Cardiac Arrest Survival Rates Research Articles

In-hospital cardiac arrest in middle-income settings: A comprehensive analysis of clinical profiles and outcomes of both adults and pediatrics

BackgroundIn hospital cardiac arrest is associated with poor survival despite basic and advanced life support measures. This study aimed to identify the clinical characteristics and outcomes of cardiac arrests occurring during in-hospital admission to the tertiary care center in Pakistan. MethodA retrospective, cross-sectional study at Aga Khan University Hospital from 2021 to 2023 analyzed 230 cardiac arrest cases. Data included demographics, arrest type, timing, initial rhythm, resuscitation duration, and arrest location. American Heart Association guidelines were adhered to for life support. The main outcomes focused on the return of spontaneous circulation survival to hospital discharge. ResultsDuring the study, 230 cardiac arrests were observed: 152 in adults (mean age 57.8, 142 shockable cases, ROSC 52.6 %, alive at discharge 28.3 %) and 78 in pediatric patients (mean age 4.99, non-shockable rhythm 85.9 %, ROSC 51.3 %, alive at discharge 17.9 %). Adult Charles comorbidity index: 2.88 (SD±2.08), pediatric index: 0.610 (SD±0.88). Survival rates were lower with a high comorbidity index and code duration > 20 min. ConclusionThe study provides valuable observational data that challenges global survival rates for in-hospital cardiac arrest. It highlights how factors like being in monitored units and the presence of rapid response teams can lead to higher survival rates. The research underscores the influence of comorbidities, initial rhythms, and the duration of resuscitation efforts on patient outcomes, emphasizing the need for more research, especially in settings with limited resources.

Correlation between personal characteristics and intention to perform bystander Cardiopulmonary Resuscitation

Out-of-hospital cardiac arrest is a major problem globally characterized by poor survival rates, particularly in residential settings. A delay in administering Cardiopulmonary Resuscitation (CPR) can reduce the survival rate, which is currently at 1 in 10. The chance of survival is influenced by several factors, including patient, population, and health system, particularly the actions of bystanders due to the need for immediate administration of CPR. Although the role of bystanders is very important in increasing the survival rate of cardiac arrest, not all individuals present at the scene are willing to carry out CPR due to personal characteristics. Therefore, this research aimed to explore the potential correlation between personal characteristics and the intention (willingness) to provide basic life support.The investigation was carried out in Malang City using descriptive correlation design and data were collected with questionnaires distributed through Google Forms. The sample consisted of residents of Malang City, with inclusion criteria comprising individuals aged between 17-65 years, not health workers or health students, and the ability to fill in data using Google Forms. After collection, the data obtained were processed descriptively using the SPSS 23 version.The results showed that among 283 respondents, 80.6% were in the early adult age range, 64% were female, 57.6% had the last education level SMA/SMK, and 65.4% were students. Furthermore, the analysis showed that the intentions of the majority of respondents were in the moderate range, accounting for 64.7%. Correlation analysis showed a significant association between personal characteristics and intention, where age, gender, level of education, occupation status, and experience had correlation scores of -0.089, 0.054, 0.107, 0.104, and -0.261.In conclusion, this research showed correlation strength for all characteristics ranging from very low to low, emphasizing the need to enhance the intention to perform bystander CPR across all levels. This is due to the very low correlation between community characteristics and intention. To overcome this challenge, a strategy that has been proven effective in increasing intention is educating the public regarding cardiac arrest assistance.

Design and validation of an In Vitro test bench for the investigation of cardiopulmonary resuscitation procedure

Despite recent clinical and technological advancements, the cardiac arrest survival rate remains as low as 10%. To enhance patient outcomes, it is crucial to deepen the understanding of cardiopulmonary resuscitation (CPR) at a fundamental level. Currently, there is a lack of knowledge on the physiological effects of CPR, in particular on the hemodynamics in the heart and the great vessels. The design and validation of a dedicated in vitro heart simulator, capable of replicating the physiological response to CPR, holds the potential to provide valuable insights into the fluid dynamics in the heart during CPR but also to be used as a platform for the development and testing of mechanical CPR machines. The main objective of this study is to design and validate the first in vitro heart simulator that can replicate the physiological response during CPR. For that, a custom-made heart simulator is designed consisting of an elastic model of the complete heart and a controllable linear actuator. The heart model is positioned in an anatomical position, and the linear actuator compresses the model at specific rates and depths. Flow and pressure waveforms are recorded on the newly developed simulator at 60 contractions per minute and results are validated against reported in vivo data in the literature. Finally, the system’s capabilities are evaluated by considering several combinations of compression rates and depths.

Association Between Emergency Medical Services Intervention Volume and Out-Of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis

BackgroundOut of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown. ObjectivesTo investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA. MethodsA retrospective cohort study using including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low-volume and high-volume. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were then matched 1:1 using a propensity score. Conditional logistic regression was then used. ResultsA total of 2,014 adult patients (69% male, median age 68 [57 - 79] years) were analyzed, 50.5% (n=1,017) were managed by low-volume MICU and 49.5% (n=997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR=0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR=1.01, 95%CI [0.78;1.3]), ROSC at hospital admission (OR=0.92, CI95% [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR=0.92 CI95% [0.53;1.62]). ConclusionsThe study suggest that there is no association between MICU volume of intervention and patients with OHCA outcomes. However, further research involving a larger number of centers is necessary to draw definitive conclusions.

Ghrelin for Neuroprotection in Post–Cardiac Arrest Coma

Out-of-hospital cardiac arrest survival rates have markedly risen in the last decades, but neurological outcome only improved marginally. Despite research on more than 20 neuroprotective strategies involving patients in comas after cardiac arrest, none have demonstrated unequivocal evidence of efficacy; however, treatment with acyl-ghrelin has shown improved functional and histological brain recovery in experimental models of cardiac arrest and was safe in a wide variety of human study populations. To determine safety and potential efficacy of intravenous acyl-ghrelin to improve neurological outcome in patients in a coma after cardiac arrest. A phase 2, double-blind, placebo-controlled, multicenter, randomized clinical trial, Ghrelin Treatment of Comatose Patients After Cardiac Arrest: A Clinical Trial to Promote Cerebral Recovery (GRECO), was conducted between January 18, 2019, and October 17, 2022. Adult patients 18 years or older who were in a comatose state after cardiac arrest were assessed for eligibility; patients were from 3 intensive care units in the Netherlands. Expected death within 48 hours or unfeasibility of treatment initiation within 12 hours were exclusion criteria. Patients were randomized to receive intravenous acyl-ghrelin, 600 μg (intervention group), or placebo (control group) within 12 hours after cardiac arrest, continued for 7 days, twice daily, in addition to standard care. Primary outcome was the score on the Cerebral Performance Categories (CPC) scale at 6 months. Safety outcomes included any serious adverse events. Secondary outcomes were mortality and neuron-specific enolase (NSE) levels on days 1 and 3. A total of 783 adult patients in a coma after cardiac arrest were assessed for eligibility, and 160 patients (median [IQR] age, 68 [57-75] years; 120 male [75%]) were enrolled. A total of 81 patients (51%) were assigned to the intervention group, and 79 (49%) were assigned to the control group. The common odds ratio (OR) for any CPC improvement in the intervention group was 1.78 (95% CI, 0.98-3.22; P = .06). This was consistent over all CPC categories. Mean (SD) NSE levels on day 1 after cardiac arrest were significantly lower in the intervention group (34 [6] μg/L vs 56 [13] μg/L; P = .04) and on day 3 (28 [6] μg/L vs 52 [14] μg/L; P = .08). Serious adverse events were comparable in incidence and type between the groups. Mortality was 37% (30 of 81) in the intervention group vs 51% (40 of 79) in the control group (absolute risk reduction, 14%; 95% CI, -2% to 29%; P = .08). In patients in a coma after cardiac arrest, intravenous treatment with acyl-ghrelin was safe and potentially effective to improve neurological outcome. Phase 3 trials are needed for conclusive evidence. Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.

The Self-Expandable Impella CP (ECP) as a Mechanical Resuscitation Device.

The survival rate of cardiac arrest (CA) can be improved by utilizing percutaneous left ventricular assist devices (pLVADs) instead of conventional chest compressions. However, existing pLVADs require complex fluoroscopy-guided placement along a guidewire and suffer from limited blood flow due to their cross-sectional area. The recently developed self-expandable Impella CP (ECP) pLVAD addresses these limitations by enabling guidewire-free placement and increasing the pump cross-sectional area. This study evaluates the feasibility of resuscitation using the Impella ECP in a swine CA model. Eleven anesthetized pigs (73.8 ± 1.7 kg) underwent electrically induced CA, were left untreated for 5 min and then received pLVAD insertion and activation. Vasopressors were administered and defibrillations were attempted. Five hours after the return of spontaneous circulation (ROSC), the pLVAD was removed, and animals were monitored for an additional hour. Hemodynamics were assessed and myocardial function was evaluated using echocardiography. Successful guidewire-free pLVAD placement was achieved in all animals. Resuscitation was successful in 75% of cases, with 3.5 ± 2.0 defibrillations and 1.8 ± 0.4 mg norepinephrine used per ROSC. Hemodynamics remained stable post-device removal, with no adverse effects or aortic valve damage observed. The Impella ECP facilitated rapid guidewire-free pLVAD placement in fibrillating hearts, enabling successful resuscitation. These findings support a broader clinical adoption of pLVADs, particularly the Impella ECP, for CA.

Sex Differences in Out-of-Hospital Cardiac Arrest Survival Trends.

Out-of-hospital cardiac arrest survival rates have improved over time. This study established whether improvements were similar for women and men, and to what extent resuscitation characteristics or in-hospital procedures contributed to sex differences in temporal trends. This retrospective cohort study included 3386 women and 8564 men from North Holland, the Netherlands, who experienced an out-of-hospital cardiac arrest from a cardiac cause in 2005 to 2017. Yearly rates of 30-day survival and secondary outcomes were calculated. Sex differences in temporal trends were evaluated with age-adjusted Poisson regression analysis, including interaction for sex and out-of-hospital cardiac arrest year. Resuscitation characteristics and in-hospital procedures were added to the model, and a spline at 2013 was considered. During the study period, the average 30-day survival was 24.9% in men and 15.7% in women. The 30-day survival rate increased in men (20% to 27.2%; P<0.001) but not in women (15.0% to 11.6%; P=0.40). The increase in the 30-day survival rate was 3% higher per year in men than in women (rate ratio, 1.03 [95% CI, 1.00-1.05]), with a stronger difference after 2013. Men had a larger increase in survival rate to the hospital arrival than women in 2005 to 2013, and, after 2013, an advantage over women in survival rate after hospital arrival. The sex differences were partly explained by differing trends in shockable initial rhythm (eg, adjusted rate ratio, 1.01 [95% CI, 0.99-1.03] for 30-day survival) and provision of in-hospital procedures. Changes in rates of 30-day survival, survival to hospital arrival, and, after 2013, survival from hospital arrival to 30 days were more beneficial in men than women. The differences in trends were partly explained by shockable initial rhythm and in-hospital procedures.

The Knowledge and Practice of Cardiopulmonary Resuscitation (CPR) among Nursing Students

Cardiac arrest is the sudden cessation of a person’s cardiac activity and is often fatal if corrective life-saving interventions are not performed quickly. The American Heart Association advocates the need for high CPR competency among healthcare providers to increase the cardiac arrest survival rate. This study aimed to determine the knowledge and practice of nursing students on the acquisition and retention of CPR. A quantitative descriptive-correlation design was used, and a sample of 76 nursing students of Universiti Malaysia Sabah were recruited via a non-probability purposive technique. Data were collected using an online survey questionnaire that consists of 3 sections: Demographic, knowledge of CPR, and practice of CPR. They were analyzed using the correlation method. The results of this study are about the knowledge and practice of CPR. Nursing students' knowledge of the acquisition of CPR could be higher (39.36%), as is their practice (31.95%). The correlation coefficient between knowledge and practice is insignificant (rho = -0.073, p 0.531).In this study, both the knowledge and practice of CPR are independent.

Assessment of Basic Life Support Knowledge Among Medical Students in Jordan: Implications for Improving Out-of-Hospital Cardiac Arrest and Road Traffic Accident Survival Rates.

This study aimed to assess the level of basic life support (BLS) knowledge among fifth- and sixth-year medical students in Jordan, identify differences in knowledge levels between male and female students and between different universities, and provide insights into the current status of BLS training in medical education in Jordan. The study had 570 respondents, with females constituting 61.1% of the sample. The total average score for medical students was 12.24/17 (72%), and there was a considerable variation in the response rate between universities. The study found that students whose source of knowledge was previous college courses had the highest mean score, and only 24.9% knew the proper position of both hands while doing chest compressions. The study underscores the importance of adequate BLS training for healthcare providersto improve survival rates and reduce mortality and morbidity associated with out-of-hospital cardiac arrest and road traffic accidents. The findings of this study could inform future interventions aimed at improving BLS knowledge and skills.

20 Impact of COVID-19 Infection Prevention and Control (IPC) restrictions on cardiac arrest (CA) survival rates in pre-hospital practice: A scoping review

20 Impact of COVID-19 Infection Prevention and Control (IPC) restrictions on cardiac arrest (CA) survival rates in pre-hospital practice: A scoping review

Abstract 341: Regional Variation in Cardiac Arrest Response and Outcomes in North Carolina - A Call to Action

Background: In the United States, despite advances in cardiac arrest systems of care, out of hospital cardiac arrest (OHCA) treatment and survival are highly variable. In North Carolina, intensive efforts to improve prehospital care are ongoing. We sought to investigate the variation in OHCA community response and outcomes in North Carolina (NC), and to assess underlying differences in system-, patient- and county-level characteristics in an effort to optimize regional cardiac arrest care. Methods: All adult (age &gt;18 years) OHCAs from 2016-2020 in 36 counties of North Carolina were included from the Cardiac Arrest Registry to Enhance Survival. We excluded cases that were EMS witnessed and that occurred in nursing homes. Response and outcome variation as well as county characteristics were described according to tertile of survival with good neurologic outcome (CPC 1/2). Results: Overall, 18,563 OHCAs occurred of which 22.4% had a shockable rhythm, 84.7% occurred at home and 50.7% were witnessed. Overall survival to hospital discharge with good neurologic outcome was 8.1%, with a state-wide variation among counties between 0% and 21.2% while Utstein survival was 26.1% overall, ranging between 0% and 47.8%. Bystander CPR rates were 41.8% (variation between 22.6% - 64.5%). First responder or bystander AED application was 42.9% of cases (variation between 8.6% - 66.6%) and 11.1% (variation between 2.7% and 19.7%) received defibrillation before EMS arrival. Counties within the highest tertile of survival were characterized by higher population density, lower unemployment rates and higher average household income. Such counties were further characterized by higher rates of bystander and first responder CPR and AED use prior to EMS arrival (Table 1). Conclusion: In NC, cardiac arrest response metrics and survival rates showed a dramatic regional variation, with particularly low survival in rural settings, calling for regional efforts to optimize cardiac arrest care.

The Role of Automated External Defibrillator Use in the Out-of-Hospital Cardiac Arrest Survival Rate and Outcome: A Systematic Review.

Out-of-hospital cardiac arrest (OHCA) remains a significant cause of death. The chance of survival significantly increases when immediate defibrillation with an on-siteautomated external defibrillator (AED) is available. Our aim is to systematically evaluate the impact of public access defibrillators (PAD) on the outcomes of outpatient cardiac arrest. We conducted a systematic review of the data from global studies on the role of bystander and emergency medical service (EMS) interventions, primarily focusing on the usage of AEDs, during OHCA events. The results highlight the critical significance of PADsin improving survival outcomes in OHCA settings. The majority of OHCA incidents occurred in private residences, but public spaces such as schools and airports had better outcomes, likely due to AED accessibility and trained individuals. Placing AEDs in public areas, especially high-risk zones, can boost survival chances. Timely defibrillation, particularly by bystanders, correlated with better survival and neurological conditions. The review emphasizes the importance of widespread cardiopulmonary resuscitation (CPR) and AED training, strategic AED placement, and continuous monitoring of interventions and outcomes to enhance survival rates and neurological recovery after OHCAs. This systematic review showed that bystander interventions, including CPR and AED usage, significantly increased the survival rate. Overall, immediate response and accessibility to AEDs in public areas can significantly improve outcomes in OHCA events.

Cardiac Arrest Bundle of cARE Trial (CABARET) survey of current UK neuroprotective CPR practice

Despite low out of hospital cardiac arrest (OOHCA) survival rates within the UK, animal studies hint at improved cerebral blood flow via a bundled neuroprotective CPR approach. The CABARET study introduces three key devices: the Head Up Position (HUP), Active Compression/Decompression (ACD) CPR, and the Impedance Threshold Device (ITD). A survey involving 27 UK pre-hospital critical care services indicated none are using these interventions widely, either alone or bundled. The CABARET team is now initiating a pilot study to investigate the feasibility of this CPR bundle, aiming to fill the prevailing evidence void in resuscitation research.

Updating the model for Risk-Standardizing survival for In-Hospital cardiac arrest to facilitate hospital comparisons

BackgroundRisk-standardized survival rates (RSSR) for in-hospital cardiac arrest (IHCA) have been widely used for hospital benchmarking and research. The novel coronavirus 2019 (COVID-19) pandemic has led to a substantial decline in IHCA survival as COVID-19 infection is associated with markedly lower survival. Therefore, there is a need to update the model for computing RSSRs for IHCA given the COVID-19 pandemic. MethodsWithin Get With The Guidelines®-Resuscitation, we identified 53,922 adult patients with IHCA from March, 2020 to December, 2021 (the COVID-19 era). Using hierarchical logistic regression, we derived and validated an updated model for survival to hospital discharge and compared the performance of this updated RSSR model with the previous model. ResultsThe survival rate was 21.0% and 20.8% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.72) and excellent calibration. The updated parsimonious model comprised 13 variables—all 9 predictors in the original model as well as 4 additional predictors, including COVID-19 infection status. When applied to data from the pre-pandemic period of 2018–2019, there was a strong correlation (r = 0.993) between RSSRs obtained from the updated and the previous models. ConclusionWe have derived and validated an updated model to risk-standardize hospital rates of survival for IHCA. The updated model yielded RSSRs that were similar to the initial model for IHCAs in the pre-pandemic period and can be used for supporting ongoing efforts to benchmark hospitals and facilitate research that uses data from either before or after the emergence of COVID-19.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the operational efficiency of emergency medical services and its association with out-of-hospital cardiac arrest survival rates: A population-based cohort study in Kobe, Japan.

To identify whether the coronavirus disease 2019 (COVID-19) pandemic affects the operational efficiency of emergency medical services (EMS) and the survival rate of out-of-hospital cardiac arrest (OHCA) in prehospital settings. We conducted a population-based cohort study in Kobe, Japan, between March 1, 2020, and September 31, 2022. In study 1, the operational efficiency of EMS, such as the total out-of-service time for ambulances, the daily occupancy rate of EMS, and response time, was compared between the pandemic and nonpandemic periods. In study 2, the impacts of the changes in EMS operational efficiency were investigated among patients with OHCA, with 1-month survival as the primary outcome and return of spontaneous circulation, 24-h survival, 1-week survival, and favorable neurological outcomes as the secondary outcomes. Logistic regression analysis was conducted to identify the factors associated with survival among patients with OHCA. The total out-of-service time, occupancy rate, and response time significantly increased during the pandemic period (p < 0.001). The response time during the pandemic period increased significantly per pandemic wave. Regarding OHCA outcomes, 1-month survival rates during the pandemic period significantly decreased compared with those during the nonpandemic period (pandemic 3.7% vs. nonpandemic 5.7%; p < 0.01). Similarly, 24-h survival (9.9% vs. 12.8%), and favorable neurological outcomes significantly decreased during the pandemic period. In the logistic regression analysis, response time was associated with lower OHCA survival in all outcomes (p < 0.05). The COVID-19 pandemic has been associated with reduced operational efficiency of EMS and decreased OHCA survival rates. Further research is required to improve the efficiency of EMS and OHCA survival rates.

Improving Out-of-Hospital Cardiac Arrest Survival Rates—Optimization Given Constraints

Improving Out-of-Hospital Cardiac Arrest Survival Rates—Optimization Given Constraints

Abstract 12: Identifying Emergency Medical Service Agencies In Black And Hispanic Communities With High Cardiac Arrest Survival Rates

Background: Black and Hispanic individuals have lower survival rates for out-of-hospital cardiac arrest (OHCA). Whether there are Emergency Medical Service (EMS) agencies in Black and Hispanic communities with high survival rates for OHCA is unknown but critical to identifying strategies to reduce racial and ethnic disparities in OHCA survival. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified adults with non-traumatic OHCA during 2015-2019. EMS agencies were categorized as working in Black/Hispanic communities if &gt;50% of residents in their catchment area were Black or Hispanic. Using hierarchical logistic regression, we calculated risk-standardized survival rates (RSSR) to hospital admission for OHCA in each EMS agency, adjusted for patients’ age, sex, witnessed arrest status, presumed arrest etiology, initial cardiac arrest rhythm, and arrest location. We then examined the distribution of EMS agencies that work in Black/Hispanic communities across quartiles of OHCA survival. Results: Among 764 EMS agencies (258,342 OHCAs), the median RSSR was 27.4% with an absolute difference of &gt;10% across quartiles (median 22.4% in the lowest vs. 32.9% in the highest quartile; 191 EMS agencies in each quartile). There were 82 EMS agencies working in Black/Hispanic communities overall, with 26 (31.7%) in the lowest RSSR quartile and 15 (18.3%) in the highest. After further adjustment for agency-level rates of bystander CPR, EMS response time and termination of resuscitation practices, there remained 29 (35.4%) EMS agencies in the lowest RSSR quartile and 16 (19.5%) in the highest. Conclusion: EMS agencies working in Black and Hispanic communities have lower prehospital survival for OHCA, although high-performing agencies exist. Identifying best practices at EMS agencies with the highest prehospital survival rates, particularly among agencies serving Black and Hispanic communities, has the potential to improve overall OHCA survival and reduce existing survival disparities.

Prevalence, Outcomes, and Risk Factors for Cardiorespiratory Arrest in the Intensive Care Unit: An Observational Study.

BackgroundCardiorespiratory arrest is defined as an abrupt halt in the cardiac mechanical activity that is accompanied by the loss of a detectable pulse, the cessation of breathing, and the loss of consciousness. The aim of this study is to create a clinical–epidemiological profile of patients who experienced cardiorespiratory arrest and were admitted to the intensive care unit to evaluate the associated factors and their impact on the prognosis of these patients.Patients and methodsFrom January to December 2019, the medical records of 135 patients who received cardiopulmonary resuscitation were reviewed for this cross-sectional observational study. The information was collected according to the Utstein model.ResultsA low return of spontaneous circulation of 22.2% was observed, with a predominance of females (53.3%) and older patients (68.9%), multiple comorbidities at admission (68.4%), and asystole as the predominant rhythm. Female sex and age >60 years were statistically significant (p = 0.017), as was the association between sex and comorbidities (p = 0.036), with heart disease being the most prevalent in females (p = 0.036).ConclusionIn this study, even though the resuscitation maneuver time (start of resuscitation following arrest) was very short and the defibrillation was performed promptly, there was a high prevalence of cardiac arrest and low survival rates after cardiopulmonary resuscitation.How to cite this articleMenezes da Silva A, Braga AL, Cruvinel de Souza V. Prevalence, Outcomes, and Risk Factors for Cardiorespiratory Arrest in the Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2022;26(6):704–709.

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions.

OBJECTIVES:The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts.DESIGN:Retrospective cohort study.SETTING:New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY.PATIENTS:Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest.INTERVENTIONS:None.MEASUREMENT AND MAIN RESULTS:Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; p = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; p < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; p = 0.03), but otherwise there were no significant differences between groups.CONCLUSIONS:Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society

2022 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration With the American Academy of Pediatrics, American Association for Respiratory Care, the Society