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Confirmation of COVID-19 in Out-of-Hospital Cardiac Arrest Patients and Postmortem Management in the Emergency Department during the COVID-19 Outbreak

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Author(s)
Changho KimIn Hwan YeoJong Kun KimYeonjoo ChoMi Jin LeeHaewon JungJae Wan ChoJi Yeon HamSuk Hee LeeHan Sol ChungYou Ho MunSang Hun LeeYang Hun Kim
Keimyung Author(s)
Lee, Sang Hun
Department
Dept. of Emergency Medicine (응급의학)
Journal Title
Infection and Chemotherapy
Issued Date
2020
Volume
52
Issue
4
Keyword
COVID-19Heart arrestFeverChest X-rayScreening
Abstract
Background:
There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak.

Materials and Methods:
We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA.

Results:
Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018). Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 ??100) and a specificity of 22.5% (95% CI: 13.5 ??34.0).

Conclusion:
The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR.
Keimyung Author(s)(Kor)
이상훈
Publisher
School of Medicine (의과대학)
Citation
Changho Kim et al. (2020). Confirmation of COVID-19 in Out-of-Hospital Cardiac Arrest Patients and Postmortem Management in the Emergency Department during the COVID-19 Outbreak. Infection and Chemotherapy, 52(4), 562–572. doi: 10.3947/ic.2020.52.4.562
Type
Article
ISSN
2092-6448
Source
https://icjournal.org/DOIx.php?id=10.3947/ic.2020.52.4.562
DOI
10.3947/ic.2020.52.4.562
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/42843
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학)
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