Patients with COVID-19 Are Unlikely to Survive In-Hospital Cardiac Arrest

Early in the COVID-19 pandemic, experts debated about whether cardiopulmonary resuscitation (CPR) should be offered to critically ill patients with COVID-19, in light of concern for healthcare worker exposure. More than 1 year after the first case of COVID-19 occurred in the U.S., we have a growing body of evidence suggesting that outcomes after in-hospital cardiac arrest are poor (NEJM JW Gen Med Nov 15 2020 and BMJ 2020; 371:m3513 and JAMA Intern Med 2021; 181:279).

Investigators from a rural health system (3 hospitals) in Georgia analyzed all patients (63) with COVID-19 who underwent CPR from March to August 2020. Median age was 66, median body-mass index was 35 kg/m², almost all patients had hypertension, and nearly two thirds had diabetes. Most patients were supported with mechanical ventilation. In-hospital mortality was 100%. Return of circulation was achieved in about one quarter of patients. Most events occurred in the intensive care unit, with time to CPR of less than 1 minute. Initial shockable rhythms were rare (7%), and almost all patients had moderate-to-severe hypoxemia. Within the same health system during a similar period in 2019, one third of patients who suffered in-hospital cardiac arrest survived to discharge.