Holm Astrid, Jerkeman Matilda, Sultanian Pedram, Lundgren Peter, Ravn-Fischer Annica, Israelsson Johan, Giesecke Jasna, Herlitz Johan, Rawshani Araz
Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden.
BMJ Open. 2021 Nov 30;11(11):e054943. doi: 10.1136/bmjopen-2021-054943.
We studied characteristics, survival, causes of cardiac arrest, conditions preceding cardiac arrest, predictors of survival and trends in the prevalence of COVID-19 among in-hospital cardiac arrest (IHCA) cases.
Registry-based observational study.
We studied all cases (≥18 years of age) of IHCA receiving cardiopulmonary resuscitation in the Swedish Registry for Cardiopulmonary Resuscitation during 15 March 2020 to 31 December 2020. A total of 1613 patients were included and divided into the following groups: ongoing infection (COVID-19 n=182), no infection (COVID-19 n=1062) and unknown/not assessed (n=369).
We studied monthly trends in proportions of COVID-19 associated IHCAs, causes of IHCA in relation to COVID-19 status, clinical conditions preceding the cardiac arrest and predictors of survival.
The rate of COVID-19+ patients suffering an IHCA increased to 23% during the first pandemic wave (April), then abated to 3% in July, and then increased to 19% during the second wave (December). Among COVID-19+ cases, 43% had respiratory insufficiency or infection as the underlying cause of the cardiac arrest, compared with 18% among COVID-19- cases. The most common clinical sign preceding cardiac arrest was hypoxia (57%) among COVID-19+ cases. OR for 30-day survival for COVID-19+ cases was 0.50 (95% CI 0.33 to 0.76), compared with COVID-19- cases.
During pandemic peaks, up to one-fourth of all IHCAs are complicated by COVID-19, and these patients have halved chance of survival, with women displaying the worst outcomes.
我们研究了院内心脏骤停（IHCA）病例中2019冠状病毒病（COVID-19）的特征、生存率、心脏骤停原因、心脏骤停前状况、生存预测因素及患病率趋势。
基于登记处的观察性研究。
我们研究了2020年3月15日至2020年12月31日期间在瑞典心肺复苏登记处接受心肺复苏的所有IHCA病例（年龄≥18岁）。共纳入1613例患者，并分为以下几组：正在感染（COVID-19，n = 182）、未感染（COVID-19，n = 1062）和未知/未评估（n = 369）。
我们研究了与COVID-19相关的IHCA比例的月度趋势、与COVID-19状态相关的IHCA原因、心脏骤停前的临床状况以及生存预测因素。
在第一波疫情高峰（4月）期间，发生IHCA的COVID-19阳性患者比例增至23%，随后在7月降至3%，然后在第二波疫情（12月）期间增至19%。在COVID-19阳性病例中，43%的患者心脏骤停的潜在原因是呼吸功能不全或感染，而COVID-19阴性病例中这一比例为18%。在COVID-19阳性病例中，心脏骤停前最常见的临床体征是缺氧（57%）。与COVID-19阴性病例相比，COVID-19阳性病例30天生存率的比值比为0.50（95%置信区间0.33至0.76）。
在疫情高峰期间，所有IHCA病例中高达四分之一并发COVID-19，这些患者的生存机会减半，女性的结局最差。
