In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study [Covid-19危重患者院内心脏骤停：多中心队列研究]

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BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3513 (Published 30 September 2020)
Cite this as: BMJ 2020;371:m3513

Authors
Salim S Hayek, Samantha K Brenner, Tariq U Azam, Husam R Shadid, Elizabeth Anderson, Hanna Berlin, Michael Pan, Chelsea Meloche, Rafey Feroz, Patrick O’Hayer, Rayan Kaakati, Abbas Bitar, Kishan Padalia, Daniel Perry, Pennelope Blakely, Shruti Gupta, Shahzad Shaefi, Anand Srivastava, David M Charytan, Anip Bansal, Mary Mallappallil, Michal L Melamed, Alexandre M Shehata, Jag Sunderram, Kusum S Mathews, Anne K Sutherland, Brahmajee K David E Leaf

Abstract
Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19).

Design Multicenter cohort study.

Setting Intensive care units at 68 geographically diverse hospitals across the United States.

Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19.

Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality.

Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older.

Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.