Outcomes of Cardiopulmonary Resuscitation in Patients With COVID-19—Limited Data, but Further Reason for Action

Abstract

Outcomes of Cardiopulmonary Resuscitation in Patients With COVID-19-Limited Data, but Further Reason for ActionCardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) in patients with coronavirus disease 2019 (COVID-19) presents unique challenges.Cardiopulmonary resuscitation may be delayed because of isolation procedures, and advanced life support resources may be limited.Additionally, CPR for patients with COVID-19 exposes health care workers to increased risk of viral transmission.Improving our understanding of the likelihood of successful outcomes after CPR is crucial to informing goals-of-care discussions, determining the appropriateness of resuscitative efforts, and guiding policy.To date, to our knowledge, there is limited evidence on outcomes for IHCA among patients with COVID-19.A single-center study of 136 patients with IHCA in Wuhan, China, reported poor outcomes but was limited by cardiac arrests occurring during shortages of advanced life support resources. 1 Nonetheless, this study found only 18 patients (13%) achieved return of spontaneous circulation, 4 (3%) survived to 30 days, and only 1 (<1%) achieved a favorable neurological outcome by 30 days.In this issue of JAMA Internal Medicine, Thapa et al 2 report what to our knowledge are the first US data on outcomes for IHCA among patients with COVID-19.In their case series of 54 patients, 52 (96%) had a nonshockable initial rhythm, 29 (54%) achieved return of spontaneous circulation, and 0 survived to hospital discharge (95% CI, 0%-6.6%).This very low hospital survival is likely driven by several factors, including critical illness in most patients at the time of arrest and the many patients with nonshockable initial rhythms.Additionally, presumed respiratory etiology of arrest for most patients, lack of therapies to effectively treat the underlying disease, and potential delays in response time for donning of personal protective equipment may have contributed to poor outcomes.These small case series reporting hospital survival after IHCA among patients with COVID-19 must be interpreted with caution, as only 1 or 2 additional survivors would make important differences in the observed estimates.Outcomes in the setting of COVID-19 may not actually differ from pre-COVID-19 outcomes of IHCA for patients with nonshockable rhythms, for whom hospital survival is often less than 15%. 3 Nonetheless, this article 2 represents important early evidence suggesting outcomes for IHCA in patients with COVID-19 pneumonia are likely poor, particularly among patients with respiratory failure.Improving outcomes for patients with severe illness with COVID-19 and IHCA will be

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