Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest?*

Abstract

Objectives: There is limited data regarding outcomes after in-hospital cardiac arrest among coronavirus disease 2019 patients. None of the studies have reported the outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in the United States. We describe the characteristics and outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in rural Southwest Georgia. Design: Retrospective cohort study. Setting: Single-center, multihospital. PATIENTS: Consecutive coronavirus disease 2019 patients who experienced in-hospital cardiac arrest with attempted resuscitation. Interventions: Attempted resuscitation with advanced cardiac life support. Measurement and Main Results: Out of 1,094 patients hospitalized for coronavirus disease 2019 during the study period, 63 patients suffered from in-hospital cardiac arrest with attempted resuscitation and were included in this study. The median age was 66 years, and 49.2% were males. The majority of patients were African Americans (90.5%). The most common comorbidities were hypertension (88.9%), obesity (69.8%), diabetes (60.3%), and chronic kidney disease (33.3%). Eighteen patients (28.9%) had a Charlson Comorbidity Index of 0–2. The most common presenting symptoms were shortness of breath (63.5%), fever (52.4%), and cough (46%). The median duration of symptoms prior to admission was 14 days. During hospital course, 66.7% patients developed septic shock, and 84.1% had acute respiratory distress syndrome. Prior to in-hospital cardiac arrest, 81% were on ventilator, 60.3% were on vasopressors, and 39.7% were on dialysis. The majority of in-hospital cardiac arrest (84.1%) occurred in the ICU. Time to initiation of advanced cardiac life support protocol was less than 1 minute for all in-hospital cardiac arrest in the ICU and less than 2 minutes for the remaining patients. The most common initial rhythms were pulseless electrical activity (58.7%) and asystole (33.3%). Although return of spontaneous circulation was achieved in 29% patients, it was brief in all of them. The in-hospital mortality was 100%. Conclusions: In our study, coronavirus disease 2019 patients suffering from in-hospital cardiac arrest had 100% in-hospital mortality regardless of the baseline comorbidities, presenting illness severity, and location of arrest.

Effects of COVID-19 on in-hospital cardiac arrest: incidence, causes, and outcome – a retrospective cohort study

“…The occurrence of IHCA among hospitalized patients with COVID-19 commonly ranges from 6 to 14% [9,10]. We confirmed these results and found an incidence of 8%.…”

“…We confirmed these results and found an incidence of 8%. The outcome after IHCA in patients with COVID-19 is worse, and high mortality rates, ranging from 88 to 100%, have been reported [9,10,13,15,40]. These reports led to a controversial discussion about futility and appropriateness of care in patients suffering from COVID-19.…”

“…SARS-CoV-2 primarily affects the respiratory system which can lead to rapid deterioration and severe respiratory failure. Recent clinical studies reported high [9,10,13]. As patients with COVID-19 primarily suffer from respiratory failure, comparing the characteristics and outcomes of IHCA to patients suffering from respiratory failure related and not related to COVID-19 seems reasonable.…”

“…COVID-19 has resulted in high rates of hospitalization and a high number of patients requiring intensive care unit (ICU) treatment [5,6]. The course of disease can be complicated, and can potentially lead to cardiac arrest (CA) for several reasons, as shown by various studies [7][8][9][10]. An increase in out-of-hospital cardiac arrest (OHCA) cases was observed during the COVID-19 pandemic [11,12].…”

“…However, little is known about the CA risk in hospitalized patients with COVID-19 [10,[13][14][15]. Poor in-hospital survival following in-hospital cardiac arrest (IHCA) in patients with COVID-19 has been described, and mortality ranged from 88 to 100% [9,10,13,15]. However, data on in-hospital cardiac arrest (IHCA) in patients with respiratory failure with and without COVID-19 are scarce.…”