Global Impact of COVID-19 Infection Requiring Admission to the Intensive Care Unit: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis provides a contemporary and global assessment of the point estimate of mortality and risk factors for patients admitted to intensive care units (ICUs) with severe COVID-19.Methods: Medline, Embase and the Cochrane library were searched up to 1 August 2020. Pooled prevalence of participant characteristics, clinical features and outcome data were calculated using random effects models. Subgroup analyses were based on geographical distribution, study type, quality assessment, sample size, end date and patient disposition.Results: Forty-five studies with 16561 patients from 17 countries across four continents were included. Patients with COVID-19 admitted to ICU had a mean age of 62·6 years (95%CI 60.4-64·7). Common comorbidities included hypertension (49.5% (44·9-54·0)) and diabetes (26.6 (22·7-30·8)). Over three-quarters developed Acute Respiratory Distress Syndrome (76.1% (66·7-95·2)). Mechanical ventilation was required in 71.9% (66·6-77·8), vasopressor support in 68.1% (60.4-75.4), renal replacement therapy in 16.9% (12.1-22·2) and extracorporeal membrane oxygenation in 6.4% (4·1-9.1). The duration of ICU and hospital admission was 10·8 days (9·3-18·4) and 19·1 days (16·3-21·9) respectively with in-hospital mortality of 28.1% (23·4-33·0, I2 96%). No significant subgroup effect was observed.Conclusions: Critically ill patients with COVID-19 who are admitted to ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global mortality for severe COVID-19 is <1/3.Funding Statement: There was no funding source for this study.Declaration of Interests: The authors declare no competing interests.