Organizational characteristics: Effect on outcome of ICU COVID-19 patients in Belgium

Patel, Jigar; Janapala, Rajesh Naidu; Belfaqeeh, Omar; Alhashmi, Abdulla; Pourmand, Ali

doi:10.1016/j.lanepe.2021.100062

Cited by 3 publications

(2 citation statements)

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“…Despite numerous studies among countries on the organization of Intensive Care Medicine during the COVID-19 pandemic were published (3-10), healthcare systems could not be compared directly based on their results. Our study underscores previous evidence that regional population variation might be unnoticed when evaluating data on a national level only (25,(40)(41)(42), whereas drivers of regional variation affect the risk and outcome of patients, independent of age, sex, disease severity, comorbidities, critical care support strategies, therapies, and complications (43)(44)(45). The differences observed in our cohort foster discussion about admission criteria and the interpretation of available evidence as resembled in the differences in organ support therapy.…”

Section: Discussionsupporting

confidence: 85%

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study*

Mesotten

Meijs

Bussel

et al. 2021

Critical Care Medicine

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OBJECTIVES: To investigate healthcare system–driven variation in general characteristics, interventions, and outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU within one Western European region across three countries. DESIGN: Multicenter observational cohort study. SETTING: Seven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany. PATIENTS: Consecutive COVID-19 patients supported in the ICU during the first pandemic wave. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline demographic and clinical characteristics, laboratory values, and outcome data were retrieved after ethical approval and data-sharing agreements. Descriptive statistics were performed to investigate country-related practice variation. From March 2, 2020, to August 12, 2020, 551 patients were admitted. Mean age was 65.4 ± 11.2 years, and 29% were female. At admission, Acute Physiology and Chronic Health Evaluation II scores were 15.0 ± 5.5, 16.8 ± 5.5, and 15.8 ± 5.3 ( p = 0.002), and Sequential Organ Failure Assessment scores were 4.4 ± 2.7, 7.4 ± 2.2, and 7.7 ± 3.2 ( p < 0.001) in the Belgian, Dutch, and German parts of Euregio, respectively. The ICU mortality rate was 22%, 42%, and 44%, respectively ( p < 0.001). Large differences were observed in the frequency of organ support, antimicrobial/inflammatory therapy application, and ICU capacity. Mixed-multivariable logistic regression analyses showed that differences in ICU mortality were independent of age, sex, disease severity, comorbidities, support strategies, therapies, and complications. CONCLUSIONS: COVID-19 patients admitted to ICUs within one region, the Euregio Meuse-Rhine, differed significantly in general characteristics, applied interventions, and outcomes despite presumed genetic and socioeconomic background, admission diagnosis, access to international literature, and data collection are similar. Variances in healthcare systems’ organization, particularly ICU capacity and admission criteria, combined with a rapidly spreading pandemic might be important drivers for the observed differences. Heterogeneity between patient groups but also healthcare systems should be presumed to interfere with outcomes in coronavirus disease 2019.

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Section: Discussionsupporting

confidence: 85%

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study*

Mesotten

Meijs

Bussel

et al. 2021

Critical Care Medicine

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“…We thank Patel et al [1]. for the interest in our work describing the role of organizational issues on the outcome of critically ill COVID-19 patients admitted to Intensive Care Units (ICU) in Belgium [2].…”

mentioning

confidence: 99%

Organizational characteristics: Effect on outcome of ICU COVID-19 patients in Belgium – Authors' reply

Taccone¹,

Goethem²,

Pauw³

et al. 2021

The Lancet Regional Health - Europe

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Cardiac arrest and coronavirus disease 2019

Baldi

Cortegiani

Savastano

2022

Current Opinion in Critical Care

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Purpose of reviewThe impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). Recent findingsAn increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SummaryCardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.

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Organizational characteristics: Effect on outcome of ICU COVID-19 patients in Belgium

Cited by 3 publications

References 1 publication

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study*

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study*

Organizational characteristics: Effect on outcome of ICU COVID-19 patients in Belgium – Authors' reply

Cardiac arrest and coronavirus disease 2019

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