Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study.
Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study.
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中国武汉市 2019 年冠状病毒病重症患者的体外膜氧合治疗：一项回顾性多中心队列研究
DOI：
10.1007/s11596-021-2311-8
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发表时间：
2021-03
影响因子：
2.4
通讯作者：
Wei X
中科院分区：
文献类型：
--
作者：
Fang J;Li R;Chen Y;Qin JJ;Hu M;Huang CL;Cheng L;He Y;Li Y;Zhou Q;Zhou DX;Huang F;Lei F;Yang B;Chen J;Deng HP;Yuan YF;Xia JH;Wan S;Li HL;Wei X
目前，关于体外膜肺氧合（ECMO）治疗在2019冠状病毒病（COVID-19）患者中的应用，还缺乏深入的证据。这项回顾性多中心队列研究纳入了中国武汉7家定点医院的COVID-19患者。患者随访至2020年6月30日。进行单因素和多因素logistic回归分析，以确定与ECMO撤机失败相关的风险因素。倾向评分匹配用于匹配接受静脉-静脉ECMO的患者与仅接受有创机械通气（IMV）治疗的患者。在88例接受ECMO治疗的患者中，分别有27例和61例患者成功脱离ECMO。此外，分别有15、15和65例患者进一步脱离IMV、出院或在住院期间死亡。在多变量logistic回归分析中，ICU入院时淋巴细胞计数≤0.5×109/L和D-二聚体浓度>4×正常值上限，ECMO启动前24 h PaCO 2峰值>60 mmHg，以及ICU住院期间未进行气管切开术与ECMO撤机几率较低独立相关。在倾向评分匹配分析中，混合效应考克斯模型检测到ECMO组住院期间ICU入院后120天全因死亡率的风险比较低。在ECMO启动前，存在淋巴细胞减少、ICU入院时D-二聚体浓度较高和高碳酸血症有助于识别预后不良的患者。气管切开术可促进脱离ECMO。ECMO相对于仅IMV治疗与重症COVID-19患者的结局改善相关。
Currently, little in-depth evidence is known about the application of extracorporeal membrane oxygenation (ECMO) therapy in coronavirus disease 2019 (COVID-19) patients. This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan, China. The patients were followed up until June 30, 2020. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. Of 88 patients receiving ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. In the multivariate logistic regression analysis, a lymphocyte count ≤0.5×109/L and D-dimer concentration >4× the upper limit of normal level at ICU admission, a peak PaCO2>60 mmHg at 24 h before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group. The presence of lymphocytopenia, higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis. Tracheotomy could facilitate weaning from ECMO. ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.
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影响因子：
3.7
作者：
Delmas, C.;Zapetskaia, T.;Silva, S.
通讯作者：
Silva, S.
DOI：
10.1111/jth.14817
发表时间：
2020-05
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
通讯作者：
--
影响因子：
15.9
作者：
Chen, Guang;Wu, Di;Ning, Qin
通讯作者：
Ning, Qin
影响因子：
168.9
作者：
Peek, Giles J.;Mugford, Miranda;Elbourne, Diana
通讯作者：
Elbourne, Diana
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,