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Should We Resuscitate COVID-19 Patients Who Arrest?

April 28, 2020

Written by Clay Smith

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The outcome for hospitalized patients with COVID-19 who arrested was dismal in this case series. The risk of CPR may outweigh the benefit.=

Why does this matter?
CPR in patients with COVID-19 risks aerosolizing virus particles. What is the outcome for patients with COVID-19 who arrest? New AHA guidelines state that in COVID-19 patients who arrest, we should, “consider age, comorbidities, and severity of illness in determining the appropriateness of resuscitation and balance the likelihood of success against the risk to rescuers and patients from whom resources are being diverted.”

Over a 40-day span in Wuhan China, 136 patients hospitalized with pneumonia from COVID-19 arrested. The cause of arrest, not surprisingly, was respiratory in 83%. Overall, 90% had asystole, 4.4% PEA, and 5.9% shockable rhythm. Of all 136 patients, 13% had ROSC, and 3% survived to 30 days. Most importantly, just one person had 30-day neurologically intact survival (1/136, 0.7%). All patients received resuscitative efforts consistent with AHA/ILCOR guidelines. This begs the question – should we do CPR and ACLS if ill patients with COVID-19 arrest? The risk for everyone in the room may not justify the benefit, in my opinion.

In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation. 2020 Apr 10. pii: S0300-9572(20)30142-8. doi: 10.1016/j.resuscitation.2020.04.005. [Epub ahead of print]

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What are your thoughts?