Looking to the Past to Improve the Future: A Narrative Review of Lessons Learned from Inpatient Cardiac Arrest Care During the COVID-19 Pandemic.

Background: Inpatient cardiac arrest care had to be adapted to meet the needs of patients and providers during the COVID-19 pandemic. Providers working in the emergency department and in the inpatient setting have acquired extensive experience and expertise in caring for patients with COVID-19 related cardiac arrest. We summarize recent reports relevant to clinicians on inpatient cardiac arrest care, provider and patient safety, and effective use of resources. Methods: We performed literature searches of the PubMed database on inpatient cardiac arrest, COVID-19, healthcare-associated coronavirus transmission, and others. The authors' collections of lived experience as inpatient care providers and clinically useful materials gathered during the pandemic were included. Results: We summarize current knowledge about cardiac arrest in COVID-19 relevant to hospitalist practice, describe lessons learned to date, and provide practical guidance for addressing cardiopulmonary resuscitation for patients with COVID-19. We discuss literature on risk factors for cardiac arrest in patients with COVID-19; risk of infection for rescuers performing resuscitation in patients with COVID-19 and mitigation strategies; goals of care during cardiac arrest in a patient with COVID-19; reducing the risk of exposure to rescuers (including pre-cardiac arrest care); reducing cross-contamination during cardiac arrest in patients with COVID-19; prioritizing oxygenation and ventilation strategies with lower aerosolization risk; maximizing resources during cardiac arrest in patients with COVID-19; and post-cardiac arrest care. Conclusions: Advances made in the care of inpatient cardiac arrest patients during the COVID-19 include domains of patient risk stratification, provider safety, advance directives, and others. Lessons in the management of inpatient cardiac arrest learned during this pandemic are likely to applicable to future pandemics.