{"id":814,"date":"2020-05-26T12:04:32","date_gmt":"2020-05-26T06:34:32","guid":{"rendered":"http:\/\/www.potentialloops.org\/?p=814"},"modified":"2020-05-26T12:04:34","modified_gmt":"2020-05-26T06:34:34","slug":"no-evidence-blanket-do-not-resuscitate-orders-for-covid-19-patients-are-necessary-investigators-urge-caution","status":"publish","type":"post","link":"https:\/\/www.potentialloops.org\/?p=814","title":{"rendered":"No evidence blanket ‘do-not-resuscitate’ orders for COVID-19 patients are necessary; investigators urge caution"},"content":{"rendered":"\n

Date: May 22, 2020 <\/p>\n\n\n\n

Source 1: American Heart Association <\/p>\n\n\n\n

Source 2: www.sciencedaily.com<\/a><\/p>\n\n\n\n

Summary: It’s inappropriate to consider blanket do-not-resuscitate orders for COVID-19 patients because adequate data is not yet available on US survival rates for in-hospital resuscitation of COVID-19 patients and data from China may not relate to US patients, according to a new article. <\/p>\n\n\n\n

It’s inappropriate to consider blanket \ndo-not-resuscitate orders for COVID-19 patients because adequate data is\n not yet available on U.S. survival rates for in-hospital resuscitation \nof COVID-19 patients and data from China may not relate to U.S. \npatients, according to a new article published today in Circulation: Cardiovascular Quality and Outcomes<\/em>, an American Heart Association journal.<\/p>\n\n\n\n

There is a presumption that COVID-19 patients have a low survival \nrate after resuscitation, based on a recent study from Wuhan, China, \nthat found an overall survival of 2.9% in 136 COVID-19 patients who \nunderwent cardiopulmonary resuscitation for in-hospital cardiac arrest. \nHowever, that prognosis should not be applied to the U.S., said Saket \nGirotra, M.D., S.M., assistant professor of medicine in the division of \ncardiovascular diseases at the University of Iowa Carver College of \nMedicine, on behalf of the American Heart Association’s Get With The \nGuidelines\u00ae-Resuscitation (GWTG-R) investigators.<\/p>\n\n\n\n

In the study, “Survival After In-Hospital Cardiac Arrest In \nCritically Ill Patients: Implications For Covid-19 Outbreak?,” \ninvestigators report data from the GWTG-R registry of in-hospital \ncardiac arrest patients. They examined data from 2014-2018 on patients \nsimilar to the COVID-19 population: 5,690 adult patients who underwent \nCPR for in-hospital cardiac arrest while being treated in an intensive \ncare unit (ICU) for pneumonia or sepsis and were receiving mechanical \nventilation at the time of cardiac arrest.<\/p>\n\n\n\n

While researchers noted an overall survival rate of only 12.5% in the\n U.S. simulation, there were many variables that could affect survival \nand neurologic outcomes. The probability of survival without severe \nneurological disability ranged from less than 3% to more than 22%, \nacross key patient subgroups. The probability of mild to no disability \nranged from about 1% to 17% across key patient subgroups.<\/p>\n\n\n\n

While survival rates were low in older and sicker patients in whom \nthe initial heart rhythm was non-shockable, survival rates were much \nhigher (more than 20%) in younger patients with an initial shockable \nrhythm who were not being treated with vasopressor medications prior to \nthe cardiac arrest. Vasopressor medications are generally used to \nimprove blood pressure and cardiac output in emergency situations such \nas septic shock or cardiac arrest.<\/p>\n\n\n\n

“Such large variation in survival rates suggests that a blanket \nprescription of do-not-resuscitate orders in patients with COVID-19 may \nbe unwarranted. Such a blanket policy also ignores the fact that early \nexperience of the pandemic in the U.S. reveals that a about a quarter of\n COVID-19 patients are younger than 50 years of age and otherwise \nhealthy. Cardiac arrest in such patients will likely have a different \nprognosis,” the researchers said.<\/p>\n\n\n\n

The article concludes that .” .. in a cohort of critically ill \npatients on mechanical ventilation, survival outcomes following \nin-hospital resuscitation were not uniformly poor. These data may help \nguide discussions between patients, providers and hospital leaders in \ndiscussing appropriate use of resuscitation for COVID-19 patients.”<\/p>\n\n\n\n

Co-authors are Yuanyuan Tang, Ph.D.; Paul S. Chan M.D., M.Sc.; and \nBrahmajee K. Nallamothu, M.D., M.P.H. Nallamothu is the Editor-in-Chief \nof Circulation: Cardiovascular Quality and Outcomes<\/em>. This \nmanuscript was reviewed by an external guest editor: Dennis T. Ko, M.D.,\n M.Sc. Disclosures and funding sources are listed in the manuscript.<\/p>\n\n\n\n

\n\n\n\n

Story Source:<\/strong><\/p>\n\n\n\n

Materials<\/a> provided by American Heart Association<\/strong><\/a>. Note: Content may be edited for style and length.<\/em><\/p>\n\n\n\n

www.sciencedaily.com<\/a><\/p>\n\n\n\n

\n\n\n\n

Journal Reference<\/strong>:<\/p>\n\n\n\n

  1. Saket Girotra, Yuanyuan Tang, Paul S. Chan, Brahmajee K. Nallamothu. Survival After In-Hospital Cardiac Arrest In Critically Ill Patients: Implications For Covid-19 Outbreak?<\/strong> Circulation: Cardiovascular Quality and Outcomes<\/em>, 2020; DOI: 10.1161\/CIRCOUTCOMES.120.006837<\/a>\n<\/li><\/ol>\n\n\n\n
    \n\n\n\n

    Cite This Page<\/strong>:<\/p>\n\n\n\n