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Higher Mortality Rate in Ventilated COVID-19 Patients

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What your doctor is reading on Medscape.com:

APRIL 13, 2020 — Mortality could be as high as two thirds among patients with COVID-19 who require ventilation, new data from the United Kingdom’s Intensive Care National Audit and Research Center (ICNARC) show.

Some clinicians are asking whether other techniques, such as extracorporeal membrane oxygenation (ECMO), could improve outcomes, but the data are unclear.

The ICNARC data, posted online April 10, include data from 3883 patients with confirmed COVID-19 who were admitted to intensive care units (ICUs) in England, Wales, or Northern Ireland and for whom data on the first 24 hours of ICU care are available.

Of those, 871 patients died, 818 patients survived to ICU discharge, and 2194 patients were still receiving ICU care.

Among patients whose ICU outcome is known, 66.3% of the 1053 patients who required mechanical ventilated died, compared with 19.4% of the 444 patients who required basic respiratory support.

Importantly, mortality among patients with COVID-19 who require mechanical ventilation appears higher than that for patients with other types of viral pneumonia. Specifically, the ICNARC report shows a mortality rate of 35.1% among patients who were treated in the ICU for viral pneumonia and who required mechanical ventilation from 2017 to 2019.

The new ICNARC findings are consistent with previous reports of smaller case series. For example, a single-center case series of 52 patients treated in Wuhan, China, showed that 37 (71%) required mechanical ventilation and 32 (61.5%) died within 28 days of ICU admission. Morality was higher among those who required mechanical ventilation than among those who did not (94% vs 35%).

Similarly, a case series of 24 patients with COVID-19 who were treated in ICUs in the Seattle area indicated that 20 (75%) required mechanical ventilation. With a minimum follow-up of 14 days, four of the 20 patients had been discharged home, four remained hospitalized but were no longer in the ICU, nine had died, and three continued on ventilation in the ICU.


Time to Change Ventilator Strategies?

Results such as these have some physicians asking whether standard respiratory therapy protocols for typical acute respiratory distress syndrome (ARDS) might need to be adjusted for this novel pneumonia. As one critical care physician recently wrote in Britain’s the Spectator, because of the threat of ventilator-induced lung injury, “putting patients on ventilators for COVID-19 pneumonia could be a bridge to nowhere.

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