Mechanical ventilation and mortality among 223 critically ill patients with COVID-19 – a multicentric study in Germany

Roedl, Kevin; Jarczak, Dominik; Thasler, Liina; Bachmann, Martin; Schulte, Frank; Bein, Berthold; Weber, Christian Friedrich; Schäfer, Ulrich; Veit, Carsten; Hauber, Hans-Peter; Kopp, Sebastian; Sydow, Karsten; de Weerth, Andreas; Bota, Marc; Schreiber, Rüdiger; Detsch, Oliver; Rogmann, Jan-Peer; Frings, Daniel; Sensen, Barbara; Burdelski, Christoph; Boenisch, Olaf; Nierhaus, Axel; de Heer, Geraldine; Kluge, Stefan

BACKGROUND: There are large uncertainties regarding outcome of patients with COVID-19 and mechanical ventilation (MV). High mortality (50 – 97%) was proposed by some groups, leading to considerable uncertainties regarding outcome of critically ill patients with COVID-19. OBJECTIVES: The aim was to investigate the characteristics and outcome of critically ill patients with COVID-19 requiring intensive Care Unit (ICU) admission and mechanical ventilation. METHODS: A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February-June 2020 were included. Patient demographics, severity of illness, ICU course were retrospectively evaluated. RESULTS: There were 223 critically ill COVID-19 patients included. The majority, 73% (n=163), were male; median age was 69 (IQR 58 - 77.5) years, with 68% (n=151) patients had at least one chronic medical condition. Their SOFA-score was median 5 ([3], [4], [5], [6], [7], [8], [9]) points on admission. Overall, 167 (75%) patients needed MV. Non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) were used in in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to NIV/HFNC failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n=72), and due to severe respiratory failure extracorporeal membrane oxygenation was necessary in 9% (n=20) of patients. Experimental antiviral-therapy was used in 9% (n=21). Complications during ICU stay were: septic shock (40%, n=90), heart failure (8%, n=17) and pulmonary embolism (6%, n=14). Length of ICU-stay was median 13 days ([5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]), duration of MV was 15 days ([8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]). ICU-mortality was 35% (n=78) and 44% (n=74) among patients with MV. CONCLUSION: In this multicentre observational study of 223 critically ill patients with COVID-19 the survival to ICU discharge was 65%, and 56% among patients requiring MV. Patients showed high rate of septic complications during their ICU-stay.