If the patient isn’t already on a mechanical ventilator when the “code blue” is called, he’s likely to be intubated during cardiopulmonary resuscitation. Is that reasonable for a COVID-19 patient?
SkepticalScalpel (a retired surgeon) is wondering the same as I:
What’s the survival rate of COVID-19 patients admitted to an ICU and given mechanical ventilation?
From Physician’s Weekly:
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.
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 [apparent COVID-19 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.
***
We know nothing about the survival rate of COVID-19 patients who have undergone cardiopulmonary resuscitation.
Regarding that last sentence: Cardiopulmonary resuscitation probably puts lots of viruses into the air, likely increasing the risk of infection transmission to healthcare providers. So if CPR is futile, let’s not do it. Believe it or not, most healthcare providers did not sign up for a high risk of death when they leave for work in the morning.
Source: Mortality rate of COVID-19 patients on ventilators | Physician’s Weekly
Steve Parker, M.D.
PS: Contrary to what you may hear from the mainstream media, most experienced intensivists and hospitalists are comfortable deciding whether cardiopulmonary resuscitation is worthwhile or not. I fully expect that once a COVID-19 patient is on a ventilator and in intractable shock (hypotension), DNR status (do not resuscitate) is recommended to the responsible party. It’s over when the cardiac arrest finally comes.
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