Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019: Experience with 32 Patients
Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019: Experience with 32 Patients
复制标题
DOI：
10.1097/mat.0000000000001185
复制
发表时间：
2020-07-01
期刊：
影响因子：
4.2
通讯作者：
Slepian, Marvin J.
中科院分区：
文献类型：
--
作者：
Jacobs, Jeffrey P.;Stammers, Alfred H.;Slepian, Marvin J.
随着2019冠状病毒病（COVID-19）病例在全球范围内激增，迫切需要加强我们对体外膜肺氧合（ECMO）在管理COVID-19重症患者中的作用的理解，这些患者发生了传统治疗难以治愈的急性呼吸和心脏损害。本文旨在回顾我们对32例确诊COVID-19患者进行ECMO治疗的初步临床经验。创建了一个多机构登记和数据库，并用于评估所有接受SpecialtyCare提供的ECMO支持的患者。采集的数据包括患者特征、2019冠状病毒病前风险因素和合并症、2019冠状病毒病诊断确认、ECMO支持的特点、用于治疗2019冠状病毒病的特定药物以及出院后的短期结果。该分析包括我们所有接受ECMO支持的COVID-19患者，分析窗口从2020年3月17日开始，当时我们的第一名COVID-19患者接受ECMO治疗，并于2020年4月9日结束。在这项研究的24天里，32名连续的COVID-19患者在9家不同的医院接受了ECMO治疗。截至分析时，17人仍在ECMO上，10人在拔管前或拔管后不久死亡，5人存活并在从ECMO移除后拔管，其中1人出院。ECMO期间存活患者的辅助药物如下：5名存活者中有4名接受静脉类固醇，5名存活者中有3名接受抗病毒药物（Remdesivir），5名存活者中有2名接受抗白细胞介素-6受体单克隆抗体（Tocilizumab或Sar）治疗，5名存活者中有1名接受羟氯喹治疗。对这32名ECMO支持的严重肺功能损害的COVID-19患者的分析表明，ECMO可能在抢救特定的COVID-19重症患者方面发挥有用的作用。必须获得额外的患者经验和相关的临床和实验室数据，以进一步确定ECMO在COVID-19和急性呼吸窘迫综合征（ARDS）患者中的最佳作用。这些初步数据可能提供有用的信息，以帮助确定护理这些具有挑战性的患者的最佳策略，也可能为未来急需的关于使用ECMO治疗COVID-19患者的研究提供框架。
As coronavirus disease 2019 (COVID-19) cases surge worldwide, an urgent need exists to enhance our understanding of the role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 who develop acute respiratory and cardiac compromise refractory to conventional therapy. The purpose of this manuscript is to review our initial clinical experience in 32 patients with confirmed COVID-19 treated with ECMO. A multi-institutional registry and database was created and utilized to assess all patients who were supported with ECMO provided by SpecialtyCare. Data captured included patient characteristics, pre-COVID-19 risk factors and comorbidities, confirmation of COVID-19 diagnosis, features of ECMO support, specific medications utilized to treat COVID-19, and short-term outcomes through hospital discharge. This analysis includes all of our patients with COVID-19 supported with ECMO, with an analytic window starting March 17, 2020, when our first COVID-19 patient was placed on ECMO, and ending April 9, 2020. During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at nine different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died before or shortly after decannulation, and five are alive and extubated after removal from ECMO, with one of these five discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: four of five survivors received intravenous steroids, three of five survivors received antiviral medications (Remdesivir), two of five survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and one of five survivors received hydroxychloroquine. Analysis of these 32 COVID-19 patients with severe pulmonary compromise supported with ECMO suggests that ECMO may play a useful role in salvaging select critically ill patients with COVID-19. Additional patient experience and associated clinical and laboratory data must be obtained to further define the optimal role of ECMO in patients with COVID-19 and acute respiratory distress syndrome (ARDS). These initial data may provide useful information to help define the best strategies to care for these challenging patients and may also provide a framework for much-needed future research about the use of ECMO to treat patients with COVID-19.