In-hospital cardiac arrest incidence and outcomes in the era of COVID-19: an observational study in a Singapore hospital

Ting Lyu,Monika Gulati Kansal,Shanaz Matthew Sajeed,Faheem Ahmed Khan,Chee Keat Tan,Ian Cendana,Rou An Tan,Shekhar Dhanvijay,Patricia Leong,Amit Kansal,Jared D’Souza

doi:10.1186/s12245-021-00356-7

Abstract

BackgroundCOVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period.MethodsWe conducted a retrospective study in a tertiary care hospital in Singapore. The study compared the incidence and outcomes of code blue activations over a 3-month period from March to May 2020 (COVID-19 period) with the same months in 2019 (pre-COVID-19 period). The primary outcome of the study was the rate of survival to hospital discharge for IHCA. The secondary outcomes included incidence of all code blue activation per 1000 hospital admissions, incidence of IHCA per 1000 hospital admissions.OutcomesThe rate of survival to hospital discharge for IHCA was 5.88% in the COVID-19 period as compared to 10.0% in the pre-COVID-19 period [odds ratio (OR), 0.72; 95% confidence interval (CI), 0.26-1.95]. Compared to pre-COVID-19 period, there were more IHCA incidences per 1000 hospital admissions in the COVID-19 period (1.86 vs 1.03; OR, 1.81; 95% CI, 0.78-4.41).ConclusionsThe study observed a trend towards higher incidence of IHCA and lower rate of survival to hospital discharge during COVID-19 pandemic compared to pre-COVID-19 period.

Highlights

Coronavirus disease 2019 (COVID-19) pandemic has caused a global healthcare crisis
Despite a 6% decrease in hospital admissions during COVID-19 study periods as compared to the pre-COVID-19 control period, the number of code blue activations increased by 35% (34 cases increased to 46 cases) (Table 1)
The Acute Physiology And Chronic Health Evaluation (APACHE) II score calculated within 24 h of intensive care unit (ICU) admission was similar between two periods

Summary

Introduction

Coronavirus disease 2019 (COVID-19) pandemic has caused a global healthcare crisis. As a highly transmittable disease, COVID-19 has posed a significant threat to healthcare workers. Ng Teng Fong General Hospital (NTFGH) is a healthcare institution located in the west of Singapore with a novel code blue activation system [5]. Since late February 2020, with more COVID-19 cases reported in Singapore, HCBT in NTFGH adopted full precautions to handle all code blue cases in order to minimise the risk of COVID-19 exposure [6]. COVID-19 pandemic has resulted in significant strain on healthcare resources and this requires diligent resource re-allocation. We aim to describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) during this period as compared to non-pandemic period

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Discussion

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