A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients

Abhishek Bhardwaj, MD, FACP; Mahmoud Alwakeel, MD; Talha Saleem, MD; Saira Afzal, MD; Sura Alqaisi, MD; Aisha R. Saand, MD; Hanan Al. Najjar, MD; Lori Griffiths, RN, MPH; Xiaozhen Han, MS; Xiaofeng Wang, PhD; Silvia Perez-Protto, MD, MS, FCCM; Benjamin S. Abella, MD, MPhil, FAHA, FACEP; David F. Gaieski, MD, FACEP, FCCM; Abhijit Duggal, MD, MPH, MSc; Francois Abi Fadel, MD, FACP, FCCP

doi:10.1097/CCE.0000000000000425

Critical Care Explorations (May 2021)

A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients

Abhishek Bhardwaj, MD, FACP,
Mahmoud Alwakeel, MD,
Talha Saleem, MD,
Saira Afzal, MD,
Sura Alqaisi, MD,
Aisha R. Saand, MD,
Hanan Al. Najjar, MD,
Lori Griffiths, RN, MPH,
Xiaozhen Han, MS,
Xiaofeng Wang, PhD,
Silvia Perez-Protto, MD, MS, FCCM,
Benjamin S. Abella, MD, MPhil, FAHA, FACEP,
David F. Gaieski, MD, FACEP, FCCM,
Abhijit Duggal, MD, MPH, MSc,
Francois Abi Fadel, MD, FACP, FCCP

Affiliations

Abhishek Bhardwaj, MD, FACP: 1 Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Mahmoud Alwakeel, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Talha Saleem, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Saira Afzal, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Sura Alqaisi, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Aisha R. Saand, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Hanan Al. Najjar, MD: 2 Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH.
Lori Griffiths, RN, MPH: 3 Department of Quality Data Registries, Cleveland Clinic, Cleveland, OH.
Xiaozhen Han, MS: 4 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Xiaofeng Wang, PhD: 4 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Silvia Perez-Protto, MD, MS, FCCM: 5 Departments of Outcomes Research and Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
Benjamin S. Abella, MD, MPhil, FAHA, FACEP: 7 Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
David F. Gaieski, MD, FACEP, FCCM: 8 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
Abhijit Duggal, MD, MPH, MSc: 1 Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Francois Abi Fadel, MD, FACP, FCCP: 1 Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.

DOI: https://doi.org/10.1097/CCE.0000000000000425
Journal volume & issue: Vol. 3, no. 5
p. e0425

Abstract

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IMPORTANCE:. In-hospital cardiac arrest survival among coronavirus disease 2019 patients has been reported to range from 0% to 12%. These numbers are significantly lower than reported prepandemic in-hospital cardiac arrest survival rates of approximately 20–25% in the United States for non–coronavirus disease 2019 patients. OBJECTIVE:. To assess the incidence of in-hospital cardiac arrest survival of coronavirus disease 2019 patients. DESIGN:. A retrospective cohort study of adult patients with coronavirus disease 2019 subsequently found to have in-hospital cardiac arrest and underwent cardiopulmonary resuscitation (cardiopulmonary resuscitation). SETTING:. Multiple hospitals of the Cleveland Clinic Health System. PATIENTS:. All adult patients (age ≥ 18 yr) admitted to Cleveland Clinic Health System with a diagnosis of coronavirus disease 2019 who experienced in-hospital cardiac arrest requiring cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS:. From March 01, 2020 to October 15, 2020, 3,555 patients with coronavirus disease 2019 were hospitalized; 1,372 were admitted to the ICU; 58 patients had in-hospital cardiac arrest. Median age of this cohort was 66.5 years (interquartile range, 55.0–76.0 yr). Patients were predominantly male (62.5%), White (53.4%), with a median body mass index of 29.7 (interquartile range, 25.8–34.6). Most in-hospital cardiac arrests were in critical care environments (ICU), 51 of 58 (87.9%); seven of 58 (12.1%) were on ward locations. Thirty-four of 58 patients (58.6%) were on mechanical ventilation prior to in-hospital cardiac arrest with a median duration of mechanical ventilation of 9 days (interquartile range, 2–18 d). Twenty-four of 58 patients (44%) were on vasopressors prior to arrest. Initial arrest rhythm was pulseless electrical activity at (63.8%), asystole (29.3%), and pulseless ventricular tachycardia/fibrillation (6.9%). Of the 58 patients, 35 (60.3%) attained return of spontaneous circulation, and 13 of 58 (22.4%) were discharged alive. CONCLUSIONS:. We report a 22% survival to discharge after in-hospital cardiac arrest in coronavirus disease 2019 patients, a survival rate similar to before the coronavirus disease 2019 pandemic.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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