**Introduction/Hypothesis**
The COVID-19 pandemic has inflicted a remarkable burden on the healthcare system across the world. The impact on clinical care has resulted in unpredictable outcomes for patients. Cardiac arrest management has been affected significantly during the pandemic. Changes in guideline recommendations include donning personal protective equipment (PPE) prior to cardiopulmonary resuscitation (CPR). Moreover, an emphasis was placed on aerosol generating procedures such as chest compressions and endotracheal intubation. Alternatively, acquiring COVID-19 infection by itself may be associated with worse outcomes. Our aim is to examine the characteristics and outcomes of laboratory confirmed COVID-19 patients and compare them with laboratory tested but negative for COVID-19 in patients sustaining in-hospital cardiac arrest.

**Methods (e.g. case series, trial or case report)**
This is a single-centre retrospective record review study which included 277 patients. Data was collected from code blue sheets located at the institution’s cardiopulmonary resuscitation (CPR) committee. We categorized patients into 2 groups: 115 patients who had IHCA during the COVID-19 pandemic and 162 patients after the COVID-19 pandemic. Clinical characteristics of the patients including age, gender, past medical history, location of the arrest, and initial rhythm were compared.

**Results**
The incidence of in-hospital cardiac arrest (IHCA) during the 5-month period in the peak of COVID-19 pandemic was 1.23%. While the incidence during the 5-month period the year after the pandemic was 1.11%. Our results show lower return of spontaneous circulation (ROSC) (p< 0.01) and survival to hospital discharge (p< 0.01) during the peak of COVID-19 when compared to after the pandemic. Moreover, the absence of pneumonia carried a higher odds for ROSC (0.78, 95%CI [0.63-0.95]). Upon examining a subgroup of patients with pneumonia, we found the endotracheal tube placement had higher rates of ROSC (p< 0.01) and survival to discharge (p= 0.01).

**Conclusion**
Our sample associates lower rates of ROSC and survival to hospital discharge with the peak of COVID-19 pandemic. Specifically, patients with pneumonia had lower rates of ROSC during the pandemic.



Characteristics and Outcomes of In-Hospital Cardiac Arrest During and After the COVID-19 Pandemic