Scientists have found that cardiac arrest is common among critically ill patients with COVID-19, and is associated with poor survival, particularly among those aged 80 or older, an advance that may help guide end-of-life care discussions in people severely affected by the coronavirus infection. The researchers, including those from the University of Michigan in the US, estimated the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest in critically ill adults with COVID-19.
Their findings, published in the journal The BMJ, are based on data for 5,019 critically ill patients — aged 18 years or over — with COVID-19 admitted to the intensive care units (ICUs) at 68 hospitals across the US. According to the study, 701 (14 per cent) of the patients had in-hospital cardiac arrest within 14 days of admission to the intensive care unit, of whom only 400 (57 per cent) received cardiopulmonary resuscitation, or CPR — an emergency life-saving procedure that is done when someone’s breathing or heartbeat has stopped.
Patients who had in-hospital cardiac arrest were older, had more underlying health conditions, and were more likely to be admitted to a hospital with fewer intensive care unit beds. However, the scientists said hospital resources, staffing, expertise, strain, or other factors not captured in this study, could have had a major impact.
They said patients who received CPR were younger than those who did not with only 12 per cent of those who underwent the emergency procedure survived to hospital discharge, and only seven per cent did so with normal or mildly impaired neurological status. According to the study, most patients who survived to hospital discharge needed only a short course of CPR. Survival also differed by age, with more than a fifth of the patients younger than 45 years surviving compared with three per cent of those aged 80 or older.
Citing the limitations of the research, the scientists said they were unable to assess the quality and timeliness of CPR, and the limiting data to the first 14 days after intensive care unit admission. They said these drawbacks may have led to a potential underestimation of the true rate of cardiac arrest. However, the researchers said the strengths included use of high quality, detailed data for a large number of patients who were followed until death or discharge.
They added that cardiac arrest is common in critically ill patients with COVID-19, and is associated with poor survival even when CPR is provided, particularly in patients aged 80 or older. “Our study data could help inform patients, family members, and clinicians in complex decision making about patients with COVID-19 who are at risk of cardiac arrest or who have experienced cardiac arrest,” the scientists concluded.
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