Armstrong RA, et al. Anaesthesia 2020 - Review.
ABSTRACT
The emergence of coronavirus disease 2019 (COVID-19) has led to high demand for intensive care services worldwide. However, the mortality of patients admitted to the Intensive Care Unit (ICU) with COVID-19 is unclear. Here, we perform a systematic review and meta-analysis, in line with PRISMA guidelines, to assess the reported ICU mortality for patients with confirmed COVID-19. We searched MEDLINE, EMBASE, PubMed and Cochrane databases up to 31 May 2020 for studies reporting ICU mortality for adult patients admitted with COVID-19. The primary outcome measure was death in intensive care as a proportion of completed intensive care unit admissions, either through discharge from the ICU or death. The definition thus excluded patients still alive on ICU. Twenty-four observational studies including 10,150 patients were identified from centres across Asia, Europe, and North America. In-ICU mortality in reported studies ranged from 0-84.6%. Seven studies reported outcome data for all patients. In the remaining studies, the proportion of patients discharged from ICU at the point of reporting varied from 24.5-97.2%. In patients with completed ICU admissions with COVID-19 infection, combined ICU mortality was 41.6% (95%CI 34.0-49.7%, I2 = 93.2%). Subgroup analysis by continent showed that mortality is broadly consistent across the globe. As the pandemic has progressed the reported mortality rates have reduced from above 50% to close to 40%. The in-ICU mortality from COVID-19 is higher than usually seen in ICU admissions with other viral pneumonias. Importantly, the mortality from completed episodes of ICU differs considerably from the crude mortality rates in some early reports.
PMID:32602561 | DOI:10.1111/anae.15201