key: cord-0780205-6841sw9a
authors: Proudfoot, Alastair G.; O’Brien, Ben; Schilling, Richard; Gould, Doug W.; McGlennan, Alan
title: Rapid establishment of a COVID-19 critical care unit in a convention centre: the Nightingale Hospital London experience
date: 2021-01-28
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06334-6
sha: 19b12901aea568581fbe738b1732be5ac8f4df2e
doc_id: 780205
cord_uid: 6841sw9a

nan

Fifty-four patients were cared for between 7 April and 7 May with a peak of 35 patients ( Figure S2 ). Median age was 61 years with a male bias (45/54, 83%, Table S1 ). The patient characteristics and severity of illness on admission to NHL were broadly similar to those reported in the national cohort with equivalent median APACHE II scores (15 vs. 15) and PaO 2 /FiO 2 ratios (14.7 kPa vs. 15.8 kPa, Table S1 ). Median critical care length of stay prior to NHL admission was 4 days (range 2-16 days). Requirement for organ support and duration of organ support were similar between the NHL and national cohorts. Seven (13%) patients were extubated at NHL. Twenty (37%) patients died whilst an in-patient at NHL and a further 6/27 (11%) died following repatriation to their local critical care unit once critical care capacity in London was restored ( Figure S3 ). Overall critical care mortality (including death in critical care following transfer from NHL) was 48.1% compared with 47.7% in the national dataset for patients requiring advanced respiratory support (Table S1 ). Duration of critical care amongst survivors was a median of 34.5 days (IQR 16-47 days) compared to 12 days (IQR 5-28 days, Table S1 ) nationally which may have reflected the absence of a tracheostomy service at NHL for safety reasons.

Mortality at NHL compares favorably with international case series of over 50% for those who receive mechanical ventilation [1, 2] albeit that 50% of patients were transferred out for both clinical and non-clinical reasons ( Figure S3 ). Further, mortality nationally in mid-April, when NHL was operational, was 67% [3, 4] and declined over time as experience of both patient and systems management evolved [5] . While criteria for transfer to NHL meant that admissions may have been biased *Correspondence: alastair.proudfoot1@nhs.net towards more clinically stable patients, these outcomes were achieved on a site with significant logistical challenges, including no pre-existing oxygen supply. NHL opened with critical care nurse:patient ratios (1:6) and consultant:patient ratios (1:30) with no pre-established governance or operating procedures specific to the environment or staffing model. NHL was also operational at a time when there was significant uncertainty regarding optimal patient management and no proven diseasemodifying pharmaceutical interventions.

Whether the NHL blueprint was the optimal model of care or represented appropriate resource allocation remains moot but it was deemed necessary at a time of crisis. The operating model as originally conceived, was based on previous (influenza) pandemics. Subsequent clinical experience highlights that the clinical syndrome of COVID-19 and the spectrum and duration of multi-organ support requires comprehensive critical care capability. Future planning should account for this. Nonetheless, the need for emergency critical care capacity remains a realistic prospect for this pandemic and future viral pandemics and whilst there are challenges in accurate comparisons with other critical care units, the data herein suggest that emergency critical care in an alternative setting can be delivered efficiently and effectively.

Incidence of ARDS and outcomes in hospitalized patients with COVID-19: a global literature survey

Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study

ICNARC report on COVID-19 in critical care

Trends in intensive care for patients with COVID-19 in England, Wales and Northern Ireland Preprints

Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies

The online version contains supplementary material available at https ://doi. org/10.1007/s0013 4-020-06334 -6. 

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Accepted: 4 December 2020