key: cord-0883787-rxd47pyh
authors: Shah, Priyank; Olarewaju, Ayodeji
title: The authors reply
date: 2021-05-25
journal: Crit Care Med
DOI: 10.1097/ccm.0000000000005134
sha: 921cd204578e6abecc79b9e6d94c7d0b06cc22a6
doc_id: 883787
cord_uid: rxd47pyh

nan

W e agree with Barros et al (1) that our findings are considerably different than theirs. In the first 1,094 consecutive hospitalized coronavirus disease 2019 patients at our institution, the overall mortality was 13.6% (1), as we reported in our recently published article (2) in Critical Care Medicine. The attempted resuscitation was significantly higher, more than seven times in our hospitalized COVID-19 patients compared with the authors' (5.8% vs 0.8%). Although the pre-arrest therapies and features of cardiac arrest events are similar, we are not sure if the baseline comorbidities of our patients are comparable to that of the authors' institution. Our hospitalized COVID-19 patients have a higher burden of comorbidities compared with general U.S. population (3). The likelihood of success from cardiopulmonary resuscitation depends on the cause of arrest as well as on the health status of the patient (4). A number of prearrest and intra-arrest factors associated with poor survival after in-hospital cardiac arrest (IHCA) were present in our patients.

We will like to point out that the attempt by Barros et al (1) to compare our patient population to theirs is problematic for a number of reasons. First, there is significant difference in the total number of patients that underwent resuscitation (63 vs 7), which may account for some difference in survival. Second, authors mention that 66% of survivors had no neurologic deficits, however, even in their limited data, the overall survival with no neurologic deficits would be about 28% (2/7). Third, a significant number of patients at the authors' institution had a donot-resuscitate order entered 12 hours before their death. This will easily account for the difference in number of resuscitated patients between our institution and authors' institution and possibly the rate of survival.

We agree with the authors that in select patients hospitalized with COVID-19 who experience cardiac arrest, attempts at resuscitation are appropriate and potentially lifesaving. As at the time we submitted our article, there was no data in the United States about the survival to discharge in COVID-19 patients suffering IHCA. Indeed, the title and conclusions of our article were meant to provoke more conversation and highlight the need for more data about IHCA in COVID-19 patients and not to label cardiopulmonary resuscitation futile. All critically ill patients should have early goals of care conversations to clarify treatment preferences regardless of code status.

To the Editor: W e read with great interest the article published in a recent issue of Critical Care Medicine by Shah et al (1) . The authors conducted a single-center retrospective cohort study of hospitalized patients with coronavirus disease 2019 (COVID-19) to examine outcomes after inhospital cardiac arrest (IHCA) with attempted cardiopulmonary resuscitation (CPR). Among 1,094 hospitalized patients, 63 suffered from IHCA, with an in-hospital mortality of 100%. Similar findings were reported in two other recently reported single-center studies: one that included 31 patients with IHCA (2), and another that included 60 such patients (3), with a 100% inhospital mortality reported in both studies. The authors conclude that their study "raises important questions about the futility of ACLS measures in these patients. "

We recently reported the outcomes following IHCA using data from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19, a large multicenter cohort study of critically ill adult patients with COVID-19 admitted to ICUs at 68 geographically diverse hospitals across the United States (4). Among 5,019 patients, 701 (14.0%) had IHCA, 400 of whom received CPR. A total of 48 of the 400 (12.0%) who received CPR survived to hospital discharge. These findings are consistent with those recently reported in a study of critically ill patients with non-COVID-19 disease from the American Heart Association Get With the Guidelines-Resuscitation registry (5). Our study (1) does not support the notion that CPR is universally futile in hospitalized patients with COVID-19, although we agree that outcomes are often poor and that early initiation of goals of care discussions in such patients is appropriate. Thus, we urge providers, patients, and families to exercise caution in using findings from single-center studies to inform life-and-death decisions regarding the potential futility of CPR.

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

The authors reply: REFERENCES 1

The authors have disclosed that they do not have any potential conflicts of interest.