Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time.
Autor: | Jacobs JP; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee.; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida., Stammers AH; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Louis JS; Departments of Surgery and Pediatrics, Children Hospital of Georgia, Augusta University, Augusta, Georgia., Hayanga JWA; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia., Firstenberg MS; The Medical Center of Aurora, Aurora, Colorado., Mongero LB; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Tesdahl EA; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Rajagopal K; Department of Clinical Sciences, University of Houston College of Medicine, Houston Heart, HCA Houston Healthcare, Houston, Texas., Cheema FH; Department of Clinical Sciences, University of Houston College of Medicine, Houston Heart, HCA Houston Healthcare, Houston, Texas.; HCA Research Institute, Nashville, Tennessee., Patel K; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Esseghir F; Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida., Coley T; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Sestokas AK; From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee., Slepian MJ; Departments of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona., Badhwar V; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia. |
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Jazyk: | angličtina |
Zdroj: | ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2021 May 01; Vol. 67 (5), pp. 496-502. |
DOI: | 10.1097/MAT.0000000000001434 |
Abstrakt: | The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy. Competing Interests: Disclosure: Dr. Jacobs has received funds from SpecialtyCare. Dr. Firstenberg has received funds from Maquet Cardiovascular and Medtronic. Mr. Stammers, Ms. Mongero, Dr. Tesdahl, Mr. Patel, Mr. Coley, and Dr. Sestokas are paid employees of SpecialtyCare, Inc. The remaining authors have no conflicts of interest to report. (Copyright © ASAIO 2021.) |
Databáze: | MEDLINE |
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