Surgeons in surge — the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists. Issue 1 (30th November 2020)

• Record Type: Journal Article
• Authors: Choron, Rachel Leah; Butts, Christopher A; Bargoud, Christopher; Krumrei, Nicole; Teichman, Amanda L; Schroeder, Mary; Bover Manderski, Michelle T; To, Jennifer; Moffa, Salvatore M; Rodricks, Michael B; Lissauer, Matthew; Gupta, Rajan
• Is Part Of: Trauma surgery & acute care open. Volume 5:Issue 1(2020)
• Publication Date: 2020-11-30
• Subjects: critical illness -- intensive care units -- mortality -- respiratory distress syndrome -- adult; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2020-000557
• Languages: English
• ISSNs: 2397-5776

Abstract

Abstract : Background: Reported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division. Methods: This was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded. Results: One hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients. Conclusions: This is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis. Level of evidence: Level V.