Questioning the Futility of Cardiopulmonary Resuscitation in Patients With Severe Coronavirus Disease 2019

To the Editor:

We read with great interest the article published in a recent issue of Critical Care Medicine by Shah et al (¹). The authors conducted a single-center retrospective cohort study of hospitalized patients with coronavirus disease 2019 (COVID-19) to examine outcomes after in-hospital cardiac arrest (IHCA) with attempted cardiopulmonary resuscitation (CPR). Among 1,094 hospitalized patients, 63 suffered from IHCA, with an in-hospital mortality of 100%. Similar findings were reported in two other recently reported single-center studies: one that included 31 patients with IHCA (²), and another that included 60 such patients (³), with a 100% in-hospital mortality reported in both studies. The authors conclude that their study “raises important questions about the futility of ACLS measures in these patients.”

We recently reported the outcomes following IHCA using data from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19, a large multicenter cohort study of critically ill adult patients with COVID-19 admitted to ICUs at 68 geographically diverse hospitals across the United States (⁴). Among 5,019 patients, 701 (14.0%) had IHCA, 400 of whom received CPR. A total of 48 of the 400 (12.0%) who received CPR survived to hospital discharge. These findings are consistent with those recently reported in a study of critically ill patients with non–COVID-19 disease from the American Heart Association Get With the Guidelines-Resuscitation registry (⁵). Our study (¹) does not support the notion that CPR is universally futile in hospitalized patients with COVID-19, although we agree that outcomes are often poor and that early initiation of goals of care discussions in such patients is appropriate. Thus, we urge providers, patients, and families to exercise caution in using findings from single-center studies to inform life-and-death decisions regarding the potential futility of CPR.