Survival After In-Hospital Cardiac Arrest in Critically Ill Patients

Abstract

The coronavirus disease 2019 (COVID-19) outbreak is placing a considerable strain on US healthcare systems by requiring both significant acute resources and endangering healthcare team members through airborne infection. 1Many US healthcare systems are now considering how to treat patients with COVID-19 who suffer cardiac arrest based on a presumption of poor survival after resuscitation in patients with COVID-19. 2However, empirical data on cardiac arrest survival in COVID-19 from the United States are not available at the moment.To inform this debate, we report survival data following cardiopulmonary resuscitation in a cohort of critically ill patients with pneumonia or sepsis who were receiving mechanical ventilation in an intensive care unit (ICU) at the time of arrest.Using Get With The Guidelines-Resuscitation, a US registry of in-hospital cardiac arrest patients, 3 we identified all adult patients (age 18 years and older) who underwent cardiopulmonary resuscitation for an index in-hospital cardiac arrest event.To simulate our study cohort as closely as possible to the COVID-19 population, we restricted our cohort to 5690 patients hospitalized in an ICU with a diagnosis of pneumonia or sepsis during the hospitalization and who were receiving mechanical ventilation at the time of arrest during 2014 to 2018.The study outcomes included survival to discharge, survival with a cerebral performance category (CPC) score of 1 (none to mild neurological disability), and survival with a CPC of 1 or 2 (no worse than moderate disability).We examined the above survival outcomes overall and stratified by patient age (categorized as <50, 50-59, 60-69, 70-79, and ≥80 years), initial rhythm (asystole or pulseless electrical activity [PEA] versus ventricular fibrillation or pulseless ventricular tachycardia) and whether patients were receiving intravenous vasopressors at the time of arrest.All analyses were carried out using SAS.The study was reviewed by Saint Luke's Hospital's Mid America Heart Institute Institutional Review Board, which waived the requirement for informed consent.Because of the sensitive nature of the data collected for this study, requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to Get With The Guidelines-Resuscitation ([email protected]).The median age was 65 years.All patients were located in an ICU and were receiving mechanical ventilation at the time of arrest.The initial cardiac arrest rhythm was asystole or PEA in a majority (87%) of patients and more than half (57%) were also receiving intravenous vasopressors at the time of arrest.The overall rate of survival to discharge was 12.5%.Rate of survival with CPC of 1 or 2 was 9.2% and survival with CPC of 1 was 6.2%.The Table includes rates of overall survival, survival with a CPC of 1 or 2, and survival with a CPC of 1 across categories of age-group, initial rhythm, and need for vasopressors.Older age, initial rhythm of asystole or PEA, and use of vasopressors

Topics & Concepts