Survival after in-hospital cardiac arrest 35% lower in COVID-19 patients

Defibrillator paddles
Defibrillator paddles

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Adult COVID-19 patients who had an in-hospital cardiac arrest (IHCA) were 35% less likely to receive potentially life-saving defibrillation without delay and survive to hospital release, according to a study today in JAMA Network Open.

University of Iowa at Iowa City researchers led the study of 24,915 patients with IHCA from 286 US hospitals, of whom 5,916 (23.7%) had COVID-19, from March to December 2020.

The research team analyzed data from the American Heart Association's Get With the Guidelines Registry (GWTG-R), which compiles information on patients who have IHCA at participating US hospitals. Among the 24,915 patients with IHCA, average age was 64.7 years, 39.5% were women, 24.8% were Black, 61.1% were White, 3.8% were of other races, and 10.3% were of unknown race.

The 5,916 COVID-19 patients were younger and more often men and of Black race; more likely to have an initial nonshockable rhythm, pneumonia, respiratory insufficiency, or sepsis; and be receiving mechanical ventilation and vasopressors to treat low blood pressure at the time of IHCA.

'Sizable effect' of pandemic on in-hospital resuscitation

Relative to uninfected patients, those with COVID-19 had lower rates of survival to hospital release after IHCA (11.9% vs 23.5%; adjusted relative risk [RR], 0.65) and return of spontaneous circulation (53.7% vs 63.6%; adjusted RR, 0.86). They were also more likely to experience delays in defibrillation (27.7% vs 36.6%; RR, 1.30) but not epinephrine administration.

The link between COVID-19 and worse survival after IHCA held true for patients with nonsurgical diagnoses, those in an intensive care unit, and those who received timely defibrillation or epinephrine administration.

The authors noted that studies from early in the pandemic reported survival rates of less than 3% among COVID-19 patients who had an IHCA. "However, these results were from single-center studies that comprised only 295 patients with COVID-19 in hospitals that were overwhelmed early during the pandemic," the authors wrote.

Noting that roughly 1 in 4 patients who experienced IHCA in the study had COVID-19. "This observation underscores the sizable effect of the pandemic on in-hospital resuscitation," they wrote.

The study findings, the authors said, are relevant to healthcare providers and hospitals amid the continuing pandemic.

"Because IHCA survival among patients with COVID-19 in this study was not as poor as reported previously, we believe that COVID-19 infection alone should not be used as a criterion for withholding resuscitation care from hospitalized patients," they wrote. "As new variants emerge, future studies will be needed to assess the ongoing impact of COVID-19 infection on IHCA survival."

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