Outcomes for in-hospital cardiac arrest for COVID-19 patients at a rural hospital in Southern California

Nene, R. V.; Amidon, N.; Tomaszewski, C.; Lafree, A.; Nene, Rahul V; Amidon, Nicole; Tomaszewski, Christian A; Wardi, Gabriel; Lafree, Andrew

Rationale: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has necessitated a significant reassessment of the approach to resource allocation. There is limited data on survivability after inhospital cardiac arrest (IHCA) for patients with coronavirus disease 2019 (COVID-19), particularly in rural and resource-limited settings. In this study, we describe the characteristics and outcomes for COVID-19 patients suffering IHCA at a rural hospital in Southern California. Methods: This was a single-center retrospective observational study performed at a rural situated community hospital in Southern California. A hospital registry of COVID-19 patients was queried for all patients who suffered IHCA and received cardiopulmonary resuscitation (CPR) between May 1st 2020 and July 31st 2020. A manual chart review was performed to confirm cardiac arrest (CA), COVID-19 positivity, as well as to obtain patient demographics, medical comorbidities, COVID-19 specific therapies administered, oxygen requirement prior to CA, details of the resuscitation, and final disposition. Results: We identified twenty one patients who suffered IHCA and received CPR. The majority of these patients were Hispanic, male, and aged 50-70, and the most common medical comorbidities were diabetes and hypertension. Many patients received COVID-19 specific therapies, including dexamethasone, remdesivir, or convalescent plasma. 20/21 patients suffered respiratory arrest, with an initial rhythm of pulseless electrical activity or asystole. Return of spontaneous circulation (ROSC) was achieved in 3/9 patients already receiving mechanical ventilation, but all 3 expired within the following 24 hours. ROSC was achieved in 10/12 patients not already intubated, though most also expired within a few days. The only 2 patients who survived to discharge suffered respiratory arrest after their oxygen delivery dislodged. Conclusion: To our knowledge, this is the first study of COVID-19 cardiac arrests specifically in a rural setting in the United States. In this study at a small community hospital with limited resources and a predominantly Hispanic population, we found low survivability after IHCA in COVID-19 patients. While more is being learned about the disease, and treatment modalities are improving, cardiac arrest portends an extremely poor prognosis. A better appreciation of these outcomes should help inform providers and patients when discussing code status and attempts at resuscitation, particularly in resource limited settings.