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. 2020 Nov 30;5(1):e000557.
doi: 10.1136/tsaco-2020-000557. eCollection 2020.

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

Rachel Leah Choron  1 , Christopher A Butts  1 , Christopher Bargoud  2 , Nicole Krumrei  1 , Amanda L Teichman  1 , Mary Schroeder  1   3 , Michelle T Bover Manderski  4 , Jennifer To  1 , Salvatore M Moffa  5 , Michael B Rodricks  1 , Matthew Lissauer  1 , Rajan Gupta  1
Affiliations

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

Rachel Leah Choron et al. Trauma Surg Acute Care Open. .

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.

Keywords: adult; critical illness; intensive care units; mortality; respiratory distress syndrome.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Survival of critically ill patients with COVID-19 in an acute care surgery intensive care unit (ICU).
See this image and copyright information in PMC

References

    1. WHO WHO Director-General’s opening remarks at the media briefing on COVID-19: 11 March 2020. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (1 Jul 2020).
    1. Coronavirus COVID-19 global cases The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.jhu.edu/map.html (Accessed July 1, 2020).
    1. New Jersey COVID-19 Dashboard The State of New Jersey department of Health. https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml (Accessed July 1, 2020).
    1. Centers for Disease Control and Prevention Coronavirus disease 2019 (COVID-19): cases in US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html (Accessed July 1, 2020).
    1. Yu Y, Xu D, Fu S, Zhang J, Yang X, Xu L, Xu J, Wu Y, Huang C, Ouyang Y, et al. . Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Crit Care 2020;24:219. 10.1186/s13054-020-02939-x - DOI - PMC - PubMed