COVID-19 Negatively Associated With In-Hospital Cardiac Arrest Survival

Saket Girotra, MD

Approximately 1 in 4 patients with in-hospital cardiac arrest (IHCA) in 2020 had a suspected or confirmed COVID-19 infection, according to new findings.

The disease was associated with a one-third lower rate of overall survival, as well as a 30% increased rate of delayed defibrillation in shockable IHCA.

“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 sub- groups, including patients who received timely treatment with defibrillation and epinephrine,” wrote study author Saket Girotra, MD, SM, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine.

In the earlier stages of the COVID-19 pandemic, discussions were had regarding poor survival rates reported after in-hospital cardiac arrest among patients with COVID-19 infection in both the United States and China. However, there remained unanswered questions on whether these reported IHCA survival rates were broadly representative.

As such, the current study investigated the association of COVID-19 infection with survival outcomes of US adults after IHCA, using data from the American Heart Association Get With the Guidelines-Resuscitation (GWTG-R) registry.

Girotra and colleagues constructed multivariable hierarchical regression models to compare survival to discharge and return of spontaneous circulation (ROSC) for 20 minutes or more among patients with and without a suspected or confirmed COVID-19 infection.

A total of 24,915 patients with IHCA from 286 hospitals (mean age, 64.7 years) were included in the study from the GWTG-R. The population was 9848 women (39.5%) and 15 066 men (60.5%), while reported race and ethnicity data show 6170 patients (24.8%) were Black, 15,223 (61.1%) were White, and 948 (3.8%) were of other race of ethnicity.

From this group, a suspected or confirmed COVID-19 infection was found in 5916 patients (23.7%). Data show patients with COVID-19 were younger, more frequently men, Black, and more likely to have an initial nonshockable rhythm, pneumonia, respiratory insufficiency, or sepsis. Additionally, these patients were more likely to be receiving mechanical ventilation and vasopressors at time of IHCA.

Moreover, the findings show patients with COVID-19 and ICHA had lower survival rates to discharge (11.9% versus 23.5%; adjusted relative risk [RR], 0.65 [95% CI, 0.60 - 0.71]; P <.001) and ROSC (53.7% versus 63.6%; adjusted RR, 0.86 [95% CI, 0.83 - 0.90]; P <.001).

Investigators also observed these patients were more likely to have received delayed defibrillation (27.7% versus 36.6%; RR, 1.30 [95% CI, 1.09 - 1.55]; P = .003), but not delayed epinephrine treatment.

Consistent worsening survival outcomes were observed in the association between COVID-19 infection and patients with nonsurgical diagnoses, patients in the ICU, and those who had received timely defibrillation or epinephrine treatment.

“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,” Girotra concluded.

The study, “Association of COVID-19 Infection With Survival After In-Hospital Cardiac Arrest Among US Adults,” was published in JAMA Network Open.