ABSTRACT
PurposeThe effect of vasopressors on mortality of critically ill patients with COVID-19 has not been studied extensively. Materials and MethodsA systematic search of PubMed, Scopus, and clinicaltrials.gov was conducted for relevant articles until January 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was mortality at latest follow-up. The quality of studies was assessed using the MINORS tool. Paired meta-analysis was used to estimate the pooled risk ratios along with their 95% Confidence Interval. ResultsAnalyses of 21 studies (n=7900) revealed that vasopressor use is associated with mortality in patients who receive vasopressors compared to those who do not receive vasopressor therapy [RR (95%CI): 4.26 (3.15, 5.76); p<0.001]. In-hospital and 30-day mortality are significantly higher in patients who receive vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p<0.001 and RR (95%CI): 2.97 (1.72, 5.14); p<0.001, respectively]. The highest mortality rate was observed with vasopressin or epinephrine, while the lowest mortality rate was observed with angiotensin-II. Also, analyses of data from 10 studies (n=3519) revealed that vasopressor use is associated with acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p<0.001]. ConclusionVasopressor use was associated with an increase in in-hospital mortality, 30-day mortality, and acute kidney injury in critically ill patients with COVID-19.
ABSTRACT
AimTo estimate the incidence of in-hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID-19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non-ICU patients with COVID-19. MethodsWe systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. ResultsEleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID-19 patients was 7% [95% CI: 4 - 11%; P < 0.0001] and 44% [95% CI: 30 - 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42 - 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow-up was 59% [95% CI: 37 - 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. ConclusionThe incidence of IHCA amongst hospitalized COVID-19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ. What this paper addsSection 1: What is already known on this subject O_LIMortality in COVID-19 patients ranges between 20% and 40%. C_LIO_LIit has been reported that patients with COVID-19 have a high incidence of IHCA and higher mortality. C_LIO_LIThis paper aimed to calculate the proportion of COVID-19 patients who experience IHCA and their outcome, as well as compare the outcome of IHCA between ICU and non-ICU patients. C_LI Section 2: What this study adds O_LIApproximately 7% of hospitalized COVID-19 patients suffer from IHCA and 44% of those achieve ROSC. C_LIO_LIThe rate of ROSC was higher in ICU patients, but the rate of mortality did not differe between ICU and non-ICU patients. C_LI
