The authors reply.

At the time of submission of our recently published article (1) in Critical Care Medicine, there were no data regarding survival after in-hospital cardiac arrest among coronavirus disease 2019 (COVID-19) patients in the United States. We acknowledge that our study (1) raised concerns regarding the benefit of cardiopulmonary resuscitation (CPR) in hospitalized COVID-19 patients suffering cardiac arrest. However, the goal of our study (1) was to initiate robust debate and encourages further research into a very important question that has a significant impact on resource allocation. We did not suggest early termination of resuscitative efforts or premature withdrawal of life-sustaining measures for such patients.

We agree with the authors that based on recent larger studies, CPR is not universally futile in hospitalized COVID-19 patients. However, our study (1) was unique in terms of patient demographics. More than 90% of patients in our study (1) were African-Americans. It is well known that African-Americans have significantly lower survival rates after cardiac arrest compared with Caucasian patients (2). Furthermore, our hospitalized COVID-19 patients were sicker with higher comorbidity burden compared with other areas (3).

We would like to point out that we have mentioned the lack of generalizability of our findings in the Limitations section of our article (1) due to our unique patient population as well as the fact that it was a single-center study. We completely agree with the authors (4) that providers, patients, and families should exercise caution in using findings from single-center studies such as ours (1) to make decisions regarding resuscitative measures. We believe that goals of care conversations should be a core component of the care pathway for every critically ill patient at every stage of their care in the hospital. We hope our study (1) will encourage future research to explore racial differences in the outcomes of cardiac arrest in COVID-19 patients.