Aldabagh Mohammad, Wagle Sneha, Cesa Marie, Yu Arlene, Farooq Muhammad, Goldberg Ythan
Montefiore Medical Center, New York, NY 10467, USA.
Healthcare (Basel). 2021 Oct 1;9(10):1315. doi: 10.3390/healthcare9101315.
There are limited data regarding the outcome of in-hospital cardiopulmonary resuscitation (CPR) in COVID-19 patients. In this study, we compared the outcomes of in-hospital cardiac arrests (IHCA) before and at the peak of the COVID-19 pandemic at Montefiore Medical Center in the Bronx, New York, United States. We also identified the most common comorbidities associated with poor outcomes in our community.
This was a multi-site, single-center, retrospective, observational study. Inclusion criteria for COVID patients were all confirmed positive cases who had in-hospital cardiac arrest (IHCA) between 1 March 2020 and 30 June 2020. The non-COVID cohort included all cardiac arrest cases who had IHCA in 2019. We excluded all out-of-hospital cardiac arrest (OHCA). We compared actual survival to that predicted by the GO-FAR score, a validated prediction model for determining survival following IHCA.
There were 334 cases in 2019 compared to 450 cases during the specified period in 2020. Patients who initially survived cardiac arrest but then had their code statuses changed to do not resuscitate (DNR) were excluded. Groups were similar in terms of sex distribution, and both had an average age of about 66 years. Seventy percent of COVID patients were of Black or Hispanic ethnicity. A shockable rhythm was present in 7% of COVID patients and 17% of non-COVID patients ( < 0.05). COVID patients had higher BMI (30.7 vs. 28.4, < 0.05), higher prevalence of diabetes mellitus (58% vs. 38%, < 0.05), and lower incidence of coronary artery disease (22% vs. 35%, < 0.05). Both groups had almost similar predicted average survival rates based on the GO-FAR score, but only 1.5% of COVID patients survived to discharge compared to 7% of non-COVID patients ( < 0.05).
The rate of survival to hospital discharge in COVID-19 patients who suffer IHCA is worse than in non-COVID patients, and lower than that predicted by the GO-FAR score. This finding may help inform our patient population about risk factors associated with high mortality in COVID-19 infection, as well as educate hospitalized patients and healthcare proxies in the setting of code status designation.
关于新冠病毒病（COVID-19）患者院内心肺复苏（CPR）的结果，相关数据有限。在本研究中，我们比较了美国纽约布朗克斯区蒙特菲奥里医疗中心在COVID-19大流行之前和高峰期的院内心脏骤停（IHCA）结果。我们还确定了在我们社区中与不良预后相关的最常见合并症。
这是一项多中心、单中心、回顾性观察性研究。COVID患者的纳入标准为2020年3月1日至2020年6月30日期间所有确诊为院内心脏骤停（IHCA）的阳性病例。非COVID队列包括2019年所有发生IHCA的心脏骤停病例。我们排除了所有院外心脏骤停（OHCA）。我们将实际生存率与GO-FAR评分预测的生存率进行了比较，GO-FAR评分是一种用于确定IHCA后生存情况的经过验证的预测模型。
2019年有334例病例，而2020年指定期间有450例病例。最初心脏骤停存活但随后其抢救状态改为不要复苏（DNR）的患者被排除。两组在性别分布方面相似，平均年龄均约为66岁。70%的COVID患者为黑人或西班牙裔。7%的COVID患者和17%的非COVID患者出现可电击心律（<0.05）。COVID患者的体重指数（BMI）较高（30.7对28.4，<0.05），糖尿病患病率较高（58%对38%，<0.05），冠状动脉疾病发病率较低（22%对35%，<0.05）。根据GO-FAR评分，两组的预测平均生存率几乎相似，但只有1.5%的COVID患者存活至出院，而非COVID患者为7%（<0.05）。
发生IHCA的COVID-19患者的出院生存率低于非COVID患者，且低于GO-FAR评分预测的生存率。这一发现可能有助于我们的患者群体了解与COVID-19感染高死亡率相关的风险因素，以及在抢救状态指定的情况下对住院患者和医疗代理人进行教育。
