In-hospital cardiac arrest in patients with coronavirus 2019.
COVID-19
Cohort study
In-hospital cardiac arrest
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
29
09
2020
revised:
18
12
2020
accepted:
08
01
2021
pubmed:
31
1
2021
medline:
4
3
2021
entrez:
30
1
2021
Statut:
ppublish
Résumé
Coronavirus Disease 2019 (COVID-19) has caused over 1 200 000 deaths worldwide as of November 2020. However, little is known about the clinical outcomes among hospitalized patients with active COVID-19 after in-hospital cardiac arrest (IHCA). We aimed to characterize outcomes from IHCA in patients with COVID-19 and to identify patient- and hospital-level variables associated with 30-day survival. We conducted a multicentre retrospective cohort study across 11 academic medical centres in the U.S. Adult patients who received cardiopulmonary resuscitation and/or defibrillation for IHCA between March 1, 2020 and May 31, 2020 who had a documented positive test for Severe Acute Respiratory Syndrome Coronavirus 2 were included. The primary outcome was 30-day survival after IHCA. There were 260 IHCAs among COVID-19 patients during the study period. The median age was 69 years (interquartile range 60-77), 71.5% were male, 49.6% were White, 16.9% were Black, and 16.2% were Hispanic. The most common presenting rhythms were pulseless electrical activity (45.0%) and asystole (44.6%). ROSC occurred in 58 patients (22.3%), 31 (11.9%) survived to hospital discharge, and 32 (12.3%) survived to 30 days. Rates of ROSC and 30-day survival in the two hospitals with the highest volume of IHCA over the study period compared to the remaining hospitals were considerably lower (10.8% vs. 64.3% and 5.9% vs. 35.7% respectively, p < 0.001 for both). We found rates of ROSC and 30-day survival of 22.3% and 12.3% respectively. There were large variations in centre-level outcomes, which may explain the poor survival in prior studies.
Sections du résumé
BACKGROUND
Coronavirus Disease 2019 (COVID-19) has caused over 1 200 000 deaths worldwide as of November 2020. However, little is known about the clinical outcomes among hospitalized patients with active COVID-19 after in-hospital cardiac arrest (IHCA).
AIM
We aimed to characterize outcomes from IHCA in patients with COVID-19 and to identify patient- and hospital-level variables associated with 30-day survival.
METHODS
We conducted a multicentre retrospective cohort study across 11 academic medical centres in the U.S. Adult patients who received cardiopulmonary resuscitation and/or defibrillation for IHCA between March 1, 2020 and May 31, 2020 who had a documented positive test for Severe Acute Respiratory Syndrome Coronavirus 2 were included. The primary outcome was 30-day survival after IHCA.
RESULTS
There were 260 IHCAs among COVID-19 patients during the study period. The median age was 69 years (interquartile range 60-77), 71.5% were male, 49.6% were White, 16.9% were Black, and 16.2% were Hispanic. The most common presenting rhythms were pulseless electrical activity (45.0%) and asystole (44.6%). ROSC occurred in 58 patients (22.3%), 31 (11.9%) survived to hospital discharge, and 32 (12.3%) survived to 30 days. Rates of ROSC and 30-day survival in the two hospitals with the highest volume of IHCA over the study period compared to the remaining hospitals were considerably lower (10.8% vs. 64.3% and 5.9% vs. 35.7% respectively, p < 0.001 for both).
CONCLUSIONS
We found rates of ROSC and 30-day survival of 22.3% and 12.3% respectively. There were large variations in centre-level outcomes, which may explain the poor survival in prior studies.
Identifiants
pubmed: 33515638
pii: S0300-9572(21)00020-4
doi: 10.1016/j.resuscitation.2021.01.012
pmc: PMC7839632
mid: NIHMS1667248
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
72-78Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL146894
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007891
Pays : United States
Investigateurs
Jordan Anderson
(J)
Katherine M Berg
(KM)
Mahlaqa Butt
(M)
Donna S Covin
(DS)
Aashka Damani
(A)
Patrick J Donnelly
(PJ)
Haytham M A Kaafarani
(HMA)
Sarah Kabariti
(S)
Thomas C Kingsley
(TC)
Rachel Kohn
(R)
Kevin C Ma
(KC)
Margaret Mullen-Fortino
(M)
Leon Naar
(L)
Frances Mae West
(FM)
Patrick Zeniecki
(P)
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
N Engl J Med. 2012 Nov 15;367(20):1912-20
pubmed: 23150959
Nephron Clin Pract. 2012;120(4):c179-84
pubmed: 22890468
Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006837
pubmed: 32438836
BMJ. 2020 May 22;369:m1966
pubmed: 32444366
Resuscitation. 2020 Mar 1;148:25-31
pubmed: 31945429
Am J Respir Crit Care Med. 2020 Jun 1;201(11):1337-1344
pubmed: 32298146
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Resuscitation. 2020 Aug;153:161
pubmed: 32574656
Resuscitation. 2019 Nov;144:166-177
pubmed: 31536777
JAMA Netw Open. 2020 Jul 1;3(7):e2010403
pubmed: 32648925
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Crit Care Med. 2016 Jan;44(1):54-63
pubmed: 26457753
Circulation. 2015 Apr 21;131(16):1415-25
pubmed: 25792560
J Am Heart Assoc. 2014 Jan 31;3(1):e000400
pubmed: 24487717
Circ Cardiovasc Qual Outcomes. 2020 Nov;13(11):e007303
pubmed: 32975134
JAMA Intern Med. 2021 Feb 1;181(2):279-281
pubmed: 32986117
Circ Cardiovasc Qual Outcomes. 2020 May;13(5):e006779
pubmed: 32255661
J Am Heart Assoc. 2020 Jul 21;9(14):e017111
pubmed: 32552164
Resuscitation. 2020 Aug;153:45-55
pubmed: 32525022
Resuscitation. 2020 Oct;155:3-5
pubmed: 32707146
Circulation. 2020 Jun 23;141(25):e933-e943
pubmed: 32270695
Crit Care Med. 2013 May;41(5):1252-7
pubmed: 23388519
Resuscitation. 2020 Jun;151:18-23
pubmed: 32283117
JAMA. 2020 May 12;323(18):1771-1772
pubmed: 32219360
N Engl J Med. 2020 May 21;382(21):2012-2022
pubmed: 32227758
J Am Coll Cardiol. 2019 Apr 2;73(12):1598-1600
pubmed: 30922482
Resuscitation. 2018 Nov;132:1-5
pubmed: 30138650
Scand J Trauma Resusc Emerg Med. 2011 Jun 15;19:38
pubmed: 21672267
BMJ. 2020 Sep 30;371:m3513
pubmed: 32998872
Resuscitation. 2020 Jun;151:189-196
pubmed: 32246986