COVID -19 infection negatively impacts survival of resuscitated cardiac arrest patients: JAMA.

There have been discussions about universal do-not-resuscitate (DNR) orders for patients with COVID-19 as the survival in this class of patients has been dismal. Poor survival rates as low as <3% have been reported previously. In a recent cohort study by Girotra et al COVID-19 infection has been found to be associated with a one-third lower rate of overall survival and is accompanied by a 30% increased rate of delayed defibrillation in shockable in-hospital cardiac arrest (IHCA). These findings were recently published in JAMA Cardiology.

Whether the poor IHCA survival rate reported in earlier studies is broadly representative of patients with COVID-19 in US hospitals remains unknown. The current study examined the association of COVID-19 infection with survival outcomes of US adults after IHCA.

This study included 24 915 patients with IHCA from 286 hospitals who had a mean age of 64.7 years. A suspected or confirmed COVID-19 infection was present in 23.7% of patients. The comparison between COVID-19 infected and non-infected patients generated the following findings:

1. Patients with COVID-19 were younger, and more likely to have an initial nonshockable rhythm, pneumonia, respiratory insufficiency, or sepsis and be receiving mechanical ventilation and vasopressors at the time of IHCA.

2. These patients were also likely to have lower rates of survival to discharge (11.9% vs 23.5%) and return of spontaneous circulation (ROSC) (53.7% vs 63.6%).

3. COCID-19 infected patients were also more likely to have received delayed defibrillation.

4. The association between COVID-19 infection and worse survival outcomes was consistent for patients with nonsurgical diagnoses, patients in the ICU, and patients who had received timely defibrillation or epinephrine treatment.

"Although delays in resuscitation, especially defibrillation, may have contributed to lower survival, the negative association of COVID-19 with survival in this study was consistent across subgroups, including patients who received timely treatment with defibrillation and epinephrine", note the authors.

Should DNR be the norm for COVID-19 IHCA survivors?

"Because IHCA survival among patients with COVID-19 in this study was not as poor as reported previously, we believe that COVID-19 infection alone should not be used as a criterion for withholding resuscitation care from hospitalized patients", argue the authors.

As new variants emerge, future studies will be needed to assess the ongoing impact of COVID-19 infection on IHCA survival.

Source: JAMA Cardiology: doi:10.1001/jamanetworkopen.2022.0752