Chest. 2020 Sep 14:S0012-3692(20)34493-7. doi: 10.1016/j.chest.2020.08.2114. Online ahead of print.
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.