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Cardiopulmonary Resuscitation in COVID-19 Pandemic

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 11074

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Special Issue Editor

Prof. Dr. Lukasz Szarpak

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Guest Editor

1. Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
2. Polish Society of Emergency Medicine, Warsaw, Poland
Interests: emergency medicine; critical care; anesthesiology; research outcomes; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic poses a huge challenge to health care systems around the world and presents real problems for emergency response in patients with suspected SARS-CoV-2 infection. COVID-19 may result in sudden cardiac arrest due to severe respiratory failure, but also other organ failures, including heart failure. Complications after the SARS-CoV-2 infection has resolved are also a problem, which may lead to sudden cardiac arrest and death in the course of, for example, pulmonary embolism. Resuscitation of patients infected or suspected of being infected with SARS-CoV-2 requires safe BLS and ALS management. Special attention should be paid to the safety of rescuers, the use of appropriate personal protective equipment, and the performance of procedures with an increased risk of staff infection, including endotracheal intubation and other airway management procedures. Another important problem is the quality of the resuscitation activities performed with full personal protective equipment. Maintaining the high quality of effective resuscitation in the COVID-19 era requires special attention to both the safety of rescuers and the quality of rescue operations, as well as an understanding of the mechanisms leading to sudden cardiac arrest in the course of COVID-19.

Prof. Dr. Lukasz Szarpak
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

Cardiopulmonary resuscitation
Chest compression
Outcomes
Return of spontaneous circulation
Advanced cardiovascular life support
Evidence based medicine
COVID-19
SARS-CoV-2

Published Papers (3 papers)

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Research

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12 pages, 679 KiB

Open AccessArticle

Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

by Kevin Roedl, Gerold Söffker, Dominic Wichmann, Olaf Boenisch, Geraldine de Heer, Christoph Burdelski, Daniel Frings, Barbara Sensen, Axel Nierhaus, Dirk Westermann, Stefan Kluge and Dominik Jarczak

J. Clin. Med. 2021, 10(10), 2195; https://doi.org/10.3390/jcm10102195 - 19 May 2021

Cited by 2 | Viewed by 2287

Abstract

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients with COVID-19 treated at the intensive care unit (ICU). The aim was to investigate the incidence and outcome of intensive care unit cardiac arrest (ICU-CA) in critically ill patients with COVID-19. This was a retrospective analysis of prospectively recorded data of all consecutive adult patients with COVID-19 admitted (27 February 2020–14 January 2021) at the University Medical Centre Hamburg-Eppendorf (Germany). Of 183 critically ill patients with COVID-19, 18% (n = 33) had ICU-CA. The median age of the study population was 63 (55–73) years and 66% (n = 120) were male. Demographic characteristics and comorbidities did not differ significantly between patients with and without ICU-CA. Simplified Acute Physiological Score II (SAPS II) (ICU-CA: median 44 points vs. no ICU-CA: 39 points) and Sequential Organ Failure Assessment (SOFA) score (median 12 points vs. 7 points) on admission were significantly higher in patients with ICU-CA. Acute respiratory distress syndrome (ARDS) was present in 91% (n = 30) with and in 63% (n = 94) without ICU-CA (p = 0.002). Mechanical ventilation was more common in patients with ICU-CA (97% vs. 67%). The median stay in ICU before CA was 6 (1–17) days. A total of 33% (n = 11) of ICU-CAs occurred during the first 24 h of ICU stay. The initial rhythm was non-shockable (pulseless electrical activity (PEA)/asystole) in 91% (n = 30); 94% (n = 31) had sustained return of spontaneous circulation (ROSC). The median time to ROSC was 3 (1–5) minutes. Patients with ICU-CA had significantly higher ICU mortality (61% vs. 37%). Multivariable logistic regression showed that the presence of ARDS (odds ratio (OR) 4.268, 95% confidence interval (CI) 1.211–15.036; p = 0.024) and high SAPS II (OR 1.031, 95% CI 0.997–1.065; p = 0.077) were independently associated with the occurrence of ICU-CA. A total of 18% of critically ill patients with COVID-19 suffered from a cardiac arrest within the intensive care unit. The occurrence of ICU-CA was associated with presence of ARDS and severity of illness. Full article

(This article belongs to the Special Issue Cardiopulmonary Resuscitation in COVID-19 Pandemic)

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10 pages, 751 KiB

Open AccessArticle

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

by Magdalena J. Borkowska, Miłosz J. Jaguszewski, Mariusz Koda, Aleksandra Gasecka, Agnieszka Szarpak, Natasza Gilis-Malinowska, Kamil Safiejko, Lukasz Szarpak, Krzysztof J. Filipiak and Jacek Smereka

J. Clin. Med. 2021, 10(6), 1209; https://doi.org/10.3390/jcm10061209 - 15 Mar 2021

Cited by 17 | Viewed by 2841

Abstract

Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25; 95% confidence interval, CI: 0.12, 0.53; p < 0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88; 95% CI: 0.63, 1.22; p = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19; 95% CI: 0.04, 0.96; p = 0.04; I² = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67; 95% CI: 0.55, 0.81; p < 0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35; 95% CI: 0.07, 26.19; p = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients. Full article

(This article belongs to the Special Issue Cardiopulmonary Resuscitation in COVID-19 Pandemic)

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Review

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20 pages, 4806 KiB

Open AccessReview

How to Maintain Safety and Maximize the Efficacy of Cardiopulmonary Resuscitation in COVID-19 Patients: Insights from the Recent Guidelines

by Dominika Chojecka, Jakub Pytlos, Mateusz Zawadka, Paweł Andruszkiewicz, Łukasz Szarpak, Tomasz Dzieciątkowski, Miłosz Jarosław Jaguszewski, Krzysztof Jerzy Filipiak and Aleksandra Gąsecka

J. Clin. Med. 2021, 10(23), 5667; https://doi.org/10.3390/jcm10235667 - 30 Nov 2021

Cited by 2 | Viewed by 4978

Abstract

Since December 2019, the novel coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has remained a challenge for governments and healthcare systems all around the globe. SARS-CoV-2 infection is associated with increased rates of hospital admissions and significant mortality. The pandemic increased the rate of cardiac arrest and the need for cardiopulmonary resuscitation (CPR). COVID-19, with its pathophysiology and detrimental effects on healthcare, influenced the profile of patients suffering from cardiac arrest, as well as the conditions of performing CPR. To ensure both the safety of medical personnel and the CPR efficacy for patients, resuscitation societies have published modified guidelines addressing the specific reality of the COVID-19 pandemic. In this review, we briefly describe the transmission and pathophysiology of COVID-19, present the challenges of CPR in SARS-CoV-2-infected patients, summarize the current recommendations regarding the algorithms of basic life support (BLS), advanced life support (ALS) and pediatric life support, and discuss other aspects of CPR in COVID-19 patients, which potentially affect the risk-to-benefit ratio of medical procedures and therefore should be considered while formulating further recommendations. Full article

(This article belongs to the Special Issue Cardiopulmonary Resuscitation in COVID-19 Pandemic)

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