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Mughal M, Kaur I, Waxman S, Gandhi H, Kakadia M, Khakwani Z, Okoh A, Shah K, Obaid A, Sirpal V, Azad S, Jaffery A, Jagdey H, Tawfik I, Alam M. Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience.
Purpose
To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest.
Methods
This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021.
Results
A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1).
Conclusions
Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - I Kaur
- Monmouth Medical Center, Long Branch, United States of America
| | - S Waxman
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Kakadia
- Monmouth Medical Center, Long Branch, United States of America
| | - Z Khakwani
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - A Okoh
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - A Obaid
- Monmouth Medical Center, Long Branch, United States of America
| | - V Sirpal
- Monmouth Medical Center, Long Branch, United States of America
| | - S Azad
- Monmouth Medical Center, Long Branch, United States of America
| | - A Jaffery
- Monmouth Medical Center, Long Branch, United States of America
| | - H Jagdey
- Bronx-Lebanon Hospital Center, Bronx NY, United States of America
| | - I Tawfik
- Monmouth Medical Center, Long Branch, United States of America
| | - M Alam
- Baylor College of Medicine, The Department of Medicine, Section of Cardiology, Houston, United States of America
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