Code Blue for COVID-19 Patients: No Survivors

According to US data, the survival rate of COVID-19 patients with persistent in-hospital cardiac arrest (IHCA) was low.

According to Corey Mayer, DO, and MBA at William Beaumont Hospital in Royal Oak, Michigan, 53.7% of these 54 patients returned to spontaneous circulation after a median CPR of 8 minutes. JAMA Internal Medicine..

Approximately half of these patients had their code status changed to “not revived.” The other half was recoded but still died after additional CPR.

Eventually, all 54 COVID-19 patients survived to be discharged after IHCA.

According to Meyer’s group, “high mortality after CPR is likely to be multifactorial.”

The initial rhythm was 96.3% unshocked, 81.5% showed pulseless electrical activity, and 14.8% showed asystole. Two patients had pulseless ventricular tachycardia.

“Given that most patients in this study developed an unshockable rhythm, the results could be bad. In addition, at the time of cardiac arrest, many patients had mechanical artificial respiration, renal replacement He was receiving therapy or vasopressor support and was previously shown to be associated with poor outcome after IHCA. “

Their findings are Wuhan, China, The 30-day survival rate of IHCA at COVID-19 was found to be only 2.9% in the cohort, which had a predominantly shockless rhythm.

In contrast, an estimated quarter of IHCA patients survived until they were discharged before the pandemic, and in 81% of cases the initial rhythm was unshocked, Mayer’s team said.

Given the nature of aerosol production in the resuscitation process and the limited supply of PPE nationwide, further research is needed to understand the risks and benefits of performing long-term CPR in hospitalized COVID-19 patients. The group urged it to be necessary.

Deepen your understanding of the possibilities Successful results after CPR It is important to inform discussions about care goals, determine the adequacy of rehabilitation efforts, and guide policies, “says J. Randall Curtis, MD, MPH, and J. Randall Curtis, MD, MPH, of Harborview Medical Center and the University of Washington, Seattle. My colleague agreed. Invited commentary..

In March, the American Heart Association Provisional guidance Concerning safeguards for hospitals and EMS workers to revive people with cardiac arrest.

Investigators identified 1,309 adults diagnosed with COVID-19 who were admitted to Mayer’s facility during the early stages of the pandemic from March 15 to April 3, 2020.

Of these patients, 60 received IHCA CPR and 54 had sufficient documentation for the current analysis (median age 61.5 years, 61.1% male).

Most patients had comorbidities, including hypertension (77.8%), diabetes (55.6%), or hyperlipidemia (50.0%). The median BMI was 33.

The median time from admission to cardiac arrest was 8 days. At the time of cardiac arrest, 79% were on ventilator, 33% were renal replacement therapy, and 46.3% were vasopressor support.

The Chinese and US case series “should be interpreted with caution, as only one or two additional survivors make a significant difference in the observed estimates,” Curtis and colleagues warned. ..

“Results with COVID-19 settings may actually be the same as before COVID-19. IHCA results According to the editor, patients with unshocked rhythms often have a survival rate of less than 15% in hospitals. “

In any case, improving the outcomes of critically ill patients with COVID-19 and IHCA is “challenging,” they wrote.

“These early results do not guarantee a universal ban on resuscitation for COVID-19 patients, but we will discuss care goals in the early stages of COVID-19, make changes and re-discuss them. It emphasizes the importance of consideration, in the clinical setting, “Curtis’ group emphasized.

It is worth noting that two-thirds of the cohort were African-American. African Americans tend to demand CPR despite poor prognosis, report poor advance care planning documents, poor communication quality during serious illness, and high distrust of the health care system. I will. I commented.

“Current data on IHCA outcomes for COVID-19 patients have significant limitations, but sufficient to conclude that it is important to implement a program that facilitates conversations about community values ​​and goals. I have data. Discussion of early care goals According to the editor, for patients hospitalized with COVID-19. “

An established program to initiate these discussions includes Conversation project And Preparing for your care..