Characteristics and Outcomes of In-Hospital Cardiac Arrests in Patients with SARS-CoV-2 Infection

Abstract

Background: Cardiopulmonary resuscitation poses unique challenges in patients with SARS-CoV-2 infection who develop in-hospital cardiac arrest (IHCA). Recent studies have shown variable rates of survival for IHCA in patients with COVID-19. Our study aims to describe and compare characteristics and outcomes of patients with and without COVID-19 who developed IHCA. Methods: In this single-center retrospective study, we studied 162 adult patients from Baylor St. Luke's Medical Center in Houston, Texas during the first COVID-19 surge (March to August 2020). Eligible patients were those with IHCA who were identified through the Getting with the Guidelines-Resuscitation registry. Patients with Do-Not-Resuscitate orders were excluded. Demographics, comorbidities, and IHCA characteristics were determined and abstracted from electronic health records. Characteristics and outcomes of COVID and non-COVID patients were compared. Results: Thirty-one COVID and 131 non-COVID IHCA occurred at Baylor St. Luke's Medical Center from March to April 2020. Age was similar between the groups, with higher male predominance in the COVID arrest group (81% vs 55%, p=0.005). There was a significantly higher proportion of Hispanic (32% vs 15%) and Asian patients (13% vs 3%) and a lower proportion of black (19% vs 37%) and white patients (29% vs 41%) in the group of COVID arrests. The COVID IHCA group had less comorbid heart failure (16% vs 47%, p =0.005), right ventricular dysfunction (16% vs 34%, p=0.13), COPD (0 vs 13%, p=0.034) and malignancy (3% vs 19%, p=0.031), but higher rates of diabetes (74% vs 42%, p=0.002) and asthma (16% vs 1%, p<0.001). The COVID IHCA group had higher oxygen requirements on admission (median FiO2 0.36 vs 0.21, p=0.01) and at the time of cardiac arrest (median FiO2 0.4 vs 1.0, p<0.001) and there was a trend toward arrests later in the hospital stay when compared to the non-COVID IHCA group (30% occurring in the first 72 hours vs 42%, respectively). IHCA survival was lower in those with COVID (55% vs 74%, p=0.035). Conclusion: There were significant differences in demographics and comorbidities between patients with and without COVID-19 who developed IHCA at our institution. Survival rates were lower in COVID patients, though our institution's 19% rate of survival to discharge is higher than those of previous studies.