In hospital cardiac arrest in Intensive Care Unit versus non Intensive Care Unit patients with COVID 19. A systematic review and meta analysis

Aim: To estimate the incidence of in hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID 19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non ICU patients with COVID 19. Methods: We systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. Results: Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID 19 patients was 7% [95% CI: 4, 11%; P < 0.0001] and 44% [95% CI: 30, 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42, 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow up was 59% [95% CI: 37, 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. Conclusion: The incidence of IHCA amongst hospitalized COVID 19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

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Withdrawal of Life-Sustaining Therapy in Intensive Care Unit Patients Following Out-Of-Hospital Cardiac Arrest: An Australian Metropolitan ICU Experience

10.21203/rs.3.rs-1215202/v1 ◽

2022 ◽

Author(s):

Nilesh Anand Devanand ◽

Mohammed Ishaq Ruknuddeen ◽

Natalie Soar ◽

Suzanne Edwards

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Length Of Stay ◽

Motor Response ◽

Temperature Management ◽

Icu Patients ◽

Icu Length Of Stay ◽

Clinical Records ◽

Hospital Cardiac Arrest

Abstract Objective: To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA).Methods: A retrospective review of ICU data from patient clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, clinical attributes and targeted temperature management were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 hours) and late (ICU length of stay ≥72 hours). Factors independently associated with WLST were determined by multivariable binary logistic regression using a backward elimination method, and results were depicted as odds ratios (OR) with 95% confidence intervals (CI).Results: The study selection criteria resulted in a cohort of 260 ICU patients post-OHCA, with a mean age of 58 years and the majority were males (178, 68%); 151 patients (58%) died, of which 145 (96%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 38.90, 95% CI 4.55–332.57; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day 3 post-OHCA was the strongest factor associated with delayed WLST (OR 91.59, 95% CI 11.66–719.18; p < 0.0001).Conclusion: The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day 3 post-OHCA are independently associated with WLST.

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The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10235573 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5573

Author(s):

Karol Bielski ◽

Agnieszka Szarpak ◽

Miłosz Jaroslaw Jaguszewski ◽

Tomasz Kopiec ◽

Jacek Smereka ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Survival Outcomes ◽

Cochrane Central Register ◽

Mortality And Morbidity ◽

Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

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Outcome of octogenarians versus nonoctogenarians admitted to the intensive care unit with return of spontaneous circulation after out-of-hospital cardiac arrest

Critical Care ◽

10.1186/cc5646 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P486

Author(s):

I van Stijn ◽

R Bosman ◽

H Oudemans-van Straaten ◽

P van der Voort ◽

J Wester ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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Abstract 13013: Survival After In-Hospital Cardiopulmonary Resuscitation for Cardiac Arrest in Patients With COVID-19: An Updated Meta-Analysis

Circulation ◽

10.1161/circ.144.suppl_2.13013 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Archana Pattupara ◽

Devika Aggarwal ◽

Kirtipal S Bhatia ◽

Olga Gomez-Rojas ◽

vardhmaan jain ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurological Recovery ◽

Term Survival ◽

Performance Category ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Several small studies have reported variable outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19. A clear estimate is important in prognostication and guiding resuscitation efforts and policies for these patients. Methods: A search of PubMed, Embase, and Scopus databases was conducted to identify studies reporting outcomes after IHCA in adult patients with confirmed COVID-19. The cumulative characteristics of the patients were described. The primary outcome studied was survival at 30 days or at hospital discharge (short term survival). Additional outcomes of interest were proportional prevalence of the initial rhythm at arrest, return of spontaneous circulation (ROSC), and neurological recovery (defined as Cerebral Performance Category Score of 1-2 ). Metanalysis of proportions was performed utilizing the Metaprop command. A random effects model was chosen to account for interstudy variance. Results: A total of 13 eligible studies were identified and included in the analyses. Out of all the hospitalized patients with COVID-19, 1,618 underwent advanced cardiac resuscitation after an IHCA. Patients who had a cardiac arrest had a median age between 50-69 years. IHCA occurred predominantly in men, and in the ICU setting. Shockable rhythms were identified in 8% (95% CI 5-10%, I2; 56%) and non-shockable rhythms in 89% (95% CI 85-94% I2; 84%) of patients (Fig. 1a). ROSC was achieved in 40% (95% CI 31-48% I2; 90%) (Fig. 1b). Only 7 % ( 95% CI 3-12% I2; 86%) of patients survived at 30 days/hospital discharge (Fig. 1c). Neurological recovery was seen in 5% (95% CI 3-9% I2; 67%) of patients who suffered a IHCA (Fig. 1d). Conclusions: Our meta-analysis demonstrates the majority of the cardiac arrests in patients with COVID-19 have non-shockable rhythms. Survival rate in these patients is low, and neurological recovery is unfavorable. This study provides further insight in guiding resuscitation efforts in these patients.

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Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽

10.1161/circ.132.suppl_3.18070 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Michael J Jacobs ◽

Leo S Derevin ◽

Sue Duval ◽

James E Pointer ◽

Karl A Sporer

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Outcome Data ◽

Neurological Function ◽

Inverse Association ◽

Advanced Airway ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

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Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919830896 ◽

2019 ◽

Vol 27 (3) ◽

pp. 155-161 ◽

Cited By ~ 1

Author(s):

Veerapong Vattanavanit ◽

Supattra Uppanisakorn ◽

Thanapon Nilmoje

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

American Heart Association ◽

American Heart ◽

Medical Intensive Care Unit ◽

Heart Association ◽

Temperature Management ◽

Medical Intensive Care ◽

Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

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Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620967083 ◽

2020 ◽

Vol 26 ◽

pp. 107602962096708

Author(s):

Belayneh Kefale ◽

Gobezie T. Tegegne ◽

Amsalu Degu ◽

Melaku Tadege ◽

Desalegn Tesfa

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

English Language ◽

Meta Analysis ◽

Thrombotic Event ◽

Cochrane Library ◽

Pooled Prevalence ◽

D Dimer

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

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Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619842004 ◽

2019 ◽

Vol 9 (7) ◽

pp. 779-787 ◽

Cited By ~ 5

Author(s):

Laust Obling ◽

Christian Hassager ◽

Charlotte Illum ◽

Johannes Grand ◽

Sebastian Wiberg ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Area Under The Curve ◽

Youden Index ◽

Cardiac Intensive Care Unit ◽

Infrared Pupillometry ◽

Cardiac Intensive Care ◽

Neurological Pupil Index ◽

Hospital Cardiac Arrest

Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

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