Background: SARS-CoV-2 disease (COVID) affects all sections of the community, but some people contract the disease in a form requiring ICU admission. Immunocompromised patients (ICP) figure among the fragile patients whose access to critical care may be denied in the event of ICU bed-shortage. Our aims were: 1) to describe our management experience in seeking to assure equal critical-care consideration for both ICP and immuno-competent patients during the COVID surge, 2) to assess how successful this would be in terms of outcome for all patients, 3) to compare ICU stays of ICP, whether they survived or not, so as to detect possible prognostic factors. Methods: : We conducted a cohort study in medical ICUs of a university-affiliated hospital hit by an uncontrolled cluster of COVID. We compared the levels of activity before and during COVID: number of patients (whether COVID+ or COVID-, whether ICP or not);bed-occupancy and bed-availability;mortality rates and the need for sanitary evacuations analyzed to avoid triage decisions. Results: : During the pre-COVID period, 396 patients, including 9.3% ICP, were admitted. During the COVID period, 547 patients, including 243 COVID+ (of whom 24 ICP), were admitted: this required an 8 ICU bed-extension (+14.5% beds), a transfer of 69 immuno-competent COVID- patients to surgical ICU step-down beds, and the transfer of 22 immuno-competent COVID patients to distant hospitals. Despite sanitary evacuations, there was a daily average of 2 ICU-access refusals, the patients being taken in charge by step-down units. Health evacuations were decided on when the weekly number of COVID admissions doubled. No ICP was denied access to the ICU;no COVID- ICP was hospitalized during the first 9 weeks of the surge. 28-day mortality was 41.6% in ICP versus 27.3% in immuno-competent patients (p=0.021, log-rank test). With the exception of SAPSII and SOFA, no factor was different between clinical and ICU-stay characteristics among ICP, whether surviving or not.Conclusion and Relevance: Equal critical-care consideration for both immuno-compromised and immunocompetent patients during the COVID-19 surge was possible with acceptable outcome. Sanitary doctrine and fine-tuned hospital logistics were mandatory both at local and national level to reach this goal.
Equal critical care consideration for both immunocompromised and immunocompetent patients during the COVID-19 surge