Background: Inpatient cardiac arrest care had to be adapted to meet the needs of patients and providers during the COVID-19 pandemic. Providers working in the emergency department and in the inpatient setting have acquired extensive experience and expertise in caring for patients with COVID-19 related cardiac arrest. We summarize recent reports relevant to clinicians on inpatient cardiac arrest care, provider and patient safety, and effective use of resources. Methods: We performed literature searches of the PubMed database on inpatient cardiac arrest, COVID-19, healthcare-associated coronavirus transmission, and others. The authors’ collections of lived experience as inpatient care providers and clinically useful materials gathered during the pandemic were included. Results: We summarize current knowledge about cardiac arrest in COVID-19 relevant to hospitalist practice, describe lessons learned to date, and provide practical guidance for addressing cardiopulmonary resuscitation for patients with COVID-19. We discuss literature on risk factors for cardiac arrest in patients with COVID-19; risk of infection for rescuers performing resuscitation in patients with COVID-19 and mitigation strategies; goals of care during cardiac arrest in a patient with COVID-19; reducing the risk of exposure to rescuers (including pre–cardiac arrest care); reducing cross-contamination during cardiac arrest in patients with COVID-19; prioritizing oxygenation and ventilation strategies with lower aerosolization risk; maximizing resources during cardiac arrest in patients with COVID-19; and post–cardiac arrest care. Conclusions: Advances made in the care of inpatient cardiac arrest patients during the COVID-19 include domains of patient risk stratification, provider safety, advance directives, and others. Lessons in the management of inpatient cardiac arrest learned during this pandemic are likely to applicable to future pandemics.

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Purpose: Patients with Type-2 Diabetes Mellitus (T2DM) are at increased risk of colorectal neoplasms (CRN). Previous studies have shown an increased risk of CRN with chronic Insulin therapy and a decreased risk associated with the use of insulin sensitizers. In this study the impact of various anti-diabetic medications on the prevalence of CRN will be compared. Methods: Charts of 401 T2DM patients undergoing asymptomatic screening colonoscopy between January2006 and June2010 were reviewed. Patient variables including age, sex, race, family history, smoking, Aspirin usage, h/o CAD, diabetic medications including metformin, thiazolidinediones, sulfonylureas and Insulin, Hemoglobin A1C at the time of colonoscopy and technical variables like cecal intubation rate, the quality of bowel preparation were recorded. Signifi cant CRN was defi ned as polyp > 1 cm in size, >= 3 adenomas and those with villous histology on biopsy. Patients with previous history of colonoscopy, infl ammatory bowel disease or CRN were excluded. Results: Patients who were taking the above mentioned diabetic medications were compared with those not on these medications in terms of the prevalence of polyps and the adenomas. No signifi cant diff erence was found in polyp prevalence among the users and non-users of metformin (38% vs 39.6%) (p-value -0.752) or thiazolidinediones (34.5% vs 40.1%) (p-value -0.355) or Insulin (39.8% vs 38.6%) (p-value -0.835) or aspirin (42% vs 36.2%) (p-value -0.229). Sulfonylurea users had signifi cantly more number of polyps detected when compared to non-users (47.7% vs 34.7%) (p-value -0.012). Prevalence of adenomas was also comparable for all the medications except for sufonylureas which showed a trend toward more adenomas among its users. Quality of bowel preparation and the cecal intubation rates were comparable among the groups. Mean age of the patients in the study was 60.4 years and the average Hemoglobin A1c was 7.98%. On logistic regression analysis male gender and the age of patients were found to be signifi cant predictors for detection of polyps whereas sulfonylurea usage and smoking showed a strong trend to be a predictor. Conclusion: Our study did not show the increased risk of CRN with Insulin therapy or the benefi cial eff ects of Insulin sensitizers as shown in the previous studies. Instead sulfonylurea users had an increased prevalence of polyps which might be medication eff ect acting through various cellular pathways. Further studies are needed.

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