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In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge.

Publication ,  Journal Article
Chan, PS; Spertus, JA; Kennedy, K; Nallamothu, BK; Starks, MA; Girotra, S
Published in: Circ Cardiovasc Qual Outcomes
February 2022

BACKGROUND: Recent reports on challenges in resuscitation care at hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic raise questions about how the pandemic affected outcomes for in-hospital cardiac arrest throughout the United States. METHODS: Within Get With The Guidelines-Resuscitation, we conducted a retrospective cohort study to compare in-hospital cardiac arrest survival during the presurge (January 1-February 29), surge (March 1-May 15) and immediate postsurge (May 16-June 30) periods in 2020 compared to 2015 to 2019. Monthly COVID-19 mortality rates for each hospital's county were categorized, per 1 000 000 residents, as low (0-10), moderate (11-50), high (51-100), or very high (>100). Using hierarchical regression models, we compared rates of survival to discharge in 2020 versus 2015 to 2019 for each period. RESULTS: Of 61 586 in-hospital cardiac arrests, 21 208 (4309 in 2020), 26 459 (5949 in 2020), and 13 919 (2686 in 2020) occurred in the presurge, surge, and postsurge periods, respectively. During the presurge period, 24.2% survived to discharge in 2020 versus 24.7% in 2015 to 2019 (adjusted odds ratio, 1.12 [95% CI, 1.02-1.22]). In contrast, during the surge period, 19.6% survived to discharge in 2020 versus 26.0% in 2015 to 2019 (adjusted odds ratio, 0.81 [0.75-0.88]). Lower survival was most pronounced in communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates (interaction P<0.001). Resuscitation times were shorter (median: 22 versus 25 minutes; P<0.001), and delayed epinephrine treatment was more prevalent (11.3% versus 9.9%; P=0.004) during the surge period. Survival was lower even when patients with confirmed/suspected COVID-19 infection were excluded from analyses. During the postsurge period, survival rates were similar in 2020 versus 2015 to 2019 (22.3% versus 25.8%; adjusted odds ratio, 0.93 [0.83-1.04]), including communities with high COVID-19 mortality (interaction P=0.16). CONCLUSIONS: Early during the pandemic, rates of survival to discharge for IHCA decreased, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

February 2022

Volume

15

Issue

2

Start / End Page

e008420

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • SARS-CoV-2
  • Retrospective Studies
  • Registries
  • Pandemics
  • Humans
  • Hospitals
  • Heart Arrest
  • Cardiovascular System & Hematology
 

Citation

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Chan, P. S., Spertus, J. A., Kennedy, K., Nallamothu, B. K., Starks, M. A., & Girotra, S. (2022). In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge. Circ Cardiovasc Qual Outcomes, 15(2), e008420. https://doi.org/10.1161/CIRCOUTCOMES.121.008420
Chan, Paul S., John A. Spertus, Kevin Kennedy, Brahmajee K. Nallamothu, Monique A. Starks, and Saket Girotra. “In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge.Circ Cardiovasc Qual Outcomes 15, no. 2 (February 2022): e008420. https://doi.org/10.1161/CIRCOUTCOMES.121.008420.
Chan PS, Spertus JA, Kennedy K, Nallamothu BK, Starks MA, Girotra S. In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge. Circ Cardiovasc Qual Outcomes. 2022 Feb;15(2):e008420.
Chan, Paul S., et al. “In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge.Circ Cardiovasc Qual Outcomes, vol. 15, no. 2, Feb. 2022, p. e008420. Pubmed, doi:10.1161/CIRCOUTCOMES.121.008420.
Chan PS, Spertus JA, Kennedy K, Nallamothu BK, Starks MA, Girotra S. In-Hospital Cardiac Arrest Survival in the United States During and After the Initial Novel Coronavirus Disease 2019 Pandemic Surge. Circ Cardiovasc Qual Outcomes. 2022 Feb;15(2):e008420.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

February 2022

Volume

15

Issue

2

Start / End Page

e008420

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • SARS-CoV-2
  • Retrospective Studies
  • Registries
  • Pandemics
  • Humans
  • Hospitals
  • Heart Arrest
  • Cardiovascular System & Hematology