Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry

 

by Jonathan Chelly, Gaetan Plantefève, Toufik Kamel, Cédric Bruel, Saad Nseir, Christopher Lai, Giulia Cirillo, Elena Skripkina, Sébastien Ehrminger, Fernando-Daniel Berdaguer-Ferrari, Julien Le Marec, Marine Paul, Aurélie Autret and Nicolas Deye

 

Annals of Intensive Care volume 11, Article number: 155 (2021)

 

Background

Initial reports have described the poor outcome of unexpected cardiac arrest (CA) in intensive care unit (ICU) among COVID-19 patients in China and the USA. However, there are scarce data on characteristics and outcomes of such CA patients in Europe.

Methods

Prospective registry in 35 French ICUs, including all in-ICU CA in COVID-19 adult patients with cardiopulmonary resuscitation (CPR) attempt. Favorable outcome was defined as modified Rankin scale ranging from 0 to 3 at day 90 after CA.

Results

Among the 2425 COVID-19 patients admitted to ICU from March to June 2020, 186 (8%) experienced in-ICU CA, of whom 146/186 (78%) received CPR. Among these 146 patients, 117 (80%) had sustained return of spontaneous circulation, 102 (70%) died in the ICU, including 48 dying within the first day after CA occurrence and 21 after withdrawal of life-sustaining therapy. Most of CA were non-shockable rhythm (90%). At CA occurrence, 132 patients (90%) were mechanically ventilated, 83 (57%) received vasopressors and 75 (51%) had almost three organ failures. Thirty patients (21%) had a favorable outcome. Sepsis-related organ failure assessment score > 9 before CA occurrence was the single parameter constantly associated with unfavorable outcome in multivariate analysis.

Conclusions

In-ICU CA incidence remains high among a large multicenter cohort of French critically ill adults with COVID-19. However, 21% of patients with CPR attempt remained alive at 3 months with good functional status. This contrasts with other recent reports showing poor outcome in such patients.

 

Cardiac injury in COVID-19

Julie Helms, Alain Combes &  Nadia Aissaoui 

Intensive Care Medicine (2021) Published: 02 November 2021

Patients with coronavirus disease 2019 (COVID-19) can present with a large panel of cardiac manifestations, including myocardial infarction with (type 1) or without (type 2) obstructive coronary artery disease, arterial or venous thromboembolic disease, pericarditis and myocarditis, arrhythmias, acute heart failure, shock or cardiac arrest. The most frequent cardiac abnormality reported in COVID-19 is acute cardiac injury (ACI), defined by cardiac troponin elevation > 99th percentile. ACI occurred in as many as 50% and 21% of critically ill and hospitalized COVID-19 patients, respectively, rates which were higher than in severe diseases caused by other respiratory viruses. COVID-19 patients with ACI were older (median age 70 years), had increased markers of systemic inflammation, more frequent malignant arrhythmias, shock and need for intensive care unit (ICU) care and higher mortality rates, with myocardial injury being the second cause of death after respiratory failure. Furthermore, compared to a pre-COVID-19 population, COVID-19 patients with type 1 myocardial infarction had prolonged symptom-to-admission times, more frequent cardiogenic shock and higher mortality. It should also be emphasized that COVID-19 patients had frequent cardiovascular comorbidities such as hypertension, obesity, metabolic syndrome and pre-existing coronary artery disease that may have precipitated cardiac complications…

Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review

Link to article: Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review

by Xinye Li, Xiandu Pan, Yanda Li, Na An, Yanfen Xing, Fan Yang, Li Tian, Jiahao Sun, Yonghong Gao, Hongcai Shang and Yanwei Xing

Critical Care volume 24, Article number: 468 (2020) 28 July 2020

Background

Cardiac injury is now a common complication of coronavirus disease (COVID-19), but it remains unclear whether cardiac injury-related biomarkers can be independent predictors of mortality and severe disease development or intensive care unit (ICU) admission.

Methods

Two investigators searched the PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), Wanfang, MedRxiv, and ChinaXiv databases for articles published through March 30, 2020. Retrospective studies assessing the relationship between the prognosis of COVID-19 patients and levels of troponin I (TnI) and other cardiac injury biomarkers (creatine kinase [CK], CK myocardial band [CK-MB], lactate dehydrogenase [LDH], and interleukin-6 [IL-6]) were included. The data were extracted independently by two investigators.

Results

The analysis included 23 studies with 4631 total individuals. The proportions of severe disease, ICU admission, or death among patients with non-elevated TnI (or troponin T [TnT]), and those with elevated TnI (or TnT) were 12.0% and 64.5%, 11.8% and 56.0%, and 8.2% and. 59.3%, respectively. Patients with elevated TnI levels had significantly higher risks of severe disease, ICU admission, and death (RR 5.57, 95% CI 3.04 to 10.22, P < 0.001; RR 6.20, 95% CI 2.52 to 15.29, P < 0.001; RR 5.64, 95% CI 2.69 to 11.83, P < 0.001). Patients with an elevated CK level were at significantly increased risk of severe disease or ICU admission (RR 1.98, 95% CI 1.50 to 2.61, P < 0.001). Patients with elevated CK-MB levels were at a higher risk of developing severe disease or requiring ICU admission (RR 3.24, 95% CI 1.66 to 6.34, P = 0.001). Patients with newly occurring arrhythmias were at higher risk of developing severe disease or requiring ICU admission (RR 13.09, 95% CI 7.00 to 24.47, P < 0.001). An elevated IL-6 level was associated with a higher risk of developing severe disease, requiring ICU admission, or death.

Conclusions

COVID-19 patients with elevated TnI levels are at significantly higher risk of severe disease, ICU admission, and death. Elevated CK, CK-MB, LDH, and IL-6 levels and emerging arrhythmia are associated with the development of severe disease and need for ICU admission, and the mortality is significantly higher in patients with elevated LDH and IL-6 levels.