Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.64
Peer-review started: January 20, 2021
First decision: February 14, 2021
Revised: February 16, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: February 28, 2021
Processing time: 41 Days and 5.2 Hours
The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019 (COVID-19). A small percentage of patients with COVID-19 will require intensive care and possibly mechanical ventilation. The mortality of intensive care interventions in patients with COVID-19 remains unclear.
To identify mortality rate of COVID-19 patients receiving different interventions in the critical care unit.
We searched OVID Medline, SCOPUS, MedRxIv, preprints.org, and Centers for Disease Control databases from November 2019 to April 10, 2020 for articles on COVID-19. Teams of 2 independent reviewers reviewed titles and abstract for studies that reported mortality of human adults with COVID-19 and exposure to a critical care intervention [Intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation, or cardiopulmonary resuscitation (CPR)]. We used a descriptive analysis and unweighted averages of mortality across studies.
Our search identified 6973 articles and 20 met inclusion: 17 for intensive care, 13 for mechanical ventilation, 5 for hemodialysis, 2 for extracorporeal membrane oxygenation, and 1 for CPR. Mortality associated with intensive care admission ranged from 9%-83%, with overall mortality 32.5% (95%CI: 32.4%-32.6%). Mortality associated with intubation from 16.7%-100% with overall mortality 64.0% (95%CI: 62.4%-65.5%). In patients requiring hemodialysis, mortality ranged from 0%-100%, with average mortality 75.3% (95%CI: 72.6%-77.4%).
Patients with COVID-19 requiring intensive care have high mortality rates. Authorities can use this data to establish pharmacoeconomic studies to make decisions about allocation of scarce resources if necessary.
Core Tip: This systematic review identifies the mortality associated with critical care interventions in patients with novel coronavirus disease 2019. These include intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation, or cardiopulmonary resuscitation. Average mortality for intensive care admission was 32.5%. While mortality is high, this is lower than initially described in early reports of the pandemic. Physicians can hopefully use this data to inform decisions about goals of care or, if necessary, allocation of scarce resources.