The conclusion, published in a research paper yesterday JAMA Internal Medicine, Found that 52 out of 54 patients who experienced cardiac arrest from 15 March to 3 April (96.3%), including vascular rhythm, 44 (81.5%), with pulseless cardiac electrical activity, and 8 (14.8 %) Were systole (flatlining). Reduced rhythms are those in which the use of defibrillation to restore normal heartbeat is highly unlikely.
Two patients (3.7%) had pulmonary ventricular tachycardia (an abnormally rapid heart rhythm). CPR achieved spontaneous circulation (ROSC) withdrawal in 29 patients (53.7%) after an average of 8 minutes. Of the 29 patients, 15 (51.7%) had changed their code status to not revive, and 14 patients (48.3%) had been re-coded and had to undergo additional CPR; all die.
The average time from hospital admission to cardiac arrest was 8 days and the average duration of CPR was 10 minutes. 43 patients (79.6%) were receiving mechanical ventilation in cardiac arrest, 18 (33.3%) were on dialysis, and 25 (46.3%) required vasopressor drugs to treat low blood pressure.
The median patient age was 61.5 years, of 54 patients, 33 (61.1%) were male, 36 (66.7%) were black, and many were obese (mean body mass index was 33 kg / m)2), Hypertension (42 patients, 77.8%), diabetes (50) [55.6%]), And high cholesterol (27) [50.0%]).
Meaningless rhythm, critical illness
The authors noted that, prior to the epidemic, 25% of patients who experienced a cardiac arrest in the hospital (81% of them initially survived to a hospital release with heart rhythm). He attributed the dismal mortality in his study to a high proportion of patients with postoperative death and severe disease requiring mechanical ventilation, dialysis, and vasopressor support – all associated with poor outcomes after hospitalized cardiac arrest Huh.
The findings, the researchers said, are similar to Chinese studies at the onset of the epidemic, which show a 30-day survival rate of only 2.9% in COVID-19 patients who had a hospitalized cardiac arrest. While 94.1% of the patients in that study had nonspecific rhythm, only 13% experienced ROSC.
The authors called for more studies and the development of guidelines on the risks and benefits of prolonged CPR, an aerosol-generating process that allows health workers aerial routes to pathogens such as SARS-COV-2, viruses such as COVID-19 Can make it out of. This group of patients.
“Transmission of severe acute respiratory syndrome coronavirus 1 [the virus that causes SARS] Health care personnel have already been documented during CPR, “he wrote, referencing the 2004 Canadian study,” Exposure can be further complicated by limited supplies of personal protective equipment. “
The important role of caring for initial goals
In an invited comment in the same magazine, Matthew Modes, MD, MPP, MS; Robert Lee, MD, MS; And j. Randall Curtis, MD, MPH; The University of Washington in Seattle reported that the lack of effective COVID-19 treatment and the delay in CPR were delayed because of the need for the first Dawn PPE to contribute to 100% mortality.
He said the study’s findings do not warrant universal do-not-resuscitate orders for coronovirus patients, but they underscore the importance of discussing care goals with patients and families during their illness and if the patient’s If the clinical situation worsens again. .
Modes, Lee and Curtis said, “Promoting early goal-care discussions should be a priority for patients, families, physicians, health systems, and policy makers.” “Such a shared focus provides ample opportunities for health system and public health interventions.”
Because two-thirds of the study patients were black, and black patients are less likely to document advance care planning than others, and health professionals lack poor communication and trust, it is important for providers to respect personal preferences and It is important to promote good. The authors of the communication, the commentator, said.
“In the context of COVID-19, black individuals and persons of color are likely to develop a serious illness requiring contracting COVID-19 or hospitalization; this association is most likely due to disparities,” he wrote . “In this way, the urge to eliminate racial disparities in health care has never been clear.”