Severity of Respiratory Failure and Outcome of Patients Needing a Ventilatory Support in the Emergency Department During Italian Novel Coronavirus SARS-CoV-2 Outbreak: Preliminary Data on the Role of Helmet CPAP and Non-Invasive Ventilation

Abstract

Background: Novel Coronavirus SARS-CoV-2 epidemic is spreading around the world. At the end of February, the outburst of the epidemic has hit hard on northern Italian’s hospitals. As of today, no data have been published regarding the severity of respiratory failure of patients presenting to the Emergency Departments. Moreover, the outcome of the patients forced to undergo Continuous Positive Airway Pressure (CPAP) devices or Non-Invasive ventilation (NIV) due to lack of Intensive Care resources is unknown. “Papa Giovanni XXIII” hospital (HPG23) of Bergamo is one of the largest hospitals in the Country, whit an Emergency Department (ED) managing over 100.000 patients per year.

Methods: This is a retrospective observational study based on chart review of patients presenting to the Emergency Department of HPG23 from 29/02/2020 to 10/03/2020 with a clinical condition highly suspicious for COVID-19 infection. Registration of admission rates, severity of respiratory failure (ARDS classification), need of respiratory support and outcome of patients treated with a ventilatory were registered on 23rd of March 2020.

Results: From 29/02 to 10/03 611 patients with a suspected diagnosis of COVID-19 infection were admitted at our ED; 320 (52%) met the criteria for hospital admission. Among those admitted to the hospital, 99 (31%) needed to be immediately started on ventilatory support (81% CPAP, 7% NIV, 12% Invasive Mechanical Ventilation). Among the patients on ventilatory support, 17% received a diagnosis of mild, 51% of moderate, and 31% of severe ARDS. Eighty-five (86%) of the 99 patients needing a ventilatory support eventually had SARS-CoV-2 infection confirmed by PCR test on nasal-pharyngeal swab. The overall mortality rate as of march, 23rd was 61,2%, ranging from 100% in patients older than 80 years to 0% in those younger than 50 years old. NIV/CPAP failure occurred in 87,1% of patients.

Conclusion: The population of patients suspected for COVID-19 infection presenting at our ED showed a very high rate of severe respiratory failure, in urgent need of outstanding intensive care resources. Mortality rates of critically ill patients are similar to previously reported studies. CPAP/NIV can help to reduce the mortality rate among patients that cannot be treated invasively by orotracheal intubation due to lack of intensive care resources.

Funding Statement: The authors reported that no funds were received for this research project.

Declaration of Interests: Roberto Cosentini reports personal fees from Fisher & Paykel, outside the submitted work None of the other authors have any interest to disclose.

Ethics Approval Statement: Study approved by the ethics committee of Bergamo on 01March 2020.