Data on COVID-19 patients admitted to the ICU who require mechanical ventilation reveal the significant majority of these patients do not survive. Four different studies point to high fatality rates for intubated coronavirus patients.
1) Patients in London
A study at Intensive Care National Audit & Research Centre in London, looked at 2,249 COVID-19 patients receiving critical care at hospitals in the in UK’s Case Mix Program through Apr 3. At the conclusion of the study, 1,559 patients were still in the ICU. For the 690 patients with recorded outcomes, 50.1% (346 patients) died, while 49.9% (344) were discharged from critical care.
Researchers identified a total of 388 patients who received advanced respiratory support, with 128 (33%) of these patients also receiving basic respiratory support. Another 160 patients received basic respiratory support only. Of the 388 patients in the advanced or advanced+basic respiratory support group, 83.8% died, compared to only 16.3% mortality in the basic respiratory support group.
Source: ICNARC. “ICNARC report on COVID-19 in critical care.” 2020 Apr 4. Accessed: https://www.icnarc.org/About/Latest-News/2020/04/04/Report-On-2249-Patients-Critically-Ill-With-Covid-19
2) Patients in Northern Italy
A study of 1,591 critically-ill patients COVID-19 in Italy found that a subset of 1,287 patients needed respiratory support. Of those 1,287 patients, 88% (1,150 patients) were intubated and 11% (137 patients) received NIV. At the conclusion of the study, 58% of overall patients (920) were still in the ICU. Of the remaining 651 patients with recorded outcomes, 39.3% (256) were discharged from the ICU while 62.2% (405) died.
Researchers also noted that patients 64-and-older had more than double the mortality rate of patients 63-and-younger, 36% vs 15% respectively.
Giacomo Grasselli, MD. “Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.” JAMA. Published online 2020 April 6. Accessed at doi:10.1001/jama.2020.5394
3) Patients in Wuhan
Research published in Lancet Respiratory Medicine looked at critical care patients in Wuhan in the early weeks of the novel coronavirus epidemic. Data on 52 adult patients admitted to ICUs in December and January were analyzed and researchers found 61.5% (32 patients) had died by day 28.
Of the 37 patients receiving mechanical ventilation, 94% died. Researchers also noted that the average time from ICU admission to death was seven days, and 81% of nonsurvivors had ARDS. Sixty-two percent of deaths were in patients 60-years-old and over.
Source: Xiaobo Yang, et al. “Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.” Lancet Resp Med. 2020 Feb 24. Accessed https://doi.org/10.1016/S2213-2600(20)30079-5
4) Patients in Seattle
An analysis of 24 patients admitted to the ICU in Seattle, Washington found significant mortality for those requiring mechanical ventilation. According to the study published in the New England Journal of Medicine, by day eighteen, overall mortality was 50% (12 patients), with 3 remaining intubated in the ICU, 4 transferred out of the ICU, and 5 were discharged home. Eleven of the 12 deaths occurred in the first 10 days of ICU care (mean 6.5 days).
Of the 18 patients (75%) who needed mechanical ventilation, at least nine died (50%+). Researchers noted their case fatality rate may be underestimated because 3 patients remained intubated when their study concluded.
Source: Bhatraju P, et al. “Covid-19 in Critically Ill Patients in the Seattle Region—Case Series.” N Eng J Med. 2020 Mar 30. Accessed DOI:10.1056/NEJMoa2004500
Image credit: NIAID-RML. Novel Coronavirus SARS-CoV-2. This scanning electron microscope image shows SARS-CoV-2 (round blue objects) emerging from the surface of cells cultured in the lab. SARS-CoV-2, also known as 2019-nCoV, is the virus that causes COVID-19. The virus shown was isolated from a patient in the US.