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Today, two studies suggest that patients with COVID-19 who are very fragile or have cardiac arrest are two to three times more likely to die than those not infected with the virus.
Fragility, COVID-19 and intensive care
The first study, an observational survey conducted by researchers at the University of Birmingham in England and published in Age and aging, involved 5,711 patients with COVID-19 with a median age of 74 years in 55 hospitals in 12 countries.
Investigators found that the risk of death increased with age, with people over the age of 80 having 3.6 times the risk of dying compared to those aged 18 to 49. [CFS], 8) were 3 times more likely to die than those with a low score (1 to 3), regardless of age. CFS scores of 4 to 9 were associated with an increased likelihood of adverse outcomes. Frailty is a condition in which the body is more sensitive to the effects of illness.
The risk of death also increased with increasing inflammation, kidney disease, cardiovascular disease and cancer, and was higher in men than in women. Although delirium was not associated with an increased risk of death, it was linked to a higher likelihood of ICU admission, as were increased disease severity, higher levels of inflammation and a body mass index of less than 18.5 kg / m.2 (extremely underweight) or 30 or over (obese). Patients over 80 years of age and those with frailty or dementia were less likely than others to be admitted to an intensive care unit.
Older, more frail (CFS, 7 vs. 1 to 3) patients with delirium, dementia or mental illness were seven times more likely to require higher level care at home or in long-term care facilities duration after discharge from hospital. hospital.
The authors said that increasing death rates with age and frailty could be the result of coronary artery dysfunction leading to constriction of blood vessels and organ damage, high levels of inflammation, an tendency to blood clots, increased likelihood of viral infection due to abnormalities. angiotensin converting enzyme 2 activity and age-related alteration of the immune response.
“Increased awareness of the importance of measuring frailty as well as age and co-morbidities in hospitalized patients will help clinicians make holistic decisions involving the treatment of reversible disease, prevention of unwanted or distressing treatments, and early rehabilitation, “the authors wrote.
Lead author of the study, Carly Welch, said in a press release from the University of Birmingham that old age was identified as a significant risk factor for COVID-19 at the start of the pandemic. “However, not all older people are the same, we all age differently – some people can live to be 90 without developing frailty, and this can develop even without the presence of other long-term conditions,” she declared.
Co-author Mary Ni Lochlainn of King’s College London said in the statement that she hopes the study results will improve understanding of frailty as a risk factor distinct from age and both influence policy hospital and public. “A better understanding of frailty among the general public will allow for better communication between clinicians, patients and their families or caregivers, and can be used to reflect on how we make sure that the right treatment is given to all. patients according to their wishes, ”she said.
No COVID patient with cardiac arrest released from hospital alive
The second study, conducted by researchers at the University of Gothenburg in Sweden and published in European Heart Journal, included 1,946 cases of out-of-hospital cardiac arrest (OHCA) and 1,080 in-hospital cardiac arrest (IHCA) cases reported to the Swedish Cardiopulmonary Resuscitation Register from January 1 to July 20, 2020.
After the onset of the pandemic in mid-March, 88 (10%) of patients with OHCA and 72 (16.1%) with IHCA had COVID-19, with a 30-day mortality rate 3.4 times higher in those with OHCA and 2.3 times higher with IHCA. Women who had IHCA were nine times more likely to die during the pandemic than before.
The odds ratio (OR) for death within 30 days for OHCA patients with coronavirus, compared to their uninfected counterparts, was 3.40 and the corresponding hazard ratio (HR) was 1.45. The adjusted 30-day survival was 4.7% for COVID-19 patients and 9.8% for uninfected patients during the pandemic, up from 7.6% before the pandemic. Of all COVID-19 OHCA patients, 83.4% died within 24 hours of hospitalization.
IHCA patients diagnosed with COVID-19 were also at greater risk of death than their uninfected peers (OR, 2.27); the corresponding HR was 1.48. The adjusted 30-day survival in IHCA COVID-19 patients was 23.1%, compared to 39.5% in uninfected patients and 36.4% before the pandemic. Most (60.5%) of COVID-19 IHCA patients died within 24 hours of hospitalization.
Among OHCA patients, 20.4% had shocking heart rhythms, compared to 25.9% for those with IHCA. A total of 1,746 OHCA patients (89.7%) and 680 IHCA patients (63.0%) died. Compared to before the pandemic, the rate of patients discharged alive from the hospital rose from 38.9% to 33.0%. As of July 20, no COVID-19 patient with cardiac arrest had been released alive, and only four patients (4.5%) had survived for up to 30 days.
Although the improvement in the survival rate of non-coronavirus patients with OHCA or IHCA was not statistically significant, if there had been an improvement, this could have been partly due to the 8.2% increase in witness cardiac arrests and a 47% increase in cookie use. defibrillators, say the authors.
Compared to the pre-pandemic period, COVID-19 has almost tripled the risk of dying from OHCA, increasing 4.5 times for men and a third for women. The risk of dying after ACI has more than doubled, increasing by half for men and more than nine times for women.
The share of OHCAs caused by respiratory problems increased 2.7 times during the pandemic, while the use of compression cardiopulmonary resuscitation (CPR) increased by 8.6%. At the same time, the proportion of people treated with both chest compression and mouth-to-mouth resuscitation rose from 33% before the pandemic to 23%.
The authors noted that this may have been caused in part by guidelines released in March 2020 by the European Resuscitation Council and the Swedish Resuscitation Council that advised witnesses of cardiac arrest in a person suspected of having COVID- 19 Avoid mouth-to-mouth resuscitation and focus on chest compressions.
Co-author Araz Rawshani, MD, PhD, University of Gothenburg, said in a press release from the European Society of Cardiology that while compression-only CPR can be as effective as combined compressions and mouth resuscitation -to-mouth in other patients, it may not be the case for people with COVID-19, who suffer from respiratory failure.
Rawshani said the study also found that fewer COVID-19 hospital patients were being monitored with electrocardiograms (ECGs), which can save lives by immediately alerting staff to cardiac arrest. “We believe that patients with COVID-19 should be monitored with ECGs and monitored for oxygen saturation, as this would allow rapid recognition of irregular heartbeats and declining oxygen saturation,” he said. he declares.
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