Cardiac Arrest Incidence and Outcome Among Patients With COVID-19 in French ICUs

Study Overview
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Brief Summary
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the novel coronavirus disease 2019 (COVID-19) pandemic. Among COVID-19 complications, in-hospital cardiac arrest (IHCA) was reported with a very poor outcome in a retrospective single-center study (0,7% of 30 days survival with good neurological outcome among IHCA patients with a resuscitation attempt), related to its natural course and management. The incidence of unexpected in-ICU cardiac arrest (ICUCA) due to COVID-19 is still unknown. Additionally, outcome of COVID-19 patients admitted in ICU for an out-of-hospital cardiac arrest (OHCA) is also undescribed. The objective this study is : to report the incidence of ICUCA among patients hospitalized in French ICU for COVID-19. to report morbidity and mortality among COVID-19 patients admitted alive in ICU for an OHCA or an IHCA. The secondary objective is to assess outcome and identify risk factors of ICUCA occurrence among patients admitted for COVID-19.

Detailed Description
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Retrospective and prospective multicentric observational registry in French intensive care units (ICU) including all consecutive adult patients admitted in ICU with a documented SARS-CoV-2 disease : For an out-of-hospital or an in-hospital cardiac arrest (OHCA and IHCA respectively) Or presenting an unexpected in-ICU cardiac arrest (ICUCA) Patients characteristics, cardiac arrest history and patients outcome will be recorded according to Utstein recommendations. Patients presenting an expected cardiac arrest in ICU related to withdrawal of life sustaining therapies (WLST) will be excluded.

Official Title
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Cardiac Arrest Incidence and Outcome Among Patient With COVID-19 Pneumonia in French ICUs

Conditions
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Sars-CoV2, Covid-19

Intervention / Treatment
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* Other: Cardiopulmonary resuscitation
* Other: Modified Rankin score


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted in intensive care unit with a documented SARS-CoV-2 disease For an out-of-hospital or an in-hospital cardiac arrest Or an in-hospital cardiac arrest Or presenting an unexpected in-intensive care unit cardiac arrest Exclusion Criteria: Age under 18 y.o Expected in-intensive care unit cardiac arrest related to withdrawal of life sustaining therapies. Withdrawal of patient or next-of-kin informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Unexpected in-intensive care unit cardiac arrest patients<br>ICUCA Patients admitted in intensive care unit for a confirmed COVID-19 and presenting an unexpected in-intensive care unit cardiac arrest | Other: Cardiopulmonary resuscitation<br>* Cardiopulmonary resuscitation<br>Other: Modified Rankin score<br>* 0 - no symptoms at all - no significant disability despite symptoms; able to carry out all usual duties and activities - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance - Moderate disability; requiring some help, but able to walk without assistance - Moderately severe disability; unable to walk and attend to bodily needs without assistance - Severe disability; bedridden, incontinent and requiring constant nursing care and attention - Dead<br>|
| In-hospital cardiac arrest patients<br>IHCA Patients admitted in intensive care unit for an in-hospital cardiac arrest with a confirmed Covid-19 | Other: Modified Rankin score<br>* 0 - no symptoms at all - no significant disability despite symptoms; able to carry out all usual duties and activities - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance - Moderate disability; requiring some help, but able to walk without assistance - Moderately severe disability; unable to walk and attend to bodily needs without assistance - Severe disability; bedridden, incontinent and requiring constant nursing care and attention - Dead<br>|
| Out-of-hospital cardiac arrest<br>OHCA Patients admitted in intensive care unit for an out-hospital cardiac arrest with a confirmed Covid-19 | Other: Modified Rankin score<br>* 0 - no symptoms at all - no significant disability despite symptoms; able to carry out all usual duties and activities - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance - Moderate disability; requiring some help, but able to walk without assistance - Moderately severe disability; unable to walk and attend to bodily needs without assistance - Severe disability; bedridden, incontinent and requiring constant nursing care and attention - Dead<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of unexpected cardiac arrest | Percentage of unexpected in-intensive care unit cardiac arrest among COVID-19 patients admitted to intensive care unit | 7 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Charlson score | Diabetes, hypertension, smoking, dyslipidemia, coronary artery disease, chronic respiratory insufficiency, chronic heart failure, chronic renal insufficiency, chronic hepatic insufficiency, chronic neurological disease, cancer, malignant hemopathy. Charlson score's minimum and maximum values are 0 and 40 respectively, the lowest score corresponds to a better outcome. | 7 months | 
| Organ failure score at ICU admission and/or before unexpected in-ICU cardiac arrest | Respiratory failure, neurological impairment, circulatory failure, hepatic failure, haematological failure, renal failure. Sofa score's minimum and maximum values are 0 and 24, the lowest score corresponds to a better outcome | 7 months | 
| Etiology retained to explain cardiac arrest occurrence | Cardiac origin; Respiratory origin; Metabolic origin; unknown origin | 7 months | 
| Modified Rankin score (mRS) at ICU discharge, at hospital discharge and at 3 months | 0 - no symptoms at all - no significant disability despite symptoms; able to carry out all usual duties and activities - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance - Moderate disability; requiring some help, but able to walk without assistance - Moderately severe disability; unable to walk and attend to bodily needs without assistance - Severe disability; bedridden, incontinent and requiring constant nursing care and attention - Dead | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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novel coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Out-of-hospital cardiac arrest, In-hospital cardiac arrest, unexpected cardiac arrest, Intensive care unit