A Systematic Review of the Incidence and Outcomes of In-Hospital Cardiac Arrests in Patients With Coronavirus Disease 2019*

Abstract

OBJECTIVES: To investigate the incidence, characteristics, and outcomes of in-hospital cardiac arrest in patients with coronavirus disease 2019 and to describe the characteristics and outcomes for patients with in-hospital cardiac arrest within the ICU, compared with non-ICU patients with in-hospital cardiac arrest. Finally, we evaluated outcomes stratified by age. DATA SOURCES: A systematic review of PubMed, EMBASE, and preprint websites was conducted between January 1, 2020, and December 10, 2020. Prospective Register of Systematic Reviews identification: CRD42020203369. STUDY SELECTION: Studies reporting on consecutive in-hospital cardiac arrest with a resuscitation attempt among patients with coronavirus disease 2019. DATA EXTRACTION: Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines. Discrepancies were resolved by consensus or through an independent third reviewer. DATA SYNTHESIS: Eight studies reporting on 847 in-hospital cardiac arrest were included. In-hospital cardiac arrest incidence varied between 1.5% and 5.8% among hospitalized patients and 8.0–11.4% among patients in ICU. In-hospital cardiac arrest occurred more commonly in older male patients. Most initial rhythms were nonshockable (83.9%, [asystole = 36.4% and pulseless electrical activity = 47.6%]). Return of spontaneous circulation occurred in 33.3%, with a 91.7% in-hospital mortality. In-hospital cardiac arrest events in ICU had higher incidence of return of spontaneous circulation (36.6% vs 18.7%; p < 0.001) and relatively lower mortality (88.7% vs 98.1%; p < 0.001) compared with in-hospital cardiac arrest in non-ICU locations. Patients greater than or equal to 60 years old had significantly higher in-hospital mortality than those less than 60 years (93.1% vs 87.9%; p = 0.019). CONCLUSIONS: Approximately, one in 20 patients hospitalized with coronavirus disease 2019 received resuscitation for an in-hospital cardiac arrest. Hospital survival after in-hospital cardiac arrest within the ICU was higher than non-ICU locations and seems comparable with prepandemic survival for nonshockable rhythms. Although the data provide guidance surrounding prognosis after in-hospital cardiac arrest, it should be interpreted cautiously given the paucity of information surrounding treatment limitations and resource constraints during the pandemic. Further research is into actual causative mechanisms is needed.

Impact of the COVID-19 pandemic on in-hospital cardiac arrests in the UK

“…This differs from data from a US registry which indicate an increase in non-shockable rhythms during the pandemic period 5 . Other studies of IHCA during the COVID-19 pandemic have documented an increase in the proportion of non-shockable rhythms but are studies of patients with confirmed COVID-19 infection unlike our study which involved all patients with an IHCA 1 .…”

“…Evidence suggests an impact of SARS-COV-2 infection on the risk of in-hospital cardiac arrest (IHCA) and the processes of care and patient outcomes following IHCA. [1] , [2] In the United Kingdom (UK), measures to help hospitals cope with the pandemic included cancelling elective surgery, discharging many hospital patients, and preparing for an increase in patients requiring respiratory support, all of which may have altered the case mix of the inpatient population. Additionally, hospital staff were deployed to more acute, and often less familiar, clinical areas.…”

Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry

“…Indeed, the incidence of overall in-ICU CA and those with CPR attempt was 14, and 8%, respectively, in the only other published multicenter in-ICU CA cohort of patients admitted for COVID-19 in USA [ 16 ]. Moreover, a recent review of the incidence of IHCA in patient with COVID-19 reported between 8 and 11% among ICU patients [ 22 ].…”

“…Conversely, this difference in outcome could mainly be explained by our inclusion criteria and selection of patients: only in-ICU CA patients with CPR attempt have been included here in our study. By contrast, most of previous studies have included a limited number of in-ICU CA (with or without CPR attempt) or only IHCA in unmonitored wards which are known to be associated with poorer outcome [ 22 , 23 ].…”

Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic

“…A few publications have started emerging regarding outcomes of in-hospital cardiac arrest during the COVID-19 pandemic yielding information regarding gender, age, common initial rhythm, survival to discharge, or achievement of ROSC. 3,[10][11][12][13][14] To the best of our knowledge, this is the first study reporting the epidemiology and outcomes of IHCA pre-and during pandemic in Pakistan.…”