Do mechanically ventilated covid-19 patients present a higher case-fatality rate compared with other infectious respiratory pandemics? A systematic review and meta-analysis

Background: Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV). Objective: Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1). Materials and Methods: We searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1). Results: Overall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%–52.8%] vs. 48.1% [95% CI, 39.2%–57.2%] and 39.7% [95% CI, 29.3%–51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%; 95% CI, 60.9%–78.8%). Conclusions: COVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.