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
Processing time: 41 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

The novel coronavirus disease 2019 (COVID-19) has ravaged humans across the globe. Mortality is high, especially in the most critically ill patients. Due to the pandemic nature of the virus, some locations have been forced to ration resources.

Research motivation

Critical care is, by nature, highly resource intensive. With limited resources and an overwhelming number of critically ill patients in some communities, discussions about rationing limited resources have begun. Fundamental to these discussions is understanding the probability of survival of the most intensive interventions.

Research objectives

Our objective was to identify, via systematic review, the mortality rate of COVID-19 patients receiving different interventions in the critical care unit, namely intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation, or cardiopulmonary resuscitation.

Research methods

We conducted a systematic review of several databases using accepted systematic review methods to identify the mortality rate of COVID-19 patients receiving intensive care admission, mechanical ventilation, acute hemodialysis, extracorporeal membrane oxygenation (ECMO), or cardiopulmonary resuscitation (CPR). Studies included were observational.

Research results

Our search identified 20 studies overall. Mortality associated with intensive care admission averaged 32.5%. Mortality associated with intubation averaged 64.0%. In patients requiring hemodialysis, mortality averaged 75.3%. There were limited studies on ECMO and CPR. The one study on CPR showed only 0.7% (1/136) had a good neurologic outcome.

Research conclusions

Mortality among COVID-19 patients requiring intensive care is high, though not as high as initially reported. This information can be used to guide goals of care of individual patients and system level discussion about rationing scarce resources when locales are overwhelmed.

Research perspectives

Critical care does have a high, but certainly not universal, mortality rate. Further research should identify individual risk factors for poor outcome among patients requiring critical care. CPR, though, appears to have low chance of survival. The decision to perform CPR on critically ill patients should be very carefully considered.