The role of extracorporeal life support for patients with COVID-19: Preliminary results from a statewide experience
The role of extracorporeal life support for patients with COVID-19: Preliminary results from a statewide experience
复制标题
DOI：
10.1111/jocs.14583
复制
发表时间：
2020-04-25
影响因子：
1.6
通讯作者：
Gutsche, Jacob
中科院分区：
文献类型：
--
作者：
Sultan, Ibrahim;Habertheuer, Andreas;Gutsche, Jacob
目的了解新冠肺炎危重患者需要体外生命支持的临床资料。方法采用全州范围内多机构协作的方法，收集首批10例需要体外膜氧合的新冠肺炎危重患者的临床资料。结果前10例需要体外膜氧合的患者年龄在31~62岁之间，男性占70%。7例(70%)患有合并症。大多数患者(80%)在症状出现前2周内已知与新冠肺炎阳性患者有过病理性接触和接触，或曾前往美国境内的大流行地区。这些患者都不是医护人员。最常见的症状是高热(90%)，咳嗽(80%)和呼吸困难(70%)，其次是乏力和胃肠道症状(均为30%)，肌肉痛、味觉丧失、胸膜胸痛和神志不清(均为10%)。所有患者在胸部X光片上均有双侧浸润性病变，提示间质性病毒性肺炎。所有患者均采用静脉-静脉构型插管。2名患者(20%)分别在7天和10天后成功脱离ECMO支持，1名患者(10%)目前正在脱机过程中。1名患者(10%)在接受体外膜氧合治疗9天后死于多器官功能衰竭。结论这些来自全州合作的初步多机构数据为了解前10名新冠肺炎患者的临床特征和他们的初始临床病程提供了深入的了解。这些随访时间较长的危重病人的发病率和死亡率可能会更高。
Objective There is a paucity of clinical data on critically ill patients with COVID-19 requiring extracorporeal life support.Methods A statewide multi-institutional collaborative for COVID-19 patients was utilized to obtain clinical data on the first 10 critically ill COVID-19 patients who required extracorporeal membrane oxygenation (ECMO).Results Of the first 10 patients that required ECMO for COVID-19, the age ranged from 31 to 62 years with the majority (70%) being men. Seven (70%) had comorbidities. The majority (80%) of patients had known sick contact and exposure to COVID-19 positive patients or traveled to pandemic areas inside the United States within the 2 weeks before symptom onset. None of the patients were healthcare workers. The most common symptoms leading to the presentation were high fever >= 103 degrees F (90%), cough (80%) and dyspnea (70%), followed by fatigue and gastrointestinal symptoms (both 30%), myalgia, loss of taste, pleuritic chest pain, and confusion (all 10%). All patients had bilateral infiltrates on chest X-rays suggestive of interstitial viral pneumonia. All patients were cannulated in the venovenous configuration. Two (20%) patients were successfully liberated from ECMO support after 7 and 10 days, respectively, and one (10%) patient is currently on a weaning course. One patient (10%) died after 9 days on ECMO from multiorgan dysfunction.Conclusions These preliminary multi-institutional data from a statewide collaborative offer insight into the clinical characteristics of the first 10 patients requiring ECMO for COVID-19 and their initial clinical course. Greater morbidity and mortality is likely to be seen in these critically ill patients with longer follow-up.