Paul S Chan1,2, John A Spertus1,2, Kevin Kennedy1, Brahmajee K Nallamothu3, Monique A Starks4, Saket Girotra5. 1. Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., J.A.S., K.K.). 2. University of Missouri-Kansas City (P.S.C., J.A.S.). 3. University of Michigan School of Medicine and Ann Arbor V.A. Medical Center (B.K.N.). 4. Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (M.A.S.). 5. University of Iowa Carver College of Medicine, Iowa City (S.G.).
Abstract
BACKGROUND: Recent reports on challenges in resuscitation care at hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic raise questions about how the pandemic affected outcomes for in-hospital cardiac arrest throughout the United States. METHODS: Within Get With The Guidelines-Resuscitation, we conducted a retrospective cohort study to compare in-hospital cardiac arrest survival during the presurge (January 1-February 29), surge (March 1-May 15) and immediate postsurge (May 16-June 30) periods in 2020 compared to 2015 to 2019. Monthly COVID-19 mortality rates for each hospital's county were categorized, per 1 000 000 residents, as low (0-10), moderate (11-50), high (51-100), or very high (>100). Using hierarchical regression models, we compared rates of survival to discharge in 2020 versus 2015 to 2019 for each period. RESULTS: Of 61 586 in-hospital cardiac arrests, 21 208 (4309 in 2020), 26 459 (5949 in 2020), and 13 919 (2686 in 2020) occurred in the presurge, surge, and postsurge periods, respectively. During the presurge period, 24.2% survived to discharge in 2020 versus 24.7% in 2015 to 2019 (adjusted odds ratio, 1.12 [95% CI, 1.02-1.22]). In contrast, during the surge period, 19.6% survived to discharge in 2020 versus 26.0% in 2015 to 2019 (adjusted odds ratio, 0.81 [0.75-0.88]). Lower survival was most pronounced in communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates (interaction P<0.001). Resuscitation times were shorter (median: 22 versus 25 minutes; P<0.001), and delayed epinephrine treatment was more prevalent (11.3% versus 9.9%; P=0.004) during the surge period. Survival was lower even when patients with confirmed/suspected COVID-19 infection were excluded from analyses. During the postsurge period, survival rates were similar in 2020 versus 2015 to 2019 (22.3% versus 25.8%; adjusted odds ratio, 0.93 [0.83-1.04]), including communities with high COVID-19 mortality (interaction P=0.16). CONCLUSIONS: Early during the pandemic, rates of survival to discharge for IHCA decreased, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.
BACKGROUND: Recent reports on challenges in resuscitation care at hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic raise questions about how the pandemic affected outcomes for in-hospital cardiac arrest throughout the United States. METHODS: Within Get With The Guidelines-Resuscitation, we conducted a retrospective cohort study to compare in-hospital cardiac arrest survival during the presurge (January 1-February 29), surge (March 1-May 15) and immediate postsurge (May 16-June 30) periods in 2020 compared to 2015 to 2019. Monthly COVID-19 mortality rates for each hospital's county were categorized, per 1 000 000 residents, as low (0-10), moderate (11-50), high (51-100), or very high (>100). Using hierarchical regression models, we compared rates of survival to discharge in 2020 versus 2015 to 2019 for each period. RESULTS: Of 61 586 in-hospital cardiac arrests, 21 208 (4309 in 2020), 26 459 (5949 in 2020), and 13 919 (2686 in 2020) occurred in the presurge, surge, and postsurge periods, respectively. During the presurge period, 24.2% survived to discharge in 2020 versus 24.7% in 2015 to 2019 (adjusted odds ratio, 1.12 [95% CI, 1.02-1.22]). In contrast, during the surge period, 19.6% survived to discharge in 2020 versus 26.0% in 2015 to 2019 (adjusted odds ratio, 0.81 [0.75-0.88]). Lower survival was most pronounced in communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates (interaction P<0.001). Resuscitation times were shorter (median: 22 versus 25 minutes; P<0.001), and delayed epinephrine treatment was more prevalent (11.3% versus 9.9%; P=0.004) during the surge period. Survival was lower even when patients with confirmed/suspected COVID-19 infection were excluded from analyses. During the postsurge period, survival rates were similar in 2020 versus 2015 to 2019 (22.3% versus 25.8%; adjusted odds ratio, 0.93 [0.83-1.04]), including communities with high COVID-19 mortality (interaction P=0.16). CONCLUSIONS: Early during the pandemic, rates of survival to discharge for IHCA decreased, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.
Authors: R O Cummins; D Chamberlain; M F Hazinski; V Nadkarni; W Kloeck; E Kramer; L Becker; C Robertson; R Koster; A Zaritsky; L Bossaert; J P Ornato; V Callanan; M Allen; P Steen; B Connolly; A Sanders; A Idris; S Cobbe Journal: Circulation Date: 1997-04-15 Impact factor: 29.690
Authors: Ian Jacobs; Vinay Nadkarni; Jan Bahr; Robert A Berg; John E Billi; Leo Bossaert; Pascal Cassan; Ashraf Coovadia; Kate D'Este; Judith Finn; Henry Halperin; Anthony Handley; Johan Herlitz; Robert Hickey; Ahamed Idris; Walter Kloeck; Gregory Luke Larkin; Mary Elizabeth Mancini; Pip Mason; Gregory Mears; Koenraad Monsieurs; William Montgomery; Peter Morley; Graham Nichol; Jerry Nolan; Kazuo Okada; Jeffrey Perlman; Michael Shuster; Petter Andreas Steen; Fritz Sterz; James Tibballs; Sergio Timerman; Tanya Truitt; David Zideman Journal: Circulation Date: 2004-11-23 Impact factor: 29.690
Authors: Mary Ann Peberdy; Joseph P Ornato; G Luke Larkin; R Scott Braithwaite; T Michael Kashner; Scott M Carey; Peter A Meaney; Liyi Cen; Vinay M Nadkarni; Amy H Praestgaard; Robert A Berg Journal: JAMA Date: 2008-02-20 Impact factor: 56.272
Authors: Mary Ann Peberdy; William Kaye; Joseph P Ornato; Gregory L Larkin; Vinay Nadkarni; Mary Elizabeth Mancini; Robert A Berg; Graham Nichol; Tanya Lane-Trultt Journal: Resuscitation Date: 2003-09 Impact factor: 5.262
Authors: Zachary D Goldberger; Paul S Chan; Robert A Berg; Steven L Kronick; Colin R Cooke; Mingrui Lu; Mousumi Banerjee; Rodney A Hayward; Harlan M Krumholz; Brahmajee K Nallamothu Journal: Lancet Date: 2012-09-05 Impact factor: 79.321
Authors: Michael W Donnino; Justin D Salciccioli; Michael D Howell; Michael N Cocchi; Brandon Giberson; Katherine Berg; Shiva Gautam; Clifton Callaway Journal: BMJ Date: 2014-05-20
Authors: Dana P Edelson; Comilla Sasson; Paul S Chan; Dianne L Atkins; Khalid Aziz; Lance B Becker; Robert A Berg; Steven M Bradley; Steven C Brooks; Adam Cheng; Marilyn Escobedo; Gustavo E Flores; Saket Girotra; Antony Hsu; Beena D Kamath-Rayne; Henry C Lee; Rebecca E Lehotsky; Mary E Mancini; Raina M Merchant; Vinay M Nadkarni; Ashish R Panchal; Mary Ann R Peberdy; Tia T Raymond; Brian Walsh; David S Wang; Carolyn M Zelop; Alexis A Topjian Journal: Circulation Date: 2020-04-09 Impact factor: 29.690
Authors: Pedram Sultanian; Peter Lundgren; Anneli Strömsöe; Solveig Aune; Göran Bergström; Eva Hagberg; Jacob Hollenberg; Jonny Lindqvist; Therese Djärv; Albert Castelheim; Anna Thorén; Fredrik Hessulf; Leif Svensson; Andreas Claesson; Hans Friberg; Per Nordberg; Elmir Omerovic; Annika Rosengren; Johan Herlitz; Araz Rawshani Journal: Eur Heart J Date: 2021-03-14 Impact factor: 29.983
Authors: Kayla M Secrest; Theresa M Anderson; Brad Trumpower; Molly Harrod; Sarah L Krein; Timothy C Guetterman; Paul S Chan; Brahmajee K Nallamothu Journal: Resusc Plus Date: 2022-10-11