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Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Nielson C, Kelly K, Attah R, Pei Z, Wang Y, Firpo MA, Park AH. Comparing Aerosol Generation in Human and Animal Tissues During Common Otolaryngology Procedures. Otolaryngol Head Neck Surg 2023; 169:1491-1498. [PMID: 37313962 DOI: 10.1002/ohn.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether hamster and human tissues generate similar amounts of aerosolized particles using common otolaryngology surgical techniques. STUDY DESIGN Quantitative experimental research. STUDY SETTING University research laboratory. METHODS Drilling, electrocautery, and coblation were performed on human and hamster tissues. Particle size and concentration were measured during the surgical procedures using a scanning mobility particle sizer and an aerosol particle sizer (SMPS-APS) and GRIMM aerosol particle spectrometer. RESULTS SMPS-APS and GRIMM measurements detected at least 2-fold increases in aerosol concentrations compared to baseline during all procedures. Procedures performed on human and hamster tissues produced similar trends and order of magnitude of aerosol concentrations. Generally, hamster tissues produced higher aerosol concentrations compared to human tissues, and some of these differences were statistically significant. Mean particle sizes for all procedures were small (<200 nm), although statistically significant differences in particle size were identified between human and hamster tissues during coblation and drilling. CONCLUSION Aerosol-generating procedures performed on human and hamster tissue produce similar trends in aerosol particle concentrations and sizes, although we observed some differences between the 2 tissue types. Further studies should be performed to understand the clinical significance of these differences.
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Affiliation(s)
- Christopher Nielson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kerry Kelly
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Reuben Attah
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Zheyuan Pei
- Department of Chemical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Yong Wang
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew A Firpo
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Soleimani-Sardo M, Shirani M, Strezov V. Heavy metal pollution levels and health risk assessment of dust storms in Jazmurian region, Iran. Sci Rep 2023; 13:7337. [PMID: 37147406 PMCID: PMC10163266 DOI: 10.1038/s41598-023-34318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/27/2023] [Indexed: 05/07/2023] Open
Abstract
The Jazmurian basin in Iran is an area affected by climate change and desertification where aerosols and dust storms are common. The aim of this work was to determine the human and ecological risks from atmospheric particles during dust storms in different cities in the Jazmurian basin. For this purpose, the dust samples were collected from Jiroft, Roodbar Jonoob, Ghaleh Ganj, Kahnooj and Iranshahr cities, which are located around the Jazmurian playa in southeast of Iran. Satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol products and the Aerosol Optical Depth (AOD) were used to detect aerosol loading in the atmosphere. Moreover, the trace element composition of the collected particles was determined and used to evaluate human and ecological impact assessment using US EPA human health risk assessment and ReCiPe 2016 endpoint hierarchist impact assessment method incorporated in the OpenLCA 1.10.3 software. The human health risk assessment of the particles revealed high non-carcinogenic risks for children from exposure to nickel and manganese and carcinogenic risks in both adults and children due to hexavalent chromium, arsenic and cobalt during dust storm events. Terrestrial ecotoxicity was found to have the largest ecological impact on ecosystems with copper, nickel and zinc exhibiting the largest contributions.
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Affiliation(s)
- Mojtaba Soleimani-Sardo
- Department of Environmental Science and Engineering, Faculty of Natural Resources, University of Jiroft, P. O. Box 7867161167, Jiroft, Iran.
| | - Mahboube Shirani
- Department of Chemistry, Faculty of Science, University of Jiroft, P. O. Box 7867161167, Jiroft, Iran.
| | - Vladimir Strezov
- School of Natural Sciences, Faculty of Science and Engineering, Macquarie University, NSW, 2109, Australia
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4
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Goodarzi A, Khodaveisi M, Abdi A, Salimi R, Oshvandi K. Healthcare providers' experiences in hospital resuscitation of patients with COVID-19: a qualitative study. BMC Nurs 2022; 21:238. [PMID: 36008836 PMCID: PMC9406244 DOI: 10.1186/s12912-022-01020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP’s experiences of CPR in patients with COVID-19. Methods A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method. Results The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor’s degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. “Human aspects of Care”, “Perceived Psychological Effects of Resuscitation in COVID-19”, “HCP’s perceptions of factors affecting the resuscitation process in COVID-19”, and “Perceived differences in COVID-19 resuscitation compared to non-COVID patients” were super-ordinate themes. Conclusions The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants’ fatigue or lack of oxygen due to the use of personal protective equipment (PPE).
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Affiliation(s)
- Afshin Goodarzi
- Department of medical emergency, Faculty of Paramedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Home Care) Research Center, Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Salimi
- Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran.
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5
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Apiratwarakul K, Cheung LW, Bhudhisawasdi V, Tiamkao S, Ienghong K. The Viability of Using Remote Controlled Mechanical Chest Compression Devices to Reduce Contamination in Cardiac Arrest Patients during the COVID-19 Pandemic. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Mechanical chest compression devices play an important role in assisting patients undergoing cardiac arrest. However, this equipment induces an aerosol-generating procedure that could contaminate hospital staff. The development of a remote control system for mechanical chest compression devices may solve the problem; however, there are currently no studies regarding the efficacy of this system.
AIM: This study aims to analyze efficacy of remote control systems for mechanical chest compression devices and compare it with non-remote control systems.
METHODS: This was an analytical cross-sectional study at Srinagarind Hospital, Thailand. Data were collected in two periods of the study. The first period was between January and December 2021 using a non-remote control system to operate the mechanical chest compression device. The second period was from January to April 2022 and collected data on the use of a remote control system.
RESULTS: Sixty-four participants were examined over the 16-month period of the study. A total of 53.1% (n = 34) of participants were male and the mean age of the patients was 52.4 ± 5.1 years old. The number of emergency medical service members (EMS) needed for resuscitation in the remote control group was less than the non-remote control group (3 vs. 5; p = 0.040). The number of emergency department (ED) members needed for resuscitation in the remote control group was four compared with eight in the non-remote control group.
CONCLUSIONS: The remote controlled mechanical chest compression device can effectively reduce the number of staff working both in the EMS and in the ED of the hospital, thus reducing exposure and contamination from aerosol-generating procedure. It was also proven accurate in terms of rate and depth of chest compression according to resuscitation guidelines.
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6
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Brady WJ, Chavez S, Gottlieb M, Liang SY, Carius B, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Cardiac arrest in the out-of-hospital and in-hospital settings. Am J Emerg Med 2022; 57:114-123. [PMID: 35561501 PMCID: PMC9045864 DOI: 10.1016/j.ajem.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Its impact on the health and welfare of the human population is significant; its impact on the delivery of healthcare is also considerable. Objective This article is another paper in a series addressing COVID-19-related updates to emergency clinicians on the management of COVID-19 patients with cardiac arrest. Discussion COVID-19 has resulted in significant morbidity and mortality worldwide. From a global perspective, as of February 23, 2022, 435 million infections have been noted with 5.9 million deaths (1.4%). Current data suggest an increase in the occurrence of cardiac arrest, both in the outpatient and inpatient settings, with corresponding reductions in most survival metrics. The frequency of out-of-hospital lay provider initial care has decreased while non-shockable initial cardiac arrest rhythms have increased. While many interventions, including chest compressions, are aerosol-generating procedures, the risk of contagion to healthcare personnel is low, assuming appropriate personal protective equipment is used; vaccination with boosting provides further protection against contagion for the healthcare personnel involved in cardiac arrest resuscitation. The burden of the COVID-19 pandemic on the delivery of cardiac arrest care is considerable and, despite multiple efforts, has adversely impacted the chain of survival. Conclusion This review provides a focused update of cardiac arrest in the setting of COVID-19 for emergency clinicians.
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7
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Kane A, Nolan J. Changes to the European Resuscitation Council guidelines for adult resuscitation. BJA Educ 2022; 22:265-272. [DOI: 10.1016/j.bjae.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
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8
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Atkins DL, Sasson C, Hsu A, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, Chan M, Chan PS, Cheng A, Clemency BM, de Caen A, Duff JP, Edelson DP, Flores GE, Fuchs S, Girotra S, Hinkson C, Joyner BL, Kamath-Rayne BD, Kleinman M, Kudenchuk PJ, Lasa JJ, Lavonas EJ, Lee HC, Lehotzky RE, Levy A, McBride ME, Meckler G, Merchant RM, Moitra VK, Nadkarni V, Panchal AR, Ann Peberdy M, Raymond T, Roberts K, Sayre MR, Schexnayder SM, Sutton RM, Terry M, Topjian A, Walsh B, Wang DS, Zelop CM, Morgan RW. 2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists. Circ Cardiovasc Qual Outcomes 2022; 15:e008900. [PMID: 35072519 DOI: 10.1161/circoutcomes.122.008900] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Dianne L Atkins
- Carver College of Medicine, University of Iowa (D.L.A., S.G.)
| | | | - Antony Hsu
- St Joseph Mercy Hospital, Ann Arbor, MI (A.H.)
| | - Khalid Aziz
- University of Alberta, Edmonton, Canada (K.A.)
| | - Lance B Becker
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Robert A Berg
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | | | - Steven M Bradley
- Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.)
| | | | - Melissa Chan
- University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada (M.C., G.M.)
| | - Paul S Chan
- Mid America Heart Institute and the University of Missouri-Kansas City, MO (P.S.C.)
| | - Adam Cheng
- Alberta Children's Hospital, University of Calgary, AB, Canada (A.C.)
| | | | - Allan de Caen
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Jonathan P Duff
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | | | - Gustavo E Flores
- Emergency & Critical Care Trainings, San Juan, Puerto Rico (G.E.F.)
| | - Susan Fuchs
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL (S.F., M.E.M.)
| | - Saket Girotra
- Carver College of Medicine, University of Iowa (D.L.A., S.G.)
| | - Carl Hinkson
- Providence Regional Medical Center, Everett, WA (C.H.)
| | - Benny L Joyner
- University of North Carolina at Chapel Hill, NC (B.L.J.)
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.)
| | | | | | | | | | | | | | - Arielle Levy
- Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.)
| | - Mary E McBride
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL (S.F., M.E.M.)
| | - Garth Meckler
- University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada (M.C., G.M.)
| | - Raina M Merchant
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.).,University of Pennsylvania, Philadelphia, PA (R.M.M.)
| | - Vivek K Moitra
- College of Physicians & Surgeons of Columbia University, NY (V.K.M.)
| | - Vinay Nadkarni
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | - Ashish R Panchal
- The Ohio State University Wexner Medical Center, Columbus, OH (A.R.P.)
| | | | - Tia Raymond
- Medical City Children's Hospital, Dallas, TX (T.R.)
| | | | | | | | - Robert M Sutton
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH (M.T.)
| | - Alexis Topjian
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Brian Walsh
- Children's Hospital Colorado, Aurora, CO (B.W.)
| | - David S Wang
- Columbia University Irving Medical Center, NY (D.S.W.)
| | | | - Ryan W Morgan
- The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., V.N., A.T., R.W.M., R.M.S.)
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Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep 2022; 12:800. [PMID: 35039578 PMCID: PMC8764072 DOI: 10.1038/s41598-021-04749-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/29/2021] [Indexed: 12/14/2022] Open
Abstract
Bystander cardiopulmonary resuscitation (BCPR), early defibrillation and timely treatment by emergency medical services (EMS) can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of the COVID-19 pandemic on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR 1.38, 95% CI 1.11–1.71, p = 0.0069). BCPR did not differ during and before the COVID-19 pandemic (OR 0.94, 95% CI 0.80–1.11, p = 0.4631), although bystander defibrillation was significantly lower during the COVID-19 pandemic (OR 0.65, 95% CI 0.48–0.88, p = 0.0107). EMS call-to-arrival time was significantly higher during the COVID-19 pandemic (SMD 0.27, 95% CI 0.13–0.40, p = 0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.
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10
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Machino H, Irie J, Hiraki K, Ukaji Y, Sawaya S, Nomura O, Hanada H. Japanese medical students’ awareness of cardiopulmonary resuscitation in the context of the COVID‐19 pandemic. Acute Med Surg 2022; 9:e745. [PMID: 35356484 PMCID: PMC8946261 DOI: 10.1002/ams2.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Aim To evaluate Japanese medical students’ awareness of newly recommended cardiopulmonary resuscitation (CPR) and airway management procedures in the context of the coronavirus disease (COVID‐19) pandemic. Methods An online survey was sent in December 2020 to all medical students at Hirosaki University in Japan. The survey included 15 questions and quizzes regarding prior experience of learning the new CPR guidelines in response to COVID‐19, knowledge of conventional CPR, and COVID‐19 context CPR and airway management procedures. Results Of all medical students at the university, 457 (57.1%) responded to the survey. Among these, 22% reported that they were knowledgeable about CPR procedure in the COVID‐19 pandemic setting. Prior knowledge of CPR in the context of COVID‐19 was a significant positive predictor of quiz score regarding the CPR procedure (β = 0.60, P < 0.01) and the airway management procedure (β = 0.34, P = 0.02) in the context of the COVID‐19 pandemic. Conclusions Medical students with experience learning the new COVID‐19 context CPR guidelines had sufficient knowledge of CPR and advanced airway management procedures in the setting of the COVID‐19 pandemic. Implementation of a formal medical education curriculum based on the newly recommended CPR and advanced life support guidelines is needed to improve medical students’ awareness and skills of CPR and airway management in the context of the COVID‐19 pandemic.
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Affiliation(s)
| | - Jin Irie
- Department of Emergency and Disaster Medicine Hirosaki University Hirosaki Japan
| | | | - Yukari Ukaji
- School of Medicine, Hirosaki University Hirosaki Japan
| | | | - Osamu Nomura
- Department of Emergency and Disaster Medicine Hirosaki University Hirosaki Japan
| | - Hiroyuki Hanada
- Department of Emergency and Disaster Medicine Hirosaki University Hirosaki Japan
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11
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Jafari D, Cohen AL, Monsieurs K, Becker LB. Changing resuscitation strategies during a pandemic: lessons from the consecutive surges in New York and global challenges. Curr Opin Crit Care 2021; 27:656-662. [PMID: 34581299 DOI: 10.1097/mcc.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW To provide a framework for resuscitation of COVID-19 critical illness for emergency and intensive care clinicians with the most up to date evidence and recommendations in the care of COVID-19 patients in cardiac arrest or in extremis. RECENT FINDINGS Performing cardiopulmonary resuscitation (CPR) on COVID-19 patients requires the clinicians to adopt infection mitigation strategies such as full personal protective equipment, mechanical chest compression devices, and restricting the number of people present during the resuscitation. The time of intubation is a subject of ongoing research and clinicians should use their best judgment for each patient. Clinicians should prepare for CPR in prone position. Particular attention should be given to the psychological well-being of the staff. Point of care ultrasound has proved to be an invaluable diagnostic tool in assessing ventricular dysfunction and parenchymal lung disease. Although novel therapies to supplant the function of diseased lungs have shown promise in select patients the evidence is still being collected. The end-of-life discussions have been negatively impacted by prognostic uncertainty as well as barriers to in person meetings with families. SUMMARY The resuscitation of critically ill COVID-19 patients poses new challenges, but the principles remain largely unchanged.
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Affiliation(s)
- Daniel Jafari
- Department of Emergency Medicine.,Department of Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine, Hofstra Northwell, Hempstead, New York, USA
| | | | - Koen Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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12
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Hsu A, Sasson C, Kudenchuk PJ, Atkins DL, Aziz K, Becker LB, Berg RA, Bhanji F, Bradley SM, Brooks SC, Chan M, Chan PS, Cheng A, Clemency BM, de Caen A, Duff JP, Edelson DP, Flores GE, Fuchs S, Girotra S, Hinkson C, Joyner BL, Kamath-Rayne BD, Kleinman M, Lasa JJ, Lavonas EJ, Lee HC, Lehotzky RE, Levy A, Mancini ME, McBride ME, Meckler G, Merchant RM, Moitra VK, Morgan RW, Nadkarni V, Panchal AR, Peberdy MA, Raymond T, Roberts K, Sayre MR, Schexnayder SM, Sutton RM, Terry M, Walsh B, Wang DS, Zelop CM, Topjian A. 2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circ Cardiovasc Qual Outcomes 2021; 14:e008396. [PMID: 34641719 PMCID: PMC8522336 DOI: 10.1161/circoutcomes.121.008396] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Antony Hsu
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI (A.H.)
| | - Comilla Sasson
- ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.)
| | - Peter J Kudenchuk
- Department of Medicine/Division of Cardiology (P.J.K.), University of Washington, Seattle
| | - Dianne L Atkins
- Stead Family Department of Pediatrics (D.L.A), Carver College of Medicine, University of Iowa
| | - Khalid Aziz
- Division of Newborn Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada (K.A.)
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY (L.B.B.)
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Farhan Bhanji
- Department of Pediatrics, McGill University, Montreal, QC, Canada (F.B.)
| | - Steven M Bradley
- Minneapolis Heart Institute, Healthcare Delivery Innovation Center, MN (S.M.B.)
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada (S.C.B.)
| | - Melissa Chan
- Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.)
| | - Paul S Chan
- Department of Internal Medicine, Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City (P.S.C.)
| | - Adam Cheng
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Canada (A.C.)
| | - Brian M Clemency
- Department of Emergency Medicine, University at Buffalo, NY (B.M.C.)
| | - Allan de Caen
- Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Jonathan P Duff
- Division of Critical Care, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (A.d.C., J.P.D.)
| | - Dana P Edelson
- Section of Hospital Medicine, University of Chicago, IL (D.P.E.)
| | - Gustavo E Flores
- Emergency and Critical Care Trainings, San Juan, Puerto Rico (G.E.F.)
| | - Susan Fuchs
- Division of Emergency Medicine (S.F.), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Saket Girotra
- Department of Internal Medicine and Division of Cardiovascular Diseases (S.G.), Carver College of Medicine, University of Iowa
| | - Carl Hinkson
- Respiratory Care, Providence Regional Medical Center, Everett, WA (C.H.)
| | - Benny L Joyner
- Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill (B.L.J.)
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, IL (B.D.K.-R.)
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.K.)
| | - Javier J Lasa
- Cardiovascular Intensive Care Unit, Texas Children's Hospital, Baylor College Of Medicine, Houston (J.J.L.)
| | - Eric J Lavonas
- Department of Emergency Medicine, Denver Health and Hospital Authority, CO (E.J.L.)
| | - Henry C Lee
- Division of Neonatology, Stanford University, CA (H.C.L.)
| | - Rebecca E Lehotzky
- ECC Science & Innovation, American Heart Association, Dallas, TX (C.S., R.E.L.)
| | - Arielle Levy
- Department of Pediatrics and Department of Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, QC, Canada (A.L.)
| | - Mary E Mancini
- College of Nursing, University of Texas at Arlington (M.E. Mancini)
| | - Mary E McBride
- Divisions of Cardiology and Critical Care Medicine (M.E. McBride), Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Garth Meckler
- Department of Pediatrics and Department of Pediatric Emergency Medicine, BC Children's Hospital, University of British Columbia, Vancouver, Canada (M.C., G.M.)
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia (R.M.M.)
| | - Vivek K Moitra
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.)
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus (A.R.P.)
| | - Mary Ann Peberdy
- Division of Cardiology, Virginia Commonwealth University, Richmond (M.A.P.)
| | - Tia Raymond
- Department of Pediatrics and Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX (T.R.)
| | - Kathryn Roberts
- Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, FL (K.R.)
| | - Michael R Sayre
- Department of Emergency Medicine (M.R.S.), University of Washington, Seattle
| | - Stephen M Schexnayder
- Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Little Rock (S.M.S.)
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, OH (M.T.)
| | - Brian Walsh
- Respiratory Care, Children's Hospital Colorado, Aurora (B.W.)
| | - David S Wang
- Department of Anesthesiology, Division of Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (V.K.M., D.S.W.).,Department of Obstetrics and Gynecology, New York, NY (D.S.W.)
| | - Carolyn M Zelop
- NYU School of Medicine, New York, NY and The Valley Hospital, Ridgewood, NJ (C.M.Z.)
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine (R.A.B., R.W.M., V.N., R.M.S., A.T.)
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13
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Ott M, Krohn A, Bilfield LH, Dengler F, Jaki C, Echterdiek F, Schilling T, Heymer J. Leg-heel chest compression as an alternative for medical professionals in times of COVID-19. Am J Emerg Med 2021; 50:575-581. [PMID: 34560564 PMCID: PMC8420094 DOI: 10.1016/j.ajem.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression. METHODS 20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods. In a second approach, potential aerosol spread during chest compression was visualized. RESULTS Our data indicate no credible difference between manual and leg-heel compression. The distance to potential aerosol spread could have been increased by leg-heel method. CONCLUSION Under special circumstances like COVID-19-pandemic, leg-heel chest compression may be an effective alternative without previous training compared to manual chest compression while markedly increasing the distance to the patient.
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Affiliation(s)
- Matthias Ott
- Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany.
| | - Alexander Krohn
- Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Laurence H Bilfield
- Fellow of the American Academy of Orthopaedic Surgeons, Fellow of the American Board of Independent Medical Examiners, 4450 Belden Village St NW, Canton, OH, USA
| | - Florian Dengler
- Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Christina Jaki
- Simulation Center STUPS, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Fabian Echterdiek
- Department of Nephrology, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Tobias Schilling
- Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Johannes Heymer
- Department of Interdisciplinary Emergency and Intensive Care Medicine, Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
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14
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Horowitz JM, Owyang C, Perman SM, Mitchell OJL, Yuriditsky E, Sawyer KN, Blewer AL, Rittenberger JC, Ciullo A, Hsu CH, Kotini-Shah P, Johnson N, Morgan RW, Moskowitz A, Dainty KN, Fleitman J, Uzendu AI, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2020 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2021; 10:e021575. [PMID: 34369175 PMCID: PMC8475047 DOI: 10.1161/jaha.121.021575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Clark Owyang
- Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine Weill Cornell Medicine New York City NY
| | - Sarah M Perman
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Oscar J L Mitchell
- Division of Pulmonary and Critical Care Department of Medicine University of Pennsylvania Philadelphia PA
| | | | - Kelly N Sawyer
- Department of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health Duke University Durham NC
| | - Jon C Rittenberger
- Guthrie-Robert Packer Hospital Emergency Medicine Residency Geisinger Commonwealth Medical College Sayre PA
| | - Anna Ciullo
- Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
| | - Cindy H Hsu
- Department of Emergency Medicine Department of Surgery Michigan Center for Integrative Research in Critical Care Michigan Medicine University of Michigan Ann Arbor MI
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago Chicago IL
| | - Nicholas Johnson
- Division of Pulmonary, Critical Care, & Sleep Medicine Department of Emergency Medicine University of Washington Seattle WA
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia Philadelphia PA
| | - Ari Moskowitz
- Division of Critical Care Medicine Montefiore Medical Center Bronx, New York NY
| | - Katie N Dainty
- North York General Hospital University of Toronto Toronto Canada
| | - Jessica Fleitman
- Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Anezi I Uzendu
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Benjamin S Abella
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Felipe Teran
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
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15
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A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients. Crit Care Explor 2021; 3:e0425. [PMID: 34036276 PMCID: PMC8133239 DOI: 10.1097/cce.0000000000000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE: In-hospital cardiac arrest survival among coronavirus disease 2019 patients has been reported to range from 0% to 12%. These numbers are significantly lower than reported prepandemic in-hospital cardiac arrest survival rates of approximately 20–25% in the United States for non–coronavirus disease 2019 patients. OBJECTIVE: To assess the incidence of in-hospital cardiac arrest survival of coronavirus disease 2019 patients. DESIGN: A retrospective cohort study of adult patients with coronavirus disease 2019 subsequently found to have in-hospital cardiac arrest and underwent cardiopulmonary resuscitation (cardiopulmonary resuscitation). SETTING: Multiple hospitals of the Cleveland Clinic Health System. PATIENTS: All adult patients (age ≥ 18 yr) admitted to Cleveland Clinic Health System with a diagnosis of coronavirus disease 2019 who experienced in-hospital cardiac arrest requiring cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS: From March 01, 2020 to October 15, 2020, 3,555 patients with coronavirus disease 2019 were hospitalized; 1,372 were admitted to the ICU; 58 patients had in-hospital cardiac arrest. Median age of this cohort was 66.5 years (interquartile range, 55.0–76.0 yr). Patients were predominantly male (62.5%), White (53.4%), with a median body mass index of 29.7 (interquartile range, 25.8–34.6). Most in-hospital cardiac arrests were in critical care environments (ICU), 51 of 58 (87.9%); seven of 58 (12.1%) were on ward locations. Thirty-four of 58 patients (58.6%) were on mechanical ventilation prior to in-hospital cardiac arrest with a median duration of mechanical ventilation of 9 days (interquartile range, 2–18 d). Twenty-four of 58 patients (44%) were on vasopressors prior to arrest. Initial arrest rhythm was pulseless electrical activity at (63.8%), asystole (29.3%), and pulseless ventricular tachycardia/fibrillation (6.9%). Of the 58 patients, 35 (60.3%) attained return of spontaneous circulation, and 13 of 58 (22.4%) were discharged alive. CONCLUSIONS: We report a 22% survival to discharge after in-hospital cardiac arrest in coronavirus disease 2019 patients, a survival rate similar to before the coronavirus disease 2019 pandemic.
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