Cerebral performance category; Cardiac arrest; Cardiopulmonary resuscitation; DNR, Do not resuscitate; HLD, Hyperlipidemia; HTN, Hypertension; IHCA, In-hospital cardiac arrest; OHCA, Out-of-hospital cardiac arrest; PEA, Pulseless electrical activity; ROSC; ROSC, Return of spontaneous circulation; VF, Ventricular fibrillation; VT, Ventricular tachycardia.