Khosla Rahul, Delio Joseph, Glass Lisa N, Khosla Shikha G, Awan Omar, Bawa Amandeep, Vyas Kavita
Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, USA.
Pulmonary and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, USA.
Cureus. 2021 Jun 1;13(6):e15365. doi: 10.7759/cureus.15365. eCollection 2021 Jun.
During the COVID-19 pandemic, many patients are hospitalized, and those suffering from in-hospital cardiac arrest (IHCA) have been previously reported to have poor outcomes. This is a single-center, retrospective, observational study conducted at the Veterans Affairs Medical Center, Washington, DC, USA. The inclusion criteria were: patients admitted to the hospital with a diagnosis of COVID-19 who underwent cardiopulmonary resuscitation (CPR) for IHCA. Patients were labeled as COVID-19 positive based on a laboratory-confirmed positive polymerase chain reaction test. Patients with do-not-resuscitate (DNR) orders, those who were made comfort care, or enrolled in hospice were excluded. The study was approved by the hospital's institutional review board. A total of 155 patients with COVID-19 infection were admitted; 145/155 (93.5%) admitted to the medical floor and 10/155 (6.5%) to the medical intensive care unit (MICU). 36/145 (24.8%) floor patients were upgraded to MICU. Of the 46 patients treated in MICU, 17/46 (36.9%) were excluded for DNR status. From the remaining 29/46 (63.1%) patients, 19/29 (65.5%) patients survived, and 10/29 (34.5%) patients had IHCA. All 10/10 (100%) died after CPR without return of spontaneous circulation (ROSC). The initial rhythm was non-shockable in all patients, with pulseless electrical activity (PEA) in 7/10 (70%) and asystole in 3/10 (30%) patients. Patients with COVID-19 infection who had an IHCA and underwent CPR had a 0% survival at our hospital. Discussions on advanced care options, especially CPR, with COVID-19 patients and their families, are important as the overall prognosis after CPR for IHCA is poor.
在新冠疫情期间，许多患者住院治疗，此前有报道称，院内心脏骤停（IHCA）患者的预后较差。这是一项在美国华盛顿特区退伍军人事务医疗中心进行的单中心、回顾性观察研究。纳入标准为：因新冠确诊入院且因院内心脏骤停接受心肺复苏（CPR）的患者。基于实验室确诊的聚合酶链反应检测呈阳性，患者被标记为新冠阳性。不包括有“不要复苏”（DNR）医嘱的患者、接受舒适护理或入住临终关怀病房的患者。该研究获得了医院机构审查委员会的批准。共有155例新冠感染患者入院；145/155（93.5%）入住普通内科病房，10/155（6.5%）入住内科重症监护病房（MICU）。36/145（24.8%）的普通内科病房患者被升级到MICU。在MICU接受治疗的46例患者中，17/46（36.9%）因DNR状态被排除。在其余29/46（63.1%）患者中，19/29（65.5%）存活，10/29（34.5%）发生院内心脏骤停。所有10/10（100%）患者在心肺复苏后未恢复自主循环（ROSC）而死亡。所有患者的初始心律均不可电击复律，7/10（70%）为无脉电活动（PEA），3/10（30%）为心脏停搏。在我院，因院内心脏骤停接受心肺复苏的新冠感染患者生存率为0%。鉴于院内心脏骤停心肺复苏后的总体预后较差，与新冠患者及其家属讨论高级护理选择，尤其是心肺复苏，非常重要。
