scholarly journals Cohort study of the characteristics and outcomes in patients with COVID-19 and in-hospital cardiac arrest

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054943
Author(s):  
Astrid Holm ◽  
Matilda Jerkeman ◽  
Pedram Sultanian ◽  
Peter Lundgren ◽  
Annica Ravn-Fischer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Clinical Sign ◽  
Clinical Conditions ◽  
Second Wave ◽  
Hospital Cardiac Arrest ◽  
Pandemic Wave ◽  
Ongoing Infection

ObjectiveWe studied characteristics, survival, causes of cardiac arrest, conditions preceding cardiac arrest, predictors of survival and trends in the prevalence of COVID-19 among in-hospital cardiac arrest (IHCA) cases.Design and settingRegistry-based observational study.ParticipantsWe studied all cases (≥18 years of age) of IHCA receiving cardiopulmonary resuscitation in the Swedish Registry for Cardiopulmonary Resuscitation during 15 March 2020 to 31 December 2020. A total of 1613 patients were included and divided into the following groups: ongoing infection (COVID-19+; n=182), no infection (COVID-19–; n=1062) and unknown/not assessed (n=369).Main outcomes and measuresWe studied monthly trends in proportions of COVID-19 associated IHCAs, causes of IHCA in relation to COVID-19 status, clinical conditions preceding the cardiac arrest and predictors of survival.ResultsThe rate of COVID-19+ patients suffering an IHCA increased to 23% during the first pandemic wave (April), then abated to 3% in July, and then increased to 19% during the second wave (December). Among COVID-19+ cases, 43% had respiratory insufficiency or infection as the underlying cause of the cardiac arrest, compared with 18% among COVID-19– cases. The most common clinical sign preceding cardiac arrest was hypoxia (57%) among COVID-19+ cases. OR for 30-day survival for COVID-19+ cases was 0.50 (95% CI 0.33 to 0.76), compared with COVID-19– cases.ConclusionDuring pandemic peaks, up to one-fourth of all IHCAs are complicated by COVID-19, and these patients have halved chance of survival, with women displaying the worst outcomes.

scholarly journals Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study

BMJ ◽  
2019 ◽  
pp. l430 ◽  
Author(s):  
Junichi Izawa ◽  
Sho Komukai ◽  
Koichiro Gibo ◽  
Masashi Okubo ◽  
Kosuke Kiyohara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Time Dependent ◽  
Adjusted Risk ◽  
Shockable Rhythm ◽  
Adjusted Risk Ratio ◽  
Advanced Airway ◽  
Sequential Matching ◽  
Hospital Cardiac Arrest

Abstract Objective To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. Design Cohort study between January 2014 and December 2016. Setting Nationwide, population based registry in Japan (All-Japan Utstein Registry). Participants Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. Main outcome measures Survival at one month or at hospital discharge within one month. Results Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). Conclusions In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.

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