In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

BMJ. 2020 Sep 30;371:m3513. doi: 10.1136/bmj.m3513.

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.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • Cohort Studies
  • Coronavirus Infections / complications
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / virology
  • Female
  • Heart Arrest / mortality*
  • Heart Arrest / virology
  • Hospital Mortality*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / virology
  • United States / epidemiology

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2