Cardiac Arrest Management in United States Emergency Departments During the First Year of the COVID-19 Pandemic, 2020.

Abstract

The COVID-19 pandemic posed exposure risk for health care personnel, potentially affecting the care for patients with cardiac arrest. We compare emergency department (ED) cardiac arrest management in patients who were suspected and not suspected of COVID-19 early in the pandemic in 2020. This was a multicenter prospective observational cohort study of cardiac arrest patients conducted at 20 geographically diverse United States academic EDs from May 2020 to December 2020. We used percentage point differences, proportion tests, and 95% confidence intervals (CIs) to analyze cardiac arrest management-chest compressions, defibrillation/cardioversion, airway management-by suspected COVID-19 status. We identified 1,143 cardiac arrest events managed by 437 participating physicians or advanced practice providers. Of 183 (16%) patients suspected of COVID-19, 34 (19%) had laboratory confirmation, whereas 149 (81%) were suspected by clinical impression. Comparing COVID-19 suspected and not suspected patients, proportions who received chest compressions (16.4% versus 13.5%, respectively; difference 2.9% [95% CI, -3.3 to 9.0]) and defibrillation/cardioversion (7.1% versus 5.3%, respectively; difference 1.8% [95% CI -2.5 to 6.1]) were similar. The proportion not achieving return of spontaneous circulations was also similar between the groups (62.3% versus 67.1%, respectively, difference -4.8% [95% CI -12.7 to 3.2]). Full-barrier personal protective equipment was used more often in those suspected of COVID-19 (61.8% versus 54.9%, respectively, difference of 8.1% [95% CI 0.7% to 15.5]). Despite potential exposure risks to ED personnel early in the pandemic, cardiac arrest management of patients suspected and not suspected of COVID-19 was similar.