Abstract

BackgroundInitial reports have described the poor outcome of unexpected cardiac arrest (CA) in intensive care unit (ICU) among COVID-19 patients in China and the USA. However, there are scarce data on characteristics and outcomes of such CA patients in Europe.MethodsProspective registry in 35 French ICUs, including all in-ICU CA in COVID-19 adult patients with cardiopulmonary resuscitation (CPR) attempt. Favorable outcome was defined as modified Rankin scale ranging from 0 to 3 at day 90 after CA.ResultsAmong the 2425 COVID-19 patients admitted to ICU from March to June 2020, 186 (8%) experienced in-ICU CA, of whom 146/186 (78%) received CPR. Among these 146 patients, 117 (80%) had sustained return of spontaneous circulation, 102 (70%) died in the ICU, including 48 dying within the first day after CA occurrence and 21 after withdrawal of life-sustaining therapy. Most of CA were non-shockable rhythm (90%). At CA occurrence, 132 patients (90%) were mechanically ventilated, 83 (57%) received vasopressors and 75 (51%) had almost three organ failures. Thirty patients (21%) had a favorable outcome. Sepsis-related organ failure assessment score > 9 before CA occurrence was the single parameter constantly associated with unfavorable outcome in multivariate analysis.ConclusionsIn-ICU CA incidence remains high among a large multicenter cohort of French critically ill adults with COVID-19. However, 21% of patients with CPR attempt remained alive at 3 months with good functional status. This contrasts with other recent reports showing poor outcome in such patients.Trial registration: This study was retrospectively registered in ClinicalTrials.gov (NTC04373759) in April 2020 (https://www.clinicaltrials.gov/ct2/show/NCT04373759?term=acicovid&draw=2&rank=1).

Highlights

  • Before the Coronavirus disease 2019 (COVID-19) outbreak, incidence and mortality of unexpected cardiac arrest (CA) occurring in intensive care unit (ICU)Chelly et al Ann

  • Objectives and outcome variables We aimed to report the incidence of in-ICU CA among patients admitted for COVID-19 pneumonia, and the clinical characteristics and outcome of such CA patients

  • In‐ICU CA incidence Among the 2425 patients admitted to the 35 participating ICUs with confirmed COVID-19 pneumonia during the study period, 186 (8%) experienced CA, 146 (6%) patients had cardiopulmonary resuscitation (CPR) attempted and 117 (5%) patients had sustained return of spontaneous circulation (ROSC) (Fig. 1)

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Summary

Introduction

Before the Coronavirus disease 2019 (COVID-19) outbreak, incidence and mortality of unexpected cardiac arrest (CA) occurring in intensive care unit (ICU)Chelly et al Ann. Since the beginning of the COVID-19 outbreak, small or monocentric reports from China and the USA, have uniformly described the dramatically poor outcome of patients hospitalized for COVID-19 pneumonia (including patients admitted to general/unmonitored wards or to ICU) who experienced in-hospital cardiac arrest (IHCA) [5,6,7,8] Among these reports, IHCA incidence was around 20% [5] and survival with good neurological status ranged from 0 to 0.7%, leading to discussions regarding the futility of cardiopulmonary resuscitation (CPR) attempt in such patients [9,10,11,12,13,14,15]. There are scarce data on characteristics and outcomes of such CA patients in Europe

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