COVID-19 versus non-COVID-19 inhospital cardiac arrest survival at a large us healthcare system

ABSTRACT

INTRODUCTION: Early reports from Wuhan, NYC and Detroit showed poor prognosis after in hospital cardiac arrest (IHCA) in COVID-19 patients. Factors leading to poor outcomes included overwhelmed healthcare systems, cardiac arrests on regular nursing floor instead of ICUs & shorter duration of resuscitation efforts. We aimed to assess whether there was a difference in resuscitation efforts in our healthcare system during the COVID-19 pandemic (22% survival - recently reported) when compared to our historic MICU IHCA (16% survival) resuscitation attempts. METHODS: In this retrospective study, we compared the duration of resuscitation between two cardiac arrest cohorts. Cohort one included COVID-19 IHCA patients who were admitted from 03/2020- 10/2020 in the ICU of the Cleveland Clinic Health System of NE Ohio. Cohort two included patients who were admitted to the medical ICU of Cleveland Clinic from 01/2014-12/2018. Study was approved by the IRB and data obtained through EMR and quality and patient safety registry. 21 propensity score matching was performed to derive two matched groups for outcome analysis. Wilcoxon test was used to compare the duration of resuscitation between two cohorts. Wilcoxon test was used to compare the duration. The statistical analysis was carried using R 4.0.3 and p< 0.05 was considered statistically significant. RESULTS: There were a total of 442 patients, 384 in non- COVID-19 cohort and 58 in COVID-19 cohort. The mean age of the study population was 61.3 (16.2) years and 44.5% were females. In 90.8% (n=385) patients, rhythm was nonshockable. After propensity score matching, there was no significant difference in the mean duration of resuscitation in COVID-19 (n=57) and non-COVID cohort (n=114) (13.1 (11.7) vs 11.4 (10.2), p=0.470). CONCLUSIONS: In this study, we found that there was no significant change in the duration of the resuscitation attempts in patients with COVID-19 when compared to the historic cohort of critically ill patients who had an IHCA. The favorable outcomes we noted in our patient cohort is related to the systems of care, the large ICU capacity, expansive restructuring of critical care resources and investment into critical care COVID 19 specific education.