Abstract
Background Guidance in the management of COVID-19 respiratory failure has favoured early intubation, with concerns over the use of CPAP. We adopted early CPAP and self-proning, and evaluated the safety and efficacy of this approach.
Methods This retrospective observational study included all patients with a positive COVID-19 PCR, and negative patients with high clinical suspicion. Our protocol advised early CPAP and self-proning for severe cases, aiming to prevent rather than respond to deterioration. CPAP was provided outside ICU by ward staff supported by physiotherapists and an intensive critical care outreach program. Data were analysed descriptively and compared against a large UK cohort (ISARIC).
Results 559 patients admitted before 1/May/20 were included. 365 were discharged alive, 182 died, and 12 remain inpatient. 165 patients (29.5%) received CPAP, 40 (7.2%) were admitted to ICU and 27 (4.8%) were ventilated. Hospital mortality was 33.3%, ICU mortality 54.5%. Following CPAP 64% of patients with moderate or severe ARDS, who were candidates for escalation, avoided intubation. Figures for ICU admission, intubation and hospital mortality are lower than those from ISARIC, whilst ICU mortality is similar. Following ISARIC proportions we would have admitted 92 patients to ICU and intubated 55. Using the described protocol, we intubated 27 patients from 40 admissions, and remained within our expanded ICU capacity.
Conclusion Bradford’s protocol produced good results despite our population having high levels of co-morbidity and ethnicities associated with poor outcomes. In particular we avoided overloading ICU capacity. We advocate this approach as both effective and safe.
Social media summary The use of early CPAP and proning in COVID-19 was associated with lower ICU admissions, intubation, and mortality at Bradford compared to a large UK cohort (ISARIC WHO CCP-UK).
Competing Interest Statement
TL is involved in the development of an open source CPAP device for use in low-income countries under an EPSRC grant (no funding received). RJ reports grants from Abbott Electro-physiology Research Fund, outside the submitted work. KW, AC, LM, MM, EN have nothing to disclose.
Funding Statement
No funding
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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
NHS Health Research Authority & Bradford Teaching Hospitals Director of Research
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Paper in collection COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv
The Chan Zuckerberg Initiative, Cold Spring Harbor Laboratory, the Sergey Brin Family Foundation, California Institute of Technology, Centre National de la Recherche Scientifique, Fred Hutchinson Cancer Center, Imperial College London, Massachusetts Institute of Technology, Stanford University, University of Washington, and Vrije Universiteit Amsterdam.
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