Free Download: European Resuscitation Council COVID-19 Guidelines

The World Health Organization has declared COVID-19 a pandemic. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is highly contagious. A recent systematic review that included 53,000 patients indicates that 80% of patients have mild disease, 15% have moderate disease and about 5% have severe disease requiring intensive care unit (ICU) admission.1 In this review the fatality rate was 3.1%. Among 136 patients with severe COVID-19 pneumonia and in-hospital cardiac arrest at a tertiary hospital in Wuhan, China, 119 (87.5%) had a respiratory cause for their cardiac arrest.2 In this series of patients, the initial cardiac arrest rhythm was asystole in 122 (89.7%), pulseless electrical activity in 6 (4.4%) and ventricular fibrillation/ pulseless ventricular tachycardia (VF/pVT) in 8 (5.9%). In a case series of 138 hospitalised COVID-19 patients, 16.7% of patients developed arrhythmias and 7.2% had acute cardiac injury.3 Thus, although most cardiac arrests in these patients are likely to present with a non-shockable rhythm caused by hypoxaemia (although dehydration, hypotension and sepsis may also contribute), some will have a shockable rhythm, which may be associated with drugs causing prolonged-QT syndrome (e.g. chloroquine, azithromycin) or caused by myocardial ischaemia. In the series of 136 cardiac arrests from Wuhan, four (2.9%) patients survived for at least 30 days but only one of these had a favourable neurological outcome.

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