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

IMPORTANCE:. Studying interhospital transfer of critically ill patients with coronavirus disease 2019 pneumonia in the spring 2020 surge may help inform future pandemic management. OBJECTIVES:. To compare outcomes for mechanically ventilated patients with coronavirus disease 2019 transferred to a te...

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Autores principales:	Elaine Chen, MD, FCCP, Joshua Longcoy, MPH, Samuel K. McGowan, MD, Brittney S. Lange-Maia, PhD, MPH, Elizabeth F. Avery, MSPH, Elizabeth B. Lynch, PhD, David A. Ansell, MD, MPH, Tricia J. Johnson, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/6275c285e77e4470882ada07a409a779
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spelling	oai:doaj.org-article:6275c285e77e4470882ada07a409a7792021-11-25T07:56:43ZInterhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation2639-802810.1097/CCE.0000000000000559https://doaj.org/article/6275c285e77e4470882ada07a409a7792021-10-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000559https://doaj.org/toc/2639-8028IMPORTANCE:. Studying interhospital transfer of critically ill patients with coronavirus disease 2019 pneumonia in the spring 2020 surge may help inform future pandemic management. OBJECTIVES:. To compare outcomes for mechanically ventilated patients with coronavirus disease 2019 transferred to a tertiary referral center with increased surge capacity with patients admitted from the emergency department. DESIGN, SETTING, PARTICIPANTS:. Observational cohort study of single center urban academic medical center ICUs. All patients admitted and discharged with coronavirus disease 2019 pneumonia who received invasive ventilation between March 17, 2020, and October 14, 2020. MAIN OUTCOME AND MEASURES:. Demographic and clinical variables were obtained from the electronic medical record. Patients were classified as emergency department admits or interhospital transfers. Regression models tested the association between transfer status and survival, adjusting for demographics and presentation severity. RESULTS:. In total, 298 patients with coronavirus disease 2019 pneumonia were admitted to the ICU and received mechanical ventilation. Of these, 117 were transferred from another facility and 181 were admitted through the emergency department. Patients were primarily male (64%) and Black (38%) or Hispanic (45%). Transfer patients differed from emergency department admits in having English as a preferred language (71% vs 56%; p = 0.008) and younger age (median 57 vs 61 yr; p < 0.001). There were no differences in race/ethnicity or primary payor. Transfers were more likely to receive extracorporeal membrane oxygenation (12% vs 3%; p = 0.004). Overall, 50 (43%) transferred patients and 78 (43%) emergency department admits died prior to discharge. There was no significant difference in hospital mortality or days from intubation to discharge between the two groups. CONCLUSIONS AND RELEVANCE:. In a single-center retrospective cohort, no significant differences in hospital mortality or length of stay between interhospital transfers and emergency department admits were found. While more study is needed, this suggests that interhospital transfer of critically ill patients with coronavirus disease 2019 can be done safely and effectively.Elaine Chen, MD, FCCPJoshua Longcoy, MPHSamuel K. McGowan, MDBrittney S. Lange-Maia, PhD, MPHElizabeth F. Avery, MSPHElizabeth B. Lynch, PhDDavid A. Ansell, MD, MPHTricia J. Johnson, PhDWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 10, p e0559 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Elaine Chen, MD, FCCP Joshua Longcoy, MPH Samuel K. McGowan, MD Brittney S. Lange-Maia, PhD, MPH Elizabeth F. Avery, MSPH Elizabeth B. Lynch, PhD David A. Ansell, MD, MPH Tricia J. Johnson, PhD Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
description	IMPORTANCE:. Studying interhospital transfer of critically ill patients with coronavirus disease 2019 pneumonia in the spring 2020 surge may help inform future pandemic management. OBJECTIVES:. To compare outcomes for mechanically ventilated patients with coronavirus disease 2019 transferred to a tertiary referral center with increased surge capacity with patients admitted from the emergency department. DESIGN, SETTING, PARTICIPANTS:. Observational cohort study of single center urban academic medical center ICUs. All patients admitted and discharged with coronavirus disease 2019 pneumonia who received invasive ventilation between March 17, 2020, and October 14, 2020. MAIN OUTCOME AND MEASURES:. Demographic and clinical variables were obtained from the electronic medical record. Patients were classified as emergency department admits or interhospital transfers. Regression models tested the association between transfer status and survival, adjusting for demographics and presentation severity. RESULTS:. In total, 298 patients with coronavirus disease 2019 pneumonia were admitted to the ICU and received mechanical ventilation. Of these, 117 were transferred from another facility and 181 were admitted through the emergency department. Patients were primarily male (64%) and Black (38%) or Hispanic (45%). Transfer patients differed from emergency department admits in having English as a preferred language (71% vs 56%; p = 0.008) and younger age (median 57 vs 61 yr; p < 0.001). There were no differences in race/ethnicity or primary payor. Transfers were more likely to receive extracorporeal membrane oxygenation (12% vs 3%; p = 0.004). Overall, 50 (43%) transferred patients and 78 (43%) emergency department admits died prior to discharge. There was no significant difference in hospital mortality or days from intubation to discharge between the two groups. CONCLUSIONS AND RELEVANCE:. In a single-center retrospective cohort, no significant differences in hospital mortality or length of stay between interhospital transfers and emergency department admits were found. While more study is needed, this suggests that interhospital transfer of critically ill patients with coronavirus disease 2019 can be done safely and effectively.
format	article
author	Elaine Chen, MD, FCCP Joshua Longcoy, MPH Samuel K. McGowan, MD Brittney S. Lange-Maia, PhD, MPH Elizabeth F. Avery, MSPH Elizabeth B. Lynch, PhD David A. Ansell, MD, MPH Tricia J. Johnson, PhD
author_facet	Elaine Chen, MD, FCCP Joshua Longcoy, MPH Samuel K. McGowan, MD Brittney S. Lange-Maia, PhD, MPH Elizabeth F. Avery, MSPH Elizabeth B. Lynch, PhD David A. Ansell, MD, MPH Tricia J. Johnson, PhD
author_sort	Elaine Chen, MD, FCCP
title	Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
title_short	Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
title_full	Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
title_fullStr	Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
title_full_unstemmed	Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation
title_sort	interhospital transfer outcomes for critically ill patients with coronavirus disease 2019 requiring mechanical ventilation
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/6275c285e77e4470882ada07a409a779
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Interhospital Transfer Outcomes for Critically Ill Patients With Coronavirus Disease 2019 Requiring Mechanical Ventilation

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