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Characteristics and outcomes of 21 critically-ill patients with Covid-19 in Washington State

Our take —

In this early study of critically ill patients in the United States, there was a sizeable need for mechanical ventilation and a high mortality rate. The sample size was small (21 patients); therefore, any trends or takeaways warrant further study.

Study design

Case Series

Study population and setting

21 critically ill patients (mean age, 70 years [range, 43-92 years], 52% males) with diagnosed SARS-CoV-2 infection admitted to the intensive care unit (ICU) of Evergreen Hospital in Kirkland, Washington between February 20, 2020 and March 5, 2020.

Summary of Main Findings

Presenting symptoms included shortness of breath (76%), fever (52%), and cough (48%). The mean time from onset of symptoms to hospital presentation was 3.5 days. Mechanical ventilation was required for 71% of patients, including all 15 patients who developed Acute Respiratory Distress Syndrome (ARDS). Other severe complications included cardiomyopathy (33% of patients) and a requirement for vasopressors to maintain adequate blood pressure (67%). Study follow-up for each patient was 5 days post admission or death. By the end of follow-up, 67% patients had died, 24% remained critically ill and 10% had been discharged from the ICU.

Study Strengths

Detailed presentation of laboratory abnormalities and imaging findings in critically ill patients.

Limitations

The study population includes a small number of patients from a single hospital during the early stages of the outbreak. Older patients in skilled nursing facilities represent a sizable proportion of the cases and may not be representative of the affected population in other contexts.

Value added

This is the first description of severely ill COVID-19 patients treated in a U.S care setting, including detailed laboratory and imaging findings.