Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis

Abstract

Purpose: There is no clear consensus on the clinical course of critical COVID-19 patients. We examined the clinical course among intubated survivors, non-survivors, and extracorporeal membrane oxygenation (ECMO) patients to reveal the standard clinical course and the difference among critical COVID-19 patients.Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, and Scopus for original studies published until December 11, 2020, including case accumulation and clinical course reporting. Pregnant patients and children were excluded. We followed PRISMA guidelines and registered them with PROSPERO (CRD42021235534).Results: Of the 11,716 studies identified, 94 met the selection criteria, and 2,549 cases were included in this meta-analysis. The times from intubation to extubation and death were 12.07 days (95% confidence interval 9.80–14.33 days) and 10.14 days (8.18–12.10 days), respectively, and the ECMO duration was 14.72 days (10.57–18.87 days). The time from symptom onset to hospitalization (prehospitalization period) of intubated survivors, non-survivors, and ECMO patients was 6.15 (4.61–7.69 days), 6.45 (4.55–8.34 days), and 7.15 days (6.48–7.81 days), and that from symptom onset to intubation (preintubation period) was 8.58 (7.36–9.80 days), 9.14 (7.26–11.01 days), and 10.54 days (9.18–11.90 days), respectively. Sensitivity analysis showed that the time from intubation to extubation and death was longer in the US and Europe than in East Asia.Conclusion: For COVID-19, we hypothesize that prehospitalization and preintubation periods are longer in intubated non-survivors and ECMO patients than in intubated survivors. These periods may serve as a predictor of disease severity or death and support therapeutic strategy determination.

Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany

“…Supady et al reported a slightly, but significantly better survival of patients with a shorter interval from IMV to ECMO initiation with a cut-off at 7 days (46.8% vs. 43.0%) 27 . Furthermore, in a meta-analysis the pre-hospitalization and intubation periods were longer in intubated nonsurvivors and ECMO patients than in intubated survivors 28 . In our study we observed that ECMO non-survivors have a shorter interval of IMV to ECMO initiation in comparison to ECMO survivors.…”

Predictors of poor prognosis requiring intubation in COVID-19 patients admitted in Intensive Care Unit: a Congolese observational study

“…In the literature, the timing of ICU admission and intubation remains a matter of debate in severe patients (9)(10). However, we know that the natural evolution of COVID-19 can be unpredictable, even if the first week seems decisive for patients who will present critical forms.…”

“…Indeed, several studies report a very high rate of death among COVID-19 patients who have been intubated. For some authors, the delay in deciding to intubate is one of the causes that explain this excess mortality (9)(10)(11).…”

Mortality and Associated Factors in Patients with COVID-19: Cross-Sectional Study

“…The prone position can reduce the relative fraction of the pulmonary shunt by 30% compared with the supine group in patients with injured lungs [ 19 ]. A recent meta-analysis demonstrated that the prone position improved the PaO₂/FiO₂ ratio, with better SpO₂ than the supine position, in patients with COVID-19 [ 20 ]. Despite the aforementioned beneficial effects, the present study found an association between pronation and death, which may actually reflect the greater severity in patients who were pronated to improve ventilation and gas exchange.…”