Global impact of COVID-19 infection requiring admission to the intensive care unit: a systematic review and meta-analysis

Tan, Elinor; Song, Jialu; Deane, Adam M.; Plummer, Mark P.

Background The COVID-19 pandemic has placed unprecedented burden on the delivery of intensive care services worldwide. Research question What is the global point estimate of mortality and risk factors for patients admitted to intensive care units (ICUs) with severe COVID-19? Methods In this systematic review and meta-analysis Medline, Embase and the Cochrane library were searched up to 1 August 2020. Pooled prevalence of participant characteristics, clinical features and outcome data were calculated using random effects models. Subgroup analyses were based on geographical distribution, study type, quality assessment, sample size, end date and patient disposition Results Forty-five studies with 16561 patients from 17 countries across four continents were included. Patients with COVID-19 admitted to ICU had a mean age of 62·6 years (95%CI 60.4-64·7). Common comorbidities included hypertension (49·5% (44·9-54·0)) and diabetes (26·6% (22·7-30·8)). Over three-quarters developed Acute Respiratory Distress Syndrome (76·1% (65·7-85·2)). Invasive mechanical ventilation was required in 67.7% (59.1-75.7), vasopressor support in 65·9% (52.4-78.4), renal replacement therapy in 16·9% (12.1-22·2) and extracorporeal membrane oxygenation in 6·4% (4·1-9.1). The duration of ICU and hospital admission was 10·8 days (9·3-18·4) and 19·1 days (16·3-21·9) respectively with in-hospital mortality of 28·1% (23·4-33·0, I2 96%). No significant subgroup effect was observed. Interpretation Critically ill patients with COVID-19 who are admitted to ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global mortality for severe COVID-19 is <1/3.