Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation

Chen, Elaine; Longcoy, Joshua; McGowan, Samuel; Lange‐Maia, Brittney S.; Avery, Elizabeth; Lynch, Elizabeth B.; Ansell, David; Johnson, Tricia J.

doi:10.1097/cce.0000000000000559

Cited by 13 publications

(25 citation statements)

References 35 publications

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“…A case series of six COVID‐19 patients with severe ARDS whose lungs were mechanically ventilated and were evacuated via amphibious assault ship, reported no significant change in P/F ratio post‐transfer [17]. Data from the USA also confirmed that inter‐hospital evacuation of COVID‐19 patients whose lungs were mechanically ventilated did not increase mortality [18]. Previous data in transfer of non‐COVID ARDS patients are, similarly, sparse.…”

Section: Discussionmentioning

confidence: 99%

Patient outcomes following transfer between intensive care units during the COVID‐19 pandemic

et al. 2022

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Summary Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID‐19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID‐19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID‐19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter‐hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra‐hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty‐five patients underwent inter‐hospital transfers compared with 92 intra‐hospital transfers. There was no significant change in median compliance 6 h pre‐transfer, immediately post‐transfer and 24 h post‐transfer in patients who underwent either intra‐hospital or inter‐hospital transfers. For inter‐hospital transfers, there was an initial drop in median PaO2/FIO2 ratio: from median (IQR [range]) 25.1 (17.8–33.7 [12.1–78.0]) kPa 6 h pre‐transfer to 19.5 (14.6–28.9 [9.8–52.0]) kPa immediately post‐transfer (p < 0.05). However, this had resolved at 24 h post‐transfer: 25.4 (16.2–32.9 [9.4–51.9]) kPa. For intra‐hospital transfers, there was no significant change in PaO2/FIO2 ratio. We also found no meaningful difference in pH; PaCO2;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID‐19 undergoing mechanical ventilation of the lungs may have short‐term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID‐19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Patient outcomes following transfer between intensive care units during the COVID‐19 pandemic

et al. 2022

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“…Australians critically unwell with COVID‐19 were transferred between hospitals at different stages of the pandemic, typically to provide access to higher level care, because clinical demand was unevenly distributed, or particular hospitals were under strain. The impact of inter‐hospital transfer on clinical outcomes for people with COVID‐19 has been examined overseas; 3‐6 in France, for example, inter‐hospital transfer was associated with a lower risk‐adjusted probability of dying in hospital 4,5 . Investigating its impact in Australia is particularly important, given the critical role played by inter‐hospital transfers in the health care system.…”

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confidence: 99%

Inter‐hospital transfer and clinical outcomes for people with COVID‐19 admitted to intensive care units in Australia: an observational cohort study

Cini

Neto

Burrell

et al. 2023

Medical Journal of Australia

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Objectives To examine the association between inter‐hospital transfer and in‐hospital mortality among people with coronavirus disease 2019 (COVID‐19) admitted to intensive care units (ICUs) in Australia. Design Retrospective cohort study; analysis of data collected for the Short Period Incidence Study of Severe Acute Respiratory Illness (SPRINT‐SARI) Australia study. Setting, participants People with COVID‐19 admitted to 63 ICUs, 1 January 2020 – 1 April 2022. Main outcome measures Primary outcome: in‐hospital mortality; secondary outcomes: ICU and hospital lengths of stay and frequency of selected complications. Results Of 5207 people with records in the SPRINT‐SARI Australia database at 1 April 2022, 328 (6.3%) had been transferred between hospitals, 305 (93%) during the third pandemic wave. Compared with patients not transferred, their median age was lower (53 years; interquartile range [IQR], 45–61 years v 60 years; IQR, 46–70 years), their median body mass index higher (32.5 [IQR, 27.2–39.0] kg/m2 v 30.1 [IQR, 25.7–35.7] kg/m2), and fewer had received a COVID‐19 vaccine (22% v 44.9%); their median APACHE II scores were similar (14.0; IQR, 12.0–18.0 v 14.0; IQR, 10.0–19.0). Bacterial pneumonia (64.7% v 29.0%) and bacteraemia (27% v 8%) were more frequent in transferred patients, as was the need for more intensive ICU interventions, including invasive mechanical ventilation (71.2% v 38.1%) and extra‐corporeal membrane oxygenation (26% v 1.7%). Crude ICU (19% v 14.9%) and in‐hospital mortality (19% v 18.4%) were similar for patients who were or were not transferred; median lengths of ICU (20.0 [IQR, 11.2–40.3] days v 4.6 [IQR, 2.1–10.1] days) and hospital stay (29.7 [IQR, 18.1–49.6] days v 12.3 [IQR, 7.3–21.0] days) were longer for transferred patients. In the multivariable regression analysis, in‐hospital mortality risk was lower for transferred patients (risk difference [RD], –5.0 percentage points; 95% confidence interval [CI] –10 to –0.03 percentage points), but not in the propensity score‐adjusted analysis (RD, –3.4 [95% CI, –8.9 to 2.1] percentage points). Conclusions Among people with COVID‐19 admitted to ICUs, patients transferred from another hospital required more intense interventions and remained in hospital longer, but were not at greater risk of dying in hospital than the patients who were not transferred.

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“…As the authors notice, the main result is somewhat surprising as higher mortality has not been reported in recent literature [ 2 , 3 ]. Reasons could be explained as follow: first, the authors specify that 20% of capacity transfers occurred at night, involving severe critically ill patients with acute lung injury, sepsis, and cardiogenic shock.…”

mentioning

confidence: 85%

“…Assuming that interhospital transfers are unsafe and choosing a strategy of implementation of new ICU beds to face surge of critically ill patients could lead to a higher mortality [ 7 ]. During the first months of the COVID-19 crisis, countries planned and organized large-scale interhospital transfers either for clinical or capacity reasons and demonstrated that transferred patients did not have a higher mortality rate [ 2 , 3 , 8 ]. However, we agree with the authors and acknowledge that “understanding the impact of ICU-to-ICU transfer on patient outcome is complex and must consider a couple of important aspects” such as identifying appropriate control patients.…”

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confidence: 99%

Intensive care unit-to-unit capacity transfers are associated with increased mortality: no hasty conclusions in the event of a crisis

Painvin

Ehrmann

Thille

et al. 2022

Ann. Intensive Care

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Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation

Abstract: Supplemental Digital Content is available in the text.

Cited by 13 publications

References 35 publications

Patient outcomes following transfer between intensive care units during the COVID‐19 pandemic

Patient outcomes following transfer between intensive care units during the COVID‐19 pandemic

Inter‐hospital transfer and clinical outcomes for people with COVID‐19 admitted to intensive care units in Australia: an observational cohort study

Intensive care unit-to-unit capacity transfers are associated with increased mortality: no hasty conclusions in the event of a crisis

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