Effectiveness of mechanical cardiopulmonary resuscitation for patients with COVID-19 and in hospital cardiac arrest

Cardiopulmonary resuscitation (CPR) is an aerosol generating event where healthcare workers (HCW) are at an increased risk of exposure during resuscitation of coronavirus disease 2019 (COVID-19) patients. To decrease HCW exposure, professional societies recommended the use of mechanical CPR devices where available. Previously, two randomized control trials showed that mechanical CPR devices were equally efficacious when compared to manual CPR for management of out-of-hospital cardiac arrest.^,  However, there is limited data on the use of mechanical CPR device in IHCA with conflicting results.^,  We assessed the feasibility of mechanical CPR in IHCA of COVID-19 patients and present the first report on role of mechanical CPR in COVID-19 patients.

This single healthcare system, multi-center, retrospective cohort study, included patients aged ≥18 years admitted to the Cleveland Clinic Health System’s ten hospitals in North-East Ohio with COVID-19 who subsequently had IHCA between 03/01/2020 and 10/15/2020. Data were extracted from the electronic medical records and supplemented with the quality data registry. The LUCAS® Mechanical CPR device was introduced across the healthcare system in March 2020 after an online training session followed subsequently by hands-on training of healthcare workers. After initial training, the use of LUCAS® Mechanical CPR at our institutions was left up to the discretion of the physician leading the resuscitation effort.

During the study period, 58 patients with confirmed COVID-19 and IHCA received CPR. Baseline characteristics were similar and are reported in Table 1. Initial arrest rhythm was respectively pulseless electrical activity, 63.8%, asystole, 29.3%, and pulseless ventricular tachycardia or ventricular fibrillation, 6.9%. The majority of IHCA events occurred in the ICU (51/58; 87.9%) and the remainder occurred on the regular wards (7/58; 12.1%). Return of spontaneous circulation (ROSC) occurred in 35 patients (60.3%) and 13 patients (22.4%) were discharged alive from the hospital. Of the patients who had IHCA, 41/58 (70.6%) received manual CPR and 17/58 (29.3%) received mechanical CPR. Although, the median duration of resuscitation was shorter with manual CPR compared to mechanical CPR (6 min vs. 14 min P = 0.01), there was no significant difference in achieving ROSC (65.9 vs 58.8; p = 0.61). While manual compression led to more survivors at 24 h post arrest (56.1 vs 23.5; p = 0.02), there were no difference in survival to ICU discharge (31.7 vs 11.7; p = 0.12) or survival to hospital discharge between the two groups (26.8 vs 11.8; p = 0.31). There was no difference between arrest location in implementation of mechanical vs manual CPR. No immediate complications or harm were reported from its usage. Our small sample size makes the study underpowered to detect all differences. However, as hospitals reach capacity and a large number of HCW are contracting COVID-19 disease, the use of mechanical CPR device could decrease the risk to HCW while allowing similar outcomes. To our knowledge, this is the first study to report outcomes of mechanical CPR use in COVID-19 patients. Larger studies are needed to confirm the impact on outcomes with the use of mechanical CPR devices.