Impact of the three COVID-19 surges in 2020 on in-hospital cardiac arrest survival in the United States

Background: Studies have reported lower survival for in-hospital cardiac arrest (IHCA) during the initial COVID-19 surge. Whether the pandemic reduced IHCA survival during subsequent surges and in areas with lower COVID-19 rates is unknown. Methods: Within Get-With-The-Guidelines®-Resuscitation, we identified 22,899 and 79,736 IHCAs during March to December in 2020 and 2015–2019, respectively. Using hierarchical regression, we compared risk-adjusted rates of survival to discharge in 2020 vs. 2015–19 during five COVID-19 periods: Surge 1 (March to mid-May), post-Surge 1 (mid-May to June), Surge 2 (July to mid-August), post-Surge 2 (mid-August to mid-October), and Surge 3 (mid-October to December). Monthly COVID-19 mortality rates for each hospital's county were categorized, per 1,000,000 residents, as very low (0–10), low (11–50), moderate (51–100), or high (>100). Results: During each COVID-19 surge period in 2020, rates of survival to discharge for IHCA were lower, as compared with the same period in 2015–2019: Surge 1: adjusted OR: 0.81 (0.75–0.88); Surge 2: adjusted OR: 0.88 (0.79–0.97), Surge 3: adjusted OR: 0.79 (0.73–0.86). Lower survival was most pronounced at hospitals located in counties with moderate to high monthly COVID-19 mortality rates. In contrast, during the two post-surge periods, survival rates were similar in 2020 vs. 2015–2019: post-Surge 1: adjusted OR 0.93 (0.83–1.04) and post-Surge 2: adjusted OR 0.94 (0.86–1.03), even at hospitals with the highest county-level COVID-19 mortality rates. Conclusions: During the three COVID-19 surges in the U.S. during 2020, rates of survival to discharge for IHCA dropped substantially, especially in communities with moderate to high COVID-19 mortality rates.