Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study
Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study
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DOI：
10.1016/s2213-2600(20)30328-3
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发表时间：
2020-11-01
影响因子：
76.2
通讯作者：
Combes, Alain
中科院分区：
文献类型：
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作者：
Schmidt, Matthieu;Hajage, David;Combes, Alain
发生严重急性呼吸窘迫综合征（ARDS）的COVID-19患者可出现迅速发展为深度低氧血症和死亡的症状。体外膜氧合（ECMO）治疗COVID-19重症ARDS患者的疗效尚不清楚。我们的目的是建立呼吸衰竭和COVID-19患者采用ECMO治疗的临床特征和结局。方法本回顾性队列研究在巴黎-索邦大学医院网络中进行，包括5个重症监护病房（icu），包括因COVID-19相关ARDS接受ECMO的患者。收集患者人口统计数据和每日ecmo前和ecmo后的数据和结果。随着时间的推移，可能的结果被分为四种不同的状态（状态1-4）：进行ECMO，在ICU中并脱离ECMO，活着并离开ICU，或死亡。使用多状态Cox模型对每种可能的过渡进行分层，估计每种状态的每日职业概率以及这些状态之间的过渡直到ecmo开始后第90天。后续影片于2020年7月10日被审查。结果2020年3月8日至5月2日，我院icu共收治新冠肺炎患者492例。83例接受ECMO的患者（中位年龄49 [IQR 41-56]岁，男性61[73%]）进行了60天的完整随访。ecmo前，78例（94%）患者处于俯卧位；他们的中位驾驶压力为18 (IQR 16-21) cm H2O, PaO2/FiO(2)为60 (54-68)mm Hg。在ecmo启动后60天，每个状态的估计占领概率为状态1的6% (95% CI 3-14)，状态2的18%(11-28)，状态3的45%(35-56)，状态4的31%（22-42）。35例（42%）患者发生大出血，4例（5%）发生出血性中风。30名患者死亡。经ECMO抢救的COVID-19患者的估计60天生存率与过去2年中发表的关于ECMO治疗严重ARDS的研究相似。如果再次发生COVID-19疫情，尽管优化了护理，仍应考虑对出现难治性呼吸衰竭的患者进行ECMO。爱思唯尔版权所有版权所有。
Background Patients with COVID-19 who develop severe acute respiratory distress syndrome (ARDS) can have symptoms that rapidly evolve to profound hypoxaemia and death. The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with severe ARDS in the context of COVID-19 is unclear. We aimed to establish the clinical characteristics and outcomes of patients with respiratory failure and COVID-19 treated with ECMO.Methods This retrospective cohort study was done in the Paris-Sorbonne University Hospital Network, comprising five intensive care units (ICUs) and included patients who received ECMO for COVID-19 associated ARDS. Patient demographics and daily pre-ECMO and on-ECMO data and outcomes were collected. Possible outcomes over time were categorised into four different states (states 1-4): on ECMO, in the ICU and weaned off ECMO, alive and out of ICU, or death. Daily probabilities of occupation in each state and of transitions between these states until day 90 post-ECMO onset were estimated with use of a multi-state Cox model stratified for each possible transition. Follow-up was right-censored on July 10, 2020.Findings From March 8 to May 2, 2020, 492 patients with COVID-19 were treated in our ICUs. Complete day-60 follow-up was available for 83 patients (median age 49 [IQR 41-56] years and 61 [73%] men) who received ECMO. Pre-ECMO, 78 (94%) patients had been prone-positioned; their median driving pressure was 18 (IQR 16-21) cm H2O and PaO2/FiO(2) was 60 (54-68) mm Hg. At 60 days post-ECMO initiation, the estimated probabilities of occupation in each state were 6% (95% CI 3-14) for state 1, 18% (11-28) for state 2, 45% (35-56) for state 3, and 31% (22-42) for state 4. 35 (42%) patients had major bleeding and four (5%) had a haemorrhagic stroke. 30 patients died.Interpretation The estimated 60-day survival of ECMO-rescued patients with COVID-19 was similar to that of studies published in the past 2 years on ECMO for severe ARDS. If another COVID-19 outbreak occurs, ECMO should be considered for patients developing refractory respiratory failure despite optimised care. Copyright (C) 2020 Elsevier Ltd. All rights reserved.