Emory success of COVID-19 ventilator patients brings lesson: Prepare

This spring, more than 200 patients sick with COVID-19 went into Intensive Care Units at three Emory Healthcare hospitals. Of those, 165 were so ill they needed machines to help them breathe.

But those patients who went on ventilators did better than might have been expected, based on the experience of other hospitals in the coronavirus epidemic, Emory doctors said. Their newly published study may have important lessons on preparedness not just for doctors but for government leaders as well.

“I think we were really gratified to see that, even for patients who become very ill with COVID-19, a ventilator is often a lifesaving intervention and shouldn’t be considered a death sentence,” said Dr. Sara Auld, lead author of the study.

Ventilators have gained public attention in the pandemic as a crucial tool, but one with risks. Patients who need them are already seriously ill, and many do not survive. In addition, being on a ventilator for a long time can result in damage to some patients’ lungs.

The Emory researchers pointed to death rates of 50% to 97% in ventilated patients in Washington State, Great Britain and Wuhan, China. But in Emory’s study well over half of its patients on ventilators survived, with a mortality rate of just 35.7%.

There wasn’t a detailed enough analysis for the authors to draw definite conclusions on why. But they say one thing proved helpful: They were able to get ready.

Georgia’s pandemic surge came weeks later than Wuhan’s or Washington’s, and hospitals and citizens had begun to take protective measures. That meant Emory had time to create quality space for COVID-19 patients, clearing out other cases. COVID-19 patients got real ICU beds, fully staffed and experienced critical care teams, and enough equipment and drugs for any patient who needed them.

“I don’t necessarily think there was any magic to the relative success we observed,” Auld said. “It’s a success story for public health and system preparedness and having the capacity to take care of every patient that needed ICU level care in a standard ICU.”

Emory has a policy of ventilating patients who need it earlier rather than later. Still Auld said there was no indication the ventilated patients in the study were less sick to begin with than ventilated patients in the other studies. They had levels of organ function and failure similar to, or worse than, the others.

The study was vetted by the peer review process prior to publication, Auld said.

Dr. Craig Coopersmith, director of Emory University’s Critical Care Center, said that the ratios of patients to doctors, nurses and respiratory therapists were the same during the coronavirus surge as before it. That meant the people best trained for those jobs were doing those jobs. And that also meant that specialists could come in to consult on related complications of those patients, because they weren’t swamped elsewhere in the hospital.

“I’m confident that preparedness made a difference here, in more than one way,” Coopersmith said.

“Two of three patients, even on a ventilator, survived. A significant majority of patients left the hospital alive. Even if they were on the breathing machine for over a week. Not minimizing the human tragedy of this — which is enormous and frankly incomprehensible — but at the same time, the majority of the individuals who we took care of went home to their husbands and wives and parents and children.”

The study raised other points of interest that the authors hope to address more deeply. Contrary to what has been seen elsewhere, its morbidly obese patients did better than the others. Black patients made up 70% of the critically ill coronavirus patients, but their mortality rates were the same, the authors said. The study did not say which three hospitals it chose.