Journal Article

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

Dalemo Keji, Cousins, Tom, Darnell, Robert, Orzechowska Izabella, Borowczak Kasia, Drikite Laura, Harrison, David A, Doidge, James C, Abdo, Hussein, Matthews, Tim, Saull, Michelle, Rowan, Kathryn M, Cummins, Peter, Thomas, Karen, Peters, Sam, Richards-Belle, Alvin, Samuels, Tyrone, Christian, Michael D, Koelewyn Abby, Mouncey Paul R, Demissie Hanna, Frederiksen Ditte, Furnell, Sarah, Fleming, Andrew, Gould, Doug W, Shankar-Hari Manu, Banjo Yemi

2020

Overview

PurposeTo describe critical care patients with COVID-19 across England, Wales and Northern Ireland and compare them with a historic cohort of patients with other viral pneumonias (non-COVID-19) and with international cohorts of COVID-19.MethodsExtracted data on patient characteristics, acute illness severity, organ support and outcomes from the Case Mix Programme, the national clinical audit for adult critical care, for a prospective cohort of patients with COVID-19 (February to August 2020) are compared with a recent retrospective cohort of patients with other viral pneumonias (non-COVID-19) (2017–2019) and with other international cohorts of critical care patients with COVID-19, the latter identified from published reports.Results10,834 patients with COVID-19 (70.1% male, median age 60 years, 32.6% non-white ethnicity, 39.4% obese, 8.2% at least one serious comorbidity) were admitted across 289 critical care units. Of these, 36.9% had a PaO2/FiO2 ratio of ≤ 13.3 kPa (≤ 100 mmHg) consistent with severe ARDS and 72% received invasive ventilation. Acute hospital mortality was 42%, higher than for 5782 critical care patients with other viral pneumonias (non-COVID-19) (24.7%), and most COVID-19 deaths (88.7%) occurred before 30 days. Meaningful international comparisons were limited due to lack of standardised reporting.ConclusionCritical care patients with COVID-19 were disproportionately non-white, from more deprived areas and more likely to be male and obese. Conventional severity scoring appeared not to adequately reflect their acute severity, with the distribution across PaO2/FiO2 ratio categories indicating acutely severe respiratory disease. Critical care patients with COVID-19 experience high mortality and place a great burden on critical care services.

• Publisher: Springer Nature B.V
• Subject: Coronaviruses / COVID-19 / Critical care / Epidemiology / Mortality / Patients / Pneumonia / Respiratory diseases / Viral diseases