Background

Studies have reported lower survival for in-hospital cardiac arrest (IHCA) during the initial COVID-19 surge. Whether the pandemic reduced IHCA survival during subsequent surges and in areas with lower COVID-19 rates is unknown.

Methods

Within Get-With-The-Guidelines®-Resuscitation, we identified 22,899 and 79,736 IHCAs during March to December in 2020 and 2015–2019, respectively. Using hierarchical regression, we compared risk-adjusted rates of survival to discharge in 2020 vs. 2015–19 during five COVID-19 periods: Surge 1 (March to mid-May), post-Surge 1 (mid-May to June), Surge 2 (July to mid-August), post-Surge 2 (mid-August to mid-October), and Surge 3 (mid-October to December). Monthly COVID-19 mortality rates for each hospital’s county were categorized, per 1,000,000 residents, as very low (0–10), low (11–50), moderate (51–100), or high (>100).

Results

During each COVID-19 surge period in 2020, rates of survival to discharge for IHCA were lower, as compared with the same period in 2015–2019: Surge 1: adjusted OR: 0.81 (0.75–0.88); Surge 2: adjusted OR: 0.88 (0.79–0.97), Surge 3: adjusted OR: 0.79 (0.73–0.86). Lower survival was most pronounced at hospitals located in counties with moderate to high monthly COVID-19 mortality rates. In contrast, during the two post-surge periods, survival rates were similar in 2020 vs. 2015–2019: post-Surge 1: adjusted OR 0.93 (0.83–1.04) and post-Surge 2: adjusted OR 0.94 (0.86–1.03), even at hospitals with the highest county-level COVID-19 mortality rates.

Conclusions

During the three COVID-19 surges in the U.S. during 2020, rates of survival to discharge for IHCA dropped substantially, especially in communities with moderate to high COVID-19 mortality rates.

中文翻译：

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2020 年三个 COVID-19 激增对美国院内心脏骤停存活率的影响

背景

研究报告称，在最初的 COVID-19 激增期间，院内心脏骤停 (IHCA) 的存活率较低。在随后的激增期间以及在 COVID-19 率较低的地区，大流行是否会降低 IHCA 的存活率尚不清楚。

方法

在 Get-With-The-Guidelines®-Resuscitation 中，我们分别在 2020 年 3 月至 12 月和 2015-2019 年期间确定了 22,899 和 79,736 个 IHCA。使用分层回归，我们比较了 2020 年与 2015-19 年在五个 COVID-19 期间的风险调整生存率：浪涌 1（3 月至 5 月中旬）、浪涌后 1（5 月中旬至 6 月）、浪涌 2（7 月至 8 月中旬）、浪涌后 2（8 月中旬至 10 月中旬）和浪涌 3（10 月中旬至 12 月）。每个医院县的每月 COVID-19 死亡率按每 100 万居民分类为非常低 (0-10)、低 (11-50)、中等 (51-100) 或高 (>100)。

结果

在 2020 年的每个 COVID-19 激增期间，与 2015-2019 年同期相比，IHCA 的存活出院率较低： 激增 1：调整后的 OR：0.81（0.75-0.88）；浪涌 2：调整后的 OR：0.88 (0.79–0.97)，浪涌 3：调整后的 OR：0.79 (0.73–0.86)。在每月 COVID-19 死亡率中到高的县的医院中，较低的存活率最为明显。相比之下，在两个激增后时期，2020 年与 2015-2019 年的生存率相似：浪涌后 1：调整后的 OR 0.93 (0.83-1.04) 和浪涌后 2：调整后的 OR 0.94 (0.86-1.03) ，即使在县级 COVID-19 死亡率最高的医院也是如此。

结论

在 2020 年美国的三次 COVID-19 激增期间，IHCA 的存活出院率大幅下降，尤其是在 COVID-19 死亡率中高的社区。