Critically Ill Adults with COVID-19 in New Orleans and Care with an Evidence-based Protocol

Janz, David R.; Mackey, Scott; Patel, Nirav; Saccoccia, Beau P.; St. Romain, Michelle; Busack, Bethany; Lee, Hayoung; Phan, Lana; Vaughn, Jordan; Feinswog, David; Chan, Ryan; Auerbach, Lauren; Sausen, Nicholas; Grace, Joseph; Sackey, Marian; Das, Anushka; Gordon, Angellica O.; Schwehm, Jennifer; McGoey, Robin; Happel, Kyle I.; Kantrow, Stephen P.

Background Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. Research Question What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, LA and is an evidence-based protocol for care associated with improved outcomes? Study Design and Methods: In this multi-center, retrospective, observational cohort study of intensive care units in four hospitals in New Orleans, LA, we collected data on adults admitted to an intensive care unit (ICU) and tested for SARS-CoV-2 between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU which implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days. Results The initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 comprised the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days, 0 – 28) compared with non-protocolized ICUs (0 days, 0 – 23, p = 0.005), including in adjusted analyses (p = 0.02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%, p = 0.02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital’s ICUs, the median number of ventilator-free days was 22 (IQR 0 – 27) and mortality rate was 39%. Interpretation Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in the majority of critically ill adults with COVID-19 admitted to an academic safety net hospital’s ICUs despite a high rate of co-morbidities.