Preparedness and Reorganization of Care for COVID-19 Patients in a Swiss Intensive Care Unit: Characteristics and Outcomes of the First 120 Patients

Background: In many countries, large numbers of critically ill patients with coronavirus disease 2019 (COVID-19) are admitted to the intensive care units (ICU) within a short period of time. These patients rapidly overwhelm usual emergency care capacities and sacrificing triage before ICU admission may become necessary. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favourable outcome. Methods: In this prospective single-centred observational study, all consecutive adult patients with acute respiratory failure due to COVID-19 admitted in the intensive care unit of University Hospitals of Geneva (Geneva, Switzerland) between March 9, 2020, and April 16, 2020 were enrolled. Patients’ demographic data, comorbidities, laboratory values, treatments, and clinical outcomes are collected. Findings: Within two weeks, ICU capacity increased from 30 to 110 beds, fully equipped and staffed. Since then, surge capacity has always exceeded the number of patients hospitalized in the ICU. Among 120 patients admitted to the ICU with severe and acute hypoxemic respiratory failure, 96% required invasive mechanical ventilation. Less than six weeks after the first admission, 68 (57%) patients have been discharged alive, 36 (30%) remain hospitalized in the ICU, and 16 have died, corresponding to a mortality of 13% (95% confidence interval 8-21). 99 (83%) patients were overweight, 46 (38%) obese, and 32 (27%) had no comorbidities. Patients who died were older, with a higher SAPS II score, higher levels of D-dimers, plasma creatinine, high-sensitive troponin T, and procalcitonin, required more frequent prone sessions and longer periods of paralysis, and developed more secondary sepsis. Interpretation: A rapid increase in ICU bed capacity, including adequate equipment and staffing allowed for a large number of critically ill COVID-19 patients to be taken care of within a short period of time, translating into low mortality rate and preventing a sacrificing triage. Funding Statement: None. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The institutional ethics committee approved the study (BASEC number: 2020-00917). An informed consent was obtained either from the patient or the next-of-kin.