Outcomes of in-hospital cardiac arrest in COVID-19 patients: A proportional prevalence meta-analysis
Department of Medicine, Division of Cardiovascular Medicine
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Infectious Disease | Virus Diseases
BACKGROUND: Limited epidemiological data are available on the outcomes of in-hospital cardiac arrest (CA) in COVID-19 patients.
METHODS: We performed literature search of PubMed, EMBASE, Cochrane, and Ovid to identify research articles that studied outcomes of in-hospital cardiac arrest in COVID-19 patients. The primary outcome was survival at discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and types of cardiac arrest. Pooled percentages with a 95% confidence interval (CI) were calculated for the prevalence of outcomes.
RESULTS: A total of 7,891 COVID patients were included in the study. There were 621 (pooled prevalence 8%, 95% CI 4-13%) cardiac arrest patients. There were 52 (pooled prevalence 3.0%; 95% CI 0.0-10.0%) patients that survived at the time of discharge. ROSC was achieved in 202 (pooled prevalence 39%;95% CI 21.0-59.0%) patients. Mean time to ROSC was 7.74 (95% CI 7.51-7.98) min. The commonest rhythm at the time of cardiac arrest was pulseless electrical activity (pooled prevalence 46%; 95% 13-80%), followed by asystole (pooled prevalence 40%; 95% CI 6-80%). Unstable ventricular arrhythmia occurred in a minority of patients (pooled prevalence 8%; 95% CI 4-13%).
CONCLUSION: This pooled analysis of studies showed that the survival post in-hospital cardiac arrest in COVID patients is dismal despite adequate ROSC obtained at the time of resuscitation. Nonshockable rhythm cardiac arrest is commoner suggesting a non-cardiac cause while cardiac related etiology is uncommon. Future studies are needed to improve the survival in these patients.
COVID-19, in-hospital cardiac arrest, mortality, pulseless electrical activity
DOI of Published Version
Mir T, Sattar Y, Ahmad J, Ullah W, Shanah L, Alraies MC, Qureshi WT. Outcomes of in-hospital cardiac arrest in COVID-19 patients: A proportional prevalence meta-analysis. Catheter Cardiovasc Interv. 2021 Feb 4. doi: 10.1002/ccd.29525. Epub ahead of print. PMID: 33543564. Link to article on publisher's site
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography and Interventions
Mir T, Sattar Y, Ahmad J, Ullah W, Shanah L, Alraies MC, Qureshi W. (2021). Outcomes of in-hospital cardiac arrest in COVID-19 patients: A proportional prevalence meta-analysis. COVID-19 Publications by UMMS Authors. https://doi.org/10.1002/ccd.29525. Retrieved from https://escholarship.umassmed.edu/covid19/179