The overall 30-day survival rate for COVID-19 patients receiving CPR was 4 (2.9%) patients, but only 1 (0.7%) had a favorable neurologic outcome at 30 days and just 18 (13.2%) patients achieved return of spontaneous circulation (ROSC). These figures are from a study of 136 COVID-19 patients who received CPR at a hospital in Wuhan, China.
As is true in most studies of COVID-19, two-thirds of the patients were male, and 105 (77%) were greater than 60 years old. The arrest was due to respiratory issues in 119 patients, cardiac in 10, and other in 7.
A rapid response team responded to all resuscitations—23 (17%) occurring in intensive care units. In all, 132 had witnessed cardiac arrests. The initial rhythm detected was asystole in 122 patients, ventricular fibrillation/tachycardia in 8, and pulseless electrical activity (PEA) in 6; ROSC occurred in 11 (9%) with asystole, 6 (75%) with V fib/tach, and 1 (16.7%) with PEA.
Sixteen (13.4%) of those who suffered arrests due to a respiratory cause had ROSC and 3 (2.5%) survived 30 days. Two of 10 cardiac-related arrests, and none of the 7 with other causes achieved ROSC.
The authors cited several limitations of their study including lack of data about timing of defibrillation or first epinephrine injection, duration of resuscitation, and incomplete information about any interventions patients might have undergone prior to arresting.
For comparison, a 2016 paper about the outcomes of in-hospital cardiac arrest in 12 Beijing hospitals reviewed 2712 patients with about half suffering arrests from primarily cardiac causes. Survival to discharge occurred in 6.1% of those over 60 years old vs. 12.8% for patients 60 and under. Of the 1340 (49%) with asystole, 64 (4.8%) survived to discharge compared to 22% survival for the 423 patients with ventricular fibrillation/tachycardia.
The dismal results of the Wuhan cardiac arrest study suggest two contrasting conclusions. One, it is futile to perform CPR on these patients, or two, if it saves even one life, it’s worth doing. The risk to medical personnel resuscitating such patients needs to be factored in. The authors of the Wuhan paper said, “although we did not study this formally, we are not aware of any clinical staff involved in a resuscitation attempt becoming infected with COVID-19 as a result of their involvement.” But hundreds of healthcare workers in other countries have been infected in the course of their duties.
According to a recent article in The BMJ, a hospital trust in the UK has stated that CPR should not be performed on COVID patients unless personnel are wearing full personal protective equipment (PPE), and resuscitation of COVID patients without a shockable rhythm is futile. Whether CPR is considered an aerosol generating procedure is debatable.
If caregivers contract COVID-19 and can’t work, understaffing and more deaths might result. This is an ethical dilemma that every hospital needs to address.
Skeptical Scalpel is a retired surgeon and was a surgical department chair and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.