key: cord-0724866-gps9wlqe
authors: Lauridsen, Kasper G.; Morgan, Ryan W.; Dewan, Maya; Gawronski, Orsola; Sen, Anita I.
title: In-hospital cardiac arrest characteristics, CPR quality, and outcomes in children with COVID-19
date: 2021-10-18
journal: Resuscitation
DOI: 10.1016/j.resuscitation.2021.10.013
sha: 19be7b2d725edd60d015d9ed6c282b7ac7dfe89e
doc_id: 724866
cord_uid: gps9wlqe

nan

Adult patients with SARS-CoV-2 (COVID-19) and in-hospital cardiac arrest (IHCA) demonstrated low survival rates. 1, [2] [3] [4] [5] [6] Moreover, donning of PPE led to concerns about cardiopulmonary resuscitation (CPR) quality being inadequate and speculation whether CPR of COVID-19+ patients was futile. 7, 8 Little is known about COVID-19+ IHCA in children. We present the first report describing a cohort of pediatric patients with acute COVID-19 suffering an IHCA.

We reviewed the PediRES-Q database (March 1 st 2020 -April 1 st 2021) for index pediatric (<18 years) IHCA events including patient and event characteristics, CPR quality (Zoll R-series electrodes) and outcomes. We categorized patients as COVID-19+ if having a positive polymerase chain reaction (PCR) test during admission and Patient Under Investigation (PUI) if isolated for suspected COVID-19 during CPR without a positive PCR test. Other patients (non-COVID-19/non-PUI) were the reference group. No multisystem inflammatory syndrom (MIS-C) patients were included in the COVID-19+ group. We analyzed associations between COVID-19 status and survival using multivariate logistic regression with mixed effects, accounting for clustering by site and age group as a confounding variable (<1 year, 1-8 years, >8 to <18 years).

We identified 376 pediatric IHCAs: 14 COVID-19+, 14 PUI, and 348 non-COVID-19/non-PUI (reference). COVID-19+ and PUI patients were older and more frequently had an invasive airway when compared to other patients (Supplementum 1). No notable differences in CPR quality existed between COVID-19+, PUI, and reference group patients ( Table 1) . Rates of ROSC were lower for COVID-19+ and PUI patients compared to the reference group whereas survival to hospital discharge and survival with favorable neurological outcome trended lower with longer median CPR duration although not statistically significant (Table 1 ). Zero COVID-19+ patients achieved return of circulation with extracorporeal CPR as compared to 1 PUI (7%), and 38 (10.5%) reference group patients. A sensitivity analysis comparing COVID-19+ and PUI patients combined to non-COVID/non-PUI patients showed results comparable to the primary analysis (Supplementum 2). This is the first report on CPR quality, duration, and outcomes of pediatric COVID-19+ cardiac arrest patients. Almost 29% of COVID-19+ children survived to hospital discharge, considerably better than previously reported adult COVID-19+ IHCA outcomes 2-6 but worse when compared to non-COVID/non-PUI patients (after adjustment for age and clustering by site). However, no reported differences in time to initiation of chest compressions or CPR quality existed between groups.

Extensive efforts to resuscitate COVID-19+ patients were noted, with a median total CPR duration of 19 minutes, and median CPR duration for non-survivors of 34 minutes. These resuscitative efforts are notable considering the initial discouraging outcomes reported for COVID-19+ adults who had considerably shorter CPR durations. 1, 2, 4 Limitations include: The number of COVID-19+ patients was small, data from a CPR quality improvement collaborative may not be generalizable, and we were unable to account for MIS-C.

In conclusion, substantial resuscitative efforts and comparable CPR quality for COVID-19+ patients and non-COVID-19 patients were identified. A survival rate of almost 29% for COVID-19+ patients, while lower than non-COVID-19 patients, suggests that CPR of children with COVID-19 is far from futile. (2) COVID-19+ patients combined with PUI patients. Dichotomous outcomes are presented as percent and age is reported as median [quartile 1; quartile 3]. Chest compression rate is reported as chest compressions/ minute. Associations for survival outcomes are reported as adjusted odds ratios with 95% confidence intervals. *Chest compression quality metrics obtained for 173 non-COVID-19/non-PUI patients, 6 COVID-19+ patients, and 10 PUI patients. 

In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan

Clinical characteristics and outcomes of inhospital cardiac arrest among patients with and without COVID-19

Clinical Outcomes of In-Hospital Cardiac Arrest in COVID-19

Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest?

In-hospital cardiac arrest in patients with coronavirus 2019

In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

Survival After In-Hospital Cardiac Arrest in Critically Ill Patients: Implications for COVID-19 Outbreak?

Hospitals consider universal do-not-resuscitate orders

We would like to thank the clinicians and staff at all of the pediRES-Q sites for their time and dedication to this collaborative effort.