• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
COVID-19 Clinical Outcomes

Washington State’s First COVID-19 Cases: Outcomes and Characteristics of 21 Critically Ill Patients

image_pdfFavoriteLoadingFavorite

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

Get COVID-19 Research Summaries Direct to Your Phone, with ObGFirst

Try it Free »

image_pdfFavoriteLoadingFavorite
< Previous
All COVID-19 Clinical Outcomes Posts
Next >

Related ObG Topics:

Coronavirus and COVID-19: Clinical Characteristics from 138 Patients in Wuhan, China
MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 
COVID-19 Case Series: Pregnancy and Infant Outcomes

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site