Characteristics And Icu Outcomes Of Patients With Cancer With Acute Respiratory Failure Due To Covid-19

SESSION TITLE: Lessons from the ICU: What have We Learned about the Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: The purpose of this study is to describe the characteristics and outcomes of critically ill patients with cancer and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection METHODS: We reviewed the clinical characteristics and outcomes of adult patients (\u003e 18 yrs) with active or recent history of cancer and confirmed COVID-19 who developed acute hypoxemic respiratory insufficiency/failure with radiographic opacities and were consecutively admitted to two intensive care units (ICU) at Memorial Sloan Kettering Cancer Center between March 16 and May 27, 2020 The hospital adopted an early-intubation strategy during the first 4 weeks and a waiting period of 4 weeks before considering a tracheostomy Pressure control ventilation and targeted tidal volume of 6 ml/kg predicted body weight and moderate to high PEEP was standard practice Cases were confirmed through reverse-transcriptase–polymerase-chain-reaction assays performed on nasopharyngeal swab specimens Data were manually abstracted from electronic health records RESULTS: During the study period, a total of 290 patients were admitted to the two ICUs;90 (31%) patients with active (n=87) or recent (n=3) history of cancer had COVID-19 pneumonia Mean age was 65 years;60% were male, 67% were White;49% had hypertension, 29% had diabetes mellitus;and 50% had a smoking history 52 (63%) had solid tumors and 38 (37%) had hematologic malignancies Advanced stage non-small cell lung carcinoma and breast carcinomas were the most frequent solid tumors and leukemia and lymphoma were the most common hematologic cancers Vasopressors were required in 38 (42%) and CRRT in 8 (9%) In-hospital treatments for COVID-19 included remdesivir in 20%, convalescent plasma in 12%, hydroxychloroquine in 37%, azithromycin in 35%, corticosteroids in 56%, IL-6 inhibitors (tocilizumab, siltuximab) in 6% and IL-1 receptor antagonist in 1% Acute respiratory failure (ARF) leading to invasive mechanical ventilation (MV) developed in 61 patients (68%) with a mean of 25 days on MV Prone positioning (self or during MV) was implemented in 44 patients (49%) 18 patients (30%) were extubated after a mean of 11 5 days and 16 (26%) underwent a tracheostomy, 10 of whom (63%) were successfully liberated from MV Thirty-six patients (40%) had a Do-Not-Resuscitate Order during their ICU stay As of May 27, 24 (39%) of the 61 patients who required MV have died compared to 5 (17%) of the 29 non-ventilated patients 40 patients (44%) were discharged home and 25 (28%) remain hospitalized CONCLUSIONS: Over a third of cancer patients who developed ARF due to COVID-19 requiring MV in the ICU did not survive CLINICAL IMPLICATIONS: Critically ill cancer patients with COVID-19 are at high risk of severe disease and mortality DISCLOSURES: No relevant relationships by Christine Ammirati, source=Web Response No relevant relationships by Melissa Barzola, source=Web Response No relevant relationships by Sanjay Chawla, source=Web Response No relevant relationships by Michael Dang, source=Web Response Advisory Committee Member relationship with Pronia Medical Please note: $1001 - $5000 Added 06/02/2020 by Neil Halpern, source=Web Response, value=stock options Advisory Committee Member relationship with Airstrip Please note: $1-$1000 Added 06/02/2020 by Neil Halpern, source=Web Response, value=stock options No relevant relationships by James Isbell, source=Web Response Advisory Committee Member relationship with Jazz Pharmaceuticals Please note: $1-$1000 Added 07/17/2020 by Stephen Pastores, source=Web Response, value=Consulting fee Grant Support for Clinical Trial relationship with Biomerieux Please note: $5001 - $20000 Added 07/17/2020 by Stephen Pastores, source=Web Response, value=Grant/Research Support No relevant relationships by Kate Tayban, source=Web Response