Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry
Authors: Chelly Jonathan , Plantefève Gaetan , Kamel Toufik , Bruel Cédric , Nseir Saad , Lai Christopher , Cirillo Giulia , Skripkina Elena , Ehrminger Sébastien , Berdaguer-Ferrari Fernando-Daniel , Le Marec Julien , Paul Marine , Autret Aurélie , Deye Nicolas ,   the ACICOVID-19 study group, Arnal Jean-Michel , Badie Julio , Berric Audrey , Brunet Jennifer , Bertrand Thibault , Carpentier Dorothée , Chaoui Karim , Chapelle Anaïs , Chelha Riad , Corno Gaëlle , Daubin Cédric , Descamps Richard , Demoule Alexandre , Deryckere Stéphanie , Donati Stephane-Yannis , Ducros Laurent , Embriaco Nathalie , Engrand Nicolas , Foucault Camille , Freeman Sean Anthony , Freita Ramos Santiago , Galbois Arnaud , Garnero Aude , Geay Cyrille , Guérin Laurent , Hong Tuan Ha Vivien , Hullin Thomas , Jochmans Sébastien , Kaidomar Michel , Kelway Charlotte , Labruyere Marie , Larcher Romaric , Legriel Stéphane , Leloup Maxime , Lesieur Olivier , Malissin Isabelle , Mazerand Sandie , Mégarbane Bruno , Mélone Marie-Anne , Menoret Edouard , Metzelard Matthieu , Mongardon Nicolas , Vong Ly Van Phack , Persichini Romain , Pichon Nicolas , Picos Gil Santiago , Quenot Jean-Pierre , Roux Damien , Schnell David , Sigaud Florian , Suply Clement , Sztrymf Benjamin , Terzi Nicolas , Thevenin Didier , Voicu Sebastian 
Published: November 2021

Abstract
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.
Trial registration: This study was retrospectively registered in ClinicalTrials.gov (NTC04373759) in April 2020 (https://www.clinicaltrials.gov/ct2/show/NCT04373759?term=acicovid&draw=2&rank=1).