COVID-19 infection linked to lower in-hospital cardiac arrest survival: JAMA
USA: A recent study involving data from about 25,000 people revealed that in patients with COVID-19 infection, survival after in-hospital cardiac arrest is roughly one-third lower compared to uninfected patients. The study was published as a research letter in JAMA Network Open on March 2, 2022.
Survival rates after in-hospital cardiac arrest (IHCA) while infected with COVID-19 early in the pandemic, was reported to be poor (<3%) in the US and China. This prompted discussions related to universal do-not-resuscitate orders for COVID-19 patients. These results however based on single-center studies that comprised only 295 patients with COVID-19 in hospitals that were overwhelmed early during the pandemic. It was not known if the poor IHCA survival rate reported earlier reflect the broader experience of COVID-19 patients in hospitals in the United States
Based on the above background, Saket Girotra, University of Iowa Carver College of Medicine, Iowa City, and colleagues aimed to examine the association of COVID-19 infection with survival outcomes of US adults after IHCA.
For this purpose, the researchers reviewed data from the American Heart Association Get With the Guidelines–Resuscitation registry. The registry collects information on patients aged 18 years and above who experience cardiac arrest at participating hospitals in the US. The study included 24,915 patients aged 18 years and older from 286 hospitals who experienced IHCA during March–December 2020. The mean age of the patients was 64.7 years; 24.8% were Black, 61.1% were White, 3.8% were of other race or ethnicity, and 10.3% were of unknown race or ethnicity.
Survival to discharge and return of spontaneous circulation (ROSC) for at least 20 minutes were the primary outcomes.
Based on the study, the following findings were revealed:
- A total of 5,916 patients (23.7%) had suspected or confirmed COVID-19 infections, and infected patients were more likely to be younger, male, and Black.
- Patients with COVID-19 infections also were significantly more likely than noninfected patients to have nonshockable rhythm, pneumonia, respiratory insufficiency, or sepsis, and to be on mechanical ventilation or vasopressors when the IHCA occurred.
- Survival rates to hospital discharge were 11.9% for COVID-19 patients, compared with 23.5% for noninfected patients (adjusted relative risk, 0.65).
- ROSC was 53.7% and 63.6%, for infected and noninfected patients, respectively (aRR, 0.86).
- COVID-19 patients also were more likely than noninfected patients to receive delayed defibrillation. 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.
"The extremely low survival rate in early pandemic studies likely reflects the overwhelming burden on health systems at the time," the researchers wrote in their study.
They concluded, "with the emergence of new variants, future studies will be needed to assess the ongoing impact of COVID-19 infection on IHCA survival."
Reference:
Girotra S, Chan ML, Starks MA, Churpek M, Chan PS, American Heart Association Get With the Guidelines–Resuscitation Investigators. Association of COVID-19 Infection With Survival After In-Hospital Cardiac Arrest Among US Adults. JAMA Netw Open. 2022;5(3):e220752. doi:10.1001/jamanetworkopen.2022.0752
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