Jane Hayes, MPH
Washington University School of Medicine
Saint Louis, MO
Disclosure information not submitted.
Michael Frakes, APRN, FCCM
Chief Quality Officer and Director of Clinical Care
Boston MedFlight, United States
Disclosure information not submitted.
Jeremy Richards, MD
Assistant Professor
Beth Israel Deaconess Medical Center, United States
Disclosure information not submitted.
Michael Cocchi, MD
Assistant Professor
Beth Israel Deaconess Medical Center BIDMC, United States
Disclosure information not submitted.
Ari Cohen, MD
Assistant Professor
Massachusetts General Hospital, United States
Disclosure information not submitted.
Jason Cohen, DO, FCCM
Chief Medical Officer
Brigham and Women’s Hospital; Boston MedFlight, United States
Disclosure information not submitted.
James Dargin, MD, FCCM
Assistant Clinical Professor
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Franklin Friedman, MD
Assistant Professor
Tufts Medical Center, United States
Disclosure information not submitted.
.jpg "Susan Wilcox, MD, FCCM photo")
Susan Wilcox, MD, FCCM
Associate Professor
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Title: Association Between Days at Referring Hospital and Mortality in Patients Transferred with COVID-19
INTRODUCTION/HYPOTHESIS:
Prior studies have shown that transporting critically ill patients, especially those with severe acute hypoxemic respiratory failure to ECMO centers, is associated with improved outcomes. While critical care transport is associated with adverse events, prior work has shown improved outcomes when patients with COVID-19 are transported to ECMO centers. We hypothesized that rapid transfer of intubated patients with COVID-19 to ECMO centers would be associated with lower mortality.
Methods:
We performed a retrospective review of patients with suspected or confirmed COVID-19 who were transferred from sending hospitals to ECMO centers in Boston between March 1st and September 9th, 2020. Data were analyzed using descriptive statistics and simple logistic regression.
Results:
Of 590 charts identified for transported patients, 318 patients were confirmed to be COVID-19 positive. The mean age was 59 years (±14.8), 64.5% (n=205) were male, 89.6% (n=285) were transferred from the ICU, and 7.9% (n=25) received ECMO at the receiving facility. The mortality rate for the cohort was 31.8% (n=101). The mortality rate for those who received ECMO was 68%. The median number of days admitted before transfer was 3 (IQR 1-7, range 0-36) days, and the median number of days intubated before transfer was 1 (IQR 0-4, range 0-24) day. There was no observed relationship between the number of days intubated at the sending facility nor the total number of days admitted at the sending facility and mortality (p=0.65 and p=0.68, respectively). There was also no observed relationship between the number of days intubated at the sending facility nor the total number of days admitted at the sending facility and the use of ECMO at the receiving facility (p=0.34 and p=0.11, respectively). However, no patient who received ECMO was intubated for more than 7 days.
Conclusions:
Patients transferred with COVID-19 to ECMO centers had a mortality rate of 31.8%. Although the number of days before transfer ranged widely, neither the number of days intubated, nor the total number of days admitted at the sending facility were associated with mortality or the use of ECMO at the receiving institution.