SIGNIFICANT REDUCTION IN MORTALITY RATE IN CRITICALLY ILL PATIENTS WITH COVID-19 WITH THE IMPLEMENTATION OF A TREATMENT PROTOCOL-EXPERIENCE OF A TERTIARY CARE CENTER IN MIDWESTERN UNITED STATES DURING THE FIRST PEAK OF THE COVID-19 PANDEMIC

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID-19 has been an unprecedented pandemic resulting in serious morbidity and mortality. Knowledge of optimal treatment regimens for COVID-19 is evolving. The purpose of the study was to evaluate the impact of a treatment protocol on clinical outcomes of patients with COVID-19 in the intensive care unit (ICU) at a tertiary-care center during the first peak of the pandemic in Midwestern United States. METHODS: Methods: All ICU patients diagnosed with SARS-CoV-2 infection hospitalized between April 14-June 14, 2020 were included. Remdesivir was made available for use in our institution on May 14th 2020, and a treatment protocol combining remdesivir, corticosteroids and tocilizumab was implemented in the ICU, with doses as follows: Remdesivir 200mg intravenously (I.V.) on day 1, then 100 mg for 4 days;tocilizumab 400 mg I.V. once a day for 2 days;dexamethasone 6 mg I.V. daily for 10 days followed by taper. During pre-protocol period, patients were receiving hydroxychloroquine (400 mg once on day 1 followed by 200 mg twice daily orally for 4 days). We compared the pre-protocol period (labeled as P1: April 14, 2020- May 13, 2020) with protocol period (P2: May 14, 2020 -June 14, 2020) for clinical outcomes. Famotidine and multivitamins were administered to all patients during P1 and P2. RESULTS: A total of 32 and 48 patients were admitted to the ICU during P1 and P2 respectively. Both groups were similar in terms of demographic characteristics, mean (±SD) age [55(±10) and 54 (±12) years] and mean Charlson-Deyo risk score at admission [2.4(±0.8) and 2.5 (±0.9) respectively]. During both periods, a comparable number of patients needed mechanical ventilation (65% and 66% respectively), anticoagulation (74% and 76% respectively) and inotropes (41% and 40%). The mean duration of ICU stay during P1 was significantly longer than P2 [15.4 (±2.8) days versus 9.3 ± (3.8) days, p<0.0001)]. During P1, mean duration of mechanical ventilation [10 (±1.6) days] was also significantly longer than P2 [7.1 (±2.7) days] (p=0.0004). There was a significant reduction in mortality rate from 68% (22/32) during P1 to 10.4% (5/48) in P2 (p<0.0001). Patients were 4.3 times more likely to die during P1 than P2 (95% CI= 2.47-7.86). CONCLUSIONS: We observed a decrease in ICU mortality rate by 57.6% with the implementation of a treatment protocol combining remdesivir, tocilizumab and corticosteroids;we also noted a significant decline in length of ICU stay and duration of mechanical ventilation. CLINICAL IMPLICATIONS: A treatment-protocol combining remdesivir, tocilizumab and corticosteroids was effective in deceasing mortality rate by more than 50% in our ICU during the first peak of the pandemic. Our results support data recently endorsed by the NIH showing beneficial effects of these pharmacologic therapeutic interventions. DISCLOSURES: No relevant relationships by Sandeep Gupta, source=Web Response No relevant relationships by Jitendrakumar Gupta, source=Web Response No relevant relationships by Ashlesha Kaushik, source=Web Response