Causes and timing of death in critically ill COVID-19 patients

Whether patients mainly die from refractory respiratory failure directly due to SARS-CoV-2 pneumonia or from sepsis as reported in non-COVID-19 ARDS patients [3] is unknown. [...]the increased risk of pulmonary embolism extensively described among COVID-19 patients together with the SARS-CoV-2-associated myocardial injuries [4] may expose critically ill COVID-19 patients to death from a cardiac origin [5]. Causes of death were categorized in four subgroups: (1) refractory respiratory failure, (2) shock with multiorgan failure, (3) cardiac death including proven pulmonary embolism (proximal thrombus on CT-pulmonary angiography with acute cor pulmonale on echocardiography and vasopressor requirement) and unexpected cardiac arrest (neither prior oxygen desaturation nor circulatory failure) and (4) neurological death (ischemic/hemorrhagic stroke with brain herniation). SEE PDF] None of the patients dying from shock with multi-organ failure or from cardiac death died after a withholding (all the patients with unexpected cardiac arrest underwent cardiopulmonary resuscitation) or withdrawal procedure while all patients dying from a neurological cause died after a withdrawal procedure. In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study.