Updates in Prognosis for COVID: Is it really true that 88% of patients on ventilators don’t make it?

There has been a lot of talk about a new study in JAMA on the outcomes of hospitalized patients in the New York City area.  The headline was shocking in the news: mortality for those who received mechanical ventilation was 88%.  However, lets take a little bit of a deeper dive before we use this
number when we talk to patients and family members about prognosis after
mechanical ventilation due to COVID.

If I had to sum it up the prognosis for mechanically ventilated patients in this NY study, I would say something very different: out of the
1,147 patients over the age of 18 who were mechanically
ventilated, 3% were discharged alive, 25% died, and 72% were still alive
in the hospital.  So, we really don’t know what the outcomes are as the
follow-up time for most patients still alive in the hospital was so
short (about 5 days).  We do know though that overall mortality will be somewhere
between 25% and 97%, and worse for those who are elderly (see graph below).   How does this compare with other data?

First, just a quick review of what we know so far regarding prognosis in the ICU and mechanical ventilation in COVID (read our COVID prognosis page for more info).   There are two small studies that came out early on that seems to
confirm a high mortality rate. One report out of China looking at 52 critically ill adult patients with SARS-CoV-2 pneumonia
who were admitted to the intensive care unit (ICU) found that 62% died
at 28 days, with a median duration from admission to ICU death of 7
days for non-survivors. The numbers were worse for those requiring
mechanical ventilation: 81% of patients requiring mechanical ventilation had died by
28 days.

The second was from Evergreen hospital in Washington state looking at 21 critically ill patients with COVID-19 with
a median age of 70 and who were mainly admitted from a skilled nursing facility. As of March 17, mortality was 67% and 9.5% were
discharged from the ICU.  However, 24% of patients remained critically
ill at the time of reporting, so the overall ICU mortality rate is somewhere between 67% and 91%
depending on what happened to these individuals.

We also have a much larger dataset on disposition from COVID-only Intensive Care Units (ICUs) in Lombardy Region, Italy (most of whom were mechanically ventilated, but not all) shows similar numbers.  But importantly many still remain in the ICU(orange bars in graph below) making this still very preliminary.

So, where does the new JAMA article on outcomes among 5,700 patients hospitalized with COVID-19 in the New York City area fit in?    I would say that it is in-line with what we are seeing in Italy.    Mortality is significantly worse in older adults requiring mechanical ventilation, but because most individuals are still alive in the hospital, we really don’t know what the final outcomes are yet for these individuals.

Note: for a full overview of prognosis in COVID, please check out GeriPal’s COVID prognosis page.  Also to hear our COVID podcasts and other resources, check out our COVID page.

by: Eric Widera (ewidera)