key: cord-0823053-n1dh2idz
authors: Stawiarski, Kristin M; Lau, Freddy Duarte; Bindelglass, Gloria; Lancaster, Gilead
title: Trends in Cardiopulmonary Resuscitation Response Times in a Community Hospital in the COVID-19 Era
date: 2021-06-15
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2021.06.014
sha: cb39355c5c2ee71bb7b40e730f92b78229efcaa0
doc_id: 823053
cord_uid: n1dh2idz

nan

To the Editor:

Cardiopulmonary resuscitation (CPR) involves numerous aerosol-generating procedures that increase the risk of COVID-19 exposure to providers. Modified guidelines recommend that all rescuers don personal protective equipment before performing CPR. 1 We aimed to clarify the effect of such a protocol on the administration of CPR during in-hospital cardiopulmonary arrests (CPA).

A retrospective chart review was performed of the CPA events that occurred in non-COVID patients from March to November 2019 and in COVID patients during a similar time frame in 2020. A total of 121 non-COVID and 28 COVID CPA events were reviewed.

The response time to perform key resuscitation steps were abstracted for each group, including arrival of the code, respiratory therapy and anesthesia teams, time to initiation of CPR, first epinephrine bolus administration, as well as time to intubation. At our hospital, intubation is performed solely by the anesthesia team. Patients who were already intubated at the time of a CPA were excluded.

There was no delay seen in starting chest compressions or arrival of code team including respiratory therapy once a CPA was identified in COVID patients. Intubation of COVID-19 patients, however, was affected (11 min vs 7 min, 95% confidence interval (CI) 1.94-6.06, p < 0.001). This may be attributed to a prolonged anesthesia arrival time comparatively (4 min vs 3 min, CI 0.17 -1.83, p=0.01) despite similar CPA locations. Total code time was shorter in the COVID cohort at 12 min vs 20 min (CI 3.93 -12.07, p<0.001). Likewise, survival of the code and survival to hospital discharge was lower in the COVID group (43% vs 69%, p = 0.02 and 4% vs 75%, p <0.001).

We report poor survival of in-hospital CPA in COVID-19 patients. This is consistent with recent reports that have shown no survival to discharge in this population despite return of spontaneous circulation in 13-54% of reported CPAs. 2, 3 Thus, safety of first responders and infection control should be prioritized. Previous transmission of severe acute respiratory syndrome coronavirus 1 to providers during CPR has occurred and is highly probable to occur with COVID-19. 4 Initiation of CPR was similar in both groups because providers were already wearing personal protective equipment and often in the room at the beginning of the event. Primary resuscitation delays were seen with intubation. Despite almost similar arrival time of anesthesia to the CPA between the two groups, anesthesia providers arrived onsite without donned equipment and often needed assistance to locate available equipment throughout the unit prior to intubation. Watson et al. previously reported delays to CPR when donning gowns in mannequin simulation situations. 5 Simple gown modifications including pre-tied neck straps and longer waist ties that tie in front shortened delays and may need to be considered in COVID-19 situations. 5 Our institution has now stocked gowns and N95 masks in unit code carts. The clinical implications of this delay and its possible contribution to overall poor survival in COVID-19 patients' needs to be further explored.

Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the

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

-hospital cardiac arrest outcomes among patients with COVID

Possible SARS coronavirus transmission during cardiopulmonary resuscitation

The "delay effect" of donning a gown during cardio-pulmonary resuscitation in a simulation model

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.