Background : Patients hospitalized for severe COVID-19 infection are at risk for in-hospital cardiac arrest (IHCA). It is unknown whether certain characteristics of cardiac arrest care and outcomes of IHCAs during the COVID-19 pandemic differed compared to a pre-COVID-19 period. Methods : All patients who experienced an IHCA at our hospital from March 1st through May 15th 2020, during the peak of the COVID-19 pandemic, and those who had an IHCA from January 1st 2019 to December 31st 2019 were identified. All patient data was extracted from our hospital's Get With The Guidelines-Resuscitation (GWTG-R) registry, a prospective hospital-based archive of IHCA data. Baseline characteristics of patients, interventions and overall outcomes of IHCAs during the COVID-19 pandemic were compared to IHCAs in 2019, prior to the COVID-19 pandemic. Results : There were 125 IHCAs during a 2.5-month period at our hospital during the peak of the COVID-19 pandemic compared to 117 IHCAs in all of 2019. IHCAs during the COVID-19 pandemic occurred more often on general medicine wards than in intensive care units (46% vs 33%; 19% vs 60% in 2019, p<0.001), were overall shorter in duration (median time of 11 min (8.5-26.5) vs 15 min (7.0-20.0), p=0.001), led to fewer endotracheal intubations (52% vs 85%, p<0.001) and had overall worse survival rates (3% vs 13%, p=0.007) compared to IHCAs prior to the COVID-19 pandemic. Conclusions : Patients who experienced an IHCA during the COVID-19 pandemic had overall worse survival compared to those who had an IHCA prior to the COVID-19 pandemic. Our findings highlight important differences between these two time periods. Further study is needed on cardiac arrest care in patients with COVID-19.

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The effects of short- and long-term testosterone absence or treatment on the diaphragm were studied in castrated and sexually normal male rats. Compared with control rats (untreated normal males), testosterone absence or treatment did not significantly affect costal weight. In untreated castrated males, there were significant decreases in specific forces, type II fiber cross-sectional area, and myosin heavy chain (MHC) isoform 2B after 2.5 wk. In castrated males that received testosterone, there were significant increases in specific forces, type II total fiber proportional area, and relative expression of all adult diaphragm fast MHC isoforms (MHC-2all) after 2.5 wk. In normal males that received testosterone, the only significant finding was an increase in MHC-2B after 2.5 wk. Across all groups, there was close correlation between increases in maximum tetanic forces and MHC-2all. Changes in diaphragm function and composition were closely related to changes in serum testosterone levels at 2.5 wk. The lack of significant change in diaphragm function at 10 wk occurred despite changes in serum testosterone levels and diaphragm composition similar to those at 2.5 wk. These findings support our hypothesis that the effects of testosterone are dependent on basal circulating androgen levels and study duration.

The effects of dexamethasone treatment duration (2.5 vs 10 weeks) on diaphragm myosin heavy chain isoforms, fiber types, and contractile characteristics were studied in male rats. Compared with ad libitum-fed and pair-fed controls, dexamethasone significantly decreased body weight, costal diaphragm weight, and the relative expression of myosin heavy chain isoform MHC-2B. Compared with pair-fed controls, the effect on MHC-2B expression was greater after 10 weeks than after 2.5 weeks. Type I and type II costal diaphragm fiber atrophy occurred, and type II fiber atrophy was greater after 10 weeks. Costal diaphragm-specific forces were not affected significantly by dexamethasone, regardless of the treatment duration or control group comparison. Fatigue resistance indexes were increased significantly after long term treatment compared with pair-fed controls and after both short-term and long-term treatment compared with ad libitum-fed controls. In conclusion, the effects of dexamethasone on MHC isoform phenotype expression, fiber type costal diaphragm atrophy, and fatigue resistance were dependent on treatment duration, with greater effects after long-term (10 weeks) treatment.