Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 28, 2021; 9(1): 64-73
Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.64
Mortality of critical care interventions in the COVID-19: A systematic review
Joshua Davis, Rebecca Leff, Anuj Patel, Sriram Venkatesan
Joshua Davis, Department of Emergency Medicine, Vituity, Wichita, KS 67214, United States
Rebecca Leff, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8414501, Israel
Anuj Patel, College of Osteopathic Medicine, University of New England, Biddeford, ME 04005, United States
Sriram Venkatesan, College of Medicine, Sri Ramachandra Medical College and Research Institute, Chennai 600116, India
Author contributions: Davis J conceived and designed the project, initiated the search, assisted in data analysis, drafted the manuscript, and made critical revisions for content to the manuscript; Leff R, Patel A and Venkatesan S assisted in data collection, data analysis, and made critical revisions for content to the manuscript; and all authors have given final approval for the manuscript to be published and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: To the best of our knowledge, the authors have no conflicts of interest, financial or other, to declare regarding this manuscript.
PRISMA 2009 Checklist statement: The analysis presented was conducted in alignment with PRISMA 2009 guidelines and a copy of the checklist is available from the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joshua Davis, MD, Attending Doctor, Department of Emergency Medicine, Vituity, 929 N. St. Francis Avenue, Wichita, KS 67214, United States. jjvwd@udel.edu
Received: January 20, 2021
Peer-review started: January 20, 2021
First decision: February 14, 2021
Revised: February 16, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: February 28, 2021
Abstract
BACKGROUND

The novel coronavirus severe acute respiratory syndrome coronavirus 2 is associated with a severe disease known as coronavirus disease 2019 (COVID-19). A small percentage of patients with COVID-19 will require intensive care and possibly mechanical ventilation. The mortality of intensive care interventions in patients with COVID-19 remains unclear.

AIM

To identify mortality rate of COVID-19 patients receiving different interventions in the critical care unit.

METHODS

We searched OVID Medline, SCOPUS, MedRxIv, preprints.org, and Centers for Disease Control databases from November 2019 to April 10, 2020 for articles on COVID-19. Teams of 2 independent reviewers reviewed titles and abstract for studies that reported mortality of human adults with COVID-19 and exposure to a critical care intervention [Intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation, or cardiopulmonary resuscitation (CPR)]. We used a descriptive analysis and unweighted averages of mortality across studies.

RESULTS

Our search identified 6973 articles and 20 met inclusion: 17 for intensive care, 13 for mechanical ventilation, 5 for hemodialysis, 2 for extracorporeal membrane oxygenation, and 1 for CPR. Mortality associated with intensive care admission ranged from 9%-83%, with overall mortality 32.5% (95%CI: 32.4%-32.6%). Mortality associated with intubation from 16.7%-100% with overall mortality 64.0% (95%CI: 62.4%-65.5%). In patients requiring hemodialysis, mortality ranged from 0%-100%, with average mortality 75.3% (95%CI: 72.6%-77.4%).

CONCLUSION

Patients with COVID-19 requiring intensive care have high mortality rates. Authorities can use this data to establish pharmacoeconomic studies to make decisions about allocation of scarce resources if necessary.

Keywords: Coronavirus, SARS-CoV-2, COVID-19, Mortality, Systematic review, Critical care

Core Tip: This systematic review identifies the mortality associated with critical care interventions in patients with novel coronavirus disease 2019. These include intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation, or cardiopulmonary resuscitation. Average mortality for intensive care admission was 32.5%. While mortality is high, this is lower than initially described in early reports of the pandemic. Physicians can hopefully use this data to inform decisions about goals of care or, if necessary, allocation of scarce resources.