Cardiac arrest is a harbinger of poor outcomes in COVID-19 pneumonia

  • Shao F & al.
  • Resuscitation
  • 10 Apr 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Among patients with severe COVID-19 pneumonia experiencing in-hospital cardiac arrest (IHCA), rates of restoration of spontaneous circulation (ROSC) and overall outcomes are poor.

Why this matters

  • In situations with personal protective equipment (PPE) constraints, clinicians can consider alternating persons conducting chest compressions every minute.
  • A mechanical chest compression device can be used if prolonged compressions are required.
  • The American Heart Association interim guidance offers additional recommendations. 

Key results

  • Overall mortality among 761 patients with severe COVID-19 pneumonia was 19.3% at 40 days.
  • Data for 136 of 151 patients who experienced IHCA were analyzed. 
    • 80.9% (110) were age >60 years; 33.8% (46) were women.
  • Median hospital length of stay: 7 days (interquartile range: 4-11 days).
  • Comorbidity rates:
    • Hypertension: 30.2%.
    • Diabetes: 19.9%.
    • Coronary heart disease: 11.0%.
  • IHCA etiology:
    • Respiratory: 87.5% (119).
    • Cardiac: 7.4% (10).
    • Other: 5.1% (7).
  • Initial rhythm:
    • Ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT): 5.9% (8).
    • Pulseless electrical activity: 4.4% (6). 
    • Asystole: 89.7% (122).
  • Time to resuscitation initiation:
  • ROSC achieved in 75.0% (6) with initial VF/VT and 9% (11) in asystole. 
  • ROSC by age:
    • >60 years: 10.5% (11/105).
    • ≤60 years: 22.6% (7/31; P=.08).
    • Of these, 2 patients in each age group, all men, were alive at 30 days (P=.19).

Study design

  • Retrospective, single-center cohort analysis of characteristics, outcomes (ROSC, 30-day survival) among patients with severe COVID-19 and IHCA, January 15-February 25, in Wuhan, China.
  • Funding: None disclosed.

Limitations

  • Observational.
  • Residual confounders likely.
  • Limited generalizability.
  • CPR quality data lacking.