Characteristics and outcomes of in-hospital cardiac arrest among patients diagnosed with covid-19: A systematic review

Moon, J.; Moon, H.

Background: In-hospital cardiac arrest (IHCA) is difficult to manage, especially so in severe COVID-19 patients. The aim of this study was to investigate the characteristics and prognosis of IHCA in patients who were diagnosed with COVID-19. Methods: We performed a systematic review using the PubMed, Embase, Google Scholar, and MedRxiv databases from December 1, 2019 to October 1, 2020. Two independent investigators reviewed studies reporting information on IHCA in COVID-19 patients. Results: Twelve studies and case reports met our inclusion criteria, including a total of 7,134 COVID-19 patients from six countries. IHCA occurred in 956 patients, and of these, CPR documentation was available in 634. The number of males were almost double that of females (65.9% vs. 34.1%), and the mean age ranged from 42 to 69. The initial cardiac rhythm at the time of CPR in descending order of frequency was pulseless electrical activity (43.2%), asystole (37.1%), ventricular fibrillation/pulseless ventricular tachycardia (9.9%), and other/unknown (9.8%). Common comorbidities included hypertension, diabetes, hyperlipidemia, heart disease, and chronic kidney disease. Rate of survival to discharge was 8.8% (56/634), and lower rates were associated with increasing age. Among those who survived, 44.2% (23/52) had moderate to severe neurologicaldysfunction, defined by cerebral performance category score of 3 or 4. Conclusions: IHCA in COVID-19 patients carry a poor prognosis. Risks are higher in those with comorbidities and the probability of survival is lower in older adults. Even after successfulresuscitation, the risk of neurological complications is high. Further studies are needed to stratifyrisks and optimally manage IHCA in patients with COVID-19.