Outcomes after cardiac arrest in Medical Intensive Care Unit: A propensity score matching analysis of COVID-19 MICU vs non COVID-19 MICU cardiac arrest

Abhishek Bhardwaj; Mahmoud Alwakeel; Jason Kirincich; Hassan Shaheen; David F Gaieski; Benjamin S Abella; Xiaofeng Wang; Mohammed J Al-Jaghbeer; Abhijit Duggal; Francois Abi Fadel; Sudhir Krishnan

doi:10.1016/j.resuscitation.2023.109890

Outcomes after cardiac arrest in Medical Intensive Care Unit: A propensity score matching analysis of COVID-19 MICU vs non COVID-19 MICU cardiac arrest

Resuscitation. 2023 Aug:189:109890. doi: 10.1016/j.resuscitation.2023.109890. Epub 2023 Jun 28.

Affiliations

¹ Department of Internal Medicine, University of California, Riverside, CA, Unites States.
² Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, Unites States.
³ Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH, Unites States.
⁴ Department of Internal Medicine, Fairview Hospital - Cleveland Clinic, Cleveland, OH, Unites States.
⁵ Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, Unites States.
⁶ Department of Emergency Medicine and Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA, Unites States.
⁷ Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH, Unites States.
⁸ Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, Unites States. Electronic address: KRISHNS2@ccf.org.

PMID: 37390957
PMCID: PMC10303318
DOI: 10.1016/j.resuscitation.2023.109890

Abstract

Aim: To assess whether there were differences in resuscitation efforts and outcomes for medical intensive care unit (MICU) in-hospital cardiac arrest (IHCA) during the COVID-19 pandemic when compared to pre-pandemic.

Methods: Comparing COVID-19 MICU-IHCA patients (03/2020 to 10/2020) to non-COVID-19 MICU IHCA (01/2014 to 12/2018) at Clevleand Clinic Health System (CCHS) of NE Ohio. Propensity score matching analysis (PSMA) was used to create comparable groups.

Results: There were a total of 516 patients, 51 in COVID-19 MICU IHCA cohort and 465 in the non-COVID-19 MICU IHCA cohort. The mean (SD) age of the study population was 60.9 (16) years and 56% were males. In 92.1% (n = 475) patients, initial arrest rhythm was non-shockable. At the time of ICU admission, compared to the non-COVID-19 MICU-IHCA cohort, the COVID-19 MICU IHCA cohort had a lower mean APACHE III score (70 [32.9] vs 101.3 [39.6], P = <0.01). The COVID-19 cohort had a higher rate of survival to hospital discharge (12 [23.5%] vs 59 [12.7%], P = 0.03). Upon PSMA, the algorithm selected 40 COVID-19 patients and 200 non-COVID-19 patients. Imbalances in baseline characteristics, comorbidities, and APACHE III were well-balanced after matching. Survival rate after matching became non-significant; (10 [25%] vs 42 [21%], P = 0.67). Further, there were no significant differences in ICU or hospital length-of-stay or neurological outcomes at discharge for survivors in the two matched cohorts.

Conclusion: It is imperative that COVID-19 patients receive unbiased and unrestricted resuscitation measures, without any discouragement.

Keywords: Cardiac Arrest; Cardiopulmonary resuscitation; Coronavirus disease 2019; Propensity score matching analysis; Resuscitation; Severe acute respiratory syndrome coronavirus 2.

MeSH terms

COVID-19* / epidemiology
Cardiopulmonary Resuscitation*
Female
Heart Arrest*
Humans
Intensive Care Units
Male
Middle Aged
Pandemics
Propensity Score
Retrospective Studies