In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study.

OBJECTIVES

To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19).

DESIGN

Multicenter cohort study.

SETTING

Intensive care units at 68 geographically diverse hospitals across the United States.

PARTICIPANTS

Critically ill adults (age ≥18 years) with laboratory confirmed covid-19.

MAIN OUTCOME MEASURES

In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality.

RESULTS

Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older.

CONCLUSIONS

Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.