Written by Physician’s Weekly Blogger, Skeptical Scalpel

Although at the time I wrote this over 33,000 people had died from COVID 19 infections worldwide, the numbers of patients dying in intensive care units and on mechanical ventilation is unknown.

We have some early published data on percentages which vary widely. A paper from China involved 710 Covid-19 patients; 52 were admitted to an ICU. Of the 22 who eventually required mechanical ventilation, 19 (86%) died. Another early study reported 31 of 32 (97%) mechanically ventilated patients died.

Medical ventilators awaiting use

I posed the following question on Twitter: “What is the mortality rate for [COVID-19] patients who require mechanical ventilation?” and received answers ranging from 25% to 70% from people who have personal knowledge of outcomes in their hospitals.

Probably the best published information we have so far is from the Intensive Care National Audit and Research Center (ICNARC) in the UK. Of 165 patients admitted to ICUs, 79 (48%) died. Of the 98 patients who received advanced respiratory support—defined as invasive ventilation, BPAP or CPAP via endotracheal tube, or tracheostomy, or extracorporeal respiratory support—66% died.

Compare that to the 36% mortality rate of non-COVID patients receiving advanced respiratory support reported to ICNARC from 2017 to 2019.

An article in The Guardian said this about the ICNARC study, “The high death rate raises questions about how effective critical care will be in saving the lives of people struck down by the disease.”

We know nothing about the survival rate of COVID-19 patients who have undergone cardiopulmonary resuscitation.

Why do we need to know the mortality rate of patients who are on mechanical ventilation or suffer cardiac arrest?

If the number of critically ill patients exceeds the current supply of intensive care beds and ventilators as occurred in Italy, it would help intensivists to triage. And if CPR is ineffective in these patients, we should not be subjecting caregivers to the risks involved in resuscitation.

The possible need for ventilator triage is no longer theoretical, and the ethical issues are being discussed by hospital committees and others. For an in-depth look at the problem, I recommend this article from Undark, a non-profit digital magazine. If we run out of ventilators, “American medical teams, too, will soon face the hardest possible decisions over who lives, and who dies, when not everyone can be treated.”

Hospitals need to have policies in place before that crisis occurs.

Thanks to everyone on Twitter who contributed to the discussion. Stay safe.

Skeptical Scalpel is a retired surgeon and was a surgical department chair and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times.For the last 9 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,700,000 page views, and he has over 21,000 followers on Twitter.

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