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Biomedical and Clinical Sciences
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Predictive and prognostic markers
Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean ICUs

Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean ICUs

I Re Heo ¹, Tae Hoon Kim ¹, Won Jai Jung ², Gil Myeong Seong ³, Sun Jung Kwon ⁴, Jae Young Moon ⁵, Song-I Lee ⁶, Do Sik Moon ⁷, Tae-Ok Kim ⁸, Chul Park ⁹, Eun Young Choi ¹⁰, Jung-Wan Yoo ¹¹, Sunghoon Park ¹², Ae Rin Baek ¹³, Sung Yoon Lim ¹⁴, Jung Soo Kim ¹⁵, Jongmin Lee ¹⁶, Chi Ryang Chung ¹⁷, Sang-Min Lee ¹⁸, Su Hwan Lee ¹⁹, Moon Seong Baek ²⁰, Jin Won Huh ²¹, Woo Hyun Cho ²², Ho Cheol Kim ¹

I Re Heo ¹, Tae Hoon Kim ¹, Won Jai Jung ²

¹Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
²Division of Pulmonary, Allergy, and Critical Care Medicine, Korea University Anam Hospital, Seoul, Korea.
³Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
⁴Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea.
⁵Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Korea.
⁶Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea.
⁷Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju, Korea.
⁸Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
⁹Division of Pulmonology and Critical Care Medicine, Wonkwang University Hospital, Iksan, Korea.
¹⁰Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea.
¹¹Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.
¹²Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
¹³Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
¹⁴Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
¹⁵Division of Critical Care Medicine, Department of Hospital Medicine, Inha College of Medicine, Incheon, Korea.
¹⁶Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹⁷Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁸Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
¹⁹Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
²⁰Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
²¹Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²²Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Transplant Research Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

⁰Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.

Tuberculosis and Respiratory Diseases +

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April 28, 2025

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April 28, 2025

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View abstract on PubMed

Summary

This summary is machine-generated.

Life-sustaining treatment (LST) decisions for critically ill COVID-19 patients are influenced by age, comorbidities, and ICU interventions like mechanical ventilation and ECMO. Patients receiving LST had higher mortality rates, underscoring the need for clear critical care guidelines.

Area Of Science

Critical Care Medicine
Infectious Diseases
Medical Ethics

Background

Limited understanding of life-sustaining treatment (LST) decisions in critically ill COVID-19 patients.
Need to identify factors influencing LST and compare outcomes between LST and non-LST groups.

Purpose Of The Study

To identify factors influencing life-sustaining treatment decisions in critically ill COVID-19 patients.
To compare clinical outcomes between patients who received LST and those who did not.

Main Methods

Multicenter, retrospective cohort study of 1,081 COVID-19 patients in Korean ICUs (Jan 2020 - Aug 2021).
Patients categorized into LST and non-LST groups.
Demographic, clinical, and outcome data were collected and analyzed.

Main Results

19.2% of patients received LST. LST patients were older, had more comorbidities, and higher rates of mechanical ventilation and ECMO.
LST patients exhibited significantly higher ICU and hospital mortality rates.
Independent predictors of LST included advanced age, mechanical ventilation, and ECMO use.

Conclusions

Age, comorbidities, and ICU interventions are significant factors in LST decisions for COVID-19 patients.
Findings emphasize the necessity for ethical and evidence-based critical care guidelines.
Higher mortality in LST patients highlights the complexity of end-of-life care decisions.

Keywords:

COVID-19 ECMO ICU Korea Life-sustaining treatments Mechanical ventilation Predictors Retrospective cohort

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