Didn't realize 70-80% of patients on vents will die

[WombOfOnesOwn]

Just that, really.

I am friends with healthcare providers, several in emergency departments and intensive care/treatment units, from several different countries and US states. In talking to them about coronavirus, the thing that shocked me most, especially given the huge push for ventilators, is that most ventilated patients will still die.

Somehow I guess I figured it was 50/50 or better, especially with how everyone's acting about the shortages of ventilators. It's also awful because I think a lot of the people about to be ventilated don't realize how bad their odds are.

I've seen similar numbers from several different people, so I don't think it's just one bad hospital where a friend is working reporting bad stats.

I have been trying to get information about how much of this is age related, but with very little luck. My parents (in their 60s) and I (in my 30s) would like to know what those chances are so that we could be realistic about decisionmaking in the circumstance that we were among the unlucky few to end up in this situation.

Does anyone have some light they can shed? Studies or recent research? Or anything contradicting what I've heard so far, that indicates better success getting patients off-ventilator and recovered? It's a lot of trauma to put the human body through when the odds start growing slimmer.

There was an item in the Guardian today I think where they confirmed that the death rate for those on ventilators in the UK is currently running at approx 50%.

That said, bear in mind that those who have got to this stage TEND (not absolutely) to be those who are at most risk (aged, male, underlying conditions). Ironically, IF we get to the stage as in Italy where they have so many cases, they only use the ventilators on those that have a much more stable system to start with (younger, fewer underlying conditions) that percentage may start to improve... but only at the cost of people dying un-ventilated.

All research I've found has suggested the same, which explains why doctors are having to have some unpopular discussions at the moment about who would/wouldn't get vented in case of shortages. you really need to be in the best shape possible (as u can be on a vent..) to have any sort of chance, or you are just prolonging their difficulties and death and preventing someone else having a chance in the time being.

Survival of any patient on mechanical ventilation will vary and is very much dependent on the reason why they are on ventilation plus any other comorbid factors.
If a patient already has COPD or heart failure prior to ventilation,they have a very high chance of not surviving. At the moment, with regard to Covid, the majority of patient support on ventilation do have comorbid conditions, therefore the chance of survival is relatively low. The vast majority of infected people will not need ventilation as they are generallynfit and healthy.

There are two distinct machines used. Most patients will be put on respirators that aid breathing. Ventilators are for the very critical whose lungs are no longer capable of oxygenating the blood so the patient is intubation and put into a medical coma while the ventilator does the job for them.
Another even more advanced machine is ECMO. With this machine the blood is pumped from the body to a machine that oxygenates it then returns it back to the body.
It is probably correct that most who are put on ventilators or ECMO will not survive but a small percentage will so its worth trying this treatment. However the more severe the underlying respiratory failure is the less likely of survival.
A colleague who is a dentist has been put on a ventilator recently. We are all praying he pulls through. NHSE were very late with their advice to dentists so I think a significant number of dentists and staff will probably end up on the critical list.

And what does survival mean anyway? -
Discharged from icu
Discharged from hospital
Alive after 30 days
Functioning at a semblance of your previous levels?

Agree with PP.
By the time you need ventilating, you are extremely poorly anyway.

Patients dying, OP, is not an indicator that they were in a "bad hospital", but more likely they had a bad illness.

We should all be having the discussions that you and your parents are currently having OP, because, Covid 19 or not, the only certainty in life, is death - it's unavoidable.
It helps to know what your nearest and dearest would want before it gets to a stage that they need it.

Aside from all the publicity and the money being thrown around for ventilators, I'd like to know what is being put in place for palliative care?

I'm all for opting out of being ventilated but would like to know that there are plenty of syringe drivers and palliative care staff about so that my end is peaceful (and swift).

Just been reading on another thread GPs are advising DNR for those with health issues or not even going to hospital. People are shocked, but the best advice is not to get it and stay inside.

It's a lot of trauma to put the human body through when the odds start growing slimmer.

And the mind.

It's not a trauma I would want to "survive".

Do you have any sources for this statement? Because its' really not helpful to be posting vague 'a-friend-of-a-friend told me' information which can just cause even more worry for people.

All the information I've seen published on news sites suggests a rate of 50%. Which is unsurprising given that by the time you get to ventilating someone they're already extremely ill.

Source?

If you and/or your parents reach a decision you want to ensure is recorded and communicated there is information and a tool to create an advance decision (which is legally binding on HCPs if it meets certain requirements) here:

compassionindying.org.uk/making-decisions-and-planning-your-care/planning-ahead/advance-decision-living-will/

50% is a bit better, but these are the kinds of numbers consistent with what I have heard people directly reporting.

These are not "friends of friends." One person was a wedding party member of mine, another is my sister who is working in a research hospital emergency department and saw 3 crash intubations on her last shift.

Journals like in the link above have also started to note that there are poor outcomes for ventilated patients. If you look at what the ventilator survival rates are for other illnesses, you'll see that this isn't nearly as simple as "well, of course they were probably dying, they were being ventilated."

I think the percentages are high because the average age of people on them are older and/or they have underlying health issues which were already going to make surviving the virus harder to do.

When hard decisions start coming in, as in who's going to get access to a ventilator should they need one, I think the average age / health issues will start to change the statistics ... as people who are more likely to be able to survive with some help will be given that help first.

It's all awful.

If the stats are so bad for people on ventilators it begs the question even more about why the death rate in Germany is so low. I know they are testing a lot of people, and our actual case numbers are much higher than the published numbers so the % deaths is lower than it seems, but everyone says they have plenty of ventilators, far more than we do per head of population. Well that's obviously not the whole story if lots of people die on them anyway.

It depends doesn't it? I mean, the elderly in particular do very poorly when intubated. Which is why the hospital which are overloaded don't even consider them potential candidates. Younger people have better odd of benefitting from intubation. So, I guess the success rate depends on who you are intubating.

By the time you need ventilating you vvv ill. Your choice at that point is death or a tiny chance of survival. My dh is healthy and its taken over a week to recover at home from this virus. Its horrible. No test to confirm if had it. We still in isolation. He has been left weak with some damage. He is a healthy 40 year old! Stay in people

Just saw this about Germany (I know it's Andrew Neil but still seems interesting).

Andrew Neil
@afneil

I have investigated further how Germany records Covid-19 deaths and concluded its methodology does NOT explain lower level of German Covid-19 fatalities. In previous tweets I suggested international comparisons eg with UK, might not be comparing apples with apples. But we are.

The Robert Koch Institute, responsible for the official recording of deaths in Germany, says it “considers someone to be a corona death in which a corona infection was proven.” In practice this means the RKI counts as corona deaths ALL deaths associated with Covid-19.

Includes all who died from Covid-19. But also all those with underlying health problems infected by Covid-19 but for whom it’s not possible to say what killed them. Finally, those not tested before death but suspected of Covid-19 are tested post-death. Infected = Covid-19 death

So RKI method counts anyone infected with Covid-19 who dies as a Covid-19 death regardless of whether the virus killed them directly or from underlying severe illness made worse by the virus.

That is pretty much how deaths are counted in the UK. So we are comparing apples with apples. There are reasons for the lower German death toll, including, probably, extensive testing. But different methodology is not an explanation.

I have seen three colleagues on ventilators in the last week. It's heartbreaking.

I don't think even the smallest percent chance mention on this thread of 20% is a tiny percent. Certainly not when the alternative is to definitely die. A one in five chance of avoiding death is a dice I'd roll.

50% (Or 30%) of people who are on ventilators survive when they would not have done so otherwise. But at the moment ventilators will be tried for most people regardless just to try something. In due course more people won’t be put on ventilators because it is unlikely to make a difference - ventilators will be prioritised for those it is more likely to help and that percentage may increase. We will hear stories than old and frail are being denied them and how outrageous this is but it is worth remembering that for most of these it wouldn’t have made a difference to outcome.

@cologne4711 the Germany numbers indeed are strange given that we are not out of beds in the UK. So yes they have more beds but that only becomes relevant if the UK have run out. And we haven’t. There is still space. Somebody said that Germany were recording their COVID deaths differently. So if somebody had another condition that they were dying if and then got COVID - they death wouldn’t be attributable to Covid. Something like that. Is the only way to explain the low death rate. That and that they must be testing more people overall so the denominator is higher.

Ah @SwedishEdith I didn’t see that. So then indeed more extensive testing could be the reason. Also I read somewhere that to date it has run through a relatively young part of the population - people coming back from ski resorts etc.

What is the damage London? I presume he hasn't seen a doctor to know what the permanent damage to his lung is?
The staying in advice is so that we don't all get it at once, not so that we don't get it at all. Most people will probably get it at some point.

Somebody said that Germany were recording their COVID deaths differently

They're not, apparently - see Andrew Neil tweet I just posted a few minutes earlier.

Are they treating it differently? If people have access to easy testing and therefore early intervention are they doing anything differently early on? There was lots of mention about chloroquine early on that seems to have dropped off the radar, could they be nudging the odds early on with this or another drug long before it gets to intubation?