Summary Introduction On February 25, 2020, the first 2 patients were tested positive for severe acute respiratory syndrome coronavirus‑2 (SARS-CoV-2) in Tyrol, Austria. Rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease-2019 (COVID-19) patients. Methods This cohort study included all COVID-19 patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the State of Tyrol, Austria. Patients were recorded in the Tyrolean COVID-19 intensive care registry. Date of final follow-up was July 17, 2020. Results A total of 106 critically ill patients with COVID-19 were admitted to 1 of 13 ICUs in Tyrol from March 9 to July 17, 2020. Median age was 64 years (interquartile range, IQR 54–74 years) and the majority of patients were male (76 patients, 71.7%). Median simplified acute physiology score III (SAPS III) was 56 points (IQR 49–64 points). The median duration from appearance of first symptoms to ICU admission was 8 days (IQR 5–11 days). Invasive mechanical ventilation was required in 72 patients (67.9%) and 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 days (IQR 5–31 days), median hospital LOS was 27 days (IQR 13–49 days). The ICU mortality was 21.7% (23 patients), hospital mortality was 22.6%. There was no significant difference in ICU mortality in patients receiving invasive mechanical ventilation and in those not receiving it (18.1% vs. 29.4%, p = 0.284). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward. Conclusion Critically ill COVID-19 patients in Tyrol showed high severity of disease often requiring complex treatment with increased lengths of ICU and hospital stay. Nevertheless, the mortality was found to be remarkably low, which may be attributed to our adaptive surge response providing sufficient ICU resources.

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Introduction On February 25th, 2020, the first two patients were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Tyrol, Austria. Based on alarming reports from the neighboring region Lombardy in Italy, rapid measures were taken to ensure adequate intensive care unit (ICU) preparedness for a surge of critically ill coronavirus disease 2019 (COVID-19) patients.Methods A coordinated county wide step-up approach ensured adequate ICU bed availability for COVID-19 patients avoiding shortage of mechanical ventilation capacity. All patients admitted to an ICU with confirmed or strongly suspected COVID-19 in the region of Tyrol, Austria were recorded in the Tyrolean COVID-19 Intensive Care Registry. Data were censored on July 17th, 2020.Results From March 9th, 2020 to July 17th, 2020, 106 critically ill patients with COVID-19 were admitted to an ICU. Median age was 64 (interquartile range [IQR], 54-74) years and the majority of patients were male (76 patients [71.7%]). Median simplified acute physiology score III (SAPS III) was 56 (IQR, 49-64) points. The median duration from appearance of first symptoms to ICU admission was 8 (IQR, 5-11) days. Frequently observed comorbidities were arterial hypertension in 71 patients (67.0%), cardiovascular (45 patients [42.5%]) and renal comorbidities (21 patients [19.8%]). Invasive mechanical ventilation was required in 72 patients (67.9%), 6 patients (5.6%) required extracorporeal membrane oxygenation treatment. Renal replacement therapy was necessary in 21 patients (19.8%). Median ICU length of stay (LOS) was 18 (IQR, 5-31) days, median hospital LOS was 27 (IQR, 13-49) days.ICU mortality was 21.7% (23 patients), while only one patient (0.9%) died after ICU discharge on a general ward (hospital mortality 22,6%). As of July 17th, 2020, two patients are still hospitalized, one in an ICU, one on a general ward.Conclusions Critically ill COVID-19 patients admitted to an ICU in the region of Tyrol, Austria, showed a high severity of disease often requiring complex treatments with increased lengths of ICU- and hospital stay. Despite that, we found ICU and hospital mortality in this cohort to be remarkably low. Adaptive surge response providing sufficient ICU resources presumably has contributed to the overall favorable outcome.