Researchers compared outcomes of patients who had suffered in- and out-of-hospital cardiac arrest, before and after the onset of the COVID-19 pandemic (16 March 2020). Between 01 January and 20 July 2020, 3026 cardiac arrests were reported to the Swedish Registry for Cardiopulmonary Resuscitation.
Of these 3026 cardiac arrests, 1946 occurred out-of-hospital (OHCA), and 1080 occurred in-hospital (IHCA). Of the 1946 OHCAs, 1746 (89.7%) died, while 680 (63.0%) IHCAs died. During the pandemic period of the study, 88 (10.0%) OHCAs and 72 (16.1%) IHCAs had ongoing COVID-19. After calculating the relative importance of 27 different clinical features, researchers found COVID-19 status to be the sixth most important predictor of survival.
Researchers employed Cox regression to determine overall mortality, and logistic regression to determine 30-day mortality.
In-hospital cardiac arrest & COVID-19
Among IHCA cases, 532 (49.3%) were registered before the pandemic; the remainder were registered during the pandemic. COVID-19 positive patients had poor survival; 60.5% had died within 24 hours. The predicted 30-day survival probability during the pandemic period was 39.5% for COVID-19 negative patients, but only 23.1% for COVID-19 positive patients. The pre-pandemic 30-day survival was 36.4%.
The 30-day mortality rate was increased by 2.3 fold in those with COVID-19.
Out-of-hospital cardiac arrest & COVID-19
Patients with COVID-19 among these cases also showed poor survival rates; 83.4% died within 24 hours. The predicted 30-day survival probability during the pandemic period was 9.8% for COVID-19 negative patients, but only 4.7% for COVID-19 positive patients. The pre-pandemic 30-day survival was 7.6%.
The 30-day mortality was increased by 3.4 fold in those with COVID-19.
As of 20 July 2020, no patient with COVID-19 has been discharged alive following an OHCA. In contrast, 36% of COVID-19 negative patients who were hospitalized following cardiac arrest have been discharged alive.
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Author: Kelly Schoonderwoerd
Original article: Sultanian et al. Eur Heart J. 2021 Mar 14;42(11):1094-1106.
