Differential mortality with COVID-19 and invasive mechanical ventilation between high-income and low- and middle-income countries: a systematic review, meta-analysis, and meta-regression

Abstract

The COVID-19 pandemic has markedly affected the health care of patients in low-and middle-income countries (LMICs), but no systematic study to corroborate this effect has been undertaken. In addition, the survival outcomes of patients with COVID-19 who received invasive mechanical ventilation (IMV) have not been well established. We pooled evidence from all available studies and did a systematic review and meta-analysis to assess and compare mortality outcomes between LMICs and high-income countries (HICs). We searched MEDLINE and the University of Michigan Library according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 1, 2019, to July 15, 2021, for case-control studies, cohort studies, and brief reports that discussed mortality ratios and survival outcomes among patients with SARS-CoV-2 who received IMV. We excluded studies and case reports without comparison groups, narrative reviews, and preprints. A random-effects estimate of the arcsine square root transformation (PAS) of each outcome was generated with the DerSimonian-Laird method. Seven eligible studies, consisting of 243,835 patients with COVID-19, were SUMMARY included. We identified a significantly higher mortality rate (i.e., a larger PAS) among the patients receiving IMV in LMICs (PAS, 0.754; 95% CI, 0.569-0.900; P<.001) compared to patients in HICs (PAS, 0.588; 95% CI, 0.263-0.876; P<.001). Considerable heterogeneity was present within the individual subgroups possibly because of the extent of the included studies, which had data from specific countries and states but not from individual hospitals or health care centers. Moreover, the sample population in each study was diverse. Metaregression showed that a higher mortality rate among patients with COVID-19 who received IMV in both HICs (P<.001) and LMICs (P=.04) was associated with chronic pulmonary disease. Our study suggests that chronic pulmonary diseases and poor demographics lead to a worse prognosis among patients with CO-VID-19 who received IMV. Moreover, the survival outcome is worse in LMICs, where health care systems are usually understaffed and poorly financed.

Intensive care unit burden is associated with increased mortality in critically ill COVID‐19 patients

“…Mortality in mechanically ventilated COVID‐19 patients has been shown to vary over time and in different regions, 5 , 41 suggesting different viral strains and health care burden as possible determining factors. A vast majority of patients in this study had P/F ratios below 13 kPa on ICU admission, corresponding to severe acute respiratory distress syndrome (ARDS) in mechanically ventilated patients.…”

High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials

“…Of the remaining 34 studies, 26 studies were excluded after full review, leaving eight studies. Among the studies excluded after full-text review, 19 were not RCTs, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 two were conference abstracts, 27 , 28 and five did not meet inclusion criteria. 29 , 30 , 31 , 32 , 33 The Helmet-COVID RCT, comparing helmet-NIV vs usual respiratory support did not meet inclusion criteria because it included facemask-NIV as part of usual respiratory support.…”