BACKGROUND AND PURPOSE:

• One of the first COVID-19 related deaths in the US was reported at Evergreen Hospital in Kirkland, Washington
  • Several more cases seen in the subsequent weeks
  • Many cases were linked to a single nursing facility
• Arentz et al. (JAMA, 2020) describe ICU experience at Evergreen Hospital

METHODS:

• Case series (patients admitted February 20 to March 5, 2020)
• Participants
  • Confirmed SARS-CoV-2 infection
  • Admitted to the ICU at Evergreen Hospital
• Study design
  • Lab testing reviewed at admission and day 5
  • Chest radiographs reviewed by an intensivist and a radiologist
  • Patient outcome data were evaluated after 5 or more days of ICU care or at the time of death

RESULTS:

• 21 cases
  • Mean age: 70 years (range 43 to 92 years)
  • 52% male
• Comorbidities: 86%
  • Most common: Chronic kidney disease and congestive heart failure
• Initial symptoms
  • Shortness of breath: 76%
  • Fever: 52%
  • Cough: 48%
• Patients presented to the hospital after a mean onset of symptoms of 3.5 days
  • 81% of patients (n=17) were admitted to the ICU <24 hours after hospital admission
• Chest radiograph
  • Abnormal: 95% (n=20) at admission
  • Common findings: Bilateral reticular nodular opacities: 52% | Ground-glass opacities: 48%
  • By 72 hours, increasing percent of patients had bilateral reticular nodular opacities (86%) and ground-glass opacities (67%)
• Labs
  • Mean white blood cell count: 9365 μL | Within normal range: 67%
  • Absolute lymphocyte count < 1000 cells/μL: 67%
  • Liver function test abnormalities: 38%
• Mechanical ventilation: Initiated in 71% of patients (n=15)
  • ARDS: 100% (15/15)
  • Severe ARDS: 53% within 72 hours (8/15)
• Majority of patients did not present with shock at admission
  • Vasopressor use: 67% during the illness
• Cardiomyopathy: Developed in 33% of patients
• Mortality rate (as of March 17): 67%
  • Those remaining critically ill: 24%
  • Discharged from the ICU: 9.5%

CONCLUSION:

• Patients in this case series had a high rate of ARDS and high risk of mortality
  • Mechanical ventilation associated with poor short-term outcomes
• Unclear if cardiomyopathy related to severe illness in general or COVID-19 in particular
• The authors stress that
  • Study may not be generalizable: Population included mostly older adults in a nursing facility

Learn More – Primary Sources:

Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State

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